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Biomedical subjects

Z Ben-Rafael

Publications and source records attributed to Z Ben-Rafael.

At least 109 records · Page 6Linked to original sources
PubMed1998

Antepartum management protocol. Timing and mode of delivery in gestational diabetes.

We sought to determine whether strict glycemic control during diabetic pregnancy combined with elective early induction of labor reduces the rate of cesarean delivery and fetal birth trauma. We used a population-based longitudinal design covering three periods corresponding to changes in the management protocol for diabetic pregnancy at our center: 1) 1980-1989: no set level of maternal glycemia, elective cesarean section when estimated fetal weight was 4,500 g or more, and no elective early induction; 2) 1990-1992: desired mean maternal glycemia < or = 5.8 mmol/l, elective cesarean section when estimated fetal weight was 4,000 g or more, and elective early induction at 40 weeks for large-for-gestational-age fetuses; 3) 1993-1995: desired mean maternal glycemia < or = 5.3 mmol/l, elective cesarean section when estimated fetal weight was 4,000 g or more, and elective early induction at 38 weeks for large-for-gestational-age fetuses. Outcome of diabetic pregnancies was compared for the three periods, relative to that of the normal population. There was a gradual, constant, and significant decline in the incidence of macrosomia (17.9, 14.9, and 8.8%, respectively; P < 0.05) and large-for-gestational-age fetuses (23.6, 21.0, and 11.7%; P < 0.05) coupled with a gradual, nonsignificant decrease in cesarean deliveries (20.6, 18.4, and 16.2%) and in cases of shoulder dystocia (1.5, 1.2, and 0.6%), to rates close to those of the normal population. Our data show that maintaining strict control of maternal diabetes and adhering to an active management protocol for early elective delivery based on the estimated fetal weight have a significant effect on reducing the rate of macrosomia, thereby affecting the incidence of both traumatic births and cesarean deliveries.

Blood Glucose↗
PubMed1997

Prenatal sonographic findings in 187 fetuses with Down syndrome.

We determined the type and frequency of abnormal sonographic findings in 187 Down syndrome fetuses. Examinations were performed transvaginally or transabdominally between 9 and 28 weeks' gestation. Consecutive scans performed prior to knowledge of the fetal karyotype (n = 144) were analysed separately for one of the participating centres. In 93 fetuses (49.7 per cent), a total of 138 abnormalities were observed. The most commonly detected anomalies were cystic hygroma and increased nuchal fold thickness (30.5 per cent), hydrops (9.6 per cent), cardiac defects (7.5 per cent), pyelectasis or hydronephrosis (5.9 per cent), echogenic bowel (4.8 per cent), and a large variety of internal organ abnormalities (16.0 per cent) which are not typically associated with Down syndrome. Two anomalies or three anomalies in the same fetus were observed in 21 and 5 fetuses, respectively. No patterns of concurrent malformations were apparent among these fetuses. Sensitivity for Down syndrome detection by ultrasound scans performed without knowledge of the fetal karyotype was 24.1 and 42.6 per cent before 13 weeks and between 14 and 23 weeks, respectively. We conclude that structural abnormalities are frequently observed in Down syndrome fetuses, but many sonographic findings are not typically associated with this syndrome.

Abdomen↗
PubMed1997

Activated protein C resistance and adverse pregnancy outcome.

OBJECTIVE: Activated protein C resistance is a genetic disorder that predisposes to thrombosis. Hyperestrogenism strongly increases the risk of thrombosis in affected individuals. Other thrombophilic disorders, such as the antiphospholipid antibody syndrome, have been associated with adverse pregnancy outcome, probably mediated by abnormal clotting in the placental circulation. The purpose of this series is to present clinical and laboratory data on individuals with a poor obstetric history and activated protein C resistance. STUDY DESIGN: Within an 18-month period seven patients with more than five early pregnancy losses, recurrent intrauterine fetal deaths, intrauterine growth restriction, and early severe preeclampsia in association with activated protein C resistance came to our attention. The initial diagnosis was made by activated protein C ratios, and molecular diagnoses of activated protein C resistance genotypes were made by polymerase chain reaction for the factor V Leiden mutation. All patients had an extensive diagnostic workup for known etiologies of the above complications and other thrombophilic disorders. RESULTS: All patients had activated protein C ratios <1.7. Six patients were heterozygous for the Leiden mutation, and one patient was homozygous. A personal or family history of thromboembolism was present in one case and three cases, respectively. The diagnostic workup was otherwise unrevealing. One newborn was diagnosed of bilateral renal vein thrombosis on day 1 of life. CONCLUSIONS: Activated protein C resistance was found in association with extremely poor obstetric outcomes. A family or personal history of thromboembolism was suggestive in many cases. A population-based study is needed to determine the role of activated protein C resistance in adverse pregnancy outcome.

Adult↗
PubMed1997

Morphology and clinical outcomes of embryos after in vitro fertilization are superior to those after intracytoplasmic sperm injection.

OBJECTIVE: To compare embryos obtained after IVF and intracytoplasmic sperm injection (ICSI) regarding morphology and the likelihood of achieving clinical pregnancy. DESIGN: Case-control study. SETTING: An IVF unit controlling 1,310 cycles in 1996. PATIENT(S): Women having a total of 477 IVF and 475 ICSI consecutive cycles. INTERVENTION(S): Ovarian stimulation, IVF-ET, or ICSI-ET for all couples. MAIN OUTCOME MEASURE(S): Number of grade-A embryos transferred, preclinical pregnancy losses, and clinical pregnancy rates in IVF and ICSI cycles. RESULT(S): In comparison with the ICSI group, the IVF group showed significantly more grade-A embryos available for transfer (mean, 2 +/- 1.6 versus 1.8 +/- 1.5), significantly fewer preclinical pregnancy losses (1.6% versus 4%), and significantly higher clinical pregnancy rates (25% versus 19.1%). CONCLUSION(S): Embryos obtained after IVF are superior to those obtained after ICSI in relation to embryo morphology and the likelihood of achieving clinical pregnancy.

Adult↗
PubMed1997

Fetal transcerebellar diameter in Down syndrome.

OBJECTIVE: To determine whether cerebellar hypoplasia in Down syndrome is established and clinically recognizable in the second trimester of pregnancy and to evaluate the screening utility of transverse cerebellar diameter measurements for Down syndrome fetuses. METHODS: Ultrasonographic biometry data obtained before genetic amniocenteses on 42 fetuses with Down syndrome and 1161 karyotypically normal fetuses were analyzed. Mean transverse cerebellar diameters stratified by gestational age were compared. A regression equation relating transverse cerebellar diameters to gestational age was calculated for 387 normal fetuses and applied to the remaining normal (n = 774) and all Down syndrome fetuses. Ratios of observed to expected cerebellar diameters were calculated. Sensitivity, specificity, and positive predictive values were calculated for various cutoff points and Down syndrome prevalences. RESULTS: Cerebellar diameters in Down syndrome fetuses were smaller than in normal controls at all gestational ages (P < .005) by an average of 0.67-0.87 mm. A ratio of 0.92 for observed/expected cerebellar diameters yielded a sensitivity of 21%, specificity of 95%, and positive predictive values of 1.66% and 0.56% in populations with a risk for Down syndrome of one in 250 and one in 750, respectively. CONCLUSIONS: Cerebellar hypoplasia is developmentally established and sonographically recognizable in second-trimester Down syndrome fetuses. However, cerebellar size differences between normal and Down syndrome fetuses are too small to be clinically useful.

Anthropometry↗
PubMed1997

A new concept of cotreatment with human growth hormone and menotropins in ovulation induction protocols.

Follicular development in the primordial and preantral stages is almost completely independent of gonadotrophins or steroids and is mainly dependent on growth factors and local regulators. Since human growth hormone (hGH) was found to facilitate ovarian response to gonadotrophin stimulation, we hypothesized that the administration of hGH in an hypogonadotrophic state and prior to ovarian stimulation with menotropins, may initiate or facilitate the propagation of the primordial and preantral follicles to the gonadotrophin-dependent stages. We suggest that treatment with hGH prior to menotropin administration may be useful to improve results for poor responders to gonadotrophins.

Clinical Protocols↗
PubMed1997

Possible sex-correlated transmission of maternal class I HLA haplotypes.

Forty-seven alleles of class I HLA-AB loci (14 for locus A and 33 for locus B) were identified in 787 participants in two groups of unrelated families. Group I included parents and children typed for bone marrow transplantation. Group II included families typed for renal transplantation. Before statistical evaluation, the A locus alleles were grouped into eight classes according to broad specificity, and the B locus alleles were grouped according to HLA epitopes into two classes. Significant differences in HLA-AB haplotype frequencies were found between male and female offspring. When families with children of both sexes were analysed, the frequencies of maternally inherited HLA-AB haplotypes were found to be significantly different in brothers and sisters. The results suggest the possibility that the transmission of specific AB haplotypes from mother to offspring may be correlated to children's sex. The major histocompatibility complex has been shown to be involved in the expression of H-Y male-specific minor histocompatibility antigens. The possible selection in the transmission of specific maternal HLA-AB haplotypes to male offspring may contribute to the avoidance of maternal cytotoxic reactions toward the male foetus.

Adult↗
PubMed1997

Ovarian cysts and cyclic hormone replacement therapy: is there an association?

OBJECTIVES: To evaluate whether there may be an association between postmenopausal ovarian cysts and hormone replacement therapy. METHODS: The study comprised 564 consecutive, asymptomatic, postmenopausal women who were referred for routine, transvaginal ultrasound examinations between January 1 and December 31, 1995. Various demographic and ultrasonographic parameters were recorded on a prospectively-created, computerized data base. RESULTS: There was no difference in the prevalence of ovarian cysts with or without hormone replacement therapy (10.5% vs. 12.5%, respectively). However, in the subgroup of early postmenopausal women (40-55 years), the use of hormone replacement therapy was associated with a significantly reduced prevalence of ovarian cysts (10.4% vs. 28.6%; p < 0.05). CONCLUSIONS: Hormone replacement therapy is associated with a reduced prevalence of ovarian cysts in early postmenopause.

Analysis of Variance↗
PubMed1997

Interleukin-2 production by human pre-implantation embryos.

The study was conducted to determine whether pre-implantation embryos secrete interleukin-2. Conditioned media of 27 embryos derived from women during in vitro fertilization (IVF) cycles were analyzed for interleukin-2 concentration. The results showed that conditioned embryo medium from the two pronuclei stage to 24 hours later contains interleukin-2. Endometrial large granular lymphocytes, which are probably involved in placentation, replicate in response to interleukin-2. It may therefore be speculated that interleukin-2 secreted by human embryos may modulate the function and replication of large granular lymphocytes.

Blastocyst↗
PubMed1997

Caution: prenatal clubfoot can be both a transient and a late-onset phenomenon.

Clubfoot (talipes equinovarus) is a common orthopaedic malformation that can be accurately diagnosed prenatally. The study was conducted to investigate possible in utero visualization of transient and late-onset clubfoot. Early (13-16 weeks' gestation) prenatal transvaginal sonographic diagnosis of clubfoot deformity was made in 36 cases during the study period. Only those cases where follow-up examination revealed different sonographic findings were considered. The results showed that seven cases of transient (as well as relapsing) clubfoot were identified. In 4 of 7 cases, the clubfoot resolved (all after more than 10 min of observation) during the same examination. In the fifth and sixth cases, it initially resolved, later reappearing in follow-up examinations (20 and 22 weeks' gestation). In the seventh case, the clubfoot persisted for two consecutive examinations (2 weeks apart each) and later disappeared. In addition, six late-onset (22-24 weeks' gestation) clubfoot cases were identified during the study period. Although infrequent, in utero clubfoot can be both a transient and a late-onset phenomenon. Over- and under-diagnosis are potential hazards in these situations.

Clubfoot↗
PubMed1996

[Surgical treatment of extrauterine pregnancy: end of the era of laparotomy?].

Ectopic pregnancies can now be recognized very early, and in most cases, before the appearance of dramatic symptoms. This can be attributed mainly to improved diagnostic methods, such as endovaginal sonography and serial determinations of human, chorionic gonadotropin and progesterone. For this reason, extrauterine pregnancies can currently be treated by several methods, and emergency laparotomy is seldom indicated. Advances in treatment modalities, including tubal-conserving operations, laparoscopic approaches, medical treatment with methotrexate, and expectant management have all been proved to be safe and effective. Between January 1994 and June 1995, 166 patients were treated surgically for extrauterine pregnancy. Of these, 94.6% were treated by laparoscopy; laparotomy was required in only 9 (5.4%). Fecundity rates after laparoscopic treatment for ectopic pregnancy are comparable, if not better, than in those treated by laparotomy. Laparoscopic surgery offers advantages, such as reduction in operating time and shorter hospital stay and convalescence, as compared to conventional abdominal surgery. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be performed safely by laparoscopy.

Female↗