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Biomedical subjects

Ron Gonen

Publications and source records attributed to Ron Gonen.

13 recordsLinked to original sources
PubMed2007

Ehlers-Danlos syndrome: insights on obstetric aspects.

UNLABELLED: Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders characterized by joint hypermobility, skin hyperelasticity, tissue fragility, easy bruising, and poor healing of wounds. The clinical manifestations vary depending on the type of disease. The syndrome may be associated with a number of pregnancy and peripartum complications. Because of the multiorgan involvement and varied presentation of this disease, no uniform or routine obstetric and anesthetic recommendations can be made for the perinatal care of these patients. We present a review of the literature on EDS with emphasis on the obstetric, anesthetic, and perinatal consequences. We also report our experience with this syndrome: an uneventful term vaginal delivery in a 32-year-old woman diagnosed with hypermobility type of EDS. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall the potentially severe nature of Ehlers-Danlos Syndrome (EDS) in both pregnant and nonpregnant patients, summarize the wide range of signs and symptoms and its genetic inheritance, and explain the difficulty in recommending obstetric and anesthesia procedures to avoid complications.

Adult↗
PubMed2006

Association between a functional dopamine D4 receptor promoter region polymorphism (-C521T) and pre-eclampsia: a family-based study.

Although many candidate genes have been studied in pre-eclampsia (PE), the important class of catecholamine receptors that contribute to sympathetic tone and blood pressure regulation has yet to be investigated. We therefore examined the dopamine D4 receptor (DRD4) gene. We performed a prospective family-based study in 50 families (patient and both her parents) who were genotyped for three DRD4 promoter regions. These single-nucleotide polymorphisms (SNPs) were tested for association using family-based association test (FBAT) that also included two quantitative measures, aspartate aminotransferase [serum glutamic oxalacetic transaminase (SGOT)] and systolic blood pressure. SNPs were assayed using a commercially available SNAPSHOT kit and PCR products were analysed in an ABI 310 DNA analyser. A significant association (preferential transmission of the T allele from a heterozygous parent to affected mother) was observed between the -C521T SNP and PE (P = 0.019). Significant association was also observed between the -521T allele and two-dimensional measures of PE : GOT (P = 0.039) and systolic blood pressure (P = 0.036). The DRD4 promoter region -C521T SNP that reduces transcriptional efficiency of this gene is suggested to contribute to developing PE. Additionally, DRD4 -521 TT homozygosity may be a marker for severe PE.

Female↗
PubMed2006

Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants.

BACKGROUND: To evaluate the validity of fetal heart rate monitoring during the last hour prior to birth, as a predictor of long term neurodevelopmental outcome of very low birth weight infants. METHODS: A total of 111 very low birth weight infants were included in the study. Fetal heart rate tracings were obtained during the last hour prior to delivery. A perinatologist, blinded to the neonatal outcome, evaluated the tracings and divided them into three groups: reassuring, nonreassuring, and pathological. Neurodevelopmental status was evaluated at age 2 years. The relationship between fetal heart rate monitoring results and the neurodevelopmental outcome at 2 years of age was assessed with a chi-square test and the Student's t-test. RESULTS: At 2 years of age 97 (87.4%) of the children had normal neurodevelopmental function, while 14 (12.6%) had variable degrees of neurodevelopmental impairment. The fetal heart rate monitoring results were classified as reassuring (normal) in 35 cases (31.5%), nonreassuring in 56 cases (50.5%), and pathological in 20 cases (18.0%). Both normal and pathological fetal heart rate patterns were associated with similar incidence of abnormal neurodevelopmental outcome, 14.3% and 15.0% of cases, respectively (p=0.778). Pathological fetal heart rate patterns as a predictor of neurodevelopmental outcome had a sensitivity of 27%, specificity of 74%, positive predictive value of 15%, and negative predictive value of 86%. CONCLUSION: Electronic fetal heart rate monitoring prior to delivery is not a reliable tool for the prediction of neurodevelopmental impairment in premature infants of very low birth weight, at 2 years of age.

Cerebral Palsy↗
PubMed2006

Pregnancy exacerbating hepatopulmonary syndrome.

BACKGROUND: Hepatopulmonary syndrome is an uncommon complication of liver cirrhosis. The natural history of this condition and its optimal management during pregnancy are not yet known. CASE: We present the case of a 35-year-old woman with liver cirrhosis who developed severe dyspnea in the 25th week of gestation and was diagnosed as suffering from hepatopulmonary syndrome. She was managed conservatively until 35 weeks of gestation, when she was delivered by cesarean. CONCLUSION: The natural history, in this case, indicates that pregnancy may induce hepatopulmonary syndrome in an otherwise asymptomatic cirrhotic patient. Oxygen supplementation was the cornerstone of treatment and resulted in a favorable outcome.

Adult↗
PubMed2006

Results of a well-defined protocol for a trial of labor after prior cesarean delivery.

OBJECTIVE: It has been claimed that a trial of labor after cesarean carries higher maternal and fetal risks than planned cesarean delivery. Because the management of such patients in our department differs from that described in some studies, and is perhaps more cautious, we hypothesized that the outcome may be better. METHODS: We identified women with 1 previous low uterine segment cesarean who had delivered a cephalic singleton infant at gestational age 34 weeks or more from January 2000 through May 2005. Our policy is to encourage such women to undergo a trial of labor unless cesarean delivery is indicated. Unless otherwise indicated, our policy is to wait for spontaneous labor. We do not use prostaglandins, and recommend cesarean delivery if the cervix is unripe.(Bishop score < 6). We compared the outcome between women who underwent a trial of labor and women who underwent planned cesarean delivery. RESULTS: A trial of labor was attempted by 841 women (80% successful), and 467 underwent planned cesarean delivery. Uterine rupture was observed in 1 woman 18 hours after vaginal delivery. There was no difference in major or minor maternal morbidity. There was no serious neonatal morbidity. Among the planned cesarean patients, hospital stay was longer, and there were more admissions to the neonatal intensive care unit. CONCLUSION: With our well-defined protocol, a trial of labor after cesarean seems to be as safe for the mother and infant as planned cesarean delivery, and the hospital stay is shorter. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2006

Maternal complications associated with multiple cesarean deliveries.

OBJECTIVE: The claim that a planned repeat cesarean delivery is safer than a trial of labor after cesarean may not be applicable to women who desire larger families. The aim of this study was to assess maternal complications after multiple cesarean deliveries. METHODS: The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group). RESULTS: Excessive blood loss (7.9% versus 3.3%; P < .005), difficult delivery of the neonate (5.1% versus 0.2%; P < .001), and dense adhesions (46.1% versus 25.6%; P < .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004). CONCLUSION: Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2006

Instability of Doppler cerebral blood flow in monochorionic twins.

OBJECTIVE: The purpose of this study was to evaluate Doppler flow velocity changes in cerebral vessels of monochorionic twins with twin-twin transfusion syndrome (TTTS). METHODS: Repeated Doppler umbilical and cerebral blood flow studies were performed in 7 twin pairs with TTTS. Eight monochorionic twin pairs and 11 dichorionic twin pairs served as control groups. The following Doppler parameters were assessed: umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio, delta PI between the umbilical artery and MCA, and peak systolic velocity (PSV) in the MCA. RESULTS: Significant variations in PSV in the MCA and cerebral indices were found in the study group of monochorionic twins with TTTS. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus. Repeated measurements in the comparison groups were stable without significant variations. The delta cerebroplacental ratio was significantly higher in the study group (0.38 versus 0.09 and 0.19 in the comparison groups; P < .02). CONCLUSIONS: Significant changes in Doppler flow velocity and indices suggest instability of cerebral blood flow with episodes of "hyperperfusion" in monochorionic twins with TTTS. Further studies are needed to elucidate the relationship of these transient changes to neurologic sequelae in the neonate.

Blood Flow Velocity↗
PubMed2006

Chorionic villous sampling: differences in patients' perspectives according to indication, ethnic group and religion.

BACKGROUND: The decision to undergo prenatal testing may be influenced by ethnic or religious factors. OBJECTIVES: To evaluate factors that might influence the decision of pregnant women to choose chorionic villous sampling for prenatal testing. METHODS: The study group comprised 239 women referred for prenatal diagnosis who elected to undergo CVS. The data were analyzed according to indication, ethnic group and religion. RESULTS: Among women undergoing CVS because of advanced maternal age and anxiety, we noted a significantly high proportion of unbalanced families, i.e., with three or more children of the same gender and deviated gender ratio. We found a significant excess of males among the Jewish families and a significant excess of females among the non-Jewish families. Jews were over-represented in the monogenic group while Christian Arabs were over-represented in the maternal age/anxiety group. CONCLUSIONS: The proportion of women who chose CVS for prenatal diagnosis varied according to indication, ethnic group and religion. The data in this study indicate that CVS may have been utilized for balancing families with > or = 3 or more children of the same sex. Christian Arabs chose CVS more often than the other groups. Jewish women may have utilized CVS for family balancing of both sexes, while non-Jews may have utilized CVS for balancing families with > or = 3 daughters.

Chorionic Villi Sampling↗
PubMed2005

Does maternal height affect triplets' birth weight?

BACKGROUND: In cases of triplet gestation where patients are reluctant to undergo multifetal pregnancy reduction, it would be helpful to identify predictive factors regarding poor or better outcomes. One such possible factor may be maternal height, which is possibly predictive of gestational age and neonatal birth weight. MATERIAL/METHODS: To examine such a possible association, we have retrospectively evaluated 102 triplet gestations. Maternal height and BMI were compared and correlated to neonatal weight, week of delivery, NICU hospitalization duration, and other parameters of pregnancy outcome. RESULTS: Mothers taller than 165 cm gave birth to significantly heavier neonates than shorter parturients delivered of triplets. Individual and mean total triplet neonatal weights were positively correlated to maternal height. There was no significant correlation between preconceptional maternal BMI and triplet neonatal weight and week of delivery, NICU hospitalization or any other parameter. CONCLUSIONS: The taller patient (>165 cm) may be at a significantly lower risk of very low birth weight neonates and very premature delivery as compared to the shorter patient (< 165 cm). Therefore, the factor of maternal height may be taken into consideration in multiple gestation pregnancy consultations. Smaller mothers should never receive more than two embryos in IVF programs to reduce the risk of triplets almost completely.

Birth Weight↗
PubMed2005

Episiotomy: beliefs, practice and the impact of educational intervention.

OBJECTIVE: To assess the potential effect of educational intervention on episiotomy practice. STUDY DESIGN: A survey of the attitude of obstetrical caregivers toward episiotomy was conducted among obstetricians and midwives in the three public hospitals in Haifa. Data regarding episiotomy rates was collected for the years 2001-2003. At the beginning of 2002, lectures on the risks and benefits of episiotomy were given in two hospitals. Episiotomy rates before and after the lecture were compared. RESULTS: A significant and lasting reduction in episiotomy rates was observed in the two hospitals where lectures were given. There were no clinically significant and consistent changes in the episiotomy practices in the third hospital. CONCLUSION: Education may play an important role in changing common medical practices, as in episiotomy. It was clearly shown that our beliefs are not always up to date. We call for periodic reassessment of all medical procedures, as common and accepted as they are.

Attitude of Health Personnel↗
PubMed2005

Absence of association of inherited thrombophilia with unexplained third-trimester intrauterine fetal death.

OBJECTIVE: The purpose of this study was to investigate the alleged association between thrombophilia and unexplained third-trimester stillbirth. STUDY DESIGN: Case subjects were 37 women with a history of a third-trimester unexplained stillbirth. Control subjects were 46 volunteers, group-matched for ethnic origin, with no history of stillbirth, recurrent fetal loss, or thromboembolism. The pathology report of 34/37 placentas of case subjects was reviewed. RESULTS: The prevalence of at least 1 inherited thrombophilia among case subjects was 37.8% compared with 41.3% among control subjects. (OR = 0.87; 95%CI, 0.32-2.29). There was no significant difference between the groups with respect to the prevalence of any single inherited thrombophilia. There was, however, a significantly higher prevalence of antiphospholipid antibodies among case subjects compared with control subjects: 47.2% vs 8.7%, respectively (OR = 9.4; 95%CI, 2.5-42.3). No significant difference was noted in the prevalence of thrombopilia among subjects with or without placental infarcts. CONCLUSION: We did not find an association between unexplained third-trimester intrauterine fetal death and inherited thrombophilia; however, we did find such an association with antiphospholipid antibodies.

Antibodies, Antiphospholipid↗
PubMed2004

Variables associated with successful vaginal birth after one cesarean section: a proposed vaginal birth after cesarean section score.

The objective of this study was to define the variables associated with vaginal birth after cesarean section (VBAC) and to develop a scoring system for the prediction of successful VBAC. We searched our computerized database for parturients with a history of one low-transverse cesarean section (CS) who were delivered during the year 2000. Variables were categorized according to the time period in which they were obtained: (1) first prenatal visit, (2) at the onset of labor, and (3) during labor. Univariate and multiple stepwise logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Of the 475 parturients with a history of one previous CS, 136 underwent elective CS and 339 underwent a trial of VBAC, of whom 82% were successful. Of the variables that can be obtained at the onset of labor, five were significantly associated with successful VBAC: abnormal presentation as the indication for the primary CS (OR, 7.4; 95% CI 2.8 to 19.2), a previous VBAC (OR, 7.2; 95% CI, 2.1 to 24.8), cervical dilation (OR, 2.5; 95% CI, 1.3 to 4.9), gestational age < or = 41 weeks (OR, 2.8; 95% CI, 1.1 to 7.1), and lower gestational age at the primary CS (OR, 1.2; 95% CI, 1.02 to 1.4). In the proposed VBAC score, each of the four most significant variables was assigned a score ranging between 0 and 3 based on the probability for VBAC. A score < or = 2 was associated with a success rate of 42%, a score between 3 and 6 was associated with a rate of 81%, and a score between 7 and 10 was associated with a 98% successful VBAC rate (p < 0001). The proposed VBAC score may help obstetricians when counseling their patients regarding the individual likelihood of a successful VBAC.

Adult↗