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Biomedical subjects

M Hod

Publications and source records attributed to M Hod.

At least 37 records · Page 2Linked to original sources
PubMed2001

Brachial plexus injury and obstetrical risk factors.

OBJECTIVE: To determine whether known historical risk factors of brachial plexus injury differ between affected neonates and healthy controls. METHODS: The files of all 62 children with Erb's palsy who were diagnosed after birth were reviewed. The control group consisted of 124 randomly selected uninjured infants born within the same period. RESULTS: Compared with the control group, the mothers of the neonates with brachial plexus injury were found to be significantly older (32.1+/-5.2 years vs. 28.9+/-5.8 years, P = 0.01), and had a significantly higher incidence of diabetic pregnancy (69% vs. 14.5%, P = 0.001); the infants had a significantly higher mean birth weight (3846+/-576 g vs. 3220+/-582 g, P = 0.0001) and higher incidence of birth weight > or = 4000 g (27% vs. 4.8%, P = 0.0001). Two of the infants in the study group (3.2%) were born by elective cesarean section. CONCLUSIONS: Brachial plexus injury is associated with several non-predictable or preventable risk factors.

Adult↗
PubMed2001

Changes in the effects of interleukin-1beta and tumor necrosis factor-alpha on platelet activation in early pregnancy.

Platelets are known to be activated in normal pregnancy, and are further activated in pathological pregnancy states, such as preeclampsia. The factors controlling platelet activation are unknown, but cytokines, such as interleukin 1beta (IL-1beta) and tumor necrosis-alpha (TNF-alpha) have been found to affect platelet function and are believed to be involved in early pregnancy. We assessed the effects of these cytokines on platelets from women at various stages of pregnancy. We compared two methods: platelet in vitro aggregation by aggregometry, and platelet P-selectin expression by flow cytometry. IL-1beta and TNF-alpha had no effect on the in vitro aggregation and P-selectin expression of platelets from women in the first trimester of pregnancy as compared to the inhibitory effects of both in late pregnancy. We conclude that maternal platelet function undergoes a marked change throughout pregnancy.

Female↗
PubMed2000

Increased D-dimer levels in twin gestation.

In normal pregnancy, the hemostatic balance is displaced toward hypercoagulability. The elevation in plasma levels of coagulation factors VII, VIII, and X and fibrinogen and the increased concentrations of plasminogen activator inhibitors [1,2] may predispose individuals to thromboembolism, especially near term [1,3]. Because human multifetal gestation requires still greater physiological alterations, the imbalance in hemostasis is further exaggerated. It has been suggested that the changes in the coagulation system near term may even mimic low-grade disseminated intravascular coagulopathy [4]. However, for the majority of women with multifetal gestation, the coagulopathy observed in the laboratory is not clinically apparent [5]. Despite the large body of research on the physiological adaptation to pregnancy, relatively little is known of the biological adaptation in general and the hemostatic changes in particular associated with multiple gestation.

Adult↗
PubMed2000

Low-molecular-weight heparin for thrombophilia in pregnant women.

OBJECTIVE: Low-molecular-weight heparin (LMWH) is the anticoagulant of choice during pregnancy because it is associated with a low incidence of osteoporosis and thrombocytopenia. Antithrombotic therapy has recently been used to prevent pregnancy loss in high-risk patients with evidence of acquired or congenital thrombophilia. The aim of the present study was to gain further information on the teratogenic potential of LMWH in this patient group. METHODS: The study population included 46 patients with a history of recurrent abortions, intrauterine fetal death or intrauterine growth restriction (IUGR) and severe early-onset preeclampsia. Patients with a history of thromboembolism or positive findings for thrombophilia were prescribed LMWH (enoxaparin sodium, 40 mg daily) in combination with low-dose aspirin (100 mg daily) in the first trimester (group 1, n=14) or the second trimester (group 2, n=17); the remaining 15 patients received low-dose aspirin alone (group 3). RESULTS: No significant differences were noted between the groups in the incidence of congenital malformations or abortions, IUGR or preterm deliveries. One infant in group 1 had familial bilateral postaxial polydactyly of the hands and one in group 3 had patent ductus arteriosus. CONCLUSION: Despite the small size of the study groups, our results support the assumption that the use of LMWH is safe, at least as a teratogenic agent, in patients with thrombophilia throughout pregnancy.

Adult↗
PubMed2000

Path analysis on the risk of mortality in very low birth weight infants.

OBJECTIVE: The purpose of this work is to clarify by path analysis which of the predictor factors of mortality in a cohort of 423 singletons VLBW infants born at Beilinson Medical Center during the years 1980-1990 (pre-surfactant era) exert direct or indirect effect on mortality. A direct risk factor was defined as a factor having an immediate effect on the outcome without working through an intermediate variable. By contrast, an indirect risk factor was defined as a factor that does not have a direct effect on the risk of mortality but instead works through an intermediate variable. Evaluation of mortality was done at three points over time (pre-delivery, at birth and post-delivery). RESULTS: In the pre-delivery model, gestational age, appropriateness for gestational age, mother's age and fetal distress work directly on mortality in VLBW infants. At birth, mother's age, birth weight and Apgar score at the fifth minute work directly on the risk of mortality. When the assessment of the risk of death was done post-delivery, mother's age, birth weight, Apgar score at the fifth minute and seizures influence directly on mortality risk, and fetal distress, gestational age and pre-natal induced hypertension (PIH) operate indirectly on the risk of mortality. CONCLUSION: The methodology we have used can be adopted in other investigations to distinguish and measure the effect of prognostic factors on the risk of an outcome.

Causality↗
PubMed2000

Effect of antibiotic therapy in preterm premature rupture of the membranes on neonatal mortality and morbidity.

The objective of this study was to evaluate the effect of prophylactic antibiotic treatment on prenatal and neonatal outcome after preterm premature rupture of the membranes (P-PROM). The study population consisted of 172 pregnant women admitted to the Rabin Medical Center in Israel with P-PROM at 23-34 gestational weeks. The patients were divided into two groups by mode of expectant management-prophylactic ampicillin and erythromycin (study group, n = 121) or observation only (control group, n = 51) and compared for neonatal outcome. There were no significant differences between the groups in age, gravidity, parity, or gestational age at admission. Significantly more women in the study group had an interval of more than 24 hours from onset of P-PROM to delivery (98 women, 81%) than the control group (32 women, 63%) (p = 0.001). The neonatal mortality rate was significantly lower in the study group (6.6%) than the control group (1 7.6%) (p = 0.03). The lower neonatal mortality rate associated with prophylactic antibiotic treatment in P-PROM has important clinical implications for the effectiveness of this type of management.

Adult↗
PubMed2000

Evaluation of low serum vitamin B(12) in the non-anaemic pregnant patient.

Low serum vitamin B(12) concentrations in pregnancy may not indicate true megaloblastic anaemia. In the present study we compared biochemical indices of vitamin B(12) deficiency (serum homocysteine and urine methylmalonic acid) in non-anaemic pregnant women with and without low serum vitamin B(12) concentrations. The groups were matched for age, parity and gestational age. No differences were found, and all values were within normal range. These results suggest that the measurement of low serum B(12) concentrations in pregnant women should be followed by analysis at the biochemical level before vitamin B(12) injections are started.

Adult↗
PubMed2000

Pregnancy outcome in women with primary renal disease.

BACKGROUND: The preconception and intraconception parameters that are relevant to outcome in women with underlying renal disease remain controversial. OBJECTIVES: To analyze the types and frequencies of short- and long-term (2 years after delivery) maternal and neonatal complications in 38 patients with primary renal disease (46 pregnancies), most of them with mild renal insufficiency. METHODS: Logistic regression models were formulated to predict successful outcome. RESULTS: Successful pregnancy outcome (live, healthy infant without severe handicap 2 years after delivery) was observed in 98% of the patients with primary renal disease. Factors found to be significantly predictive of successful outcome were absence of pre-existing hypertension, in addition to low preconception serum uric acid level. CONCLUSIONS: Most women with primary renal disease who receive proper prenatal care have a successful pregnancy outcome. Worse pregnancy outcome was observed in women with moderate or severe renal failure. Fitted logistic models may provide useful guidelines for counseling women with preexisting renal disease about their prospects for a successful pregnancy in terms of immediate and long-term maternal and neonatal outcome.

Female↗
PubMed2000

Prediction of pregnancy outcome in subgroups of women with renal disease.

BACKGROUND: The preconception and intraconception parameters that are relevant to outcome in women with underlying renal disease remain controversial. SUBJECTS, MATERIALS AND METHODS: We analyzed the types and frequencies of short- and long-term (2 years after delivery) maternal and neonatal complications in 38 patients with primary renal disease (46 pregnancies), 24 IDDM patients with diabetic nephropathy (24 pregnancies), and 27 patients with a functioning renal allograft (42 pregnancies), most of them with mild renal insufficiency. Logistic regression models were formulated to predict successful outcome. RESULTS: Successful pregnancy outcome (live, healthy infant without severe handicap 2 years after delivery) was observed in 98% of the patients with primary renal disease, 96% of the IDDM patients with diabetic nephropathy, and 89% of the patients with a functioning renal allograft. Factors found to be significantly predictive of successful outcome were absence of preexisting hypertension in all groups, in addition to low preconception serum uric acid level in the primary renal disease patients, and long interval from transplantation to conception and use of a low dose ofprednisone in the renal transplant patients. CONCLUSION: Most women with different subtypes of renal disease have a successful pregnancy outcome with proper prenatal care. Worse pregnancy outcome was observed in women with moderate or severe renal failure. Fitted logistic models may provide useful guidelines for counseling women with preexisting renal disease about their prospects for a successful pregnancy in terms of immediate and long-term maternal and neonatal outcome.

Adult↗
PubMed2000

Regulation of platelet aggregation and adenosine triphosphate release in vitro by 17beta-estradiol and medroxyprogesterone acetate in postmenopausal women.

Clinical studies have suggested that hormone replacement therapy (HRT) may reduce the risk of coronary heart disease in postmenopausal women. Although progestins are commonly added to HRT preparations for uteroprotection, the perceived beneficial cardiovascular effects of HRT are thought to be mediated predominantly by the estrogen component. Platelets play a critical role in the pathogenesis of atherosclerosis and cardiovascular disease and, hence, it is possible that the cardiovascular effects of estrogens are mediated, at least in part, through inhibition of illicit platelet activation. The aim of this study was to examine the effects of sex steroids on adenosine diphosphate (ADP)-induced platelet aggregation and adenosine triphosphate (ATP) release in vitro in postmenopausal women. In addition, the effects of antiestrogens 14-hydroxy tamoxifen (4-OHT) and ICI 182780] and antiprogestins (RU 486 and ZK 98299) were also investigated. Preincubation of platelet-rich plasma (PRP) with antiestrogens or antiprogestins did not alter subsequent platelet aggregation or ATP release in response to ADP. However, preincubation with 17beta-estradiol (E2) significantly inhibited ADP-mediated platelet aggregation by a mean (+/-SEM) of 37%+/-6% (p = 0.02) and ATP release by 82%+/-6% (p = 0.03), an effect that was reversed by the addition of ICI 182780 or 4-OHT but not RU 486 and ZK 98299. Although the progestin medroxyprogesterone acetate (MPA) also significantly inhibited platelet aggregation (by 28%+/-5%, p = 0.02) and ATP release (by 63%+/-9%, p = 0.02), this inhibition was not reversed by the addition of antiprogestins or antiestrogens. These data show that sex steroids can modulate platelet function in vitro. Furthermore, as platelets are devoid of nuclear components, these findings indicate that estrogens may regulate platelet function through binding to a non-nuclear receptor with ligand-binding properties similar or identical to the wild-type receptor. By contrast, MPA appears to exert its effect through a mechanism that does not involve binding to the "classical" progesterone receptor.

Adenosine Triphosphate↗
PubMed2000

Course and outcome of obstetric patients in a general intensive care unit.

BACKGROUND: To characterize the course, interventions required to achieve predetermined end-points and outcome of obstetric patients admitted to a general intensive care unit. METHODS: A retrospective case series study was performed including all pregnant patients admitted to an 8-bed general intensive care unit at a tertiary care university-affiliated hospital over a 4-year period. All patients referred by the obstetricians were admitted. Patients were divided into two groups: group 1, (n = 19) those requiring mechanical ventilatory support and group 2, (n = 27) those requiring intensive monitoring. Data collected included demographics, reason for admission, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores, intensive care unit course, types of interventions used and outcome. End-points of therapy included systolic blood pressure 110-150 mmHg, urine output > or = 1 cc/kg/h and oxygen saturation > 95%. RESULTS: Over the study period, 46 obstetric patients were admitted to the intensive care unit, representing 0.2% of all deliveries and an intensive care unit utilization rate of 2.3%. Commonest admission diagnoses were pregnancy-induced hypertension and hemorrhage. Reason for admission was mechanical ventilation in 41% while 59% were admitted for monitoring. Median length of stay was 25 +/- 80.9 (mean 48.8) hours. The median APACHE II score was 6 +/- 3.9 (mean 7.24) and the TISS score was > 20 in both groups. Only one patient died (mortality rate 2.3%). CONCLUSION: Despite a short length of stay and low APACHE score, the high TISS score in obstetric patients admitted for both ventilation and monitoring suggests that these patients require a level of intervention and care typically provided by a general intensive care unit.

Adult↗
PubMed1999

Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester.

OBJECTIVE: To examine the course of pregnancy and fetal outcome in patients with twin gestations in which one abnormal fetus underwent selective feticide in the third trimester of pregnancy. DESIGN: A study of 23 consecutive late selective feticide procedures. SETTING: Department of Obstetrics and Gynecology, Rabin Medical Center, Israel. PATIENT(S): Twenty-three patients with twin pregnancies with one malformed fetus. INTERVENTION(S): Selective feticide with intracardiac injection of KCl was performed at 28-33 weeks of gestation after the diagnosis of fetal genetic (56.5%) or structural (43.5%) malformations made in the second trimester (18-24 weeks). All procedures were performed at the patient's request and on approval of a committee for fetal termination late in pregnancy. Betamethasone treatment was initiated to enhance lung maturity 3 weeks before selective feticide. All patients were placed on complete bed rest until 35 weeks' gestation. MAIN OUTCOME MEASURE(S): Early and late complications related to the procedure; outcome of pregnancy and fetal survival. RESULT(S): All 23 twin pregnancies had an uneventful course after selective feticide performed at 28-33 weeks. All birth weights were > 2,000 g (mean +/- SD, 2,628 +/- 646 g), indicating an excellent chance of survival. CONCLUSION(S): Our results suggest that late selective feticide in twin gestations is safe and efficient and results in a favorable outcome for the surviving fetus. This procedure should be performed at 28-30 weeks after treatment for enhancement of lung maturity.

Birth Weight↗
PubMed1999

Quality development in perinatal care -- the OBSQID project. OBStetrical Quality Indicators and Data.

This special communication describes the objectives and strategies of the OBStetrical Quality Indicators and Data collection (OBSQID) project, a pan-European network of researchers, healthcare providers, and professional institutions and associations using agreed key quality indicators and served by a common database. OBSQID is based on the general concept of continuous assessment, management and development of quality of care and is geared to perinatal medicine. It allows contributors to measure, on an on-going basis, the outcomes of care they provide against those of other facilities within their own region or country as well as in Europe. It identifies 'best practices' and allows for the exchange and transfer of knowledge and expertise through 'twinning' or collaborative partnerships. It also assists in setting general quality standards as well as specific guidelines aimed at ensuring all patients high quality, cost-effective care.

Data Collection↗