PubMed Health⌕ Search

Biomedical subjects

Z Hagay

Publications and source records attributed to Z Hagay.

At least 55 records · Page 3Linked to original sources
PubMed1995

Fetal Doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women.

OBJECTIVE: This study was undertaken to assess human fetal behavior and fetal blood flow after insulin-induced symptomatic maternal hypoglycemia of sufficient magnitude to elicit counterregulatory hormones and a symptomatic response. STUDY DESIGN: Plasma glucose was lowered from approximately 95 mg/dl to 45 mg/dl in decrements of 10 mg/dl every 40 minutes with the insulin clamp technique. In 10 insulin-dependent diabetic women in the third trimester, the fetus was studied by monitoring fetal heart rate and recording fetal body and breathing movements and by performing Doppler waveform analysis with real-time ultrasonography. Maternal levels of glucagon, cortisol, epinephrine, and growth hormone were measured at each plasma glucose level. RESULTS: The mean number of fetal limb and body movements at the start of the study was 25 +/- 16 per 15 minutes, which increased to a mean of 38 +/- 28 at a glucose level of 60 mg/dl and then declined to a mean of 23 +/- 10 at a glucose level of approximately 45 mg/dl. These changes, however, did not achieve statistical significance. In addition, no significant reductions in fetal breathing movements or heart rate were observed, although maternal epinephrine and growth hormone levels were significantly (p < 0.001) increased. No consistent changes in Doppler velocity waveforms were observed. CONCLUSION: These data suggest that fetal well-being remains unaltered in spite of moderate maternal hypoglycemia in diabetic women.

Blood Glucose↗
PubMed1995

Shoulder dystocia: could it be deduced from the labor partogram?

The study was undertaken to test the hypothesis that shoulder dystocia might be suspected and reliably identified from the labor partogram. A retrospective analysis of 52 consecutive patients with shoulder dystocia was performed. The 52 controls were the next consecutive parturient matched for maternal age, gestational age at delivery, parity, presentation, and infants weight at delivery. The mean dilation rate was 2.1 +/- 1.9 cm/hr in shoulder dystocia group compared to 2.4 +/- 1.5 cm/hr in the control group. The incidence of protracted rate of less than 1 cm/hr was 14.3% in shoulder dystocia group and 13.5% in the control group. The mean duration of second stage was 38.3 +/- 30.7 minutes in the shoulder dystocia group compared to 35.5 +/- 32.5 minutes in the control group. Only 1.9% have had a prolonged second stage (more than 2 hours) in the shoulder dystocia group compared to 1.9% in the control group. The difference between the groups regarding the length of labor was not statistically significant. We conclude that protracted labor does not seem to be a risk factor for shoulder dystocia.

Adult↗
PubMed1995

Severe maternal and fetal electrolyte imbalance in pregnancy after gastric surgery for morbid obesity. A case report.

BACKGROUND: Gastric surgery for morbid obesity is considered a safe procedure with favorable effects on reproductive performance. Pregnancies after gastric restrictive operations are usually well tolerated by both mother and fetus. Some postoperative complications, however, do occur, although an association between such complications and adverse pregnancy outcomes has not been reported. CASE: A 40-year-old woman had a successful gastric operation for weight reduction but developed chronic, low grade gastro-intestinal obstruction as a late complication of surgery. Subsequent pregnancies ended in late abortion or premature delivery. During her last pregnancy, reported here in detail, severe and life-threatening fetomaternal electrolyte imbalances developed. CONCLUSION: Pregnancy following a gastric operation for morbid obesity may be complicated by severe metabolic disturbances that can jeopardize both the pregnant woman and her fetus. These pregnancy complications, which are related to the primary gastric surgery, are reported here for the first time.

Adult↗
PubMed1994

The ABC of shoulder dystocia management.

In this retrospective study we analyzed our experience in management of 76 consecutive cases of shoulder dystocia. In most cases (N = 67, 88.2%) McRoberts' maneuver was sufficient in order to deliver the impacted shoulders. In 2 cases (2.6%) in addition to McRoberts' maneuver suprapubic pressure was applied. In 7 cases (9.2%) Woods' maneuver was performed after the McRoberts' maneuver and the suprapubic pressure. Based on our experience and upon careful review of the literature we propose the optimal "ABC" for the management of shoulder dystocia. It includes A) McRoberts' maneuver, B) Suprapubic pressure, C) Woods' maneuver, D) Delivery of posterior arm. We emphasize that the shoulder dystocia situation is a major emergency in obstetrics and that its management requires prompt resuscitation of the fetus during the process of its delivery.

Dystocia↗
PubMed1994

Diabetes mellitus in pregnancy and the assessment of umbilical artery waveforms using pulsed Doppler ultrasonography.

The utility of Doppler ultrasonography as a means of assessing potential alterations of vascular resistance prior to fetal or maternal compromise is very attractive. We investigated this relationship by prospectively performing Doppler studies of the fetal umbilical artery in 56 diabetic patients, 14 of whom had varying degrees of vascular complications. When regression curves were established for the S/D ratio, the Pourcelot index, and the resistance index of the fetal umbilical artery, the mean Doppler values were higher in diabetic patients with vasculopathy than in nondiabetic control patients or in diabetic patients without vasculopathy. The third trimester S/D ratio was greater than 3.0 in almost 50% of patients with vasculopathy. A tendency toward adverse outcomes was observed at S/D ratios approaching 4.0. Statistically significant correlations were found between elevated Doppler indices and maternal vasculopathy associated with hypertension and worsening renal insufficiency. Intrauterine growth retardation and neonatal metabolic complications were also significantly correlated with elevated Doppler indices. There was, however, no correlation between Doppler indices and glucose values, although most were within a euglycemic range. The aforementioned data indicate an increased resistance circuit among diabetics with vasculopathy, which may reflect a relative reduction in basal uteroplacental blood flow and the need for cautious interpretation of Doppler indices in these patients.

Adult↗
PubMed1993

Successful delivery following myocardial ischemia during the second trimester of pregnancy.

Acute myocardial infarction during pregnancy is considered to be associated with approximately 50% mortality of both mother and fetus. However, there are not enough data regarding the role of acute myocardial ischemia. We present a 36-year-old, pregnant, white female who was admitted twice at 18 and 20 weeks of gestation with acute myocardial ischemia. Cardiac catheterization revealed 70-80% stenosis of the mid left anterior descending artery (LAD) with normal antegrade flow and very good retrograde filling of the LAD from distal collaterals of the right coronary artery. Therefore, due to angiographic suggestion of protected LAD territory, we recommended medical therapy and scheduled a vaginal delivery that was successfully completed without cardiovascular complications. A stress thallium test performed 6 months later was normal, supporting our clinical judgment. In conclusion, every case of a pregnant woman with coronary insufficiency should be treated according to individual coronary anatomy and blood supply to the territory of the diseased artery, and should not be based on the old data in the literature. The decision for revascularization prior to delivery versus medical therapy, or Caesarean section versus natural delivery, should be made by a team of a cardiologist and an obstetrician.

Acute Disease↗
PubMed1993

The possible role of intravenous immunoglobulin in preventing pre-eclampsia.

Our understanding of the pathophysiologic abnormalities contributing to pre-eclampsia has increased substantially over the past decade. This has been accompanied by the introduction of various methods which reduce the incidence of pre-eclampsia to approximately the same range (4-11.8% in high risk group), by attempting to correct the pathophysiologic abnormalities involved, rather than averting its occurrence. Numerous reports suggest that pre-eclampsia is caused by an abnormal maternal immune response to antigenic challenge by the fetoplacental allograft. If this assumption is true, it may be possible to manipulate the maternal immune response to fetal allograft and to assist the immunologic homeostasis of the maternal host with her conceptus by passive immunization with intravenous immunoglobulins (IVIg) and thus, to prevent pre-eclampsia. Recently IV preparations of Ig have become available for clinical use including treatment of various immunologic disorders during pregnancy. The effectiveness of this new mode of therapy can be related to several immunological mechanisms such as blockade of antibody binding to receptors on macrophages, increase in T suppressor cells, or decrease in antibody synthesis. The latter effect may be mediated by anti-idiotypic antibodies in the Ig preparation, which may bind to idiotypes on pathogenic autoantibodies and neutralise their activity.

Animals↗
PubMed1993

Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy?

A fiber-enriched diabetic diet that contained a modest increase in dietary fiber and a commercially available fiber supplement was studied in pregnant diabetic women for its potential glucose-lowering effects. Noninsulin-requiring gestational diabetic patients were placed on a fiber-enriched diet of increasing fiber content starting with 40 gm and eventually achieving a maximum tolerable dose of 80 gm of fiber per day. Initial pilot study demonstrated that patients could not tolerate more than 40 gm of fiber-rich food. Therefore additional fiber was administered via commercially available high-fiber drink. Satisfactory patient acceptance and compliance were achieved using this method. The response curve was flat with no lowering of blood glucose with increasing dietary fiber content. Furthermore, when the group receiving the moderate-fiber dose (40 to 60 gm), the high-fiber dose (70 to 80 gm), and a third group on an American Diabetes Association recommended diet (20 gm or less of fiber) were compared, no significant difference was observed in the mean blood glucose and postprandial glucose levels. This pilot study demonstrates that high-fiber diets, although better tolerated by patients when administered in divided amounts, are not associated with a concomitant lowering of blood glucose levels in pregnant diabetic patients.

Blood Glucose↗
PubMed1993

Isolated fetal pleural effusion: a prenatal management dilemma.

OBJECTIVE: To determine the etiology, pregnancy complications, and outcome of isolated fetal pleural effusion diagnosed antenatally and to evaluate the benefits of prenatal fetal interventions. DATA SOURCES: A literature search of MEDLINE was performed for relevant English language publications between 1985-1991. In addition, reference lists of articles were used to identify reported cases of isolated fetal pleural effusion. METHODS OF STUDY SELECTION: Our search uncovered 31 papers published in peer review journals. From these reports, 82 cases met our selection criteria: All fetuses were diagnosed antenatally with pleural effusion and had no other signs of hydrops at initial diagnosis. DATA EXTRACTION AND SYNTHESIS: The etiology of isolated fetal pleural effusion was unknown in most cases. Possible causes included congenital chylothorax, goiter, lung tumors, and infection. Cardiac defects (4.9%), Down syndrome (4.9%), and polydactyly (1.2%) may be associated with isolated fetal pleural effusion. Perinatal mortality was high (36%) and was related to the development of nonimmune hydrops, prematurity, and pulmonary hypoplasia. Early gestational age at diagnosis of isolated fetal pleural effusion (32 weeks or less) was associated with poor outcome and a neonatal death rate of 55%. In contrast, the neonatal death rate approached 31% as gestational age at diagnosis exceeded 32 weeks. Fifty-four cases were managed conservatively whereas 24 received intrauterine intervention, which included either pleuroamniotic shunt or repeated thoracenteses. Neonatal death rates were 37 and 33%, respectively. CONCLUSION: Not enough data exist to support either the conservative approach or intrauterine pleural drainage in cases of isolated fetal pleural effusion diagnosed antenatally.

Female↗