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Biomedical subjects

E Sadovsky

Publications and source records attributed to E Sadovsky.

At least 55 records · Page 3Linked to original sources
PubMed1984

The effect of phenoxybenzamine on postoperative urinary complications during extradural morphine analgesia.

One hundred and fifty patients, post-Caesarean section, were investigated to evaluate the effect of epidural morphine analgesia and that of phenoxybenzamine on the frequency and extent of urinary complications. Forty patients (group A) underwent Caesarian section under general anaesthesia, while 110 patients received epidural anaesthesia. Of the latter patients, 40 received postoperative mild analgesics (group B) whilst in another 40, postoperative continuous epidural morphine was administered (group C). Thirty patients who received postoperative epidural morphine, also received oral phenoxybenzamine 10 mg, 24 and 1 hr prior to, and 8 and 16 hr following surgery (group D). The volume of urine of the first two postoperative voidings, the time delay to first micturition, difficulty in micturition and urinary retention necessitating bladder catheterization were studied. The mean volumes of the first two postoperative voidings were markedly reduced in group C (219 and 218 ml, respectively) as compared with group A (383 and 453 ml) and with group B (319 and 414 ml, respectively). In group D, these mean volumes were significantly larger at 478 ml (p less than 0.01) and 417 ml (p less than 0.01) as compared with those of group C. The mean time to the first postoperative voiding was 582 min in group C, which was significantly longer than that in group A (339 min) or in group B (448 min). In the patients treated with phenoxybenzamine, the time to the first postoperative voiding was significantly less at 322 min (p less than 0.01). The need for bladder catheterization was also increased in group B compared with group A, while in group C this increase was marked compared with both groups A and B. It was significantly less frequent in those receiving phenoxybenzamine. Phenoxybenzamine is recommended in the prevention of postoperative urinary complications associated with epidural anaesthesia and epidural morphine analgesia.

Adult↗
PubMed1984

Antepartum fetal heart rate pattern associated with major congenital malformations.

Antenatal fetal heart rate monitoring of 20 fetuses with major congenital malformations revealed loss of long-term variability in 11 (55%) and an isolated, abrupt-onset fetal heart rate deceleration in 13 (65%). In ten (50%), loss of variability coexisted with periodic fetal heart rate decelerations. These fetal heart rate changes were significantly more prevalent in the malformed group than in a control population. There was also a significantly increased incidence of fetal distress in labor and in the requirement for primary cesarean section delivery. Perinatal mortality was 75%, reflecting the lethal nature of the malformations. Loss of long-term fetal heart rate variability associated with isolated, abrupt occurrence of fetal heart rate deceleration should raise the possibility of congenital malformations in an apparently normal pregnancy.

Abnormalities, Multiple↗
PubMed1983

Fetal movements in multiple pregnancy.

Fetal activity in multiple pregnancies, as expressed by maternal daily fetal movement recordings, was compared with that in singleton pregnancies. It was found that the mean fetal activity in 33 cases of twins, six cases of triplets, one case of quadruplets, and one case of quintuplets was generally higher than that obtained during singleton pregnancies. In most cases, fetal movements of triplets, quadruplets, and quintuplets were even higher than the movement of twins.

Female↗
PubMed1983

Fetal movements and intrauterine growth retardation.

Fetal Movement (FM) rate was evaluated in cases of symmetrical and asymmetrical intrauterine growth retardation (IUGR) and was compared to the FM rate in normal pregnancy. In the 25-36th week of gestation there was a significant decrease of FM rate in both groups of IUGR which was more pronounced in the symmetrical group. Also shown, was a gradual trend of increase of the FM rate with advancing gestational age in both groups of IUGR. Cases of asymmetrical IUGR were noted, who had markedly decreased FM until cessation. In this group of IUGR decreased FM demands prompt hospitalization and fetal heart rate monitoring so that possible respiratory failure and impending fetal death can be detected.

Female↗
PubMed1983

Diagnosis of fetal jeopardy by assessment of fetal movement and heart rate accelerations.

Assessment of fetal movements by the pregnant woman is a useful screening test in high and low risk pregnancies. Decreased fetal movements to less than 10 during 12 hours is an expression of fetal distress, and may be the first alert of impending fetal death. Pregnancies with decreased fetal activity comprise a very high risk group, however some normal pregnancies are still included. With the object of excluding false positive observations, fetal heart rate monitoring was added as a secondary screening procedure. There were seventy patients with diminished fetal movements, 28 had two or more fetal heart rate accelerations in twenty minutes, while 42 had one or no accelerations in twenty minutes. In the former group there was no perinatal mortality, while in the latter, 18 (42.8%) succumbed either pre- (16.6%) or post-natally (26.2%). It is suggested that daily fetal movement recording should be the primary screening test for pregnant women. Whenever reduced fetal activity to less than 10 in 12 hours is perceived, fetal heart rate should be monitored. The existence of at least two accelerations in 20 minutes excludes all the fetuses prone to disaster. One or no accelerations in 20 minutes when coexisting with decreased fetal movements, have a very grave prognosis, and interruption of pregnancy should be considered.

Female↗
PubMed1983

Pulmonary edema occurring after isoxsuprine and dexamethasone treatment for preterm labor: Case report.

A case of maternal pulmonary edema occurring in a patient in the 32nd week of gestation is presented. This was our first case of pulmonary edema seen during a period of five years' usage of isoxsuprine in the treatment of premature labor. The patient presented was 28 years old, gravida 2, para 1, admitted to the maternity ward with premature uterine contractions. Her past history eliminate cardiac or pulmonary disease. Isoxsuprine therapy was begun with initial dose of 0.04 mg/min. and increased to 0.32 mg/min., the total dose administered was 560 mg during 48 hours. During this period she was given in dexamethasone 24 mg. Fluid balance on the first day of the treatment was +1.7 liters and on the second day +5.2 liters. Forty-eight hours from the commencement of the treatment, the patient experienced shortness of breath and chest pain. Physical examination disclosed wet rales over both lungs, sinus tachycardia and tachypnea. Laboratory examination disclosed hypopotassemia of 3 mEq/liter, hypoxemia (PO2 of 80 torr on 0.5 FiO2 face mask) with mild hyperventilation 28 torr PCO2 with normal ph 7.43. Recognition of the early signs of pulmonary edema enable swift clinical diagnosis and steps to be taken to prevent disasterous condition due to progressive hypoxemia. The prompt treatment in this complication includes discontinuation of isoxsuprine and fluid administration, placement of the patient in an erect position, intravenous furosemid 40 mg, oxygen supplement by face mask and 25 mg of meperidine. The patient's condition dramatically improved though the lung fields became completely clear from wet rales only eight hours from the start of dyspneic attack.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The definition and the significance of decreased fetal movements.

The ability to diagnose severe chronic fetal distress-impending death utilizing the six different definitions of decreased fetal movement (DFM) currently in use, was evaluated retrospectively in 616 high-risk pregnant women. The study reveals the superiority of two definitions as prognostic tools: The "movements alarm signal" (MAS), i.e. no fetal movements (FM) for at least 12 hours with audible fetal heart beats, and "ten and less FM" (less than or equal to 10 FM), i.e. ten or fewer FM in 12 hours. The application of these definitions distinguished two groups of patients which included significantly more poor outcomes than were contained by the groups of patients based on the other definitions. MAS was the definition also selecting the group with fewest false-positive cases. The monitoring of FM while utilizing one of the above two definitions of DFM as cut-off points for suspected impending fetal death is a useful adjunct in high-risk pregnancy management.

Female↗
PubMed1983

The relation between fetal heart rate accelerations and fetal movements.

Fetal heart rate (FHR) accelerations associated with fetal movements is considered a sign of fetal well-being. Fetal movements as felt by the pregnant woman and visualized by real-time ultrasonography were correlated to FHR accelerations in 52 normal and high-risk pregnant women. All fetal movements felt by the mother or seen in the real-time ultrasonography were associated with large FHR accelerations (more than 15 beats per minute lasting 15 seconds or more) or small accelerations (fewer than 15 beats per minute). The large accelerations were associated with 78.6% of fetal movements felt by the mother and 99.6% of fetal movements seen by real-time ultrasonography. The small accelerations were associated with 52.9% of fetal movements felt by the mother and 82.4% of fetal movements seen by ultrasonography. Mothers felt 75.7% of fetal movements seen by real-time ultrasonography. It was concluded that fetal movements could be verified by existence of large accelerations on the FHR tracing.

Female↗
PubMed1982

Effect of dexamethasone on amniotic fluid absorbance in Rh-sensitized pregnancy.

Five Rh-sensitized pregnant women between 23 and 30 weeks gestation, with a poor obstetric history and initially high delta A450 values, were treated with weekly doses of 24 mg of dexamethasone over a period of 2-7 weeks to enhance fetal lung maturation. Four women showed a gradual decline in delta A450 during the treatment. All five deliveries were delayed until fetal lung maturity was confirmed by amniotic fluid lecithin/sphingomyelin (L/S) ratio and all five fetuses survived. It is possible that high doses of dexamethasone delayed the anticipated intrauterine deterioration of the fetuses and may have prevented the need for intrauterine transfusions.

Absorption↗
PubMed1982

Vacuum extraction and neonatal jaundice.

Various fetal scalp lesions are related to the use of the vacuum extractor. Blood sequestered in these lesions could result in an increased bilirubin load on the functionally limited neonatal liver, leading to the development of hyperbilirubinemia. In the present study bilirubin levels of vacuum extracted neonates were compared with those of non-instrumentally delivered babies during the first 72 hours of life. Sixty-nine vacuum extracted neonates had higher bilirubin levels than 56 non-instrumentally delivered babies at 24 (114 mumol/l vs. 96 mumol/l), 48 (163 vs. 141) and 72 (194 vs. 144) hours of age. The p values were 0.05, less than 0.025 and less than 0.001 respectively. This trend was apparent in both oxytocin induced and non-induced deliveries and whether or not phototherapy cases were included in the analysis. The incidence of hyperbilirubinemia requiring phototherapy was higher after vacuum extraction than after non instrumental delivery (27.5% vs. 12.5%; p less than 0.04). Analysis of our results unexpectedly indicated that oxytocin induction was generally associated with an attenuation of bilirubin levels after both vacuum extraction and spontaneous delivery. The clinician attending newborn babies should be aware of the higher incidence of neonatal hyperbilirubinemia associated with vacuum extraction.

Bilirubin↗
PubMed1982

Fetal response to voluntary maternal hyperventilation. A preliminary report.

Maternal hyperventilation can cause transient reduction in fetal oxygen tension. Fifty women with normal and high-risk pregnancies, between the 32nd and 43rd week, were voluntarily hyperventilated; in 33, fetal heart rate (FHR) acceleration or transient tachycardia were observed (reactive FHR). Of the 33 pregnancies the outcome was good in 30 (91%) as judged by the absence of perinatal death, no fetal distress in labor and no intrauterine growth retardation (IUGR). In 14 patients in whom there was no FHR response to maternal hyperventilation (non-reactive FHR), the outcome of pregnancy was significantly worse; one infant died neonatally, 10 were either chronically (IUGR), or acutely distressed. Only in 3 was the outcome good (21%). The study showed that there is good correlation between a "reactive" FHR and favorable neonatal outcome, and between a "non-reactive" FHR and an unfavorable neonatal outcome.

Apgar Score↗
PubMed1982

Placental and fetal pathology in infectious mononucleosis. A possible indicator for Epstein-Barr virus teratogenicity.

Placentae and membranes were studied microscopically in five cases of pregnancy interruption due to maternal infectious mononucleosis in the first 2 months of pregnancy. This viral disease, caused by Epstein-Barr virus and apparently rare in pregnancy, induced specific placental lesions. In the decidua, these lesions were manifested by perivasculitis and necrotizing deciduitis. The membranes exhibited slight to moderate chorionitis. In the villi, endovasculitis, perivasculitis, and occasional vascular obliteration were found, as well as mononuclear and plasma cell villitis, with many large atypical vacuolated cells resembling plasma cells. Three fetuses were studied, two of which exhibited myocarditis. The fact that there were placental lesions in all cases studied, and that two of the fetuses exhibited myocarditis, must stimulate further research concerning the possible teratogenicity of this virus in man.

Abortion, Therapeutic↗