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Biomedical subjects

G Sher

Publications and source records attributed to G Sher.

At least 55 records · Page 3Linked to original sources
PubMed1985

Abruptio placentae with coagulopathy: a rational basis for management.

Abruptio placentae rarely produces severe maternal complications while the fetus is alive in utero. The advent of fetal death (grade III) indicates a severe form of abruptio placentae and a real risk that an overt coagulopathy might develop (grade IIIB). Overt coagulopathy associated with a live fetus is, however, uncommon. The advent of an overt coagulopathy should be viewed as ominous. Treatment of abruptio placentae with overt coagulopathy should be directed toward obtaining a rapid and atraumatic vaginal delivery. Once delivery has occurred, spontaneous reversal of the coagulopathy can be anticipated. In the opinion of one of the authors (G.S.), the advent of severe consumption coagulopathy and/or uterine inertia is an indication for intravenous therapy with aprotinin. It has been shown that such therapy will limit DIC, reverse fibrinolysis, reawaken uterine activity, and lead to rapid vaginal delivery within 6-8 hours. Aprotinin is not commercially available for clinical use in the United States. Prolongation of the abruption-delivery interval will worsen maternal prognosis. Accordingly, the advent of uterine inertia prior to complete cervical dilatation is an indication for immediate cesarean section in circumstances where aprotinin is not available. Following delivery, the physician should be on the lookout for postpartum hemorrhage, which may necessitate immediate transfusion, the administration of oxytocics, and/or uterine manipulation. Surgical intervention is rarely indicated in such cases. The patient should also be carefully observed over the ensuing days and weeks for the evolution and resolution of complications, such as renal failure, pulmonary insufficiency, and panhypopituitarism.

Abruptio Placentae↗
PubMed1984

In vitro sperm capacitation and transcervical intrauterine insemination for the treatment of refractory infertility: phase I.

Fourteen couples with long-standing infertility, associated with cervical mucus insufficiency, male subfertility, or unexplained infertility, participated in a therapeutic trial. The female partners, who were all ovulatory, were given human menopausal gonadotropin from day 2 of the menstrual cycle (controlled ovarian hyperstimulation). When plasma estradiol concentrations reached 1000 to 2000 pg/ml, human chorionic gonadotropin was given. Approximately 32 hours and again 70 hours thereafter, a masturbation specimen of the husband's sperm was capacitated in vitro and inseminated transcervically into the uterine cavity. Five women (35%) conceived following a single cycle of treatment. Four of the pregnancies are currently progressing normally; one ended in a spontaneous miscarriage in the early first trimester. The potential role of in vitro sperm capacitation and transcervical intrauterine insemination in the treatment of refractory infertility unrelated to female organic pelvic disease is discussed.

Chorionic Gonadotropin↗
PubMed1984

The development of a successful non-university-based ambulatory in vitro fertilization/embryo transfer program: phase I.

Most of the current in vitro fertilization and embryo transfer (IVF-ET) programs are university-based. The establishment of a successful ambulatory IVF program in association with a busy, two-man general obstetrics-gynecologic practice is described. Seventy-one infertile couples were screened between February 1 and October 15, 1983. Forty-three couples were judged eligible for IVF-ET. Forty-three women underwent a single attempt at ET. The first 13 of these women underwent controlled ovarian hyperstimulation (COH) with 150 mg clomiphene citrate and human chorionic gonadotropin (hCG), and the remaining 30 underwent COH with human menopausal gonadotropin (hMG) and hCG. One of the 13 patients who underwent COH with clomiphene citrate conceived but subsequently miscarried early in the first trimester, for an 8% pregnancy rate. There were 12 pregnancies among the 30 patients who received hMG and hCG, for a 40% pregnancy rate. Only three of these pregnancies miscarried in the early first trimester, and three of the nine viable pregnancies are twin gestations. The possible factors responsible for the high pregnancy rate with IVF-ET, using COH with hMG and hCG, are discussed, and the feasibility of its performance in a well-controlled, non-university program is demonstrated.

Adult↗
PubMed1983

Assaying plasma prekallikrein (PPK) by a chromogenic based method: analytical considerations and reference values in healthy adults, the pregnant woman, and the neonate.

Analytical assays that measure the amidolytic activity of plasma kallikrein (PK) must overcome the problem of anti-kallikrein inhibition during the activation of PPK to PK. We resolved this problem by exposure of plasma to 50 mg/L dextran sulfate in acetone/water (35/65, vol/vol) at 0 degrees C for 15 minutes. PK activity was assayed using the chromogenic substrate, S-2302 (KABI). A centrifugal analyzer (CentrifiChem) was used to monitor the change in absorbance at 405 nm and 37 degrees C. The assay was linear to a value 3 times that found in normal human plasma. The specificity of the substrate for PK was demonstrated by using plasma deficient in PPK (Fletcher trait) diluted with normal human pooled plasma (NHPP). Day-to-day analytical variation was 2.4% for NHPP having a mean value of 85.9 mukat/L (n = 26). Using our amidolytic method, we determined PPK values in 50 healthy adults, 80 pregnant women during each trimester of gestation, and 151 neonates (cord blood specimens). The middle 95% reference interval for the adults was 54.0 - 118.8 mukat/L, for pregnant women at first trimester: 59.0 - 129.0, second trimester: 72.3 - 161.5, third trimester: 75.6 - 152.4, day of labor: 67.7 - 144.9, and 1-9 weeks postpartum: 69.4 - 151.0 mukat/L, and for the neonate: 11.5 - 44.9 mukat/L. We observed that women on oral contraceptives had significantly greater PPK values than those not on oral contraceptives. Intra-individual variation of PPK values was relatively low in non-pregnant women with the day-to-day coefficient of variation being 4.1 - 6.1% in 5 subjects monitored over a 30 day period. The high value of inter-individual/intra-individual ratio was appreciated in pregnant women in that the PPK value observed during the first trimester was a means to predict the value approaching term. The mean PPK value during the first trimester was 105.1% of the mean seen in non-pregnant women while the mean PPK value nearing term was 130.1% of that value.

Adult↗
PubMed1983

Identifying the small-for-gestational-age fetus on the basis of enhanced surfactant production.

The clinical utility of concurrent measurements of the fetal biparietal diameter, as measured by ultrasonography and fetal pulmonary maturity, as assessed by the amniotic fluid consisted of 57 cases in which pregnancy produced a low birth weight neonate (less than 2500 g). The combination of a small fetal biparietal diameter (less than 8.5 cm) and a mature foam stability index value (0.47 or greater) was associated with small-for-gestational-age neonates in 16 of 19 cases. In addition, the occurrence of an immature foam stability index value (less than 0.47) and a fetal biparietal diameter of less than 8.5 cm was associated with appropriate-for-gestational-age newborns in 16 of 16 cases. The discriminating ability of the foam stability index test in identifying the small-for-gestational-age infant was lost when the fetal biparietal diameter was 8.5 cm or more. Of clinical note was the fact that 14 cases in which the neonatal respiratory distress syndrome occurred were all associated with appropriate-for-gestational-age infants and foam stability index values of less than 0.47 (ie, immature). The results of this study suggest a potentially important clinical role for the concurrent measurement of fetal biparietal diameter and performance of the amniotic fluid foam stability index test in the prenatal evaluation of the high-risk, small, third-trimester fetus.

Amniotic Fluid↗
PubMed1983

Assessment of fetal pulmonary maturity by the Lumadex Foam Stability Index Test.

The authors describe the operational features and performance characteristics of a new commercial kit designed to measure the amount and functionality of amniotic fluid surfactant. This kit, the Lumadex-FSI Test, is based upon the manual foam stability index test. The test requires no more than 3.0 ml of centrifuged amniotic fluid. Initial experience based on 172 specimens, including 19 cases of neonatal respiratory distress syndrome (RDS), revealed the Lumadex-FSI Test to have excellent discriminating ability in predicting the likelihood of RDS. In 18 of 19 cases in which RDS was noted, the foam stability index was 46 or less. A foam stability index of 47 or above was associated in 133 of 134 cases with fetal pulmonary maturity. Based upon contamination studies with maternal serum and meconium, the authors observed that a 1% contamination with blood, or 4% contamination with meconium, would artifactually increase the Lumadex-FSI value. The Lumadex-FSI Test demonstrated a clinical reliability similar to that of the manual foam stability index procedure, in addition to making the test simpler, faster, and more accessible to the clinician, in whose hands this test will have unique input into the management of high-risk pregnancies.

Amniotic Fluid↗
PubMed1982

Diagnostic reliability of the lecithin/sphingomyelin ratio assay and the quantitative foam stability index test: results of a comparative study.

We analyzed 331 pregnancies where clear, uncontaminated amniotic fluid was obtained within 72 hours of delivery from both normal and complicated gestations. There were 43 cases of the neonatal idiopathic respiratory distress syndrome (IRDS), 42 of which were associated with foam stability index (FSI) values of less than 0.47. In 276 of the 323 cases sufficient amniotic fluid was available to permit concurrent performance of the lecithin/sphingomyelin ratio (L/S) assay. Thirty-five cases of IRDS occurred in this group, 8 of which were associated with L/S ratio values greater than 2.0. The risk of IRDS occurrence was calculated for three groups of FSI values (shown in parentheses below). They were as follows: group I--FSI values less than or equal to 0.43 (73%); group II--FSI values of 0.44 to 0.46 (29.2%); group III--FSI values greater than or equal to 0.47 (0.35%). Comparable evaluations for the L/S ratio procedure showed the FSI test to be significantly more specific and sensitive than the L/S ratio assay. The improved performance of the FSI test was most marked in pregnancies complicated by insulin-dependent diabetes mellitus and intrauterine growth retardation. The low cost, ease and rapidity of the FSI test, as well as the fact that it does not require sophisticated technical equipment or expertise, makes this sensitive and specific assay a method of choice for the prenatal evaluation of fetal pulmonary maturity.

Amniotic Fluid↗
PubMed1982

The major determinants of perinatal mortality in a large metropolitan hospital. Results of a retrospective study.

We reviewed the records of all perinatal deaths that occurred at Mount Sinai Hospital, New York, from 1975 to 1978. The perinatal mortality rate was 20 per 1,000 births. Most potentially preventable perinatal deaths occurred in association with low birth weight. We noted that fetal deaths that occurred prior to the onset of labor were usually associated with small-for-gestational-age (SGA) or growth-retarded fetuses, whereas deaths occurring during labor were usually the result of trauma to the very small third-trimester fetus, one weighing less than 1,500 gm. Neonatal deaths most commonly resulted from prematurity-related complications (mainly the idiopathic respiratory distress syndrome) in appropriately grown, very-low-birth-weight fetuses, those weighing less then 1,500 gm at birth.

Abruptio Placentae↗
PubMed1981

Evaluation of the small third-trimester fetus using the foam stability index test.

The diagnostic effectiveness of the lecithin:sphingomyelin (L:S) ratio was compared with that of the quantitative amniotic fluid foam stability index (FSI) test in the prenatal evaluation of pregnancies associated with fetuses appropriately grown for gestational age (AGA) and with intrauterine growth retardation (IUGR). In 27 such pregnancies, both the L:S ratio assay and the FSI test were performed on amniotic fluid specimens collected within 72 hours of delivery. Of the 27 low birth weight (LBW) neonates studied, 15 were small for gestational age (SGA) but did not have idiopathic respiratory distress syndrome (IRDS), whereas of 12 AGA neonates, 9 had IRDS. The 15 IUGR cases were characterized by FSI values varying from 0.47 to 0.55, whereas the 12 AGA cases had values varying from 0.42 to 0.48. Thus, the FSI showed excellent differentiation between these 2 entities. The L:S ratio ranged from 1.1 to 3.4 in cases associated with IUGR and from 1.0 to 2.4 in AGA cases, showing a high degree of overlap. The combination of an L:S ratio of less than 1.5 and an FSI value of less than 0.47 consistently identified the fetus who would have IRDS.

Amniotic Fluid↗
PubMed1980

Trasylol in the management of abruptio placentae with consumption coagulopathy and uterine inertia.

A study was conducted on 40 patients with abruptio placentae complicated by intrauterine death of the fetus, consumption coagulopathy and uterine inertia. All patients had severe hyperfibrinolysis (FDP > 300 microgram/ml). Following correction of shock, amniotomy was performed, intrauterine pressure catheters were placed, and oxytocin infusions were begun in all cases. The diagnosis of uterine inertia was made when the cervix failed to dilate following six hours of this treatment. After diagnosing uterine inertia, 18 patients (group B) did not. All but one patient in group A showed a marked improvement in the associated consumption coagulopathy and a rapid reawakening of uterine activity with progress to spontaneous vaginal delivery. Thirteen patients in group B did not show prepartum improvement in consumption coagulopathy or a resumption of uterine activity. These patients required cesarean section. There were two maternal deaths in group B; the overall complication rate in this group was greater than in group A.

Abruptio Placentae↗
PubMed1980

Clinical evaluation of the quantitative foam stability index test.

The foam stability index (FSI) test for amniotic fluid is a quantitative test that uses ethanol as the antifoaming reagent; it presents values in terms of the highest ethanol volume fraction that will permit stable foam to occur. In this study the authors report on FSI tests results in terms of neonatal outcome in a total of 208 pregnancies in which fluids were obtained within 3 days of delivery. The authors noted a total of 27 cases of hyaline membrane disease (HMD) in their population. All 27 had FSI values of 0.47 or less, whereas 119 of the 181 patients without HMD had FSI values of 0.48 or above. The risk of HMD's occurring was calculated for 4 groups of FSI values. They were as follows: 1) FSI values less than or equal to 0.43 (62%); 2) FSI values of 0.44 and 0.45 (23%); 3) FSI values of 0.46 and 0.47% (14%); and 4) FSI values greater than 0.48 (0%). Comparable evaluations of the lecithin:sphingomyelin (L:S) ratio procedure performed on the same specimens revealed no apparently improved diagnostic reliability. In addition, in several cases of intrauterine growth retardation with normal neonatal respiratory status in which the L:S ratios were less than 1.5, the FSI test correctly predicted fetal lung maturity (FSI greater than or equal to 0.48). The authors conclude that the FSI test has sufficient diagnostic reliability to be considered as a sensitive and specific assay of fetal pulmonary maturation.

Amniotic Fluid↗
PubMed1979

Induction of labor following intrauterine death with intra-amniotic hyperosmolar urea and prostaglandin F2alpha: evaluation of placental endocrine function and changes in coagulation parameters.

A practicable and reliable method for inducing labor in patients whose pregnancies are complicated by intrauterine death of the fetus is described. The method involves the intra-amniotic instillation of 30 mg of prostaglandin F2alpha with 60 gm of urea. Twenty patients had pregnancies ranging between 22 and 41 weeks and the estimated duration of fetal death ranged between two and eight weeks. Delivery was achieved within 24 hours in all cases. Side effects and complications were minimal. Plasma human placental lactogen (hPL) and progesterone concentrations, as well as several blood coagulation parameters (i.e., plasma fibrinogen, blood platelet count, and serum fibrin degradation products (FDP) concentrations), were measured immediately prior to induction of labor. The latter (i.e., coagulation factors) were repeated at parturition. The presence of residual viable placenta prior to induction did not influence the induction-delivery interval. No statistically significant alterations in blood coagulation parameters that could be attributed to the specific method of induction employed were noted.

Amniotic Fluid↗
PubMed1979

Congenital incompetence of the cervical os: reduction of bulging membranes with a modified Foley catheter.

A case is described of congenital incompetence of the cervix associated with pronounced bulging of the fetal membranes through the cervical os. The patient, a primigravida, presented at 25 weeks' gestation without any evidence of uterine activity. She had no past history of cervical surgery or disease. The tip beyond the bulb of a size 22 Foley catheter was removed. We inflated the bulb progressively while applying sustained, gentle pressure to the bag of forewaters. Upon reducing the membranes to within the uterine cavity, we inflated the bulb of the catheter further with saline to a total volume of 25 cc. This procedure maintained the catheter within the uterine cavity and facilitated the insertion of a MacDonald cerclage in the region of the internal cervical os.

Adult↗