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Biomedical subjects

R Achiron

Publications and source records attributed to R Achiron.

At least 145 records · Page 8Linked to original sources
PubMed1992

The role of abnormal fetal heart rate in scheduling chorionic villus sampling.

OBJECTIVE: To assess the value of fetal heart rate (FHR) measurements in predicting spontaneous fetal loss in pregnancies scheduled for chorionic villus sampling (CVS). DESIGN: A prospective descriptive study. SETTING: Two hospital departments of obstetrics and gynaecology in Israel. SUBJECTS: 114 women between 9 and 11 weeks gestation scheduled for chorionic villus sampling (CVS). INTERVENTIONS: Fetal heart rate was measured by transvaginal Doppler ultrasound and compared with a monogram established from 75 fetuses. Whenever a normal FHR was recorded, CVS was performed immediately. RESULTS: 106 women had a normal FHR and underwent CVS; two of these pregnancies ended in miscarriage. In five pregnancies no fetal heart beats could be identified and fetal death was diagnosed. In three pregnancies an abnormal FHR was recorded and CVS was postponed; all three pregnancies ended in miscarriage within 2 weeks. CONCLUSION: Determination of FHR correlated with crown-rump length could be useful in predicting spontaneous miscarriage before performing any invasive procedure late in the first trimester.

Adult↗
PubMed1992

Prerupture ultrasound diagnosis of interstitial and rudimentary uterine horn pregnancy in the second trimester. A report of two cases.

Pregnancies in an interstitial and rudimentary uterine horn are rare and often fatal varieties of ectopic gestation. Ruptures tend to occur in the second trimester, resulting in maternal morbidity and mortality. Only a few cases of the ultrasonographic diagnosis of unruptured second-trimester interstitial and rudimentary uterine horn pregnancy have been reported. In two such cases second-trimester ultrasonographic examination revealed an unusual pregnancy location, thin uterine wall, incomplete myometrial layer and empty uterus.

Adult↗
PubMed1991

Prenatal sonographic diagnosis and perinatal management of ectopia cordis.

Ectopia cordis is a rare malformation presenting as an isolated lesion or as part of the Cantrell's pentology syndrome. Prenatal ultrasonographic diagnosis of ectopia cordis must be followed by a careful search for associated anomalies, since the prognosis may vary accordingly. A case of prenatal diagnosis of ectopia cordis in the early second trimester is presented. Routine sonographic examination at 18 weeks of gestation revealed protrusion of the heart into the amniotic fluid, ventricular septal defect and omphalocele. The perinatal evaluation and management are discussed.

Journal Article↗
PubMed1991

Transvaginal ultrasonic assessment of the early fetal brain.

The introduction of high resolution transvaginal transducers has expanded our knowledge of the first and early second-trimester fetus. This article describes transvaginal assessment of normal brain development. The feasibility of early detection of various fetal central nervous anomalies, such as anencephalus, exencephalus, hydrocephalus, Dandy Walker syndrome and myelomeningocele is described.

Journal Article↗
PubMed1991

Screening for fetal anomalies during the first trimester of pregnancy: transvaginal versus transabdominal sonography.

Ultrasound is a sensitive tool for the diagnosis of fetal anomalies during the prenatal period. Most knowledge about the ultrasound images of such anomalies is based on abdominal scanning during the second trimester of pregnancy. The value of transvaginal sonography for evaluating fetal anomalies and a comparison with transabdominal sonography in the first trimester has, to our knowledge, so far not been studied. During a 12-month period, 800 pregnant women between 9 and 13 weeks of gestation, underwent first a transabdominal scan followed by a transvaginal examination, in order to compare the value of the two techniques. Eight cases of fetal abnormality, including anencephaly, exencephaly, cervical myelomeningocele, cystic hygroma, omphalocele, posterior fossa cyst and syndactyly, were diagnosed by using the transvaginal sonographic approach. The standard abdominal technique failed to detect four of these anomalies, while in the other four only vague and non-specific fetal abnormalities could be demonstrated. All women with normal abdominal and vaginal sonograms in the first trimester were rescreened transabdominally at mid-gestation. Five patients with a variety of fetal anomalies, including hydrocephalus, agenesis of corpus callosum, bilateral ureteropelvic junction obstruction, right heart hypoplasia and tetralogy of Fallot, were identified in the rescreening procedure. One case of ventricular septal defect and coarctation of the aorta was not detected at either of the first or second screening procedures. Our findings show that transvaginal sonography is more sensitive than transabdominal sonography in the detection of first-trimester anomalies. However, since not all fetal anomalies are manifest so early in pregnancy, standard abdominal sonography in the second trimester is still recommended.

Journal Article↗
PubMed1991

Intravenous immunoglobulin treatment for recurrent abortions caused by antiphospholipid antibodies.

There is an association between the presence of antibodies that bind to anionic phospholipids and the occurrence of repeated spontaneous abortion. Many uncontrolled studies have reported favorable pregnancy outcome in women treated with steroids, low-dose aspirin, heparin, or their combination. Similarly, treatment failures have been reported with most of these therapeutic regimens. Immunoglobulins play a central role in immune regulation. A wide spectrum of human diseases are associated with decreased or abnormal regulation of Ig levels. Recently, IV preparations of Ig have become available for clinical use, including treatment of patients with recurrent abortions and high levels of antiphospholipid antibodies. The effectiveness of this new mode of therapy can be related to several immunological mechanisms such as blockade of antibody binding to receptors on macrophages, increase in T suppressor cells, or decrease in antibody synthesis. The latter effect may be mediated by anti-idiotypic antibodies in the Ig preparation. Determination of dosage of IV Ig, duration of treatment, and treatment intervals are all empirical in patients with recurrent abortions and high levels of antiphospholipid antibodies because antiphospholipid antibody levels are not useful for monitoring therapy. Although the data available at present are promising, additional randomized trials are needed to determine the efficacy of IV Ig in patients with immunological recurrent abortions.

Abortion, Habitual↗
PubMed1991

Heart rate as a predictor of first-trimester spontaneous abortion after ultrasound-proven viability.

To discover whether first-trimester spontaneous abortion can be predicted by embryonic heart rate (EHR), we performed a cross-sectional study during the first trimester of pregnancy using high-frequency transvaginal sonography combined with pulsed Doppler. Heart rate was measured in 603 embryos; of these, 580 continued beyond 13 weeks' gestation and 23 ended in first-trimester spontaneous abortion. Based on the continuing pregnancies, we constructed and compared EHR nomograms relating to gestational age, mean diameter of the gestational sac, and crown-rump length (CRL). Embryonic heart rate correlated best with CRL (r = 0.87), and the correlation was best described by a second-degree polynomial regression equation. The mean EHR increased progressively from 110 beats per minute (bpm) at CRL of 3-4 mm to 171-178 bpm at CRL 15-32 mm. At CRL greater than 32 mm, the EHR remained stable at a mean of 170 bpm. The EHRs of the 23 embryos that spontaneously aborted in the first trimester were evaluated according to these nomograms. In 15 cases, the EHR fell outside the 95% confidence interval for CRL (sensitivity 65%), but it was within normal limits in eight (false-negative rate 35%). In ten embryos for which pregnancy continued beyond 13 weeks, the EHR fell outside the 95% confidence interval (specificity 98%, false-positive rate 2%). Our findings suggest that EHR measurements in early pregnancy may be useful in the prediction of first-trimester spontaneous abortion after ultrasound-proven viability.

Abortion, Spontaneous↗
PubMed1991

Fetal lateral ventricle choroid plexus cysts: the dilemma of amniocentesis.

Although lateral ventricle choroid plexus cysts in the second-trimester fetus have been considered a benign developmental phenomenon of no clinical significance, an association with trisomy 18 has been suggested. We designed a prospective study to determine whether karyotype analysis is indicated when such cysts are encountered on prenatal sonogram. During a 20-month period, 5400 low-risk pregnant women were examined sonographically in the second trimester to evaluate the prevalence of fetal lateral ventricle choroid plexus cysts and the incidence of ultrasonographic anomalies associated with such cysts in fetuses with trisomy 18 referred from cytogenetic laboratories. Thirty cases of fetal lateral ventricle choroid plexus cysts (0.6%) were detected during the study period; 28 newborns were normal and two had trisomy 18. One of the affected infants had other associated ultrasonographic abnormalities suggesting aneuploidy, whereas no detectable abnormalities could be found in the other. Three other pregnant women were referred to us from the cytogenetics services because fetal karyotype revealed trisomy 18; in all three cases lateral ventricle choroid plexus cysts and other sonographic abnormalities were observed. In total, we scanned five fetuses with trisomy 18, of which all had lateral ventricle choroid plexus cysts and four had associated detectable anomalies. We could not find any association between cyst size, number, or laterality and trisomy 18. In addition to the five cases of trisomy 18 described, we found 33 other fetuses reported with trisomy 18 in the second trimester; of this total, 25 (66%) had lateral ventricle choroid plexus cysts and 30% had no other detectable abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Prenatal sonographic diagnosis of endocardial fibroelastosis secondary to aortic stenosis.

Endocardial fibroelastosis is characterized by a diffuse thickening of the left ventricular endocardium with or without other cardiac anomalies. This entity had been diagnosed prenatally previously (Bovicelli et al., 1984) at a gestational age of 36 weeks. A case of endocardial fibroelastosis due to aortic stenosis accompanied by pericardial effusion, ascites, and hydramnion, diagnosed ultrasonographically and confirmed pathologically at 21 weeks of gestation, is presented.

Adult↗
PubMed1987

Observations on the ultrasound diagnosis of ovarian neoplasms.

In order to determine whether sonography could differentiate between benign and malignant ovarian neoplasms a retrospective analysis of preoperative ultrasound examination was made. The ultrasound images were evaluated for internal consistency, presence of septae, presence of solid nodules, papillary projections and tumor borders. Evidence of ascites and omental involvement were also assessed. Our study showed that benign ovarian serous tumors had a similar appearance to low grade malignant serous tumors, and were undistinguishable from the borderline serous carcinoma. The poorly differentiated serous adenocarcinoma was characterized by the presence of thick papillary projections rather than echogenicity. However, benign or malignant mucinous tumors gave the same pattern. Loss of tumor wall definition, ascites and omental involvement may signal malignancy. The dermoid tumor had a characteristic sonographic appearance.

Adenocarcinoma↗
PubMed1987

Combined pelvic sonography and serum beta hCG, versus laparoscopy for the diagnosis of stable patient suspected of ectopic pregnancy.

The role of sonography in stable patients suspected of ectopic pregnancy is to establish the diagnosis using positive, suggestive or negative signs. Establishing whether or not intrauterine gestation is present is crucial, as is the detection of any extrauterine abnormality. Sonography may be normal in ectopic pregnancy or when it is not abnormal findings are frequently nonspecific. Therefore, the sonographic results must be correlated and integrated with the clinical history and findings as well as with other diagnostic procedures. The combination of ultrasound scanning with beta hCG was found highly contributory to the determination of the existence of an ectopic pregnancy. Understanding the objectives and limitations of each diagnostic test involved is essential for logical and optimal sequences of diagnostic procedures to be employed in patient management. During a twenty-month period, 138 patients were examined due to clinical suspicion of "sub-acute" ectopic pregnancy. Sixty-one patients were managed according to a non-invasive protocol composed of: a) ultrasound scanning alone and b) ultrasound scanning combined with serum beta subunit hCG. Ultrasonograms for ectopic pregnancy diagnosis were coded: positive (fluid in cul-de-sac or extrauterine sac); suggestive empty uterus, adnexal mass and pseudo-gestational sac) and negative (intrauterine gestational sac and normal pelvis). Surgical procedure was carried out immediately on nine patients with positive signs; all of them had ectopics. Suggestive signs were found in twenty-two patients. beta subunit hCG was determined prior to interventive procedure; ectopic pregnancy was revealed in eighteen of them. Among thirty patients with negative signs, only two patients (7% of this sub-group or 3.5% of the general group) had ectopics.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗