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Biomedical subjects

Moshe Mazor

Publications and source records attributed to Moshe Mazor.

52 records · Page 3Linked to original sources
PubMed2002

A retrospective study of unplanned out-of-hospital deliveries.

Our objective was to determine maternal characteristics and perinatal outcome of unplanned unattended deliveries en route to the hospital in comparison to unplanned deliveries attended by medical personnel within the parking facility of the hospital. All singleton deliveries occurring between 1988 and 1999 were analyzed from the computerized perinatal database. Maternal characteristics and pregnancy outcome of unattended, unplanned out-of-hospital births were compared with unplanned deliveries in the hospital parking lot, with the assistance of medical personnel. Out of 2328 out-of-hospital deliveries, 5.7% ( n=133) were managed by medical personnel in the parking lot and 94.3% ( n=2195) occurred en route to the hospital. The birth weight of newborns from the attended out-of-hospital delivery group was significantly higher than the comparison group (3126.2+/-516 g vs. 3019+/-522 g; P=0.023). A significant linear association was found between birth weight and attended out-of-hospital births (Mantel-Haenszel test for linear association; P=0.002). Moreover, these newborns were significantly more likely to be large for gestational age (OR=2.2, 95% CI 1.2-3.9; P=0.004). Parturients who delivered in the parking lot with the assistance of medical personnel, had significantly higher rates of grade 2 perineal tears (OR=8.4, 95% CI 1.1-5.4; P=0.041). Perinatal mortality was non-significantly higher among attended out-of-hospital deliveries (OR=2.8, 95% CI 0.8-8.3; P=0.279) as compared to unattended out-of-hospital deliveries. The attendance of medical personnel in unplanned out-of-hospital deliveries did not influence the birth outcome.

Adult↗
PubMed2002

Vasoconstrictive activity of oxytocin in meconium impregnated human placentas.

OBJECTIVE: The aim of our study is to determine whether oxytocin acts differently on the fetal-placental vascular bed of normal and meconium impregnated placentas. STUDY DESIGN: Isolated placental cotyledons (n=10) were dually perfused with fetal perfusion pressure used as an index of vascular resistance. As perfusion medium we used lactated Ringer salt solution, containing polyvinylpyrolidone (25 g/l), bovine serum albumin (0.1 mg/ml), glucose (1.0 g/l), heparin (20 IU/ml) and gentamycin (48 microg/ml). The pH of the medium was adjusted to 7.4 with bicarbonate. The maternal site was gassed with 95% O(2):5% CO(2) and in the fetal site with 95% N(2):5% CO(2) at 37 degree C. Perfusion rates were 4-6 and 10-12 ml/min in the fetal and maternal circulation, respectively. TNF-alpha and IL-beta1 levels in the fetal-placental perfusate were evaluated using specific commercial ELISA kits. RESULTS: No significant changes in the amount of TNF-alpha release were observed after injection of oxytocin into the fetal circulation (31+3pg/ml; P=0.5). No IL-beta1 activity was observed in the fetal perfusate of normal and meconium impregnated placentas during the experiments. No significant difference was seen in basal perfusion pressure in normal and meconium impregnated placentas, however, a bolus injection of oxytocin (10U/ml) resulted in a significant increase in perfusion pressure in meconium impregnated placentas from basal pressure of s45+5 to 88+4 mm Hg after injection of oxytocin, (P=0.004, ANOVA). CONCLUSION: Vasoconstrictive effect of oxytocin was observed only in meconium impregnated placentas and no vascular effect of oxytocin was documented in normal placentas. The clinical implication of our findings is that one should use oxytocin for stimulation of labor with caution in the presence of meconium stained amniotic fluid.

Case-Control Studies↗
PubMed2002

Ultrasound in obstetrics: a review of safety.

The data available to data suggest that diagnostic US has no adverse effect on embryogenesis or fetal growth. However, although B and M mode are safe during the first trimester, color, pulsed or power Doppler should be performed with caution. The US effects are mainly due to cavitation. However, this Mechanism has been determined mainly in animal models. Thermal effect, which was thought to be hazardous, probably does not influence fetal development.

Animals↗
PubMed2002

IL-1 activity is expressed differently during pregnancy in the rat uterine artery than in aortic or uterine tissues.

PROBLEM: Uterine artery was shown to be unique in its capacity to change in size and function during pregnancy. As interleukin-1 (IL-1) was shown to be involved in reproduction processes, the aim of this study was to determine the levels of IL-1 activity of the uterine artery tissue in pregnant rat. METHOD OF STUDY: Nine virgins and nine midpregnant rats were selected. Both uterine arteries were obtained, together with reference tissues from aorta and uterus. The levels of IL-I were examined in the above tissues after culturing with media alone (control; CT), and media that contained stimulants like tumor necrosis factor-alpha (TNF-a) or lipopolysaccharide (LPS). IL-1-like activity was evaluated by its capacity to promote the culture growth of 1A-5 and cytotoxic T lymphocyte derived (CTLD) cell lines. This activity was expressed as optical density (OD)/mg protein of the examined organ. RESULTS: Uterine artery tissue, of pregnant rats, cultured in medium alone produced significantly higher levels of IL-1 than uterine artery of virgin animals under the same conditions (16.2 S.E. 1.3 versus 0.6 S.E. 0.05 OD/mg protein, respectively; P < 0.02). Stimulation of uterine artery in vitro by LPS and TNF increased their capacity to secrete IL-1. In comparison with uterine artery, aorta produced higher levels of IL-1 in virgin rats compared with pregnant rats (13.6 S.E. 1.2 versus 1.6 S.E. 0.1; P < 0.02). Stimulation of aorta tissues (from both virgin and pregnant rats) with LPS, in vitro, significantly decreased their capacity to secrete IL-1 (P < 0.04). Stimulation of aorta tissues from virgin rats with TNF-alpha, in vitro, did not change their capacity to secrete IL-1 activity. However, stimulation of aorta tissues from pregnant rats with TNF-alpha decreased the secretion of bioactive IL-1. The levels of IL-1 produced by uterine tissues from virgin and pregnant rats were similar, and stimulation with either LPS or TNF-alpha significantly decreased their capacity to secrete IL-1 (P < 0.04). CONCLUSIONS: The high level of IL-1 activity detected during pregnancy in the uterine artery may suggest its unique involvement in the changes occurring throughout pregnancy in those blood vessels.

Animals↗
PubMed2002

Induction of transferrin secretion in murine Sertoli cells by FSH and IL-1: the possibility of different mechanism(s) of regulation.

In the present study we examined the capacity of interleukin-1 (IL-1) alpha, beta, interleukin-1 receptor antagonist (IL-1ra) and follicle stimulating hormone (FSH) to induce transferrin secretion by Sertoli cells under in vitro conditions. Primary Sertoli cell (SC) cultures from immature mice secreted constitutively transferrin. Stimulation of these cultures with IL-1alpha, IL-1beta significantly increas\d their capacity to secrete transferrin. Addition of IL-1ra to unstimulated SC cultures did not affect their capacity to secrete transferrin. Stimulation of SC cultures with a combination of both IL-1alpha and FSH or IL-1beta and FSH showed additive effect between IL-1 and FSH in their capacity to induce transferrin secretion by these cells. However, stimulation of Sertoli cells with a combination of both IL-1ra and FSH did not affect their capacity to secrete transferrin compared with FSH-stimulated cultures. Our results may suggest the involvement of testicular paracrine/autocrine factors (IL-1) and endocrine (FSH) factors in the regulation of transferrin secretion by SC. This capacity seems to be differently regulated by these factors. Thus, IL-1alpha and beta may directly affect physiological functions of the testis; which may suggest their involvement in the regulation of spermatogenesis and spermiogenesis processes and male fertility.

Animals↗
PubMed2002

Fetal plasma MMP-9 concentrations are elevated in preterm premature rupture of the membranes.

OBJECTIVE: The objective of this study was to determine whether the concentrations of matrix metalloproteinase-9 (MMP-9) in the fetal (fetal plasma and amniotic fluid) and maternal compartments (plasma) are different in patients presenting with preterm premature rupture of membranes (PROM) than in those with preterm labor and intact membranes. STUDY DESIGN: Fetal plasma MMP-9, interleukin-1beta (IL-1beta), IL-6, soluble tumor necrosis factor receptors 1 (sTNF-R1) and 2 (sTNF-R2) were measured in fetuses with preterm labor and intact membranes (n = 96) and preterm PROM (n = 43). The concentrations of analytes were determined with sensitive and specific immunoassays. A P value <.05 was considered significant. RESULTS: (1) The median fetal plasma MMP-9 concentration was significantly higher in fetuses with preterm PROM than in those with preterm labor (P =.035). (2) In contrast, fetal plasma IL-1beta, sTNF-R1, and sTNF-R2 were significantly higher in patients with preterm labor than in those with preterm PROM (IL-1beta, P =.01; sTNF-R1, P =.003; and sTNF-R2, P =.02). (3) The median amniotic fluid concentration of MMP-9 was higher in patients with preterm PROM than in those with preterm labor (P <.001). CONCLUSION: Fetuses with preterm PROM have increased concentrations of an enzyme (MMP-9) implicated in the mechanism of membrane rupture but lower concentrations of IL-1beta, sTNF-R1, and sTNF-R2 than fetuses with preterm labor and intact membranes. A role for the fetus in the genesis of preterm PROM deserves consideration.

Adolescent↗
PubMed2002

[Chickenpox during pregnancy].

Chickenpox during pregnancy is very uncommon and is known to cause fatal malformation during the first half of pregnancy. The infection during pregnancy is also associated with maternal morbidity and mortality. Furthermore, there may also be neonatal complications. Thus, any pregnant woman with Varicella infection should be hospitalized and followed-up closely. In this review, we examined the literature on Varicella Zoster during pregnancy with regard to prevalence, prenatal diagnosis, management and prevention.

Chickenpox↗
PubMed2002

Risk factors and outcome of failure to progress during the first stage of labor: a population-based study.

BACKGROUND: One of the major indications for Cesarean section (CS) is failure of labor to progress. This study was aimed at defining obstetric risk factors for failure of labor to progress during the first stage, and to determine pregnancy outcome. METHODS: A population-based study comparing all singleton, vertex, term deliveries between the years 1988 and 1999 with an unscarred uterus, complicated with failure of labor to progress during the first stage with deliveries without non-progressive labor (NPL). Multiple logistic regression analysis was performed to investigate independent obstetric risk factors associated with failure of labor to progress during the first stage. RESULTS: Failure to progress during the first stage of labor complicated 1.3% (n = 1197) of all deliveries included in the study (n = 92 918), and resulted in CS. Independent risk factors for failure of labor to progress during the first stage, using a multivariable analysis, were premature rupture of membranes (PROM; OR = 3.8, 95% CI 3.2-4.5), nulliparity (OR = 3.8, 95% CI 3.3-4.3), labor induction (OR = 3.3, 95% CI 2.9-3.7), maternal age > 35 years (OR = 3.0, 95% CI 2.6-3.6), birth weight > 4 kg (OR = 2.2, 95% CI 1.8-2.7), hypertensive disorders (OR = 2.1, 95% CI 1.8-2.6), hydramnios (OR = 1.9, 95% CI 1.5-2.3), fertility treatment (OR = 1.8, 95% CI 1.4-2.4), epidural analgesia (OR = 1.6, 95% CI 1.4-1.8) and gestational diabetes (OR = 1.4, 95% CI 1.1-1.7). Although newborns delivered after failure of labor to progress during the first stage had significantly higher rates of Apgar scores lower than 7 at 1 and 5 min as compared with the controls (18.2% vs. 2.1%; P < 0.001 and 1.3% vs. 0.2%; P < 0.001, respectively), no significant differences were noted between the groups regarding perinatal mortality (0.3% vs. 0.4%; P = O.329). Maternal anemia and accordingly packed cells transfusion (47.4% vs. 22.8%; P < 0.001 and 5.6% vs. 1.0%; P < 0.001, respectively) were higher among pregnancies complicated with failure of labor to progress during the first stage as compared with the controls. CONCLUSIONS: Major risk factors for failure of labor to progress during the first stage were PROM, nulliparity, induction of labor and older maternal age. Indications for labor induction should be carefully evaluated in order to decrease the rate of operative deliveries.

Adolescent↗
PubMed2002

Accidental out-of-hospital delivery as an independent risk factor for perinatal mortality.

OBJECTIVE: To determine maternal characteristics and perinatal outcomes of unattended out-of-hospital deliveries. STUDY DESIGN: A population-based study including all singleton deliveries between 1988 and 1999. Maternal characteristics and pregnancy outcomes of accidental out-of-hospital births were compared with those of women who delivered in the hospital. Multiple logistic regression analysis was performed to investigate independent risk factors for out-of-hospital deliveries. Another model was constructed to assess the independent risk of out-of-hospital delivery for perinatal mortality. RESULTS: The incidence of unattended, out-of-hospital deliveries was 2% (2,328/114,938). Multiparity, Bedouin ethnicity and lack of prenatal care were independently associated with out-of-hospital deliveries. Parturients who delivered out of hospital had a significantly lower rate of previous cesarean deliveries. Perinatal mortality was significantly higher among out-of-hospital deliveries, and those newborns were significantly more likely to be small for gestational age as compared to newborns with in-hospital births. In a multivariable model investigating risk factors for perinatal mortality, out-of-hospital delivery was an independent risk factor for perinatal mortality. Other significant risk factors were Bedouin ethnicity and lack of prenatal care. CONCLUSION: Accidental out-of-hospital birth, associated with multiparity, Bedouin ethnicity and lack of prenatal care, is an independent risk factor for perinatal mortality.

Accidents↗
PubMed2002

Intravenous magnesium sulphate effect on maternal serum and amniotic fluid cytokines levels in preterm labour patients.

Our objective was to evaluate the effect of intravenous magnesium sulphate administration to patients with preterm labour on maternal serum and amniotic fluid IL-1beta, IL-6, IL-10 and TNFalpha concentrations. Thirty-six patients at 24-34 weeks of singleton gestation, who presented with contractions (> or = 8 in 60 min) had amniocentesis to rule out intrauterine infection. The patients received intravenous MgSO4 for tocolysis. Twenty-six patients had amniocentesis performed before initiation of MgSO4 (controls) while 10 others had the procedure during tocolytic therapy (study patients). Magnesium, IL-1beta, IL-6, TNFalpha and IL-10 concentrations were measured. Study and control groups were statistically compared using Student t test. Mean magnesium levels were significantly higher in the study group (P < 0.01). There were no significant differences between the cytokines levels in maternal serum and in amniotic fluid between the groups. Our results suggest that the mechanism of magnesium as a tocolytic agent may not be mediated via the examined cytokines.

Adult↗
PubMed1999

Ethnic differences influence care giver's estimates of pain during labour.

The present study compared the childbirth experience of two different ethnic groups living in the same area and sharing the same medical facilities. We investigated the influence of ethnic differences between patient and care provider on the interpretation of pain. The subjects were 225 Jewish and 192 Bedouin parturients, who were prospectively evaluated for their labour pain experience. The pain intensity level was assessed by the parturient ('self-reported pain') and by a Jewish doctor and midwife ('exhibited pain') in the initial active phase of labour, using the visual analog scale (VAS). On the day after delivery, the women were asked to evaluate the present pain intensity level. Although the means of the self-assessments of pain intensity levels at the initial active phase of Jewish and Bedouin parturients were similar (8.55 and 8.53 respectively, P = 0.25), the Jewish medical staff interpreted Bedouin women to experience less pain than Jewish women (6.89 vs. 8.52, P < 0.001). On the day after delivery, the Jewish women's evaluation of their pain intensity levels again resembled that of the Bedouin women (2.02 and 2.11 respectively, P = 0.52). The Pearson correlation coefficients between the measures of self-reported and exhibited pain, were higher for Jewish than for Bedouin women (0.74 and 0.63, respectively). In a multiple linear regression analysis, both self-reported and exhibited pain scores were associated significantly with ethnicity and parity. In the model predicting exhibited pain, the level of religious observance was negatively associated with pain intensity scores. We conclude that the ethnic background of the care provider is an important determinant in estimating the suffering of the patients. It is important for the clinician to be aware of the wide spectrum of factors that might influence pain expression and interpretation. The knowledge that there are inter-ethnic differences might prevent a stereotyped response to the patient in pain.

Adult↗
PubMedDate not supplied

Effect of OB/GYN residents' fatigue and training level on the accuracy of fetal weight estimation.

OBJECTIVE: To determine the effect of Ob/Gyn residents' fatigue and training level on the accuracy of their clinical and ultrasonographical estimation of fetal weight (EFW). METHODS: In this study, clinical and ultrasonographical EFWs were performed by various residents. Actual birth weight, gravidity, parity, gestational age, body mass index, presence or absence of diabetes and hypertensive diseases, presentation and amniotic fluid index were recorded. All EFWs were divided into 3 groups according to the hour they were performed. All residents were divided into 4 groups according to their training level. The accuracy of EFW as compared with actual birth weight was then analyzed according to the shift and to the residents' seniority by using the ANOVA test. Multivariate analysis was performed to evaluate the factors that significantly and independently affected the weight evaluation. RESULTS: Statistically significant differences were found between the clinical EFW and the birth weight among the working shifts for birth weights of 2,500 g and more (p = 0.032 and p = 0.035). For clinical EFW, night shifts were the most inaccurate (9.27, 8.05 and 9.78% of error for day, evening and night shift, respectively; p = 0.03). The accuracy of ultrasonographical EFW was not affected by the residents' fatigue level. The residents' training level did not alter the accuracy of either clinical or sonographical EFW. The accuracy of clinical EFW was affected independently by the work shift (p = 0.01), whereas no factor was found to independently effect the accuracy of ultrasonographic EFW. CONCLUSIONS: Ob/Gyn residents' fatigue affects the accuracy of clinical but not ultrasonographical EFWs. Residents' training level does not alter either the clinical or sonographical EFW.

Analysis of Variance↗
PubMedDate not supplied

Maternal hypertensive disorders are an independent risk factor for the development of necrotizing enterocolitis in very low birth weight infants.

OBJECTIVE: The purpose of this study was to compare complications and outcome of preterm neonates weighing < or =1,500 g who developed necrotizing enterocolitis (NEC) to neonates without NEC. STUDY DESIGN: During January, 1995 to December, 1998, 211 live preterm neonates were born with birth weight < or =1,500 g. A cross sectional prospective study was designed and two groups were defined: 17 neonates who developed NEC and 194 without NEC. Multiple logistic regression analysis was performed to determine independent risk factors for the development of NEC. RESULTS: The prevalence of NEC was 8% (17/211). The following complications were found to be significantly higher among mothers of neonates with NEC: mild pre-eclampsia (11.8 vs. 2.6%, p=0.04); severe pre-eclampsia (35.5 vs. 12.9%, p=0.01); chronic hypertension (29.4 vs. 5.7%, p<0.001) and low birth weight (968 +/- 233 vs. 1,123 +/- 257 g, p=0.02). In contrast, mean maternal age, mean gestational age at delivery and parity were not significantly different between the groups. A multivariate analysis including the following factors: maternal hypertensive disorders, pregestational diabetes mellitus, birth weight and gestational age at delivery, found only maternal hypertensive disorders to be independent risk factors for NEC (OR=5.21, 95% CI 1.64-16.58). CONCLUSIONS: Maternal hypertension is an independent risk factor for the development of NEC in preterm neonates weighing <1,500 g. Thus, maternal vascular disorders may play an important role in the pathophysiology of NEC.

Adult↗
PubMedDate not supplied

Preterm deliveries among women with MacDonald cerclage performed due to cervical incompetence.

OBJECTIVE: The study was aimed to assess the impact of obstetric risk factors for preterm delivery among women with MacDonald cerclage performed due to cervical incompetence. STUDY DESIGN: A cohort study was conducted including all patients with MacDonald cerclage performed at 12-14 weeks gestation due to cervical incompetence (n = 793). Deliveries occurred between the years 1988 and 2002 in a University Medical Center. A multiple linear regression model was used to assess the impact of maternal characteristics as well as pregnancy complications on the length of pregnancy. RESULTS: The following factors were found to be associated with preterm delivery among these patients, in the univariate analysis: nulliparity, fertility treatments, severe preeclampsia, second-trimester bleeding, premature rupture of membranes (PROM), chorioamnionitis and placental abruption. Using a multiple linear regression model, with backward elimination, the impact of these variables on the length of pregnancy was assessed (R(2) = 0.33, p < 0.001). The mean gestational age at birth among patients without risk factors was 38.1. Second-trimester bleeding reduced gestational age by 6.4 weeks, chorioamnionitis by 5.6 weeks, placental abruption by 5.1 weeks, PROM by 3.2 weeks and severe preeclampsia by 2.4 weeks. CONCLUSIONS: Second-trimester bleeding, chorioamnionitis, placental abruption, PROM and severe preeclampsia are ominous signs for preterm delivery among patients with MacDonald cerclage performed due to cervical incompetence.

Adult↗
PubMedDate not supplied

Gender does matter in perinatal medicine.

OBJECTIVE: To investigate complications and outcome of pregnancies with male and female fetuses. METHODS: A population-based study comparing all singleton deliveries between the years 1988 and 1999 was performed. We compared pregnancies with male vs. female fetuses. Patients with a previous cesarean section (CS) were excluded from the study. Statistical analyses with the Mantel-Haenszel technique and multiple logistic regression models were performed to control for confounders. RESULTS: During the study period there were 55,891 deliveries of male and 53,104 deliveries of female neonates. Patients carrying male fetuses had higher rates of gestational diabetes mellitus (OR = 1.1; 95% CI 1.01-1.12; p = 0.012), fetal macrosomia (OR = 2.0; 95% CI 1.8-2.1; p < 0.001), failure to progress during the first and second stages of labor (OR = 1.2; 95% CI 1.1-1.3; p < 0.001 and OR = 1.4; 95% CI 1.3-1.5; p < 0.001, respectively), cord prolapse (OR = 1.3; 95% CI 1.1-1.6; p = 0.014), nuchal cord (OR = 1.2; 95% CI 1.1-1.2; p < 0.001) and true umbilical cord knots (OR = 1.5; 95% CI 1.3-1.7; p < 0.001). Higher rates of CS were found among male compared with female neonates (8.7 vs. 7.9%; OR = 1.1; 95% CI 1.06-1.16; p < 0.001). Using three multivariate logistic regression models and controlling for birth weight and gestational age, male gender was significantly associated with non-reassuring fetal heart rate patterns (OR = 1.5; 95% CI 1.4-1.6; p < 0.001), low Apgar scores at 5 min (OR = 1.5; 95% CI 1.3-1.8; p < 0.001) and CS (OR = 1.2; 95%CI 1.2-1.3; p < 0.001). Controlling for possible confounders like gestational diabetes, cord prolapse, failed induction, nonprogressive labor, fetal macrosomia, nuchal cord and true umbilical cord knots using the Mantel-Haenszel technique did not change the significant association between male gender and CS. CONCLUSION: Male gender is an independent risk factor for adverse pregnancy outcome.

Adult↗