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Biomedical subjects

J R Leiberman

Publications and source records attributed to J R Leiberman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Breech presentation and cesarean section in term nulliparous women.

OBJECTIVE: To examine pregnancy outcome in nulliparous women with single term breech presentation. METHODS: Two departments of Obstetrics and Gynecology at the same hospital used different approaches to deliver nulliparous women with singleton breech presentation at term. One department (A) delivered by trial of labor and the other (B) delivered by elective cesarean section. Prospectively and blinded to obstetric condition, parturients were assigned to either department in a systematic alternate fashion. The study period covered 8 years (1985-1992). The pregnancy outcome parameters examined were: Apgar score, intra- and post-partum death and maternal and neonatal morbidity. Neonatal morbidity was classified in three major categories: non-neurological trauma, neurological signs and respiratory problems. RESULTS: The study included 264 women of whom 135 delivered in department A and 129 in department B. Department A had 35 vaginal and 100 cesarean births and department B 10 vaginal and 119 cesarean births. There was no intra-partum death and the only post-partum death occurred among vaginal deliveries. The Apgar score was significantly worse at 1 and 5 min in vaginally delivered babies of department B. Neonatal morbidity was significantly more frequent after vaginal births (P < 0.01). Maternal morbidity was significantly higher following cesarean sections (P < 0.01). Babies of vaginal deliveries had significantly higher non-neurological trauma (P < 0.01) and pathological neurological signs (P < 0.01) than those delivered by the abdominal route. CONCLUSION: The level of risk for mother and child in the nulliparous with term singleton breech, suggests cesarean section as the preferred route of delivery.

Adult↗
PubMed1995

One or multiple previous cesarean sections are associated with similar increased frequency of placenta previa.

OBJECTIVE: The purpose of this study was to determine whether multiple previous cesarean sections would be associated with a higher frequency of placenta previa in subsequent deliveries than in women with only one previous cesarean section. STUDY DESIGN: Data of all pregnant women and deliveries were obtained from the computerized records of our department for the period 1985-1992. The study group included symptomatic placenta previa diagnosed by real time ultrasound or during labor. The data included maternal age, gravidity, parity and previous cesarean sections. Nulliparous women were excluded from the study. RESULTS: There were 58,633 deliveries during the study period, including 284 patients with placenta previa (0.48%). Increasing maternal age was associated with a higher frequency of placenta previa. Similar results were found with increasing parity. A more significant trend was found with increasing number of previous abortions. Among placenta previa deliveries 21.1% of patients had previous cesarean section, and among normal deliveries only 10.9% had previous cesarean section (P < 0.0001). The frequency of placenta previa in women with previous normal deliveries was 0.79/1000; in women with one previous cesarean section 15.39/1000; with two previous cesarean section 13.91/1000; with three previous cesarean sections 10.37/1000. While the difference between none and one previous cesarean sections was highly significant (P < 0.0001), the difference between one and more cesarean sections was not significant. CONCLUSION: Although the rate of placenta previa was significantly lower among deliveries without previous cesarean section in comparison with deliveries with one previous cesarean section, this difference was not enhanced with the increasing number of previous cesarean sections.

Adult↗
PubMed1995

Hypertensive disorders in twin pregnancies.

This study investigates the influence of hypertensive disorders on twin pregnancies for an unselected, population-based series. Between 1986 and 1991, out of a total of 56,381, 766 (1.3%) were twin deliveries at our institution, the only tertiary care hospital serving a population of about 400,000 inhabitants. The incidence of hypertensive disorders was significantly higher in twin gestations than in singleton pregnancies, at 3437/55,615 (6.2%) vs 85/766 (11.1%) (p < 0.001, OR = 1.8, 95% CI = 1.4-2.3). Hypertensive disorders were significantly higher in twin as compared to singleton pregnancies, regardless of parity, and even after adjusting for maternal age. More instrumental or surgical deliveries were needed when pregnancies were complicated by hypertension, in twin as well as singleton gestations. Despite the association between prematurity and hypertensive disorders, and prematurity and perinatal mortality, no significant difference was found in perinatal mortality between hypertensive and normotensive twin pregnancies. The neonatal death-rate in normotensive and hypertensive twin pregnancies (3.7% and 3.5% respectively) was higher than that of stillbirths (respectively 2.3% and 0%).

Delivery, Obstetric↗
PubMed1995

The diagnostic value of amniotic fluid Gram stain examination and limulus amebocyte lysate assay in patients with preterm birth.

The purpose of this study was to determine the value of Gram stain examination and Limulus amebocyte lysate (LAL) test in the detection of intraamniotic infection. Ninety women with preterm labor and intact membranes (n = 55) or preterm premature rupture of membranes (PROM) (n = 35) who delivered prematurely were included in the study. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as for mycoplasmas. Amniotic fluid analysis included Gram stain examination and limulus amebocyte lysate tests. The prevalence of positive amniotic culture was 32.2% (29/90) and the most common isolate was Ureaplasma urealyticum. Patients with preterm PROM group had a higher rate of infection than those with preterm labor and intact membranes 57.1% (20/35) vs. 16.4% (9/55), respectively (p = 0.0001). We found a lower gestational age at delivery and lower mean birth weight in neonates born to mothers with a positive amniotic fluid culture than those with negative amniotic fluid culture. The combined use of Gram stain examination and LAL test had a sensitivity and specificity of 51.7% (15/29) and 95.1% (58/61) respectively for the detection of positive amniotic fluid culture. We conclude that Gram stain examination and LAL test are rapid, simple and specific tests that can be used to detect microbial invasion of the amniotic cavity except in patients with mycoplasmas infections.

Adult↗
PubMed1995

Eradication of viridans streptococci from the amniotic cavity by parenteral antibiotic administration. A case report.

BACKGROUND: A growing body of evidence suggests that infection plays a key role in the pathogenesis of preterm labor and delivery. Recently, localized intrauterine infection was recognized as a major factor in preterm labor. CASE: We report a case of successful eradication of Viridans streptococci from the amniotic cavity in a patient with preterm labor and intact membranes at 30.5 weeks of gestation by parenteral administration of antibiotics. Following this treatment, preterm labor was arrested, and pregnancy prolonged until term delivery. CONCLUSION: Parenteral antibiotic treatment may be seriously considered for select patients presenting with preterm labor associated with microbial invasion of the amniotic cavity.

Adult↗
PubMed1994

Gestational diabetes among Bedouins in southern Israel: comparison of prevalence and neonatal outcomes with the Jewish population.

Differences in the prevalence of gestational diabetes mellitus (GDM) have recently been reported between various ethnic populations. In the Negev region of Israel, a universal free screening programme for GDM was implemented in 1985. Between 1 March 1987 and 31 July 1988 11,003 deliveries occurred at the Soroka Medical Center, which provides free delivery and postnatal care to the whole Jewish and Bedouin population of the region. GDM was found in 5.7% of Jewish and in 2.4% of Bedouin women (odds ratio, 2.3, 95% confidence interval (CI) 1.8-2.9; P < 0.0001). Ethnicity was unrelated to maternal outcome, perinatal mortality or to any of the examined morbidity conditions of the newborn. The incidence of major congenital malformations was significantly higher in Jewish than in Bedouin infants of GDM women (Fisher's Exact Test, P < 0.03). Conversely, Jewish infants had fewer minor congenital anomalies (odds ratio 0.26, 95% CI 0.09-0.73). In a multivariate logistic regression model, gestational age, mode of delivery and insulin requirement during pregnancy were the only factors independently associated with neonatal morbidity. The results of this study suggest that in our health care system, among women with GDM ethnicity is not associated with an excess of unfavourable maternal or infant outcomes.

Adult↗
PubMed1994

Idiopathic dilated cardiomyopathy in pregnancy.

We report a 34-year-old woman who presented at 21 weeks with cardiac failure due to idiopathic dilated cardiomyopathy. Following refusal of pregnancy termination, she was treated conservatively with good maternal and neonatal outcome.

Adult↗
PubMed1994

Human preterm birth is associated with systemic and local changes in progesterone/17 beta-estradiol ratios.

OBJECTIVE: The purpose of this study was to determine whether human preterm birth is associated with changes in 17 beta-estradiol and progesterone concentrations in maternal plasma and amniotic fluid. STUDY DESIGN: Forty healthy women in preterm labor with singleton pregnancies and intact membranes at 32 to 36 weeks of gestation who underwent amniocentesis for evaluation of the microbiologic status of the amniotic cavity were classified into the following two groups: 20 women who were delivered within 1 week from the amniocentesis (preterm delivery group) and 20 who were delivered at term (term delivery group). Maternal plasma and amniotic fluid concentrations of progesterone and 17 beta-estradiol were measured with sensitive and specific commercially available radioimmunoassay kits. RESULTS: The median amniotic fluid concentration of 17 beta-estradiol was significantly higher in women delivered prematurely than in those who were delivered at term (1.5 ng/ml vs 0.9 ng/ml, p = 0.0001). Moreover, the median plasma 17 beta-estradiol concentration was also significantly higher in the preterm delivery group than in the term group (14.1 ng/ml vs 6.9 ng/ml, p = 0.022). In contrast, no significant difference was found in amniotic fluid and plasma concentrations of progesterone between these two groups (24.5 ng/ml vs 27.5 ng/ml and 132.0 ng/ml vs 107.5 ng/ml, respectively). The median amniotic fluid progesterone/17 beta-estradiol ratio was significantly lower in the preterm delivery group than in those delivered at term (18.4 vs 33.6, respectively, p = 0.0017). Moreover, the median plasma progesterone/17 beta-estradiol ratio was also significantly lower in the preterm delivery group than in the term group (9.8 vs 17.0, respectively, p = 0.016). CONCLUSION: Human preterm birth is associated with significantly lower progesterone/17 beta-estradiol ratios than those of women with preterm labor delivered at term.

Adult↗
PubMed1994

The association of primiparity with intrauterine growth retardation.

The role of parity in the epidemiology of intrauterine growth retardation (IUGR) is not well understood, as some risk factors for IUGR are associated with young age and primiparity, and some are more frequent among older multiparous women. This paper examines the unique role of primiparity in the etiology of IUGR in a series of 25,614 singleton births in the southern part of Israel. The rates of IUGR were 3.5% among primiparae and 1.7% in multiparae. (Risk ratio = 1.99; 95% confidence interval, 1.69-2.35). Maternal age was associated with IUGR only among primiparae but not in multiparae. Of the obstetric factors examined, the following were found to be significantly associated with IUGR: hypertension, prior infertility, oligohydramnios, gross fetal congenital anomalies, and being a female fetus. After simultaneous adjustment for these risk factors by multiple logistic regression analysis, the odds ratio associated with parity was 1.62 (95% confidence interval, 1.30-2.01), suggesting that primiparity constitutes an independent risk factor for IUGR.

Adult↗
PubMed1994

Birth weight discordance, intrauterine growth retardation and perinatal outcomes in twins.

In a population-based study, the association between twin perinatal outcome, birth weight discordance and intrauterine growth retardation (IUGR) was investigated. Mortality was examined in 1,145 twin pairs, and neonatal morbidity was studied in 315 live-born pairs. In this study, birth weight discordance was defined as > or = 25% of the weight of the heavier twin, and IUGR was defined as < 10th percentile of gender- and gestational age-specific singleton birth weight. In univariate analyses IUGR and discordance were associated with mortality but not with morbidity. When twins were categorized by discordance and IUGR simultaneously, stillbirths were associated with IUGR, while discordant twins had elevated risks of early neonatal death. In multiple logistic regression analyses, which also included gestational age, mode of delivery, birth order, birth weight discordance and IUGR, low birth weight was the single consistent factor associated with elevated risks of mortality and morbidity. For every 250-g increase in birth weight, the risks for each condition examined fell by about 40%. Discordance was an independent risk factor only for hypoglycemia, while IUGR was not associated with any neonatal outcome. Birth weight itself seems to be the most important factor associated with perinatal outcome in twin births. Therefore, the weight of the individual fetus should be the focus of concern of the medical profession in the effort to reduce adverse outcomes in twin pregnancies.

Analysis of Variance↗
PubMed1994

Association between preterm birth and increased maternal plasma cortisol concentrations.

OBJECTIVE: To measure the amniotic fluid (AF) and plasma concentrations of cortisol in women with preterm labor and intact membranes. METHODS: Thirty-eight normal healthy women with singleton gestations, preterm labor, and intact membranes at 32-36 weeks' gestation underwent amniocentesis for evaluation of the microbiologic status of the amniotic cavity. Nineteen women delivered within 1 week of amniocentesis (preterm labor and delivery group), and 19 delivered at term (preterm labor and term delivery group). Maternal plasma and AF concentrations of cortisol were measured with sensitive and specific, commercially available radioimmunoassay kits. RESULTS: The median plasma cortisol concentration was significantly higher in women who delivered prematurely than in those who delivered at term (260 versus 240 ng/mL; P = .014). However, no significant differences in median AF cortisol concentrations were detected between the groups (13 versus 14 ng/mL). CONCLUSIONS: Although maternal plasma cortisol concentrations were significantly higher in women with preterm birth, no similar changes were found in the AF. The rise in maternal plasma cortisol may be related to the stress mechanism of labor.

Adult↗
PubMed1994

Premature delivery of small versus appropriate-for-gestational-age neonates. A comparative study of maternal characteristics.

Prematurity and growth retardation of the fetus are major factors affecting perinatal outcome. The purpose of this study was to compare maternal characteristics of 63 women who delivered a preterm, small-for-gestational-age (SGA) neonate with those of 63 women matched for parity and gestational age who delivered a preterm, appropriate-for-gestational-age (AGA) neonate. All women delivered at the Soroka Medical Center between January 1, 1985, and December 31, 1990. Mothers of SGA neonates were more likely than those of AGA neonates to be over the age of 35 years (P = .043), to have hypertensive disorders and oligohydramnios (P < .001), to have induced labor (P < .001) and to deliver by cesarean section (P < .001). In addition, they had a higher rate of morbidity in the puerperium (P = .015) and were more likely to have longer hospitalization (P = .002). In contrast, previous preterm deliveries were significantly more common in the AGA group than in the SGA group (P = .034). The results of this study indicate that women who deliver preterm SGA neonates belong to a special subgroup with unique characteristics in comparison to those who deliver preterm AGA neonates.

Adolescent↗
PubMed1993

Maternal mortality in southern Israel.

Between 1969 and 1991 there were 166,410 births in Southern Israel with 13 maternal deaths (7.8/100,000). In the Jewish population there were 119,130 deliveries with 7 maternal deaths (5.9/100,000), and the Bedouins had 47,280 deliveries with 6 maternal deaths (12.7/100,000). Prenatal care was an important preventive factor. 7 maternal deaths occurred among 151,088 women who had received prenatal care (4.6/100,000), whereas 6 such deaths occurred among 15,322 without prenatal care (39.1/100,000) (P value 0.0005). Ten of the 13 women who died were over 24 years old. Eight of the 13 patients were multiparous. Live births occurred in 6 patients and stillbirths in 5 patients. Hemorrhage, preeclampsia-eclampsia and pulmonary embolism were the leading causes of maternal death.

Cross-Cultural Comparison↗
PubMed1993

Successful treatment of preterm labour by eradication of Ureaplasma urealyticum with erythromycin.

Ureaplasma urealyticum was detected in the amniotic cavity of a woman with premature contractions at 32 weeks of pregnancy. Treatment with Erythromycin base was instituted for a period of ten days. Amniotic fluid analysis performed 48 hours after discontinuation of antibiotic treatment revealed sterile amniotic fluid. The pregnancy continued uneventfully until 39 weeks.

Administration, Oral↗
PubMed1993

The temporal relationship between maternal blood and amniotic fluid glucose levels.

OBJECTIVE: Our purpose was to examine the temporal relationship between maternal blood and amniotic fluid levels. STUDY DESIGN: Glucose levels were measured on 158 paired samples from maternal plasma and amniotic fluid obtained from healthy women undergoing genetic amniocentesis at 15 to 20 weeks of gestation. The samples of venous blood and amniotic fluid were drawn at different time intervals, randomly assigned from 0 to 200 minutes. Linear regression analysis was used to test the relationship. The significance was tested by two-tailed t test. RESULTS: A good significant correlation (r = 0.78, p < 0.01 and r = 0.67, p < 0.05) was found at 21- to 40- and 121- to 140-minute intervals, respectively. CONCLUSION: The amniotic fluid glucose level reflects the maternal blood glucose levels at specific lag times.

Adult↗
PubMed1993

Perinatal mortality in hypertensive disorders of Jewish and Bedouin populations.

The aim of this study was to retrospectively compare the perinatal mortality of Jewish and Bedouin hypertensive patients in the Southern area of Israel. Since almost 100% of the deliveries took place in the Soroka Medical Center, the sole hospital of the area, the computerized files of our department during 5 years (1986-1990) were used in the study. Data on the frequency of hypertensive disorder types, rates of stillbirths and neonatal deaths, maternal age and parity, pre-term and term deliveries, prenatal care, intrauterine growth retardation, mode of delivery and fetal sex, were analysed according to ethnicity. Among a total of 40,780 deliveries, 2343 were of hypertensive pregnancies. No difference in the prevalence of hypertensive disorders was found between Jewish and Bedouin women. Perinatal mortality in Jewish hypertensive women was 16.8/1,000 compared with 11.8/1,000 in normotensive, while among the Bedouins the rates were 44.4/1,000 and 22.9/1,000, respectively. In both populations half the rate of perinatal deaths were stillbirths, except among the Jewish hypertensive patients whose fetal deaths reached 72%. Of the risk factors examined the rate of inadequate prenatal care was higher among Bedouins than in Jews. Among women without prenatal care the Jewish hypertensives had a relative risk of 5.29 for perinatal mortality, compared to normotensive pregnant women, whereas in the Bedouins the relative risk was 2.54. Ethnicity was found not to have influence on the prevalence of hypertensive disorders among Jewish and Bedouin pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗