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R Frydman

Publications and source records attributed to R Frydman.

At least 73 records · Page 4Linked to original sources
PubMed2002

[Growth discordance in dichorionic twin pregnancies: risk factors, diagnosis and management].

OBJECTIVE: To analyse the risk factors and perinatal consequences of growth discordance among dichorionic twin pregnancies. Subjects and methods. A cohort of 346 dichorionic twin pregnancies delivered at one institution between January 1996 and December 1999 was analyzed. Two groups were compared, according to the presence or absence of growth discordance (n=72 and 274, respectively). Birth weight discordance was defined as a difference of 20% or more of the weight of the heavier twin, associated with an intra-uterine growth restriction (10(th) percentile) of at least one twin. Ultrasound discordance was defined as a difference of estimated fetal weight>20%. The two groups were compared by univariate and multivariate analysis. RESULTS: The main risk factors for birth weight discordance in multivariate analysis were ovulation induction (OR=1.6 [1.0-2.4]), multifetal pregnancy reduction (OR=2.3 [1.3-4.2]), and fetal malformations (OR=2.4 [1.0-5.4]). Ultrasound shows a poor performance in predicting discordance with a sensitivity of 55.6%, a specificity of 94.2%, a positive predictive value of 71.4% and a negative predictive value of 89.0%. Birth weight discordance was associated with a poor fetal and neonatal outcome: gestational age at delivery was 34.4 weeks versus 35.4 weeks, there were more caesarean deliveries (OR=1.9 [1.3-2.8]), a higher perinatal mortality (OR=3.7 [1.6-8.5]), and more neonatal intensive care unit admissions (OR=1.8 [1.2-2.7]). Multivariate analysis shows that growth discordance is an independent risk factor for mortality but not for cerebral adverse outcome or respiratory distress syndrome. CONCLUSION: Ovulation induction and multifetal pregnancy reduction are independent risk factors for twin birth weight discordance, which carries a poor perinatal prognosis.

Adult↗
PubMed2002

[Accompanying babies to death after late termination of pregnancy].

When feticide, necessary within the framework of late termination of pregnancy, cannot be achieved before delivery for medical reasons or because the act is refused by the parents, we propose as an alternative, to accompany the baby to death in the neonatology unit. This approach can be seen as palliative care despite the ethical and legal issues it raises. It can be an appropriate response to the parents' distress when moral and religious beliefs are contradicted by medical reality. This situation remains exceptional and must be envisaged case by case. The decision to institute the principle of accompanying babies to death was made after open discussion conducted for many years among neonatologists. The final decision cannot however be made until the obstetrical and pediatric teams have reached a sufficient degree of reciprocal confidence.

Abortion, Therapeutic↗
PubMed2002

[Uterine contractility and reproduction: new perspectives].

The contractile activity of the nonpregnant uterus plays an important role in the human reproduction process. Noticeable variation in uterine contractility occurs during the menstrual cycle to meeting some physiologic requirements of the female reproductive system. During the follicular phase, stimulation of uterine contractions by estrogens fosters sperm transport toward the fertilization site. After ovulation, contractility decreases in response to progesterone, a phenomenon that is probably involved in the embryo implantation mechanism. The comprehension of uterine contractility regulation and physiologic roles has been considerably extended during recent years by the development of direct and noninvasive assessment tools, in particular, ultrasound. Today, not only the artificial stimulation of uterine contractions, aiming at promoting sperm transport during the pre-ovulatory phase, but also their attenuation to provide optimum conditions for embryo implantation during the luteal phase, represent innovating, promising issues in the optimization of assisted reproduction treatments.

Blastocyst↗
PubMed2002

[Preimplantation genetic diagnosis experience in Paris: evaluation of first births].

OBJECTIVE: To report the birth of the first fourteen infants conceived after preimplantation genetic diagnosis (PGD) in our unit. PATIENTS AND METHODS: Fifty-nine couples were enrolled between January 2000 and July 2001. They had a total of 71 oocyte pick-up cycles. The collected oocytes were inseminated by intracytoplasmic sperm injection. The resulting embryos were biopsied on the third day of development and the genetic analysis was performed on the same day. Most of the embryo transfers were carried out on the fourth day. RESULTS: The 71 oocyte pick-up cycles yielded 872 oocytes of which 731 were suitable for intacytoplasmic sperm injection. Among the 505 embryos obtained, 421 embryos were biopsied and genetic diagnosis was performed for 312 (74%) of these. 127 embryos were transferred during the course of 58 transfer procedures. There were 18 biochemical and 12 ongoing (7 singles, 4 twins and 1 triple) pregnancies. Fourteen infants have been born and 2 are expected. CONCLUSION: PGD has gained a place among the choices offered to couples at risk of transmission of a serious and incurable genetic disease.

Adult↗
PubMed2001

[Hysteroscopic resection of submucous myomas: long term results].

STUDY AIM: To evaluate the follow-up after operative hysteroscopic resection of submucous leiomyomas. PATIENTS AND METHODS: Between January 1990 and December 1996, 200 patients underwent operative hysteroscopic resection of 289 uterine leiomyomas. Indications were: menometrorrhagia (n = 159), postmenopausal metrorrhagia (n = 22), infertility (n = 19) as sole etiology. Sixteen patients had infertility and menometrorrhagia. RESULTS: The mean follow-up was 33.4 +/- 19.2 months. Twenty-three patients were lost to follow-up. Due to the large size of the leiomyomas, 35 patients had 2 or 3 resections and a total of 241 hysteroscopic resections were performed. Twelve complications (5%) occurred without death or need for intensive care. An improvement of clinical symptoms was observed in 74% of patients. The predictive factors of failure were: size (> 5 cm), number of intracavitary leiomyomas (> 3), hysterometry (> 12 cm), intramural myoma class 2 and association of leiomyomas. Eight of the 35 infertile patients subsequently became pregnant, but with only two live births (5.8%). CONCLUSION: Hysteroscopic myomectomy appears to be safe, effective and reproducible for the treatment of menstrual disorders. Intramural class 2 and larger leiomyomas constitute the limits of the endoscopic technique.

Adult↗
PubMed2001

Operative transvaginal hydrolaparoscopy for treatment of polycystic ovary syndrome: a new minimally invasive surgery.

OBJECTIVE: To evaluate a new minimally invasive surgery for treatment of the polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. DESIGN: Prospective study. SETTING: University teaching hospital. PATIENT(S): Thirteen clomiphene citrate-resistant anovulatory women with PCOS. INTERVENTION(S): Operative transvaginal hydrolaparoscopy (THL) using a coaxial bipolar electrode. MAIN OUTCOME MEASURE(S): Feasability, ovulation rate, and pregnancy rate. RESULT(S): Ovarian drilling was performed by THL in all patients; no surgical complications occurred. Mean (+/-SD) duration of follow-up time was 6.3 +/- 3.3 months. Six patients recovered to have regular ovulatory cycles. Six pregnancies occurred; three were spontaneous, two occurred after stimulation and intrauterine insemination, and one occurred after IVF. The cumulative pregnancy rate was 33% at 3 months after THL and 71% at 6 months after THL. No miscarriages occurred. CONCLUSION(S): Transvaginal hydrolaparoscopy with ovarian drilling using bipolar electrosurgery appears to be an alternative minimally invasive in patients with PCOS who are resistant to clomiphene therapy.

Adult↗
PubMed2001

Effects of vaginal progesterone administration on uterine contractility at the time of embryo transfer.

OBJECTIVE: To investigate whether uterine contractility at the time of embryo transfer (ET) can be reduced by early onset of luteal support with progesterone administered vaginally. DESIGN: Prospective analysis. SETTING: Assisted reproduction unit. PATIENT(S): Eighty-four women undergoing 84 GnRH-a and FSH/hCG cycles for IVF-ET were studied. INTERVENTION(S): Vaginal progesterone was randomly started on the day of oocyte retrieval (group A, n = 43) or on the evening of ET (group B, n = 41). On the day of hCG administration and just before ET, 2-minute sagittal uterine scans were obtained by ultrasound and digitized with an image analysis system for assessing uterine contraction frequency. MAIN OUTCOME MEASURE(S): Uterine contraction frequency. RESULT(S): Whereas uterine contraction frequency was similar in both groups on the day of hCG (4.6 +/- 0.3 and 4.5 +/- 0.3 contractions per minute, respectively), only women in group A showed decreased uterine contraction frequency on the day of ET (2.8 +/- 0.2 vs. 4.2 +/- 0.3 contractions per minute). CONCLUSION(S): Vaginal progesterone administration starting on the day of oocyte retrieval induced a decrease in uterine contraction frequency on the day of ET as compared with preovulatory values. Uterine relaxation before ET is likely to improve IVF-ET outcome by avoiding the displacement of embryos from the uterine cavity.

Adult↗
PubMed2001

Uterorelaxing effects of vaginal progesterone: comparison of two methodologies for assessing uterine contraction frequency on ultrasound scans.

OBJECTIVE: To assess the changes in uterine contractility induced by increasing doses of P administered to estrogenized women and to compare two methodologies for assessing uterine contraction frequency from ultrasound scans. DESIGN: Prospective double-blind parallel study. SETTING: Academic tertiary center. PATIENT(S): Infertile women aged 21-39 years with premature ovarian failure. INTERVENTION(S): P support set to duplicate the luteal phase was provided every 2 days by application of 1.125 g of Crinone 4% and 8% or 2.25 g of Crinone 8%, containing 45, 90, and 180 mg of P per application, respectively. MAIN OUTCOME MEASURE(S): Changes in uterine contraction frequency following exposure to three doses of vaginal P on ultrasound scans analyzed by visualizing accelerated image sequences and using a previously described three-dimensional (3D)-derived approach. RESULT(S): A decrease in uterine contraction frequency reached statistical significance on the third day of exposure to P without differences between the three dose groups. The two methods for measuring uterine contraction frequency on ultrasound scans were equivalent. CONCLUSION(S): At all three doses studied, the vaginal P gel Crinone administered to estrogenized women induced a profound decrease in uterine contraction frequency that duplicated the changes in contractility described in the luteal phase of the menstrual cycle. Analyzing uterine contraction frequency on accelerated image sequences is as effective as our more complex approach based on identifying contractions on time mode graphs electronically reconstructed using 3D-software.

Administration, Intravaginal↗
PubMed2001

Vaginal versus oral E(2) administration: effects on endometrial thickness, uterine perfusion, and contractility.

OBJECTIVE: To compare the effects of vaginal or oral E(2) administration on endometrial thickness, uterine perfusion, and contractility. DESIGN: Prospective, randomized, crossover study. SETTING: Assisted Reproduction Unit, Clamart, France. PATIENT(S): Thirty-nine infertile women undergoing 78 E(2)/P cycles. INTERVENTION(S): Women received micronized 17beta-E(2), 2 mg/day orally (cycle days 1 to 28) and P, 300 mg/day vaginally (cycle days 15 to 28). After a menstrual cycle washout interval, women received a similar treatment except that 17beta-E(2) was administered vaginally. MAIN OUTCOME MEASURE(S): Endometrial thickness, mean uterine artery pulsatility index, endometrial blood flow, and uterine contraction frequency assessed in ultrasound scans on cycle days 14 and 18. RESULT(S): On day 14, the endometrium was thicker (8.7 +/- 0.6 vs. 7.1 +/- 0.3 mm, P< .0001), pulsatility index values were lower (2.4 +/- 0.1 vs. 3.0 +/- 0.2, P< .0002), and endometrial blood flow tended to be increased in the vaginal E(2) cycles as compared to the oral E(2) cycles. On day 18, similar differences remained. However, P-induced decrease in contraction frequency was slighter in vaginal E(2) cycles (33% vs. 18%, P< .0003). CONCLUSION(S): Vaginal E(2) administration improves endometrial proliferation and uterine perfusion, presumably because of combined local and systemic effects, but may interfere with P-induced uterine relaxation.

Administration, Intravaginal↗
PubMed2001

Simultaneous bilateral tubal pregnancy after intracytoplasmic sperm injection treated by conservative medical treatment. Interest of sonographic follow-up.

We describe a case of early bilateral tubal pregnancy diagnosed by transvaginal ultrasonography after intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). A follow-up by transvaginal sonography was done with a systematic second scan (5 days) after the first diagnosis of left tubal ectopic pregnancy in case of assisted conception procedure. This follow-up sonographic strategy permitted us to perform a conservative treatment for this case of spontaneous bilateral tubal pregnancy by two consecutive (left then right) in-situ methotrexate injections under vaginal ultrasonographic guidance without any complications.

Adult↗
PubMed2001

Neonatal group B streptococcal infection. Results of 33 months of universal maternal screening and antibioprophylaxis.

OBJECTIVE: To assess the efficacy and pitfalls of a protocol of generalized screening for group B Streptococcus (GBS) and intra-partum treatment of all carriers in a clinical setting. DESIGN: A descriptive study and comparison with an historical group. SETTING: A tertiary perinatal center. POPULATION: All women attending prenatal care in our center and delivered after 37 weeks were eligible. Study period ranged from January 1994 to September 1996. Comparison group consisted in deliveries of years 1992 and 1993. METHODS: Vaginal cultures were performed at 36 weeks on non-selective medium followed by intra-partum treatment of all carrier mothers. Rate of carriage, incidence of neonatal GBS sepsis, influence of risk factors and the reasons for failures were analysed. Comparison was made with an historical group. Statistical analysis was performed using a Chi-square test. RESULTS: There were 5374 term deliveries during the study. 3906 were screened (72.7%) and 559 of them found positive for GBS (14.3%). We observed 46 early-onset GBS diseases (0.86% of term-births). 43.5% of infections occurred in babies born from mothers without risks factors at delivery. Negative GBS cultures at sampling accounted for 43.5% of protocol failures. Comparison of the incidence of early-onset GBS disease with the previous two years showed a significant drop (1.45-0.86%, P<0.05). CONCLUSIONS: Our protocol revealed feasible and effective in reducing the incidence of early-onset GBS disease. Improvements must be studied particularly as to the predictive value of screening cultures.

Amoxicillin↗
PubMed2001

Management in intractable obstetric haemorrhage: an audit study on 61 cases.

OBJECTIVE: To refine the indications of bilateral hypogastric artery ligation (BHAL) and angiographic selective embolisation (ASE) in intractable obstetric haemorrhage. DESIGN: an audit study. SETTING: Tertiary care university hospital. POPULATION AND METHODS: Retrospective analysis of 61 cases of obstetric intractable post partum haemorrhage (PPH) initially managed either by hysterectomy or a conservative approach in a tertiary referral centre between 1983 and 1998. Procedures were reviewed as a primary (P) or secondary (S) attempt to arrest the haemorrhagic process. RESULTS: Ten hysterectomies (5 P, 5 S), 49 BHAL (48 P, 1 S) and 9 ASE (8 P, 1S) were successfully performed in arresting the haemorrhagic process. There were 7 maternal deaths, 5 following hysterectomy and 2 following a conservative approach. Atony of the uterus was the main cause of haemorrhage (n=21) and genital tract laceration was associated with the worst prognosis. Time-elapse between delivery and surgery appears to be the main prognostic factor. Nine patients became pregnant 1 to 4 years later following a conservative approach. CONCLUSIONS: ASE seems to be indicated in haemodynamically stable patients with birth canal trauma or uterine atony and clotting anomalies. BHAL is indicated when haemorrhage occurs after a cesarean section or when the patient is haemodynamically unstable. BHAL should be taught to Junior doctors in an attempt to decrease the number of patients transferred in tertiary referral centers for intractable PPH. This might also decrease the number of hysterectomies in intractable PPH.

Adult↗
PubMed2001

[Diagnosis of trisomy 21: nuchal translucency and/or serum markers?].

OBJECTIVES: To compare alternative methods of antenatal screening for Down's syndrome (nuchal translucency measurement and second trimester maternal serum screening) in a low-risk population and to evaluate the consequences of a sequential estimation of risk. METHODS: In a consecutive series of 4308 women aged less than 38 with a singleton pregnancy, we examined the detection rate of nuchal translucency (NT) measurement at 10-14 weeks and maternal serum screening (MSS) by human chorionic gonadotropin and alpha-feto-protein at 14-18 weeks. Women with a NT measurement = 3 mm and women with a MSS derived risk = 1/250 were recommended to have an amniocentesis. A second trimester detailed ultrasound scan was also performed in all women. The outcome of all pregnancies was entered in a computerized database and the detection rate and false-positive rate of different screening strategies were analysed. RESULTS: Of the 4308 pregnancies that were followed (mean maternal age 30.1 years), there were 12 cases of Down's syndrome (0.28%), all detected prenatally. Seven of twelve cases had a NT measurement above 3 mm (58%), and 6 out of ten cases with available MSS had a calculated risk = 1/250 (60%). Four of the five cases with NT measurement below 3 mm were detected by subsequent MSS. At a threshold giving 5% of positive tests, the sensitivity of NT screening and MSS were 75% and 60%, respectively. DISCUSSION AND CONCLUSION: Sequential screening for Down's syndrome by nuchal translucency and second trimester biochemistry is effective and appears to increase the detection rate compared to the use of any single test. However, this strategy is likely to raise the false-positive rate and the interpretation of MSS derived risk should be combined to the first trimester NT measurement.

Amniocentesis↗
PubMed2001

[Hysteroplasty for enlargement: apropos of the results].

The DiethylstilBbestrol (DES) is a synthetic estrogen which was prescribed from 1941 onwards for the prevention of miscarriage. As well as a possible risk of cancer, another side effect of this treatment was the possible of abnormality of the genitalia in the female issue of the prescribed user. Apart from possibly having a hypoplasic uterus, the patient is also prone, in the case where she has an undersized uterus, to having a much narrower than normal cavity. Consequently there is a tendency for an excess of muscle tissue on the uterus walls. This can be observed on an RMN. The most significant characteristics of this abnormality are: constriction rings around the proximal uterine segment, a T shaped uterus, uterus with an arched based. The idea of the plastic enlargement operation is to widen the cavity by making careful incisions on the excess muscle tissue located on the uterus wall. The objective of this is to obtain a triangular shaped cavity taking care though not to weaken the walls themselves. 51 patients were treated. We observed 31 pregnancies (49%) after 16 months with 25 ungoing pregnancies. Generally the anatomic results are excellent but it's difficult to measure the functional results or the success rate in future pregnancies. The reason for this is the enlarging of the cavity alone does not guarantee successful fertility. There are other problems to take in to account e.g. implantation, miscarriage and premature labor. There are risks with this operation: placenta percreta, a possible rupture of the uterus, though this can happen at any time with DES patients. This operation can only be recommended once a thorough examination of the patient has been made. It is not advisable with a patient who has a hypoplasic cavity in a hypoplasic uterus (hysterometry < 4 cm). This operation should never be done as a first course of action but it can be recommended above all if the patient has a constriction ring: as a sole reason for infertility; where infertility has been diagnosed and unsuccessfully treated; and an unexplained failure of ART, and where the patient has unexplained repeated miscarriages.

Abnormalities, Drug-Induced↗
PubMed2001

Placental cytokine and chemokine production in HIV-1-infected women: trophoblast cells show a different pattern compared to cells from HIV-negative women.

In utero transmission of HIV-1 has been demonstrated and may account for around 10-20% of all materno-fetal HIV-1 transmission. The possible routes for such transmission are transannexial or transplacental. In both cases, the microenvironment (cytokines and chemokines) at the placental interface could be an important regulatory factor in viral transmission. We therefore performed explant cultures of placental villi, and isolated purified trophoblasts, from term placentae obtained from HIV-1-seropositive and HIV-1-seronegative women in order to assess and compare the cytokine and chemokine secretion profiles using ELISA and semiquantitative RT-PCR. No major differences could be seen in the secretions of cytokines and chemokines at the level of whole placental tissue in HIV-1-positive and HIV-1-negative women. However, variations were observed in the expression of inflammatory cytokines and chemokines from trophoblastic cells, depending on the status of HIV-1 infection of the mothers but not the babies, all of which remained uninfected. The significance of these data is discussed.

Cytokines↗
PubMed2001

Screening for Down syndrome using first-trimester ultrasound and second-trimester maternal serum markers in a low-risk population: a prospective longitudinal study.

OBJECTIVES: To compare nuchal translucency and second-trimester maternal serum measurements as alternative methods of antenatal screening for Down syndrome in a low-risk population and to evaluate the consequence of combining the results in the estimation of risk. DESIGN: In a consecutive series of 4130 women aged less than 38 years with a singleton pregnancy, we examined both the detection rate of Down syndrome by nuchal translucency measurement at 10-14 weeks and maternal serum screening by human chorionic gonadotrophin and alpha-fetoprotein at 14-18 weeks. Women with a nuchal translucency measurement of > or = 3 mm and women with a maternal serum screening-derived risk > or = 1/250 were recommended to have amniocentesis. A second-trimester detailed ultrasound scan was also performed in all women. The outcome of all pregnancies was recorded prospectively and the detection rate and false-positive rate of different screening strategies were retrospectively analyzed. RESULTS: Out of the 4130 pregnancies that were followed (mean maternal age, 30.1 years), 12 cases of Down syndrome were observed (0.28%), all detected prenatally. Seven of 12 cases had a nuchal translucency measurement of > or = 3 mm (58%), and six out of 10 cases with available maternal serum screening had a calculated risk of > or = 1/250 (60%). Four of the five Down syndrome cases with a nuchal translucency measurement of < 3 mm were detected by subsequent maternal serum screening. At a threshold giving 5% of positive tests, the sensitivity of nuchal translucency, maternal serum screening and combined risk screening were 75%, 60% and 90%, respectively. CONCLUSIONS: In screening for Down syndrome, an approach which combines the results from first-trimester nuchal translucency and second-trimester biochemistry is effective and increases the detection rate compared to the use of any single test. However, this strategy is likely to raise the false-positive rate and the interpretation of maternal serum screening-derived risk should be combined with the first-trimester nuchal translucency measurement.

Biomarkers↗