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Biomedical subjects

S Arieli

Publications and source records attributed to S Arieli.

36 records · Page 2Linked to original sources
PubMed1993

Dynamic ultrasonographic imaging of the third stage of labor: new perspectives into third-stage mechanisms.

OBJECTIVE: Dynamic ultrasonographic imaging of the third stage of labor was performed to document ultrasonographic findings and to present new perspectives into third-stage mechanisms. STUDY DESIGN: Twenty-five normal deliveries and five with prolonged third-stage labor were studied. RESULTS: Normal third-stage labor could be divided into four phases: (1) latent phase, characterized by thick, placenta-free wall and thin, placenta-site wall; (2) contraction phase, with thickening of placenta-site wall (from < 1 cm to > 2 cm); (3) detachment phase, in which the placenta completes its separation and detaches; and (4) expulsion phase, with a sliding movement of the placenta. Although oxytocic agents were routinely used, they do not seem to influence the findings. In five cases with retained placenta the placenta-site wall was initially thin. In four of them it became thick, and the placenta was removed by traction of the cord, whereas in the fifth case the placenta-site wall remained thin and the placenta had to be removed manually. CONCLUSION: Shearing forces seem to tear the decidual septae and thereby separate the placenta. This process is completed only when the placenta-site wall attains full thickness. In cases of prolonged third-stage labor, traction of the cord should be applied only when this phase is completed and the actual sliding movement of the placenta is observed.

Female↗
PubMed1993

Chromosome 20 long arm deletion in an elderly malformed man.

A 46,XY/46,XY,del(20)(q13-->q13.33) mosaicism was identified in a 68 year old man who had mild mental retardation and severe malformation of the limbs. The clinical findings of the patient are compared to those of the very few cases of 20q deletion published to date.

Abnormalities, Multiple↗
PubMed1993

A simplified preinduction scoring method for the prediction of successful vaginal delivery based on multivariate analysis of pelvic and other obstetrical factors.

Most of the popular preinduction scoring methods were created three decades ago, applied to selected populations and based on analysis of each factor separately. In order to overcome these limitations and to try and create a simple and reliable scoring method, 401 inductions of labor were analyzed. Failure was defined as delivery by cesarean section, regardless the indication. Results of multivariate analysis demonstrated that only two of the five factors used by Bishop's method were included (cervical dilatation and fetal head station). Gestational age and parity also constituted important factors and thus the new method incorporates these four factors. The variables among each factor were scored according to their relative risk, obtained from the analysis; dilatation 3 cm or more = 2, dilatation 1-2 cm = 1, fetal head station -1 cm or lower = 1, multiparity = 1, term delivery = 1, closed cervix = 0, station -2 cm or higher = 0, primiparity = 0 and non-term delivery = 0. Comparison of the suggested scoring method and Bishop's method demonstrated that in the low score category our method predicted more accurately cesarean section rate (44.7% and 27.6%, respectively). No difference was noted among the middle or high score groups. More studies among other populations may clarify whether our proposed method really overcomes other methods concerning simplicity, universality and predictability.

Birth Weight↗
PubMed1991

Fetal breathing movements before oxytocin induction in prolonged pregnancies.

Fetal breathing movements were recorded before elective labor induction in 65 patients with uncomplicated prolonged pregnancies. Breathing activity was observed in 41 patients and was absent in 24. Comparison of these two groups indicated that the induction period was significantly shorter and the oxytocin requirement significantly lower in the group with no fetal breathing movements (mean, 319.3 vs 648.5 minutes and 1133.7 vs 2708.4 mIU, respectively). These findings remained valid regardless of Bishop scores. The data suggest that fetal breathing movements are predictive of the effectiveness of oxytocin induction in prolonged pregnancies.

Adult↗
PubMed1990

Maternal ECG recorded by internal monitoring closely mimicking fetal heart rate in a recent fetal death.

A case of intrapartum fetal death in which the maternal heart rate was recorded by internal fetal monitoring is presented. The electrical activity of the maternal heart was transmitted via the fetal body and the recording mimicked a "normal" fetal heart rate (FHR). The patient was referred because of sudden abdominal pain and bleeding; Doppler fetal heart tones were not heard. Because internal monitoring was synchronous with the maternal pulse, ultrasonography was performed and established the diagnosis of fetal demise. Awareness and usage of simple modalities are mandatory for proper diagnosis in such cases.

Adult↗
PubMed1989

Tubal patency after local methotrexate injection for tubal pregnancy.

Tubal patency was investigated by hysterosalpingography in 21 of 37 patients with unruptured tubal pregnancy treated by local methotrexate injection at laparoscopy. 18 of the 21 patients had bilateral tubal patency, and the only tube of a patient with a single fallopian tube was also patent. 6 subsequent intrauterine pregnancies have so far been recorded. Local methotrexate injection into the tubal pregnancy may provide an efficient and safe alternative to surgery in early unruptured ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1989

Local methotrexate injection: a nonsurgical treatment of ectopic pregnancy.

Twenty seven patients with unruptured tubal pregnancy were selected for nonsurgical treatment with the use of one injection of 12.5 mg of methotrexate into the ectopic site at laparoscopy. No adverse reactions were observed. In three patients (11%), a laparotomy was performed because of rising beta-human chorionic gonadotropin titers. In the other patients, serum beta-human chorionic gonadotropin levels decreased to the nonpregnant range with no further intervention, and the patients recovered uneventfully. This method is suggested as an alternative to surgery in selected cases of early unruptured tubal pregnancy.

Adult↗
PubMed1989

Elective caesarean hysterectomy. Indications and outcome: a 17-year experience of 140 cases.

In an earlier report of 86 elective Caesarean hysterectomies (1970-1979) we showed that the operation was associated with few complications but a high blood transfusion rate. In this paper we report an extended series comprised of 140 cases (1970-1986), and compare results of the 1970's series with that of the 1980's. The operative and postoperative complications were minimal during the entire period. The blood transfusion rate which was 64% in 86 cases of the 1970-1979 period decreased to 17% in 54 cases of the 1980-1986. Our results show that Caesarean hysterectomy is a safe procedure with some long-term advantages; therefore this option should be discussed with women who ask for tubal sterilization at the time of Caesarean section.

Blood Transfusion↗
PubMed1985

Perinatal outcome following physicians' strike of 1983.

Organized public medical services were profoundly disturbed during the 4 months of the physicians' strike in 1983. An unknown proportion of patients were referred to private services, but only a minority of them attended the alternative centers. The findings during the strike and the following 6 months were compared with those of the year 1982. The incidence of high-risk cases and of multiple and premature deliveries were unchanged. There was a significant rise (P less than 0.01) in the rate of cesarean sections during the strike, 10.8%, compared with 7.8% in 1982. Also, a significant reduction in instrumental deliveries and labor inductions was observed during the strike and for 4 months afterwards. There was no change in the perinatal mortality (total and corrected) or in Apgar scores. This indicates that good perinatal results were achieved despite drastic disturbances in organized perinatal care.

Apgar Score↗
PubMed1983

Sterilization at the time of cesarean section: tubal ligation or hysterectomy?

The operative, postoperative and subsequent course of 86 patients who underwent cesarean hysterectomy (C.H.) during the years 1970-1979 are compared to an equal number of cesarean sections with tubal ligation (C.S.L.). Both groups are similar regarding age, gravidity, parity, number of living children and indications for abdominal delivery. Operative and postpartum complications of both groups were all minor, although significantly (p less than 0.05) more frequent in the C.S.L. group. More patients of the C.H. group required blood transfusions than the C.S.L. group (p less than 0.01). The mean period of hospitalization was similar in both groups. Two pregnancies occurred after tubal sterilization, a failure rate of 1:43. During the follow-up period, 49 surgical gynecological procedures were performed in the C.S.L. group compared to 1 in the C.H. group. Ten patients of the C.S.L. group subsequently underwent abdominal hysterectomy. Hysterectomy is the procedure of choice for permanent sterilization and prevention of many subsequent gynecological problems. Consideration must be given to coexisting gynecological conditions while considering sterilization at elective C.S. and C.H. should be offered to those patients.

Adult↗
PubMed1981

Triplet and quadruplet pregnancies and management.

The rate of multiple pregnancies with more than 2 fetuses has significantly increased since the introduction of ovulation induction agents. From 1970 through 1978, there were 19 triplets and 6 quadruplets in the authors' department, incidences of 1:696 and 1:5370, respectively. Eighteen (72%) of the 25 multiple pregnancies followed treatment with ovulation induction agents and 7 were spontaneous. The diagnosis of more than 2 fetuses was made earlier in the induced than in the uninduced pregnancies. Management, initiated upon diagnosis, included bed rest, high-protein diet, beta-mimetic agents, progestins, dexamethasone late in the second trimester, and selective cerclage. The mean gestational age was 34 weeks in the triplets and 35 weeks in the quadruplets. Forty-four percent of the deliveries were by cesarean section and the remainder were by vaginal delivery. The mean weight of the neonates was 1807 g in the triplets and 1950 g in the quadruplets. The mean overall Apgar score was 8.16, and the perinatal mortality was 185 per 1000, corrected (more than 28 weeks) to 137 per 1000. The main neonatal complications resulted from prematurity, and maternal complications noted were postpartum hemorrhage necessitating hysterectomy in 2 patients. The preferable mode of delivery cannot be stated dogmatically. Fetal outcome was similar in vaginal and cesarean deliveries among the various gestational age groups.

Adult↗
PubMed1980

Metabolic effects of intravenous ritodrine infusion in pregnancy.

The effects of intravenous administration of Ritodrine on blood glucose, insulin, electrolytes, plasma and red cell potassium and venous pH were investigated. A highly significant increase in blood glucose and insulin occured. A highly significant negative correlation between serum and red cell potassium concentration was registered (r = -0.96268). No signficant changes during Ritodrine infusion were recorded in serum levels of sodium, chloride, calcium, phosphorus and magnesium. The pH did not seem to be influenced by intravenous Ritodrine administration. No cardiac arrhythmias or electrocardiographic deteriorations occurred. While intravenous Ritodrine administration seems to be safe in normal pregnancies, a risk may be present in diabetic and digitalized patients, and pregnant women being treated by diuretics.

Adult↗