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Biomedical subjects

Arnon Samueloff

Publications and source records attributed to Arnon Samueloff.

17 recordsLinked to original sources
PubMed2006

Perinatal outcome of teenage pregnancies in a selected group of patients.

STUDY OBJECTIVE: To explore the effect of young age on the outcome of teenage pregnancies by studying teenage deliveries in our unique population. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of teenage gravidas (age 19 and younger), who had delivered in our hospital. OUTCOME MEASURES: Mode of delivery, gestational age at delivery, newborn's weight and Apgar scores and maternal and neonatal complications. RESULTS: We recruited 565 teenage delivery cases from the hospital's computerized database. Mean maternal age was 18 (14-19). Most (96%) were married. Fifty-one percent were Jewish and 44% were Muslim. Most of the girls were nulligravidas. Mean gestational age at delivery was 39 weeks (33-44 weeks). A normal vaginal delivery ensued in 72.7%, while 9% had a cesarean section and 17.4% instrumental deliveries (compared to 85.75%, 10% and 4.25% in our adult population, respectively) and 1% underwent vaginal breech delivery. Mean birth weight was 3108 g (1450-4980 g). Apgar score of 9 at 5 minutes was recorded in 97.8% of the newborns. Prenatal care included a mean of 6 prenatal visits with a range of 1-18. The main complication was anemia; 41% had hemoglobin levels of less than 11 g/dL. The rate of other complications was low. CONCLUSIONS: In our homogenous group of teenagers, there was a similar complication rate as in the adult population. The only significant complication was anemia (less than 11 g/dL). There was a higher rate of instrumental deliveries and the cesarean delivery rate was slightly lower than in our adult population. Teenage pregnancy should not be considered as a high-risk situation as long as it is planned and followed with the normal routines of prenatal care.

Adolescent↗
PubMed2006

Prevention of early-onset neonatal group B streptococcal infection: is universal screening by culture universally applicable?

BACKGROUND: Previous assessments of maternal group B Streptococcus carrier rates in women delivering at Shaare Zedek Medical Center ranged between 3.5 and 11% with neonatal sepsis rates of 0.2-0.9/1000 live births. Because of low colonization and disease rates, routine prenatal cultures of GBS were not recommended and intrapartum prophylaxis was mainly based on maternal risk factors. OBJECTIVES: To determine whether this policy is still applicable. METHODS: We performed prospective sampling and follow-up of women admitted for labor and delivery between February 2002 and July 2002. Vaginal and rectal cultures were obtained before the first pelvic examination. GBS isolation was performed using selective broth medium and identified by latex agglutination and serotyping. Demographic data were collected by means of a standardized questionnaire. Data on the newborns were collected throughout 2002. RESULTS: Of the 629 sampled women, 86 had a positive culture and a carrier rate of 13.7%. A borderline significantly higher carriage rate was observed among mothers of North American origin (21% vs. 13.1%, P= 0.048), and a higher attack rate in their infants (3.8/1000 compared with 0.5/1000 live births in our general maternal population, P= 0.002). Eight newborns had early-onset neonatal GBS sepsis (a rate of 0.8/1000 live births), but none of them benefited from intrapartum antibiotic prophylaxis. CONCLUSIONS: An increased neonatal disease rate was observed in a population with a higher colonization rate than previously seen. In view of the higher carrier rates, we now recommend routine prenatal screening for GBS in our perinatal population.

Adult↗
PubMed2005

Does maternal height affect triplets' birth weight?

BACKGROUND: In cases of triplet gestation where patients are reluctant to undergo multifetal pregnancy reduction, it would be helpful to identify predictive factors regarding poor or better outcomes. One such possible factor may be maternal height, which is possibly predictive of gestational age and neonatal birth weight. MATERIAL/METHODS: To examine such a possible association, we have retrospectively evaluated 102 triplet gestations. Maternal height and BMI were compared and correlated to neonatal weight, week of delivery, NICU hospitalization duration, and other parameters of pregnancy outcome. RESULTS: Mothers taller than 165 cm gave birth to significantly heavier neonates than shorter parturients delivered of triplets. Individual and mean total triplet neonatal weights were positively correlated to maternal height. There was no significant correlation between preconceptional maternal BMI and triplet neonatal weight and week of delivery, NICU hospitalization or any other parameter. CONCLUSIONS: The taller patient (>165 cm) may be at a significantly lower risk of very low birth weight neonates and very premature delivery as compared to the shorter patient (< 165 cm). Therefore, the factor of maternal height may be taken into consideration in multiple gestation pregnancy consultations. Smaller mothers should never receive more than two embryos in IVF programs to reduce the risk of triplets almost completely.

Birth Weight↗
PubMed2005

The effect of the homeopathic remedies Arnica montana and Bellis perennis on mild postpartum bleeding--a randomized, double-blind, placebo-controlled study--preliminary results.

OBJECTIVE: To evaluate the effect of Arnica Montana and Bellis perennis on postpartum blood loss. DESIGN: Double blind, placebo-controlled, randomized, clinical trial. SETTING: Department of Gynecology, Shaare Zedek Medical Center, Jerusalem. INTERVENTIONS: Forty parturients were randomized to one of three groups: Arnica montana C6 and Bellis perennis C6 (n=14), Arnica montana C30 and Bellis perennis C30 (n=14), or double placebo (n=12). After 48 h the Arnica/placebo was halted, and patients continued the Bellis/placebo until cessation of lochia. MAIN OUTCOME MEASURES: Hemoglobin levels (Hb) at 48 and 72 h postpartum. RESULTS: At 72 h postpartum, mean Hb levels remained similar after treatment with homeopathic remedies (12.7 versus 12.4) as compared to a significant decrease in Hb levels in the placebo group (12.7 versus 11.6; p<0.05), in spite of less favorable initial characteristics of the treatment group. The mean difference in Hb levels at 72 h postpartum was -0.29 (95% CI -1.09; 0.52) in the treatment group and -1.18 (95% CI -1.82; -0.54) in the placebo group (p<0.05). CONCLUSION: Treatment with homeopathic Arnica montana and Bellis perennis may reduce postpartum blood loss, as compared with placebo.

Adult↗
PubMed2005

Intensive management and early delivery reduce antenatal mortality in monoamniotic twin pregnancies.

BACKGROUND: Intensive management and elective delivery between 32 and 35 weeks of monoamniotic twin pregnancies were suggested as improving perinatal outcome. We sought to evaluate this management as viewed by the outcome of monoamniotic twin pregnancies in our population. METHODS: A retrospective systematic chart review of all monoamniotic twin pregnancies, diagnosed from January 1986 to June 2002, was performed in three medical centers. Demographics, pregnancy course, and perinatal outcome were evaluated. The management and outcome were compared between the group of survivors and the groups of intrauterine fetal demise (IUFD) and miscarriage. RESULTS: Thirty-three pairs of monoamniotic twins were identified. Excluded were three women, who chose to terminate the pregnancy. Total survival rate was 60% (of 60 fetuses, 36 were born alive, but one neonate died due to sepsis). None of the IUFD occurred in hospitalized patients, and two pairs of twins died after 32 weeks. In the 10 twin pairs who died in utero, cord entanglement was documented in eight (80%). There were two cases of twin discordance and two cases of twin-to-twin transfusion syndrome. One twin of the live-born group had congenital transposition of the great arteries. Furthermore, one of the hospitalized patients was delivered by means of an emergency cesarean section because of a non-reassuring non-stress test at 30 weeks. CONCLUSIONS: Women with monoamniotic twin pregnancies should be advised about the very high mortality and morbidity rate. Early diagnosis, close in-hospital antenatal surveillance starting at fetal viability, and elective delivery at 32 weeks would reduce the antenatal mortality.

Adult↗
PubMed2004

Pregnancies in Gaucher disease: a 5-year study.

OBJECTIVE: The study was undertaken to investigate the outcome of pregnancies in Gaucher disease, particularly in enzyme-treated women. STUDY DESIGN: A retrospective study was performed of pregnant women evaluated at a referral clinic. RESULTS: There were 43 (17 treated, 26 untreated) women with 66 pregnancies (23 treated, 43 untreated). The live birth rate was 78.3% among treated, 86.0% among untreated. One treated woman had three spontaneous abortions; 3 untreated women had one each. Four pregnancies in each group had postpartum bleeding, 7 requiring transfusions. Postpartum infections were prevalent among treated. Cesarean sections were generally for historic reasons. There was no exacerbation of Gaucher disease, except one bone crisis. CONCLUSION: Most untreated women with milder disease enjoyed an uncomplicated course. Enzyme-treated patients (ie, with more severe disease) had more bleeding and infections post partum, but few had spontaneous abortions. Hematologic consultation is recommended. A review of world experience with pregnant patients with Gaucher disease is included.

Adult↗
PubMed2004

Primary nonmedically indicated cesarean section ("section on request"): evidence based or modern vogue?

Cesarean section, initially described as an emergency operative procedure for delivering moribund parturients, is now advocated by many as a routine technique with major advantages over vagi-nal delivery. In fact, it has been suggested that labor and vaginal delivery are no longer the desired consequence of pregnancy, a conclusion that reflects perceived medical advantages and patient and physician convenience. This article systematically reviews the various medical implications to the mother and infant of this procedure in the hope of facilitating a more rational approach to this spreading and controversial phenomenon.

Cesarean Section↗
PubMed2004

Successful spontaneous pregnancies in women older than 45 years.

OBJECTIVE: To characterize the reproductive history of women who delivered an infant after a spontaneous pregnancy after the age of 45 years. DESIGN: Observational study. SETTING: University departments. PATIENT(S): Two hundred nine women who conceived spontaneously and had their most recent delivery after the age of 45 years. INTERVENTION(S): Review of all individual medical charts for a complete history of all pregnancies. MAIN OUTCOME MEASURE(S): Gravidity, parity, and spontaneous abortion (SAB) rate. RESULT(S): The mean (+/-SD) age at last delivery was 45.7 +/- 0.9 years (range: 45-49). The mean parity was 9.6 +/- 4 children (range: 2-20): 81% of the women were grandmultiparas (> or =6 deliveries) and 46% were grand-grandmultiparas (> or =11 deliveries). The mean number of SAB was 1.9 +/- 1.9 (range: 0-9). Increased parity did not have a protective effect on abortion rate: 12.9% for parity 2-5, 15.6% for parity 6-10, and 21.3% for parity 11-20. Women in the study group differed significantly in their SAB rate from a general population: 11.3% vs. 17.7% at age 39, 13.2% vs. 33.8% at age 44, and 9.1% vs. 33.8% at age 45. CONCLUSION(S): Women who conceived at or after 45 years of age were mostly grandmultiparas. Although multiparity in itself did not affect SAB rates, this measure was remarkably low in our exceptionally fertile group as compared with the rates published for a general population. This unique group of grandmultiparous women might possess a genetic propensity that delays the normal rate of ovarian and oocyte senescence.

Abortion, Spontaneous↗
PubMed2003

Lack of anti-D in women at birth following antepartum immune globulin prophylaxis.

Antepartum prophylaxis using Rh immune globulin suppresses maternal immunization to transplacental transfer of Rh-positive fetal cells, and, theoretically, to be effective, anti-D should be detectable until birth. We used a sensitive gel technique to quantitatively detect the serum concentration of anti-D at birth in 150 women who had received 300 microg of Rh immune globulin at 28 weeks gestation. Our method, which was sensitive enough to detect 20-25 microg, the recommended residual amount at birth, was positive in only 21% total, and in only 13% of women at term. Fifty-seven percent of women with premature births had above the recommended level of anti-D.

Female↗
PubMed2003

Gestational vascular complications.

Severe pregnancy complications, primarily severe pre-eclampsia, placental abruption, intrauterine growth restriction (IUGR) and intrauterine fetal death (IUFD) occur in about 1-5% of gestations. This rate is even higher in special medical situations. These pregnancy complications have been shown to increase maternal and fetal morbidity and mortality considerably. Severe pregnancy complications have also been shown to be associated with deficient uteroplacental circulation and are linked with intervillous and spiral vessel thrombosis. Moreover, it has been suggested that these complications could have their basis in a deficient trophoblast invasion in the uterine spiral arteries at a stage much earlier than the clinical manifestations become evident. In the last few years, evidence has accumulated to suggest that severe pregnancy complications could have a common thrombogenic basis associated with inherited and acquired thrombophilia. In this chapter we present a comprehensive update of the aetiology, pathophysiology, clinical manifestations, diagnosis and treatment of these severe pregnancy complications.

Abruptio Placentae↗
PubMed2003

Transabdominal sonography before uterine exploration as a predictor of retained placental fragments.

OBJECTIVE: To evaluate the diagnostic accuracy of sonography in postpartum patients thought to have retained placental fragments. METHODS: The study group consisted of 39 postpartum women in whom inspection of the placenta brought up suspicion of retained placental fragments. All these women underwent manual exploration of the uterine cavity. Before the procedure, all patients had two-dimensional sonographic imaging, after which they were divided into 2 groups. The first group comprised women who were judged to have had an empty uterus or nothing but intrauterine fluid collection. The second group consisted of those in whom sonography showed echoes of what might appear as residual trophoblastic tissue, that is, echogenic, hypoechoic, or mixed echo intracavitary patterns. The sonographic patterns were then correlated with the presence or absence of retained placental fragments as found on uterine manual exploration and pathologic examination. RESULTS: In 18 patients, no suspected contents were observed on sonography. In 17 of these patients, the uterus was empty on manual uterine exploration. One of these patients had residual trophoblastic tissue, which was of minimal quantity and clinically unimportant. In 21 patients, sonography suggested retained placental tissue. In 15 of these patients, pathologic examination confirmed residual trophoblastic tissue, and in the remaining 6, the uterus contained blood clots, decidua, or both. CONCLUSIONS: Sonography is an effective tool for evaluating postpartum patients thought to have retained placental fragments. Normal sonographic findings might obviate the need for manual exploration of the uterine cavity. A questionable sonographic result is not an effective tool for distinguishing between placental fragments and blood clots.

Abdomen↗
PubMed2002

A sero-epidemiological study of herpes virus type 1 and 2 infection in Israel.

In order to obtain data on the prevalence and incidence of herpes virus type 2 (HSV(2)) infection in selected populations of women and to identify groups that might benefit from routine prenatal screening, an epidemiological study was conducted during the period 1984-1990, which showed HSV(2) seroprevalence to be 2.8%. Due to the worldwide increase of over 30% of HSV(2) infection in the past two decades, a second study was performed during the period 1 January 1998-31 December 1999. Four different population groups were studied: 172 children aged 6 months to 17 years (group 1), 716 adults, men and women aged 18-95 (group 2), 200 women aged 30-67 who participated in the first survey and were re-examined in 1999 in the second survey (group 3), and a prevalence group of 155 parturient women from six different delivery rooms (group 4). Among the healthy 716 males and females HSV(2) seroprevalence was 4.5%. When analyzed by subgroup, HSV(2) seroprevalence rose from 2.3% in the 18-30 years subgroup to 6.5% in the 30-50 years subgroup and to 7.3% in the 51-70 years subgroup, and then declined to 2.4% after age 70 years. In the 200 women re-examined, HSV(2) seroprevalence was 7.7% with a 0.55% HSV(2) sero incidence per annum. In the prevalence group HSV(2) seroprevalence was 4.5%. Sera from the 1223 participants of all four groups were also screened for HSV(1) infection. HSV(1) antibody was present in 22% of children aged 6 months-1 year, in 60% at 21 years and in 87% at age 70 years. The data support the conclusion that in Israel there is no justification for routine prenatal HSV(2) screening in the healthy female population.

Adolescent↗
PubMed2002

The pathophysiology of the fetus of the diabetic mother.

The metabolic processes that are responsible for the pathophysiology of the fetus of the diabetic mother have been elucidated in recent years and include maternal hyperglycinemia, fetal hyperglycinemia, fetal hyperinsulinemia, and increased levels of maternal, placental, and fetal insulin-like growth factors. Counter-regulatory mechanisms, such as insulin-like growth factors binding proteins and leptin also play a role. The fetal hypermetabolic state leads to increased somatic growth, obesity, and metabolic disturbances with short- and long-term consequences.

Diabetes Mellitus↗
PubMed1985

Urinary function during epidural analgesia with methadone and morphine in post-cesarean section patients.

Urinary function was assessed in 120 women after cesarean section under epidural anesthesia. Postoperative analgesia was obtained by means of epidurally administered methadone (40 patients) or morphine (40 patients). In the remaining 40 women, no narcotic drugs were given and postoperative pain was treated with intramuscular or oral non-opiate analgesics and sedatives. Both methadone and morphine provided potent postoperative pain relief. Following epidural methadone, mean urine volumes of the first two postoperative voidings were increased (543 +/- 38 ml and 571 +/- 31 ml) as compared with those after epidural morphine (219 +/- 25 ml and 218 +/- 18 ml) and with those of patients receiving non-opiate analgesics (319 +/- 28 ml and 414 +/- 30 ml). The mean time interval between the end of surgery and first voiding following methadone analgesia was shorter (336 +/- 27 min) than after morphine (582 +/- 18 min) or after non-opiate (448 +/- 28 min) analgesic drugs. Difficulty in micturition and the need for bladder catheterization were also decreased in the group with epidural methadone (2.5%) in comparison with the groups receiving morphine (57.5%) or non-opiate analgesic medicaments (12.5%). The use of epidural methadone for postoperative pain relief is advocated, both in view of its analgesic potency and of the low incidence of urinary disturbances.

Adult↗
PubMedDate not supplied

Expectant management of midtrimester premature rupture of membranes: a plea for limits.

OBJECTIVE: Our aim was to assess neonatal and maternal complications of the expectant management of pregnancies with preterm premature rupture of membranes (P-PROM) prior to 24 weeks of gestation and to delineate a patient consult strategy. STUDY DESIGN: We included all consecutive cases of early midtrimester P-PROM (16-24 weeks gestation). Information coded in our perinatal database was analyzed. Descriptive statistics, Student's t-test and Mann-Whitney test, and a logistic regression model were built accordingly. RESULTS: A total of 28 women presented with P-PROM at 16-24 weeks (mean 22.7+/-1.0 weeks). Two patients declined conservative management and one was lost to follow-up (10.7%). In all, 25 (89.2%) were followed until the onset of labor or development of chorioamnionitis. Overall, 8/25 (32%) Of the neonates survived. Pulmonary hypoplasia accounted for three deaths (3/25, 12%). Of 10 pregnancies with P-PROM before 22 weeks gestation, two (20%) neonates survived. The amount of amniotic fluid and gestational age at the time of diagnosis were crucial independent factors determining overall survival. Pulmonary hypoplasia (12%) and skeletal deformities (0%) were infrequent. The 21-day mean maternal antenatal hospital stay was further complicated by a high cesarean rate delivery (33.7%) and by postpartum infectious morbidity (32%). CONCLUSION: In cases of early midtrimester P-PROM (<24 weeks) expectantly managed, neonatal survival is positively associated with the amount of amniotic fluid present and with the gestational age at the time of diagnosis. The mothers are at increased risk of prolonged antenatal hospitalization, cesarean delivery, preterm birth, and postpartum infection. In very early midtrimester P-PROM (<22 weeks), the maternal complication rate outweighs the poor neonatal outcome and expectant management should be reconsidered.

Adult↗