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Biomedical subjects

Samuel Lurie

Publications and source records attributed to Samuel Lurie.

30 records · Page 2Linked to original sources

Atosiban treatment for uterine hyperactivity during active labor: a pilot study.

OBJECTIVE: A preliminary assessment of the ability of Atosiban to alleviate uterine hyperactivity during active labor. METHODS: Fifteen consecutive women with uterine hyperactivity during active labor were included in this prospective observational study. Atosiban was given as a single or repeated intravenous bolus dose (6.75 mg in 0.9 mL NaCl solution) if hyperactivity was not alleviated within 5 minutes with "intrauterine resuscitation" measures. RESULTS: Alleviation of uterine activity was achieved in 14 out of 15 cases and was almost immediate in the responders. Alleviation of accompanying fetal heart rate abnormalities was achieved in 13 out of 14 cases. In 7 of 15 women a cesarean section was performed, eventually. Atosiban was well tolerated by all women and no side effects were noted. There were no 5 minutes Apgar scores of less than 7. There were no cases of neonatal asphyxia or neonatal mortality. CONCLUSION: Atosiban may be an effective treatment of uterine hyperactivity during active labor.

Adult↗

Role of sonography in the diagnosis of retained products of conception.

OBJECTIVE: To present our experience with clinical and sonographic diagnosis of retained products of conception and to evaluate its correlation with histopathologic findings. METHODS: This was a retrospective study on 156 patients admitted for retained products of conception. Women were referred because of 1 or more of the following: abdominal pain, bleeding, and fever. The status of the cervix was evaluated by bimanual examination. The diagnosis of retained products of conception was made when a sonographic finding of hyperechoic or hypoechoic material was seen in any part of the uterine cavity or the presence of a thickened endometrial stripe greater than 8 mm and an irregular interface between the endometrium and myometrium was found. One hundred twenty-one women (77.6%) were admitted after dilation and curettage for abortion, and 35 (22.4%) were admitted after spontaneous labor. RESULTS: Histopathologic reports confirmed the diagnosis of retained products of conception in 86 (71%) of 121 women in the postabortion group and in 17 (48.5%) of 35 women in the postpartum group. The overall false-positive rate for sonographic diagnosis was 34%. For women after abortion and after delivery, the false-positive rates were 28.9% and 51.5%, respectively. CONCLUSIONS: Reliance on common signs and symptoms to diagnose retained products of conception as well as the use of sonography is associated with an unacceptably high false-positive rate, mainly after delivery. A more conservative approach to the treatment of retained products of conception is suggested.

Abortion, Incomplete↗

Male fetuses and the risk of cesarean delivery.

OBJECTIVE: To assess the reported increased rate of cesarean sections in women carrying male fetuses. STUDY DESIGN: A retrospective analysis of all deliveries in 2001 was performed. All singleton deliveries were enrolled. We compared fetal sex distribution in cesarean ased risk of cesarean sections performed for various indications. The study had 80% power to detect a explained by different parturient difference in the cesarean section rate in women carrying male and female fetuses. RESULTS: The overall cesarean section rate was similar in women with male or female fetuses, 19.7% and 19.1%, respectively. This lack of association was also found in specific subgroups of cesarean indications: non-reassuring fetal heart rate pattern, fetal distress, nonprogressive labor, elective cesarean, suspected macrosomia, abnormal lie and severe preeclampsia. CONCLUSION: In contrast with previous investigators, we did not find an increased risk of cesarean section in women carrying male fetuses.

Adolescent↗

The duration of the third stage of labor is subject to the location of placental implantation.

We evaluated the association between placental location and length of the third stage of labor in normal term singleton pregnancies. Two hundred consecutive singleton term live vaginal deliveries following uncomplicated pregnancies were included in a retrospective study. The mean maternal age was 27.5 +/- 5.2 years, and the mean parity was 2.2 +/- 1.4. Patients' charts were reviewed in order to determine the placental implantation site. Anterior location of the placenta was noted in 96 women (48%), posterior in 66 (33%), fundal in 26 (13%), and lateral in 12 (6%). The duration of the third stage was 9.5 +/- 5.5, 9.4 +/- 5.3, 12.8 +/- 9.5, and 7.6 +/- 3.5 min in anterior, posterior, fundal, and lateral groups, respectively (p < 0.05). The duration of the third stage of labor is statistically significantly longer, if the placenta is located in the fundal area of the uterus. Therefore, we believe that the placental location may be important in managing the third stage of labor.

Adult↗

Vacuum application through a nonfully dilated cervix: a viable option.

The aim of this cross-sectional study was to assess the feasibility of vacuum delivery through a nonfully dilated cervix. The study group consisted of 39 women with vacuum deliveries through a nonfully dilated cervix larger than 9 cm and station of the head at S or more +2 cm. These were compared to a control group of 215 vacuum deliveries at a fully dilated cervix and 46 women who underwent cesarean section at a nonfully dilated cervix larger than 9 cm. The main indication for vacuum extraction in the study group was fetal distress and in the control groups prolonged 2nd stage, dysfunctional labor and fetal distress. Maternal and neonatal morbidity was low and not different between the groups. Neonatal well being, evaluated by cord pH and 5-min Apgar score, was not different. Based on predefined criteria, vacuum extraction through a nonfully dilated cervix is a viable alternative to emergency cesarean section and is apparently not associated with higher maternal or infant morbidity.

Apgar Score↗

The history of cesarean technique.

Cesarean section has been practiced since ancient times. Unfortunately, no ancient medical documents describing the techniques for cesarean section are extant. In the early medieval period, cesarean section was usually performed by midwives. One of the first explicit instructions in medical literature on cesarean technique dates from about 1480 ce from southern Germany. We discuss the evolution of cesarean surgical technique and point up the contribution of many giants in the field of obstetrics and gynecology, such as Blundell, Frank, Harris, Joel-Cohen, Kehrer, Kerr, Lebas, Levret, Maylard, Pfannenstiel, Porro, Portes, and Sanger.

Cesarean Section↗

Association of Lewis blood group phenotype with preterm premature rupture of membranes.

OBJECTIVE: To evaluate the distribution of Lewis blood group phenotype and secretor status among women with preterm premature rupture of membranes. METHODS: ABO and Lewis blood group phenotypes were determined in 20 consecutive women with preterm premature rupture of membranes. The control group was composed of 48 women from our database without known history of preterm delivery. RESULTS: Of the 20 patients with preterm premature rupture of membranes six had blood type A (30%), nine type B (45%), two type AB (10%), three type O (15%), three Le(a(-)b(+)) (15%), one Le(a(+)b(-)) (5%), and 17 had Le(a(-)b(-)) (80%). Of the 48 controls, 18 had blood type A (37.5%), 10 type B (20.9%), two type AB (4.1%), 18 type O (37.5%), 37 Le(a(-)b(+)) (77.1%), six Le(a(+)b(-)) (12.5%), and five had Le(a(-)b(-)) (10.4%). The difference in the proportions of the A, B, AB, and O phenotypes between the groups was not statistically significant. The distribution of ABO and Lewis phenotype in the control group was similar to that in the general population. The proportion of combined recessive and nonsecretor phenotypes Le(a(+/-)b(-)) between patients with preterm premature rupture of membranes (17 of 20, 85%) and controls (11 of 48, 22.9%) was statistically significant (P <.001). CONCLUSIONS: Women with the Le(a(-)b(+)) phenotype who do secrete Le(b) antigen may have a protective effect against preterm premature rupture of membranes.

ABO Blood-Group System↗

Changes in platelet function, volume and count during labor and 24 hours postpartum.

Increased platelet activation has been reported during labor. We evaluated changes in platelet count, volume and function during labor and 24 hours postpartum. Platelet function during labor was not previously evaluated. Twenty-five healthy women in labor, subsequently having singleton spontaneous vaginal delivery following uncomplicated pregnancy at term were recruited for this prospective study. Blood was withdrawn during latent phase, active phase, second stage of labor, and 24 hours postpartum. Platelet function was assessed by hemoSTATUS2 test (Hepcon, Medtronic, USA). Twenty-five healthy non-pregnant volunteers served as controls. Platelet count and volume did not change significantly throughout labor and 24 hours postpartum. Platelet function was 120.8 +/- 26.9 %, 106.8 +/- 24.6 % (p = 0.06), 105.2 +/- 30.9 % (p < 0.05), and 117.6 +/- 21.5 % during latent phase, active phase, second stage of labor, and 24 hours postpartum, respectively. Platelet function was altered during labor while platelet count and volume did not change significantly. Platelet function remained increased when compared to non-pregnant controls.

Blood Platelets↗

Postoperative nausea and vomiting: comparison of the effect of postoperative meperidine or morphine in gynecologic surgery patients.

STUDY OBJECTIVE: To evaluate the incidence and severity of postoperative nausea and vomiting in women receiving postoperative intravenous morphine or meperidine following gynecologic surgery. DESIGN: Prospective, double-blind, randomized study. SETTING: Tertiary-care academic medical center. PATIENTS: 200 ASA physical status I, II, and III patients scheduled for elective gynecologic surgery. INTERVENTIONS: Patients received either postoperative IV morphine (n = 100) or meperidine (n = 100) following gynecologic surgery. MEASUREMENTS: We compared pain scores, sedation scores, nausea scores, well-being scores, vomiting rate, and patient satisfaction in both groups 15, 30, 60, and 120 minutes after arrival in the postoperative anesthesia care unit. MAIN RESULTS: The vomiting rate was 8/100 versus 7/100 (at 15 min), 4/100 versus 26/100 (at 30 min) (p < 0.05), 3/100 versus 23/100 (at 60 min) (p < 0.05), and 0/100 versus 0/100 (at 120 min) in the morphine or meperidine groups, respectively. The pain and sedation scores were similar in both groups. No major complications were noted in either group. CONCLUSION: Our study demonstrates an advantage of the use of morphine rather than meperidine for pain control in the immediate postoperative period following gynecologic surgery.

Adult↗

Breast engorgement and galactorrhea during magnesium sulfate treatment of preterm labor.

Breast engorgement and galactorrhea occasionally occur during tocolysis with ritodrine. We are not aware of breast engorgement and galactorrhea associated with other tocolytics. We report the first case of breast engorgement and galactorrhea during tocolysis with intravenous magnesium sulfate in a generally healthy 24-year-old woman admitted for tocolysis at 30 weeks' gestation. Breast engorgement and galactorrhea gradually subsided after magnesium sulfate was discontinued. The rapid disappearance of both the galactorrhea and the breast engorgement after discontinuation of magnesium sulfate treatment suggests a cause-effect relationship, the mechanism of which remains unclear.

Adult↗

The effects of an external nasal dilator on labor.

BACKGROUND: The aim of this study was to assess the effect of an external nasal dilator on several variables characterizing labor in both mother and fetus. METHODS: One hundred and fifty primigravida women in active labor were randomized to wear, throughout labor, either a dilator spring-loaded nasal strip or a placebo device. Data were obtained during labor and compared between the groups. After delivery, the satisfaction rate was assessed. RESULTS: No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. Satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001). CONCLUSION: Nasal strips do not change the course but ameliorate the quality of labor by improving the ease of breathing. Nasal dilators sustain the respiratory effort associated with the long process of labor and may control the switch from nasal to oronasal breathing during delivery.

Adult↗