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Biomedical subjects

G Ohel

Publications and source records attributed to G Ohel.

At least 19 recordsLinked to original sources
PubMed1995

Postdate antenatal testing.

OBJECTIVE: To test the effect on pregnancy outcome of a policy of very early commencement of postdate surveillance testing, and induction of labor at 42 weeks. METHODS: Retrospective analysis of 2776 consecutive cephalic deliveries at 38-42 weeks of gestation. Management of the postdate pregnancies included twice-weekly antenatal testing beginning at 40 completed weeks and elective induction of labor at 42 completed weeks. Pregnancy outcome parameters were compared between the groups delivered at 38-40 weeks and at 41-42 weeks. RESULTS: There were 2138 pregnancies delivered at 38-40 weeks and 638 at 41-42 weeks. The latter group had a statistically significant increase in the rate of cesarean section, mainly accounted for by an increased rate of fetal distress and failure to progress in labor. Similarly the rate of instrumental vaginal delivery, meconium in labor and macrosomia had a statistically significantly higher incidence in the postdate group. These differences in outcome were already apparent at 41 weeks of gestation. CONCLUSION: Despite early initiation of fetal surveillance, starting at 40 completed weeks, postdate pregnancies are associated with an increased rate of emergency cesarean section, macrosomia and meconium in labor.

Cesarean Section↗
PubMed1995

Spectrophotometry of amniotic fluid: a simple and rapid method for distinguishing between gestational sacs in second-trimester amniocentesis of twin pregnancies.

OBJECTIVE: To evaluate the use of an alternative and simple spectrophotometric method that could replace the intraamniotic injection of dye in the second-trimester amniocentesis of twins. METHODS: Optical densities (OD) of amniotic fluid (AF) obtained at second-trimester genetic amniocentesis were measured at 360 nm. Comparison was made between 36 twin pregnancies and 60 singleton controls. RESULTS: The mean difference in OD between two samples taken from the same sac of singleton pregnancies was very small (mean 0.004, standard deviation [SD] 0.003). However, samples drawn from each of the twin pairs' amniotic sacs varied widely (raw mean 0.176, SD 0.223; median 0.096, range 0.011-0.943). The difference between the groups was highly significant statistically (P < .001). CONCLUSION: Our preliminary experience with spectrophotometry of AF in twin amniocentesis suggests that this simple test may be useful in ascertaining that the AF samples were obtained from each of the two gestational sacs.

Amniocentesis↗
PubMed1995

Fetal urine production and micturition and fetal behavioral state.

The rate of fetal urine production and the incidence of fetal micturition was compared in periods of fetal sleep and awakeness. Sonography and fetal heart rate monitoring were concomitantly performed on 12 normal term pregnancies. Fetal bladder volumes were serially calculated, and the rate of urine production and micturition were compared between the periods of fetal sleep and awakeness. Fetal micturition occurred almost exclusively during periods of fetal awakeness (p = 0.001). There were no demonstrable differences in the rates of urine production during periods of fetal sleep and awakeness. Fetal micturition is behavioral-state dependent. Nevertheless, the fetal behavioral state is not a necessary consideration when applying urine production measurements as a test of fetal well-being.

Female↗
PubMed1994

Fetal urine production after induction of labor with prostaglandin E2.

The effect of prostaglandin E2 on fetal urine production was examined in women undergoing labor induction. An effect may be expected, because the administration of indomethacin, a potent antiprostaglandin, has been shown to cause a decrease in fetal urine production and subsequent oligohydramnios. The mean hourly fetal urine production before and 4 hours after vaginal application of prostaglandin E2 were similar (38 and 43 ml per hour, respectively). The application of prostaglandin E2 need not be taken into consideration when fetal urine production is assessed.

Administration, Intravaginal↗
PubMed1994

Epidural anesthesia in early compared with advanced labor.

OBJECTIVES: To examine whether continuous lumbar epidural analgesia administered in the early phase of labor leads to an increased incidence of instrumental vaginal deliveries. METHODS: In a retrospective analysis we have studied 563 consecutive term cephalic vaginal deliveries where an epidural was given for pain relief in labor. The type of delivery was compared in two groups. In Group 1 epidurals were given when the cervix was 3 cm or less dilated; in Group 2 when they were greater than 3 cm dilated. RESULTS: There was no difference in the incidence of instrumental deliveries in the two groups. Other variables including station of the fetal head, premature rupture of membranes, meconium, and administration of pitocin and pethidine did not effect these results. CONCLUSIONS: There is no justification in delaying epidural analgesia in labor when it is clinically indicated.

Anesthesia, Epidural↗
PubMed1994

Effect of maternal immunization with oral poliovirus vaccine on neonatal immunity.

During the summer of 1988, an outbreak of poliomyelitis caused by poliovirus 1 occurred in Israel, during which a national mass immunization campaign with oral poliovirus was undertaken. This prospective study was undertaken to assess the effect of maternal oral poliovirus immunization during the third trimester of pregnancy on neonatal immunity against poliovirus. Cord blood specimens of 88 neonates, born 2 to 7 weeks after maternal immunization, were examined for antipoliovirus antibodies and compared with 100 samples obtained from neonates 7 months before the outbreak. Blood samples were also obtained from the 62 mothers of neonates who had been immunized 2 to 5 weeks before delivery. Sera were tested for neutralizing antibodies to the 3 poliovirus types using a microneutralization technique. The geometric mean titer to poliovirus type 1 was significantly higher in neonates whose mothers were immunized during pregnancy (87.1) than in the offspring of the nonvaccinated group (53.0), P < 0.05. Two to 3 weeks after immunization, geometric mean titers against all 3 poliovirus types were higher in maternal blood than in cord blood whereas 4 to 5 weeks after vaccination a significant difference was found for type 3 only. Although oral poliovirus immunization during pregnancy resulted in higher neonatal antibody titers to poliovirus type 1, the proportion of newborns with titers of < 1:8 to the 3 poliovirus types did not change significantly.

Antibodies, Viral↗
PubMed1994

In utero vaccination.

It is estimated that 4 million children die each year of vaccine-preventable diseases and another 4 million are permanently disabled. Although vaccination is the most cost-effective health method, there is a discrepancy between our level of knowledge and practices applied. Vaccination of pregnant women provides the mother with antibodies that could be transferred across the placenta and provide the neonate with high antibody titers until active immunization is likely to be protective. The ability to provide such passive childhood immunization is beneficial and cost-effective, especially in developing countries where routine childhood immunization is not widely practiced. Further progress depends on the development of more efficient antigens, carrier proteins, and formulations of multiple-antigen vaccines. Further studies should determine the ideal timing for in utero vaccination to provide protective antibodies to the full-term infant and the premature infant. This ideally should be achieved without compromising the protective effect during the first months of life and without causing immune tolerance when given early in pregnancy. The future of in utero vaccination depends on continuing basic research, which should provide improved vaccines and clinical studies that demonstrate the safety and effectiveness of vaccination for both mothers and infants. Liability issues should be addressed and greater awareness of obstetricians, family physicians, and the general public should be achieved.

Bacterial Vaccines↗
PubMed1992

Sonographic demonstration of endometrial fluid collection following termination of pregnancy.

Intrauterine fluid collections were demonstrated by transvaginal ultrasound in 19 of 21 patients, 4-6 hours after first-trimester termination of pregnancy. Similar but lesser findings were seen 3 days later in some of the cases. Five days postoperatively, the endometrium appeared normal in all patients. Appreciation of the normal sonographic appearance of the uterine cavity following abortion is important for detecting pseudosac of ectopic pregnancy or the possibility of inappropriate curettage of an intrauterine pregnancy.

Abortion, Induced↗
PubMed1992

Continuous ambulatory peritoneal dialysis as the primary approach in the management of severe renal insufficiency in pregnancy.

Pregnancy is an unusual event in patients with chronic renal failure undergoing dialysis. The outcome in these cases is usually poor. We report a pregnancy complicated by severe renal insufficiency that was managed successfully by continuous ambulatory peritoneal dialysis. Dialysis was initiated at 24 weeks' gestation. At 34 weeks, premature labor associated with peritonitis resulted in the spontaneous delivery of a healthy male infant weighing 2400 g. The use of continuous ambulatory peritoneal dialysis during pregnancy offers theoretical advantages compared with hemodialysis. Our case, added to the available limited experience with this new modality, suggests that it may be an appropriate approach in women developing renal disease for the first time during pregnancy.

Adult↗
PubMed1991

Pseudomonoamniotic twins with cord entanglement following genetic funipuncture.

Amniocentesis was performed twice on a twin gestation, and twice there was cell growth failure in one of the twins. Therefore, funipuncture was attempted at 24 weeks. The anatomical relationship and position of the fetuses, placental cord insertion, and membranous septum dictated needle entry into the cord of the lower left fetus through the sac of the upper right fetus and the septum. The procedure was uneventful and the pregnancy was carried to 39 weeks. However, the septum between the twins had been disrupted, creating a pseudomonoamniotic pregnancy. This was noticed only after delivery of the first fetus, when it was found that the two umbilical cords were entangled. We believe that, whenever possible, puncture of the membrane between twins should be avoided. Should puncture be necessary, the possibility of pseudomonoamniotic twins must be considered.

Adult↗
PubMed1989

The 1984 national perinatal census: design, organization and uses for assessing obstetric services in Israel.

A nationwide perinatal census was conducted in Israel, in which medical, social, ethnic and demographic information on all births that took place in Israel within a predefined 3-month period was collected. The present study is the first to include 22,814 births that took place in all the obstetric units in Israel. The perinatal mortality rate decreased from 23.7 in 1964-68 to 13 in 1983-84. The frequency of cesarean section deliveries almost doubled over the last decade, while the use of forceps decreased significantly and the use of vacuum extraction did not change. The rate of low birthweight, however, remained constant over the last two decades. The level of hospital care has been shown to be significantly associated with perinatal mortality. The Israeli Perinatal Census may be used to provide information needed for promoting priority objectives for pregnancy and infant health, such as improving health status, identifying risk factors, increasing public and professional awareness, and improvement in services by protecting mother and fetus.

Adult↗
PubMed1988

Antepartum fetal heart rate characteristics in cases of premature rupture of membranes.

The present retrospective study investigates the effect of premature rupture of membranes on fetal neurocardiac maturation as reflected by the fetal heart rate (FHR) pattern. The FHR tracings of 41 cases involving premature rupture of membranes of at least 48 hours' duration at 24 to 37 weeks' of gestation were studied. Fifty-two cases of normal pregnancy who were matched for gestational age served as controls. The results demonstrate similar baseline FHR and variability in the study and control group. The incidence of FHR accelerations of 15 beats/min was significantly greater in cases of premature rupture of membranes, and their onset was detected at an earlier gestational age. In addition, the mean amplitude of FHR accelerations was significantly greater in the study group compared with the control group. As a result, patients with premature rupture of membranes have a reactive nonstress test at an earlier gestational age than do control patients. These findings support the concept that premature rupture of membranes causes accelerated neurocardiac fetal maturation, as reflected by FHR pattern, possibly by inducing a stressful intrauterine environment.

Female↗
PubMed1987

Advanced ultrasonic placental maturation in twin pregnancies.

The mean length of twin pregnancies is shorter than that of singleton pregnancies. The possibility that the shorter gestation of twins is associated with advanced fetal maturational changes was studied in relation to placental maturation. For this purpose, the sonographically determined placental gradings of 158 twin pregnancies and 474 singleton pregnancies were compared at different gestational ages. The percent distributions of placental grades, from I to III, were significantly different throughout the third trimester, with a preponderance of Grade III placentas in the twin group (p less than 0.001). Considering the reported association of Grade III placentas with advanced gestation as well as fetal lung maturity, the present study suggests earlier maturational changes in twin fetuses compared with singleton fetuses.

Female↗
PubMed1987

Neonatal auditory acuity following in utero vibratory acoustic stimulation.

The fetal heart rate response to externally applied vibratory acoustic stimulation is currently being evaluated as a test of fetal well-being. We have examined the safety of this procedure by subsequent testing of the auditory nerve and brain stem evoked responses in the neonates. The results demonstrated no differences in auditory acuity when control infants were compared with infants previously exposed to antenatal vibratory acoustic stimulation.

Acoustic Stimulation↗