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Oscar Sadan

Publications and source records attributed to Oscar Sadan.

At least 19 recordsLinked to original sources
PubMed2006

Cord around the neck: should it be severed at delivery? A randomized controlled study.

Umbilical cords often become encircled around portions of the fetus, usually the neck. The incidence ranges from 21% in one loop to 0.2% in three loops. In the present study, we assessed the practice of severing the cord, which was encircled once around the neck of the fetus, after delivery of the anterior shoulder and prior to extraction of the body. This was a prospective, randomized, controlled study. The study and the control groups included 30 women each. Cord around the neck was diagnosed during labor by ultrasound. It was cut intentionally in the study group and left intact in the control group. Demographic data were obtained. The course of labor was assessed. Neonatal outcomes measured were cord pH, Apgar scores at 5 minutes, and need for resuscitation. Length of maternal and neonatal hospitalization was determined. No differences were found between the study and the control group before, during, and after labor regarding perinatal variables such as meconium-stained amniotic fluid, fetal heart rate patterns, Apgar scores at 5 minutes, and umbilical cord pH after delivery (7.29 +/- 0.07 [SD] in the study group and 7.32 +/- 0.06 [SD] in the controls; p=0.1). Single nuchal encirclement by the umbilical cord during labor, after delivery of the anterior shoulder, can be severed or left intact. We could not detect any adverse perinatal outcome in such deliveries.

Adult↗
PubMed2006

Re-laparotomy after cesarean section.

OBJECTIVE: To assess the rate, indications, and outcome of re-laparotomy after cesarean section in the early postoperative period. DESIGN: A retrospective observational study during a 121-month period. SETTING: A tertiary care university center. POPULATION: A cohort of 3380 women who underwent cesarean section out of 18,609 parturients. MAIN OUTCOME MEASURES: Incidence of re-laparotomy after cesarean section in the early postoperative period. RESULTS: The incidence of re-laparotomy after cesarean section was 0.53% (18/3380). Of these 18 women, 12 (66%) were operated for hemorrhage, 3 (17%) for eventration, and 3 (17%) for formation of intra-abdominal abscess. Hysterectomy was required in one case (5.5%). We had no maternal mortalities. CONCLUSION: Although the incidence of re-laparotomy after cesarean in the early postoperative period is low and the outcome is favorable, several measures must be undertaken to reduce the need for re-laparotomy.

Adult↗
PubMed2006

Pregnancy-associated rhinitis.

Previous studies overestimated the incidence of pregnancy-associated rhinitis because it is a poorly defined clinical condition. The objective of this study was to assess the incidence of this unique type of rhinitis using up-to-date strict criteria. This prospective study included 109 primigravida parturients who were interviewed using a structured questionnaire and underwent detailed rhinoscopy. Pregnancy-associated rhinitis was defined as nasal obstruction symptom and rhinorrhea appearing during pregnancy, lasting for at least 2 months, and disappearing postpartum. The incidence of rhinitis associated with pregnancy at the time of delivery was 9%. No correlation was found between symptoms and signs. Pregnancy-associated rhinitis is an infrequent clinical entity. It may be related to hormonal changes and possibly altered sensation of nasal airflow.

Adolescent↗
PubMed2006

Treatment of high-grade squamous intraepithelial lesions: a "see and treat" versus a three-step approach.

OBJECTIVE: The study's subject was to examine the correlation between histologic findings in patients with high-grade squamous intraepithelial lesion (HGSIL) who have undergone loop electrosurgical excisional procedure (LEEP) with and without prior colposcopically directed biopsy. STUDY DESIGN: This retrospective study included 144 patients with cytologic HGSIL, of which 62 were treated by a three-step protocol, in which LEEP was performed only if the colposcopically directed cervical biopsies were positive (CIN II-III), and 82 women who were treated by "see and treat" protocol, in which LEEP was immediately performed if colposcopy was suggestive of CIN II or III lesions. RESULTS: There were no differences in the final histological findings between the groups. CONCLUSIONS: The colposcopically directed LEEP after a HGSIL on PAP-smear may reduce the time interval between diagnosis and treatment with a similar accuracy of diagnosis compared to the standard three-step protocol.

Adult↗
PubMed2006

Decision-to-delivery interval for instrumental vaginal deliveries: vacuum extraction versus forceps.

OBJECTIVE: The aim of this study was to assess the decision-to-delivery interval for forceps delivery and vacuum extraction. STUDY DESIGN: A retrospective analysis of all instrumental deliveries over a 1-year period in a delivery ward of a university tertiary health care facility was performed. The decision-to-delivery interval was compared between forceps delivery and vacuum extraction. RESULTS: The decision-to-delivery interval was 8.6+/-5.4 and 13.8+/-6.2 min for forceps and vacuum deliveries, respectively (P=0.0001). CONCLUSION: It appears that it is quicker to accomplish forceps delivery than vacuum extraction.

Decision Making↗
PubMed2006

Successful twin pregnancy in a patient with complete uterine septum corrected during cesarean section.

OBJECTIVE: To describe a successful in vitro fertilization (IVF) twin pregnancy in a patient with complete uterine septum who underwent partial correction during cesarean section. DESIGN: Case report. SETTING: An IVF unit at a university hospital. PATIENT(S): A 29-year-old female patient with complete uterine septum undergoing IVF-intracytoplasmic sperm injection. INTERVENTION(S): In vitro fertilization-intracytoplasmic sperm injection with single embryo transfer to each uterine cavity. MAIN OUTCOME MEASURE(S): Pregnancy course and outcome. RESULT(S): Both transferred embryos underwent implantation, resulting in twin pregnancy with a single embryo in each hemi-uterus. Cesarean section was performed at 34 weeks' gestation. Two healthy neonates were born. Resection of the uterine septum by electrocauterization was attempted during cesarean section. Diagnostic hysteroscopy performed 6 months later demonstrated the presence of the uterine septum reaching approximately 40% of the cavity. CONCLUSION(S): Whether prophylactic metroplasty should be performed in patients with uterine septae without prior history of miscarriage or pregnancy complications is still under debate. Successful implantation and fetal development might occur without prior metroplasty, as described in our case report. Metroplasty during cesarean section might be only partly successful because part of the septum might be confined in the stretched gravid uterus.

Adult↗
PubMed2006

A new approach to office hysteroscopy compared with traditional hysteroscopy: a randomized controlled trial.

OBJECTIVE: To compare a "no touch" approach to diagnostic hysteroscopy without anesthesia with traditional diagnostic hysteroscopy after intracervical injection of mepivacaine hydrochloride 3%. METHODS: A total of 130 women undergoing diagnostic hysteroscopy were included in the study and were randomized, using a computer-generated randomization list to one of two treatment groups in a ratio of 2:1. Eighty-three women underwent hysteroscopy without speculum, tenaculum, or anesthesia. Forty-seven women received intracervical anesthesia with 10 mL of 3% mepivacaine hydrochloride solution injected at two sites (3:00 and 9:00 positions) and underwent traditional hysteroscopy. Hysteroscopy was performed using a rigid 3.7-mm hysteroscope and a medium of 0.9% saline, and the image was transmitted to a screen visible to the patient. A visual analog scale (VAS) consisting of a 10-cm line was used to assess the intensity of pain experienced during and after the procedure. Overall patient satisfaction was assessed during, immediately after, 15 minutes later, and 3 days after hysteroscopy. RESULTS: The mean pain score was significantly lower in the group without the use of speculum, tenaculum, or anesthesia (VAS1: 3.8+/-2.7 versus 5.34+/-3.23, P=.01; VAS2: 3.02+/-2.50 versus 4.57+/-3.30, P=.008). Patient satisfaction rate was similar in both groups. CONCLUSION: Patients reported significantly less pain with the altered approach to diagnostic hysteroscopy compared with patients undergoing the traditional procedure with anesthesia. This new approach can therefore be considered as a useful hysteroscopic technique. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00319410

Adult↗
PubMed2005

Maternal mean corpuscle volume and oxytocin augmentation during vaginal delivery.

OBJECTIVE: The aim of this study was to assess whether low maternal MCV values are associated with adverse course of vaginal delivery. STUDY DESIGN: A retrospective analysis of 92 consecutive vertex singleton vaginal deliveries in nulliparous women in a university tertiary health care facility. MCV was considered as major outcome variable. RESULTS: 54.1% of Parturients with higher MCV needed oxytocin augmentation during labor as compared to 79.5% of parturients with lower MCV (P<0.05). The need for oxytocin for augmentation of labor was decreased with larger MCV (OR 0.90 per fL, 95% CI 0.82-0.98, P<0.05). No correlation was found between MCV and other parameters of labor course. CONCLUSION: Low maternal MCV values were associated with increased use of oxytocin augmentation during vaginal delivery.

Adult↗
PubMed2005

Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of fetal head position in the second stage of labor.

OBJECTIVE: Precise determination of fetal head position in labor is a prerequisite for safe instrumental deliveries, and essential for the assessment of labor progress. Recent studies have cast serious doubts on the accuracy of the time-honored digital vaginal examination (DVE) in comparison to transabdominal ultrasound scans (TUS). However, transabdominal imaging is technically difficult with a deeply engaged fetal head in the second stage of labor. We examined the accuracy and time requirements of transvaginal scans (TVS) in the second stage of labor for determination of fetal head position. STUDY DESIGN: Sixty laboring women in the second stage of labor with a deeply engaged fetal head were examined by experienced nurse midwives and senior residents. Fetal head position was recorded as "time on a 12-hour clock." Subsequently, TUS and TVS were independently performed by a skilled sonographer. Accuracy and time requirements for all 3 examinations were recorded. RESULTS: Fetal head position could be determined in all cases by TVS, but not in 7 cases and 9 cases by DVE and TUS, respectively (P < .03; P < .008). A discrepancy of 60 degrees or more between the DVE and TUS or TVS was found in 13/60 cases (21.7%) and 14/60 cases (23.3%), respectively. A > or = 90 degrees discrepancy was found in 9/60 cases (15%) and 12/60 cases (20%), respectively (P < .02 for comparison of TUS and TVS). In 5 cases, the digital examination erroneously perceived an occiput posterior position as occiput anterior. No significant differences in fetal head position were detected between TUS and TVS, when the examination was technically feasible. The mean time (+/-SD) required for determining fetal head position was shortest for TVS (8.7 +/- 5.8 seconds) in comparison to DVE (22.7 +/- 14.6 seconds; P < .0001) or TAS (31.7 +/- 19.1 seconds; P < .0001). CONCLUSION: Transvaginal sonography was the most successful and accurate method for determination of fetal head position in the second stage of labor, and required the least time for performance. We believe that TVS should be routinely performed in the labor room setting for the determination of fetal head position.

Abdomen↗
PubMed2005

Memory performance in late pregnancy and erythrocyte indices.

OBJECTIVE: A previous study in elderly people observed an association between chronologically younger erythrocyte population and memory impairment. The aim of this study was to assess whether a similar shift in erythrocyte population in pregnant women in late pregnancy is associated with changes in memory performance in healthy pregnant women. METHODS: Thirty healthy pregnant women were included in a prospective cross-sectional study. Explicit memory and autobiographic memory tests were performed in the late third trimester and 4 months postpartum. Mean corpuscular volume (MCV) was considered the primary predictor variable. RESULTS: The mean explicit memory recall scores were significantly higher at post-delivery compared to pre-delivery: 8.3 +/- 1.7 and 7.4 +/- 1.4, respectively (P = .015). The difference in mean autobiographic memory test score pre- and post-delivery did not reach statistical significance. A positive correlation between post-delivery explicit memory recall scores and the difference between pre- and post-delivery MCV was detected (r = 0.458, P = .01). The correlation between delta MCV and delta explicit memory recall scores was r = 0.2, P =.311. Pre-delivery autobiographic memory test scores were positively correlated with MCV (r = 0.50, P = .006), mean corpuscular hemoglobin (r = 0.57, P = .001), and mean corpuscular hemoglobin concentration (r = 0.46, P = .013). CONCLUSION: The change in erythrocyte population that is present in late pregnancy predicted explicit memory performance after delivery, when it was improved. The younger erythrocyte population that exists in late pregnancy is associated with a better autobiographic memory.

Adolescent↗
PubMed2005

Occurrence of cervical intraepithelial neoplasia in generally healthy women with exophytic vulvar condyloma acuminata.

AIM: To disclose possible association between exophytic vulvar condyloma acuminata and cervical intraepithelial neoplasia in generally healthy, sexually active women. METHODS: This retrospective study included 74 patients (study group) who were referred for laser vaporization therapy of exophytic vulvar condyloma acuminata, and 88 asymptomatic volunteers without evidence of exophytic vulvar condyloma acuminata (control group) who were referred for screening Papanicolaou (Pap) test cervical evaluation including colposcopy. The diagnosis of cervical intraepithelial neoplasia was based on Pap smear, colposcopy and/or biopsy. RESULTS: On Pap smear, atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions were found in 10 (13.5%) women with exophytic vulvar condyloma acuminata and in 2 (2.3%) asymptomatic volunteers (p < 0.05). Cervical intraepithelial neoplasia was found in 8 women with exophytic vulvar condyloma acuminata and in none of the asymptomatic volunteers (p < 0.05). CONCLUSION: An association was found between exophytic vulvar condyloma acuminata and abnormal Pap smear or positive cervical biopsy, in generally healthy women.

Adult↗
PubMed2005

Using anovaginal distance at the beginning of labor to predict the likelihood of instrumental delivery.

OBJECTIVE: To investigate whether anovaginal distance in parturients has an impact on the instrumental delivery rate. STUDY DESIGN: In this study with prospective data collection and a convenience sample, 400 parturients planning for vaginal delivery at term with a singleton fetus in vertex presentation were enrolled. Anovaginal distance was measured in the lithotomy position during the latent phase of labor or early first stage. This distance is thought to reflect the angle of inclination of the birth canal axis. RESULTS: At the cutoff point of 25 mm for anovaginal distance, the odds ratio for instrumental delivery was 2.5 (95% CI 1.48-6.6, p<0.05). A final model of instrumental delivery, controlling for various confounding variables, correctly predicted 91.38% of the instrumental deliveries (p<0.0001). The variables anovaginal distance >25 mm (OR 2.9, 95% CI 1.2-6.7, p=0.01), parity (OR 0.54, 95% CI 0.29-0.99, p=0.046) and duration of second stage of labor (OR 1.01, 95% CI 1.004-1.01, p=0.001) significantly contributed to the prediction of instrumental delivery after controlling for the other parameters. CONCLUSION: Women with an anovaginal distance of >25 mm at the beginning of labor was 2.5 more likely to undergo instrumental delivery than were women with an anovaginal distance of <25 mm.

Adult↗
PubMed2004

The decision to delivery interval in emergency and non-urgent cesarean sections.

OBJECTIVE: The aim of this study was to assess the decision to delivery interval (DDI) in our obstetric unit in comparison to current recommendations. STUDY DESIGN: A retrospective analysis of all non-elective cesarean sections during a 10 months period in a delivery ward of a university tertiary health care facility was performed. The DDI was compared between emergency and non-urgent cesarean sections. RESULTS: The DDI was 25.8 +/- 10.8 +/- and 46.2 +/- 19.9 min in the emergency and non-urgent cesareans, respectively (P < 0.01). In the emergency group, 71% delivered within 30 min compared to 35% in the non-urgent group (P < 0.05) and in the emergent-crash group 100% delivered within 30 min compared to 59% in the emergent-non-crash group (P < 0.05). No correlation was found between the DDI and umbilical artery pH or Apgar score at 1 or 5 min in infants of each cesarean group. CONCLUSION: The proposed 30 min DDI standard was achieved in 100, 71, 47 and 35% of emergent-crash, emergent, emergent-non-crash and non-urgent cesareans sections, respectively.

Adult↗
PubMed2004

Familial occurrence of isolated nonseptated nuchal cystic hygromata in midtrimester of pregnancy.

OBJECTIVE: Nonseptated cystic hygromata of the fetal neck in midtrimester of pregnancy have been associated with chromosomal and structural malformations. Consequently, fetal karyotyping is frequently offered. We describe 18 families in which 18 pairs of siblings were affected by transient nonseptated cystic hygromata in utero. METHODS: Over a seven-year period, 18 families came to our attention, with a recurrent diagnosis of fetal nonseptated cystic hygromata in two subsequent pregnancies. Detailed anatomic surveys by transvaginal ultrasound were performed between 14 to 16 weeks' gestation on the basis of self-referral. Sonographic markers for fetal aneuploidy were specifically looked for. Nonseptated cystic hygroma was diagnosed when unilateral or bilateral cystic dilations in the anterolateral aspect of the fetal neck were present, as described by Bronshtein et al. (1989). All patients underwent amniocentesis, fetal echocardiography, and transabdominal follow-up ultrasound scan at 22 to 24 weeks' gestation. RESULTS: Thirty-six sibling fetuses with isolated nonseptated hygromata (unilateral n = 5; bilateral n = 31) were identified. Amniocentesis revealed normal karyotypes in all 36 fetuses, including 20 males and 16 females. Fetal echocardiograms and neonatal pediatric examinations were normal. Sonographic resolution of the cystic hygromata was noted in all cases at the 22 to 24 weeks' follow-up scan. One pregnancy, producing a female newborn, was conceived by a remarried mother. All others were reportedly conceived by the same partners. Probability calculations suggest that if our findings were explained by chance alone, a population base of 367,000 pregnancies would have to be scanned in order to find 18 pairs of siblings with nonseptated cystic hygromata. CONCLUSION: The familial occurrence and identical natural history of the cystic lesions in utero suggest the presence of an inheritable developmental syndrome affecting the lymphatic system in utero, but without long-term sequelae.

Adult↗
PubMed2004

Patient-controlled epidural analgesia for labor pain: effect on labor, delivery and neonatal outcome of 0.125% bupivacaine vs 0.2% ropivacaine.

The objective was to evaluate the influence of patient-controlled epidural analgesia (PCEA) using low doses of bupivacaine vs. ropivacaine, on labor pain, motor blockade, progression of labor, delivery and neonatal outcome. This randomized double blind study included 565 parturients. All received a 5-mL/h infusion and PCEA (5-mL boluses with a 20-min lockout, maximum volume 20 mL/h) of either 0.125% bupivacaine (n = 313: 165 nulliparous, 148 parous) or 0.2% ropivacaine (n = 252: 113 nulliparous, 139 parous). Pain score, lower limb motor block, sensory levels, local analgesic doses required, hemodynamic parameters, side effects and complications were assessed. Obstetric variables included cervical dilation at epidural insertion, incidence of ruptured membranes and their duration, use of oxytocin, fetal heart rate changes, duration of labor, mode and outcome of delivery, and use of invasive and non-invasive fetal monitoring. Neonatal characteristics included birth weight, Apgar scores, umbilical artery pH, serum bilirubin, hypoglycemia, need for assisted ventilation, sepsis or sepsis study, feeding difficulties and respiratory distress syndrome. Ropivacaine 0.2% was equianalgesic with 0.125% bupivacaine, but produced less motor block (P < 0.0001). There were no significant differences, however, in duration of labor, delivery type or neonatal outcome.

Adult↗
PubMed2004

Herpes simplex virus infection after vacuum-assisted vaginally delivered infants of asymptomatic mothers.

OBJECTIVE: To determine whether vacuum extraction technique is associated with an increased risk of herpes simplex virus (HSV) infection in infants born to asymptomatic mothers. PATIENTS AND METHODS: We reviewed the charts of all infants born at the Edith Wolfson Medical Center and admitted to the hospital's neonatal intensive care unit from January 1999 to June 2002 diagnosed with HSV infection. RESULTS: During the study period, 6953 infants were delivered at our institution and 11 infants had HSV infection. The prevalence of neonatal HSV infection was 1.6 per 1000 live births. In 699 infants, vacuum extraction was used for delivery. Five out of the 11 infants delivered vaginally by vacuum extraction developed HSV infection at the site of the vacuum extractor application. They were born to mothers who were asymptomatic at delivery and had no history of HSV genital infection. HSV type 2 was isolated from the vesicular fluid in all infected infants delivered by vacuum extraction, and none had central nervous system involvement. The prevalence of neonatal HSV infection in vacuum-assisted births was seven per 1000 live births as compared to 0.95 in 1000 in infants delivered vaginally or by cesarean section (p<0.0001). The relative risk of HSV infection in infants born in vacuum-assisted births was 7.45 (95% confidence interval (CI) 1.99 to 27.42, p=0.001). All patients were treated with intravenous acyclovir and no recurrences of HSV infection have been noticed at follow-up. CONCLUSIONS: Laceration of the fetal scalp by vacuum extraction technique may enhance the acquisition and the early appearance of cutaneous infection in infants exposed to HSV shedding in the genital tract of asymptomatic mothers, as the virus gains access through the lacerated scalp.

Female↗
PubMed2004

Pseudocholinesterase deficiency associated with HELLP syndrome.

We report a case of decreased plasma pseudocholinesterase activity in a patient with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The pseudocholinesterase activity returned to normal with concomitant recovery of HELLP syndrome. This possible association is significant when general anesthesia is provided to patients with HELLP syndrome.

Adult↗