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Biomedical subjects

R Achiron

Publications and source records attributed to R Achiron.

155 records · Page 9Linked to original sources
PubMed1987

Fetal heart rate and uterine activity following paracervical block.

Bupivacaine without adrenaline was used for paracervical block (PCB) anesthesia in 60 low-risk parturients in whom there were no signs of fetal asphyxia. In order to evaluate its effects on fetus and uterine activity, 30 patients were given a "high dose" of 50 mg Bupivacaine, an amide-type local anesthetic agent, while 30 patients were given a "low dose" of 25 mg. Continuous fetal heart rate (FHR) monitoring in both study groups revealed nine patients with typically post PCB bradycardia and five patients with moderate PHR depression. All of them were born with excellent Apgar score. Although a decrease in fetal heart rate following PCB was noted in both groups more significant reduction was associated with the high dose block (P less than 0.05). In 11 cases, FHR depression was clearly associated with increased uterine activity, while in another three cases it was not (P less than 0.005). Oxytocin administration during the block did not affect fetal heart rate or uterine activity. The results indicate that FHR depression following PCB using Bupivacaine is dose dependent, transient and not dangerous to a normal fetus. No adverse maternal effects were noted. It is suggested that fetal heart rate depression following PCB using Bupivacaine is related to increased uterine activity.

Anesthesia, Caudal↗
PubMed1985

Ectopic pregnancy management by a non invasive protocol.

The hemodynamic stable patient suspected of extrauterine pregnancy may be a diagnostic challenge. Dilatations and curettage, Douglas puncture and laparoscopy are significant diagnostic aid in the investigation of the suspected ectopic pregnancy patient; but they are among the invasive methods. The introduction of non invasive methods such as serum beta subunit hCG and sophisticated ultrasound techniques seems to institute a more conservative approach to the "stable patient" prior to exposing her to anaesthetic and operative risks. A prospective study on "stable patients" suspected of "subacute" extrauterine pregnancy was undertaken in order to assess the diagnostic usefulness of a suggested non invasive protocol to determine whether its use has an advantage over the traditional invasive methods. 108 patients were evaluated in this study. 31 women were managed according to the non invasive protocol; patients presenting positive sonography signs underwent immediate operative procedure, patients in whom sonography revealed suggestive signs of E.U.P., expectant management was undertaken till serum beta subunit hCG confirmed or excluded the diagnosis. 77 patients were managed according to the invasive method protocol. Results indicate that the non invasive protocol has high diagnostic accuracy. Among the 31 patients no unnecessary intervention was performed. On the other hand, among the 77 patients, 43 laparoscopies were unnecessary.

Chorionic Gonadotropin↗
PubMed1984

Misinterpretation of fetal heart rate monitoring in case of intrauterine death.

Electronic fetal heart rate monitoring has become a routine examination to assess fetal well-being. This report presents an unusual case in which maternal heart rate tachycardia was obtained from a dead fetus and was interpreted erroneously. The dead fetus conducted maternal ECG even through a scalp electrode by amplifying the input signal through the Automatic Control system of the monitoring equipment. The importance of concomitant maternal radial pulse recording or a real time scan is stressed.

Adult↗
PubMed1984

Septic pelvic thrombophlebitis as an enigmatic cause of persistent puerperal fever course of disease diagnosis and treatment.

A rare case of septic puerperal pelvic thrombophlebitis is presented. This condition is an uncommon but potentially serious complication of pyogenic pelvic infection. The purpose of this report is to describe a particular form of septic pelvic thrombophlebitis (SPT) that frequently eludes diagnosis because of the absence of positive abdominal or pelvic findings. Our recent experience with this entity is interesting, because of the striking effect of heparin after many days of unsuccessful high dose multiple antibiotic treatment.

Adult↗
PubMedDate not supplied

Pregnancy during residency--an Israeli survey of women physicians.

The objective is to assess the impact of workload on pregnancy among women physicians in public hospitals in Israel. A self-administered, cross-sectional study of pregnancies among women physicians in public hospitals was conducted. An 82-item questionnaire was mailed to women physicians in the three largest university hospitals in Israel. The questionnaire assessed demographic data, pregnancy course, perceived stress, and complications during pregnancy. Response rate was 52% (207/400). The complication rates were compared with rates in the Jewish population and expressed as mean +/- SD. Mean number of pregnancies during residency was 1.3 +/- 1.2. Mean age at the first delivery was 27 +/- 3.2 years. There was a significant difference in the rates of stillbirth (32/1000 births versus 3.7/1000, p < 0.001) and premature delivery (12.4% versus 7.6%, p = 0.0014) between women physicians and the general population. There was no significant difference in the proportion of spontaneous abortions (12.7%), pregnancy induced hypertension (3.2%), hyperemesis gravidarum (3.2%), and diabetes (1%). Seven percent of women physicians changed their specialty due to pregnancy while in residency. Our results suggest that working long hours in a stressful occupation in a hospital environment has an adverse effect on pregnancy course and is associated with increased rates of stillbirth and premature delivery.

Adult↗
PubMedDate not supplied

Selective second-trimester termination of an abnormal fetus in twin pregnancies.

The probability of detecting a chromosomal or structural abnormality in one fetus of a dizygotic twin gestation is about twice that of the risk for a singleton. During the period January 1992 to October 1994 we performed selective termination of the abnormal fetus in 14 bichorionic twin gestations. Indications for selective termination were 10 structural abnormalities and 4 chromosomal abnormalities. The procedure was done at 14, 16, and between 20 and 25 weeks in 1, 2, and 11 cases, respectively. We had no pregnancy losses before 24 weeks' gestation. The mean gestational age at delivery was 34.2 +/- 3.9 (SD) weeks. In one case, severe abruptio placentae occurred and the neonate died. Thirteen neonates are alive and well. In five cases in which the procedure was done after 21 weeks' gestation, no decrease in the amount of amniotic fluid in the sac of the terminated fetus was observed. Our experience supports the general conclusion that selective termination for bichorionic abnormal twins is safe and effective.

Chromosome Aberrations↗