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Biomedical subjects

A Groutz

Publications and source records attributed to A Groutz.

54 records · Page 3Linked to original sources
PubMed1998

The effect of early epidural block administration on the progression and outcome of labor.

This study was undertaken to prospectively evaluate the effect of early administration of epidural bupivacaine (0.25%) on the progression and outcome of labor in 60 nulliparous patients. Patients were randomly divided into two groups. In group 1 (30 patients, early administration), the epidural catheter was sited and the first epidural injection of 0.25% bupivacaine administered at a cervical dilatation of <4 cm; group 2 (30 patients, late administration) received the epidural catheter and first epidural injection of 0.25% bupivacaine at a cervical dilatation of >or=4 cm. The progression and outcome of labor were compared between the two groups. There were no statistically significant differences between the two groups in rate of cervical dilatation, duration of the second stage, numbers of instrumental deliveries or cesarean sections or Apgar scores at 1 and 5 min. We conclude that there is no need to restrict epidural top-ups until cervical dilatation of 4 cm, when active management of labor is advocated.

Clinical Trial↗
PubMed1998

Double-blind, placebo-controlled study of magnesium hydroxide for treatment of sensory urgency and detrusor instability: preliminary results.

In a prospective, randomised, double-blind, placebo-controlled study 40 women with sensory urgency or detrusor instability randomly received either magnesium hydroxide (group A) or placebo (group B). Pre- and post-treatment symptoms, frequency-volume charts and cystometry results were compared. Eleven of 20 patients receiving magnesium (55%) reported a subjective improvement of their urinary symptoms, compared with five patients taking placebo (20%). In both study groups there was no statistically significant difference in pre- and post-treatment urodynamic parameters in those reporting symptomatic improvement. Magnesium was well tolerated by patients in group A, and no side effects were reported. These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women.

Dose-Response Relationship, Drug↗
PubMed1998

Successful treatment of advanced interstitial pregnancy with methotrexate and hysteroscopy. A case report.

BACKGROUND: Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy. CASE: A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial gestational sac 58 mm in diameter and containing an embryo with a crownrump length of 29 mm and embryonic heartbeats. Serum beta-human chorionic gonadatropin (hCG) level was 97,950 mIU/mL. The patient was treated with a systemic MTX/leucovorin regimen. At the end of the one-week course, no embryonic cardiac activity was detected, and a decrease in beta-hCG levels commenced. Persistent trophoblastic tissue, manifested by a low (26 mIU/mL) beta-hCG level in plateau, was successfully removed by way of hysteroscopy. CONCLUSION: Early detection of interstitial pregnancy may facilitate conservative medical treatment.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Cervical dilatation during ovum pick-up in patients with cervical stenosis: effect on pregnancy outcome in an in vitro fertilization-embryo transfer program.

OBJECTIVE: To evaluate the results of cervical dilatation during an ovum pick-up session in patients with cervical stenosis who participated in an IVF-ET program. DESIGN: A retrospective study. SETTING: In vitro fertilization-ET unit. PATIENT(S): Forty-one treatment cycles in 22 patients with known cervical stenosis. In all patients previous transcervical ET had been either extremely difficult or impossible. INTERVENTION(S): Cervical dilatation under general anesthesia during an ovum pick-up session, 48 hours before transcervical ET. MAIN OUTCOME MEASURE(S): Ease of ET procedure and clinical pregnancy rate (PR). RESULT(S): Cervical dilatation was performed in 41 IVF-ET cycles and resulted in easier transcervical ET in 39 cycles, but only one clinical and one extrauterine pregnancy. CONCLUSION(S): Cervical dilatation during the ovum pick-up session leads to easier ET in patients with cervical stenosis, but PRs after this procedure are very low.

Adult↗
PubMed1997

Comparison of transmyometrial and transcervical embryo transfer in patients with previously failed in vitro fertilization-embryo transfer cycles and/or cervical stenosis.

OBJECTIVE: To compare ultrasound-guided transmyometrial and transcervical ET in patients with cervical stenosis or in patients who failed to conceive after at least three previous IVF-ET cycles. DESIGN: A prospective, randomized study. SETTING: The IVF-ET Unit at Serlin Maternity Hospital. PATIENT(S): Forty patients undergoing IVF-ET. INTERVENTION(S): Ultrasound-guided transvaginal, transmyometrial, versus transcervical ET. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): Transmyometrial ET was performed in 20 patients and resulted in one clinical pregnancy. Transcervical ET, performed in another 20 similar patients, resulted in three clinical pregnancies. CONCLUSION(S): No benefit was derived by electing transmyometrial ET in preference to transcervical ET in patients who had failed to conceive in previous cycles.

Adult↗
PubMed1997

Influence of ovulation induction with human menopausal gonadotropin on uterine blood flow: comparison of unexplained and mechanical infertility.

A prospective study in patients undergoing in vitro fertilization treatment was conducted to assess whether any difference may be present in uterine blood flow between unexplained and mechanical infertility, before and during ovulation induction. The ascending branch of the uterine artery, the arcuate arteries, and the radial arteries were examined by transvaginal, color pulsed Doppler sonography on day 3 and on the day of human chorionic gonadotropin administration. Patients with mechanical factor demonstrated a decrease in resistance to blood flow in all the examined vessels during ovulation induction. Patients with unexplained infertility showed a contrasting trend in changes of uterine blood flow (e.g., as the cycle progressed, the resistance index increased). Moreover, the resistive index values on the day of human chorionic gonadotropin administration were significantly higher in patients with unexplained infertility. It is quite possible that the rise in impedance to uterine blood flow during ovulation induction and the higher impedance on the day of human chorionic gonadotropin administration in patients with unexplained infertility may be one of the factors responsible for the lower conception rate in these patients.

Arteries↗
PubMed1996

Second-trimester maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated oestriol after early transvaginal multifetal pregnancy reduction.

Maternal serum alpha-fetoprotein (MSAFP), human chorionic gonadotropin (hCG), and unconjugated oestriol (UE3) are used as second-trimester screening markers for the detection of various fetal abnormalities. Previous studies have suggested that second-trimester MSAFP is consistently elevated after late first-trimester transabdominal multifetal pregnancy reduction (MFPR). The present study was undertaken to evaluate the levels of all three markers after early transvaginal MFPR. Maternal serum was examined for MSAFP, hCG, and UE3 at 16-18 weeks' gestation in 28 patients who underwent transvaginal MFPR at approximately 10 weeks' gestation. The mean interval between the reduction procedure and the screening test was 7.2 +/- 0.9 weeks. The mean MSAFP value in 24 patients carrying viable twins was 2.49 +/- 0.99 multiples of the median (MOM). Two patients had elevated MSAFP values: one in association with omphalocoele and the other in relation to an adverse pregnancy outcome. All but two patients had normal hCG values (mean 1.98 +/- 1.26 MOM). Two cases with elevated hCG were associated with an adverse pregnancy outcome. Unconjugated oestriol values were within the normal range in all patients (mean 1.69 +/- 0.61 MOM). These results suggest that early transvaginal MFPR, at approximately 10 weeks' gestation, does not appear to influence second-trimester MSAFP, hCG, and UE3 levels. The values of these markers may therefore be interpreted by using the same criteria as those for the general obstetric population.

Adult↗
PubMed1996

Pregnancy outcome after multifetal pregnancy reduction to twins compared with spontaneously conceived twins.

Multifetal pregnancy reduction (MFPR) appears to be an efficacious method for improving the perinatal outcome of 'high order' multifetal gestations. The present study was undertaken to evaluate pregnancy outcomes after MFPR to twins in comparison with spontaneously conceived twins. In all, 10 patients with quadruplet gestation (group 1) and 30 patients with triplet gestation (group 2), who underwent MFPR to twins, were prospectively enrolled. Pregnancy complications, gestational age at delivery, mode of delivery and birthweights were compared with 30 consecutive spontaneous twin gestations (group 3) matched by maternal age and parity. Mean gestational age at delivery and mean birthweights were significantly lower in group 1, compared with groups 2 and 3 (33.2, 35.9, 36.9 weeks, and 1843, 2209, 2361 g respectively). The incidence of pregnancy complications was significantly higher in group 1 compared with group 3. There was also a clear trend of increased incidence of specific pregnancy complications in group 1 compared with groups 2 and 3, especially premature contractions (PMC; 50, 27 and 13% respectively), and pregnancy-induced hypertension (PIH; 40, 23 and 7% respectively). In conclusion, the initial number of fetuses before reduction was inversely correlated with gestational age at delivery and birthweight, and positively correlated with pregnancy complications. Contrary to previous studies, we found a higher incidence of pregnancy complications after MFPR compared with spontaneous twins, especially PMC and PIH.

Adult↗
PubMed1996

Effect of second-stage 0.25% epidural bupivacaine on the outcome of labor.

OBJECTIVE: To evaluate the effect of second-stage epidural bupivacaine on the outcome of labor. METHODS: Two groups of 35 patients each were randomly allocated to receive continuous epidural bupivacaine throughout labor (group 1) or until an 8-cm dilatation of the cervix (group 2). RESULTS: There was no significant difference between the 2 groups in the rates of instrument deliveries and in their Apgar scores. CONCLUSIONS: The administration of continuous epidural bupivacaine (0.25%) throughout labor and delivery does not seem to affect the outcome of labor.

Adult↗
PubMed1995

Gigantomastia complicating pregnancy. Case report and review of the literature.

Gigantomastia, or Gravidic macromastia, during pregnancy is a diffuse increase in size of the breasts over and above their physiologic size. It is a rare disorder of undetermined etiology, that may be due to hormonal excess or to hypersensitivity of the target organ. The histologic appearance is of glandular hyperplasia with an increase in connective tissue. Treatment during pregnancy is supportive and pharmacologic; once the patient has delivered surgical treatment is usually indicated. We present herewith a case report of gigantomastia during pregnancy, with a discussion of the treatment and a review of the literature.

Adult↗
PubMed1995

Impetigo herpetiformis during pregnancy: case report and review of the literature.

A case of impetigo herpetiformis in pregnancy is reported together with a review of the literature. The patient was a 25-year-old primigravida with pregnancy-induced hypertension (PIH). At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustules with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, oral prednisone, and steroid creams. Labor was induced, and a normal delivery of a healthy infant was effected, following which the patient's condition improved rapidly. The clinical and laboratory features were typical of impetigo herpetiformis as described in the literature. Impetigo herpetiformis is a rare, potentially serious skin disorder occurring particularly during pregnancy, and must be diagnosed early to allow prompt, aggressive treatment.

Adult↗
PubMed1995

Prenatal care: an update and future trends.

Prenatal care gained universal acceptance during this century, but its efficacy and impact has been questioned widely. Many studies have linked inadequate, or lack of, prenatal care with adverse pregnancy outcomes; however others have failed to confirm the association. This article reviews salient aspects of standard prenatal care, and presents future trends in this field.

Female↗
PubMed1994

Cystadenofibroma of the ovary in young women.

Cystadenofibroma of the ovary, a relatively rare benign tumor, usually appears during the fourth and fifth decades. This tumor has malignant ultrasonographic features and may also macroscopically appear as malignant during surgery. Since this tumor has a rare malignant potential, it is well-advised to be aware of the possibility of a cystadenofibroma before selecting an aggressive surgical approach in young patients. We present five cases of young patients with cystadenofibromas of the ovary.

Adenofibroma↗
PubMed1994

Pseudo-sinusoidal heart rate associated with major cardiac anomalies.

Pseudo-sinusoidal fetal heart rate (pseudo-SHR) pattern, characterised by intermittent episodes of sinusoidal heart rate and normal fetal heart rate (FHR), is considered benign although its pathophysiologic mechanism remains obscure. We present a case of pseudo-SHR episodes throughout all stages of labor associated with multiple major cardiac anomalies. We suggest that when confronted with repeated episodes of pseudo-SHR pattern, the possibility of an underlying cardiac anomaly should be considered.

Abnormalities, Multiple↗