Biomedical subjects

S Lipitz

Publications and source records attributed to S Lipitz.

137 records · Page 8Linked to original sources

PubMed1990

Failure to improve ovarian response by combined gonadotropin-releasing hormone agonist and gonadotropin therapy.

Nineteen women were treated with the gonadotropin-releasing hormone (GnRH) agonist buserelin in order to suppress the pituitary prior to gonadotropin treatment. Eight women were oligomenorrheic, 6 had polycystic ovarian disease (PCOD) and 5 women had normal cycles. Buserelin was administered for 3 weeks before ovarian stimulation, and the pituitary down-regulation was proven by provocative tests. Ovarian stimulation was then achieved by human menopausal gonadotropin (hMG) 2 ampules a day. Several abnormal responses to the combined buserelin/hMG treatment were noted in some patients. This included a sudden decrease in E2 level without LH surge (2 patients), induced follicular growth with buserelin instead of ovarian suppression (2 patients) and ovarian hyperstimulation syndrome in 3 patients with PCOD. From this we conclude that although pituitary suppression can easily be achieved by GnRH analog administration, this does not ensure the prevention of unwanted responses. It is possible that the common denominator for these abnormal responses is that they are ovarian in origin, hence they occur in spite of pituitary down-regulation. Close monitoring of the suppression and stimulation stages will detect most cases of such failures. Furthermore it is possible that not all patients are suitable for the combined treatment of gonadotropin and GnRH agonist.

Adult↗

PubMed1990

High-order multifetal gestation--management and outcome.

During the period 1975-1989, 11 high-order (quadruplet or more) multifetal gestations reaching the second trimester were treated in our department. All pregnancies resulted from ovulation induction therapy. Premature contractions occurred in all cases. Two women delivered stillborn quadruplets vaginally at 25 and 26 weeks' gestation. Nine women had cesarean deliveries at 28-35 weeks; one fetus was stillborn and two of the 39 live-born infants died. Twenty-nine (74%) weighed less than 1500 g and 16 (41%) were below the tenth percentile for gestational age. Thirty infants have been followed for at least 2 years, corrected for gestational age; 21 (70%) are developing normally, two are severely handicapped with both cerebral palsy and mental retardation, four have mild motor delay, and three have mild motor and mental delay.

Adult↗

PubMed1989

Fetal intracranial anatomy in the first trimester of pregnancy: transvaginal ultrasonographic evaluation.

The normal values and ranges of fetal intracranial structures were studied by high resolution transvaginal ultrasonic scan at 12, 13 and at 14 weeks' gestation. The data including measurements of crown rump length (CRL), bi-parietal diameter (BPD), head circumference (HC), hemispheric width (HW), lateral ventricle width (LVW), LVW/HW ratio, thalamus and cerebellum may be useful in determining deviations from the normal and also in expanding the range of prenatal diagnoses of fetal structural abnormalities in early pregnancy.

Brain↗

PubMed1989

The improving outcome of triplet pregnancies.

During the period 1975 to 1988, 78 triplet pregnancies that reached a gestational age greater than or equal to 20 weeks were treated in our department--a prevalence of 1/849 deliveries. A total of 69 (88%) of the pregnancies occurred after treatment with ovulation-induction agents. The most common complication of pregnancy was premature contractions. Elective cervical cerclage neither prolonged gestation nor decreased fetal loss. The mean gestational age at delivery was 33.2 weeks + 3.8 weeks and 86% of the patients were delivered of premature infants. The perinatal and neonatal mortality rates were 93/1000 and 51/1000, respectively. Our results show a higher proportion of low Apgar scores and respiratory disorders in the third vaginally delivered infants. Follow-up of very low birth weight infants revealed four infants (10.5%) with severe neurologic handicaps. Results of this study suggest that cesarean section is the preferred mode of delivery in triplet pregnancies. Maternal, fetal, and neonatal risks of triplet gestations are relatively low and compare favorably with recent reports on twin pregnancies.

Adult↗

PubMed1989

Selective reduction in multiple gestations: pregnancy outcome after transvaginal and transabdominal needle-guided procedures.

Selective fetal reduction was performed in the first trimester of pregnancy in 20 women with multifetal gestations after ovulation induction with human menopausal gonadotropin (hMG). In 10 women (group A) reduction was performed transabdominally, and in 10 women (group B) the transvaginal approach was used. The transvaginal technique achieved penetration of several gestational sacs without withdrawing the needle from the uterus. Fetal termination using either procedure occurred with intrafetal injection of potassium chloride. Six (60%, group A) and eight (80%, group B) patients delivered healthy newborns. One patient (group B) is at 30 weeks' gestation. Four (40%, group A) and one (10%, group B) aborted 1 day to 8 weeks after the procedure (1 septic abortion, each group). Our results suggest that transvaginal fetal reduction offers a better outcome, with minimal complications, to patients referred for selective continuation of pregnancy.

Abdomen↗

PubMed1989

Suppression with gonadotropin-releasing hormone analogues prior to stimulation with gonadotropins: comparison of three protocols.

This study compared three groups of patients treated with three different protocols of suppression of the pituitary-ovarian axis prior to and during gonadotropin stimulation for in vitro fertilization with a nonsuppressed control group. Patients treated with daily injections of DTRp6 (Decapeptyl 0.5 mg) or with a single injection of Decapeptyl depot (3.2 mg CR) had a longer folicular phase than patients treated with Buserelin (1.2-1.5 mg daily) and the patients in the control group. The number of human menopausal gonadotropin ampules required to reach adequate stimulation was also significantly higher in the former two groups of patients. The number of oocytes recovered (6-7 per patient), fertilized (45-58%) and cleaved (92-100%) did not differ among the groups. Peak estradiol levels and the pregnancy rate were highest in the group treated with Buserelin. The overall picture would indicate that suppression with Buserelin was the least profound.

Adult↗

PubMed1988

Puerperal inversion of the uterus.

Puerperal inversion of the uterus is a complication of the third stage of labor. The two main reasons are excessive cord traction and Crede fundal pressure. Its frequency in Israel is unknown. A case of acute, complete inversion of the uterus is presented, treated promptly by immediate reposition and manual separation of the placenta. The various modes of treatment are discussed. Puerperal inversion is a rare and dangerous complication. Prompt diagnosis and the proper choice of treatment will decrease the morbidity and mortality associated with this complication.

Adult↗

PubMed1987

Breast stimulation test and oxytocin challenge test in fetal surveillance: a prospective randomized study.

Fifty healthy gravidas with uncomplicated singleton pregnancies at a gestational age of 35 to 42 weeks were assigned at random for the performance of either a breast stimulation test or an oxytocin challenge test after a nonreactive nonstress test. A satisfactory contraction stress test was achieved in 21 of 25 women in the breast stimulation test group and in 24 of 25 women in the oxytocin challenge test group (nonsignificant difference). Significant differences were found in the cumulative rate of achieved contraction stress tests: in the breast stimulation test group 17 of 21 after 20 minutes and 21 of 21 at 50 minutes whereas in the oxytocin challenge test group only four of 24 at 20 minutes, eight of 24 at 50 minutes, and 21 of 24 at 150 minutes. The mean duration for the achievement of a contraction stress test was 20.9 +/- 11.5 minutes for the breast stimulation test group and 81.3 +/- 48.4 minutes in the oxytocin challenge test group. Uterine hyperstimulation occurred once in each group. No gravida went into labor within 24 hours. Breast stimulation test is a satisfactory alternative to the oxytocin challenge test, is less time-consuming, and is simpler to perform.

Adult↗

PubMedDate not supplied

Sperm head ultramorphology and chromatin stability of males with unexplained infertility who fail to fertilize normal human ova in vitro.

An in vitro nuclear chromatin decondensation test, and quantitative nuclear ultramorphology analysis, were performed on 18 males judged to be infertile, by two failures in in vitro fertilization, and 16 fertile males. These two clinical groups only differed significantly in (1) the direction of their chromatin stability change, which took place 30-120 min post-ejaculation while stored in the seminal plasma, and (2) in the incidence of the hypoelongated sperm-head. Generally, the fertile male group exhibited positive chromatin stability change after prolonged storage, and low incidence of hypoelongated sperm heads, and vice versa in the unexplained infertile group. When the nuclear chromatin decondensation test and quantitative ultramorphology analysis were performed in step-wise fashion, it was possible to correctly classify 94% of the fertile cases with 6% of false-negative, and 89% of the unexplained infertile cases with 11% of false-positive. Therefore, it appears that these tests might be of benefit clinically for identifying functional properties of sperm-cells in unexplained infertile males, which cannot be detected by routine semen analysis.

Cell Nucleus↗

PubMedDate not supplied

Is fetal growth affected by cord entanglement?

Cord entanglement is a common occurrence during delivery. We examined the association of cord complications observed at delivery and birth weight. A retrospective survey of 12,241 births was performed, supplemented with a prospective study of an additional 456 deliveries. No adverse association was found in the retrospective data between cord coiled twice or more around the newborns' neck (8.3% of cases) and birth weight. Moreover, the incidence of cord around neck was significantly lower (p < 0.0006) in infants weighing less than 2000 gm at birth. A multiple regression analysis of the prospective data did not reveal any significant influence of cord complications on birth weight. We conclude that cord entanglement was not found to be a major cause of intrauterine disadvantage in pregnancies with a viable infant at term, as reflected by birth weight.

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↗