Alex Schoenfeld

Gestational diabetes mellitus. A survey of perinatal complications in the 1980s.

Neonatal morbidity was assessed in the offspring of 878 mothers with gestational diabetes mellitus (GDM), 132 mothers with pre-GDM, and 380 control subjects. Compared with the control group, the GDM group had a higher incidence of complications, including macrosomia, hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, and major congenital anomalies (P < 0.05). Although our GDM patients were stringently managed with diet or diet plus insulin, as indicated, and maintained almost euglycemic values, these neonatal complications could not be eliminated. Our data may be consistent with observations published during the last decade that even subtle degrees of maternal hyperglycemia can have a detrimental effect on perinatal outcome. Most neonatal complications readily respond to therapy if diagnosed and treated early and promptly. Macrosomia can have a detrimental effect on delivery (trauma) and later long-term implications during childhood. Tight metabolic control with diet and, when indicated, insulin treatment may be advantageous in reducing fetal birth weight. Criteria of how tight the metabolic control should be remain to be accurately defined.

NSAIDs: Maternal and Fetal Considerations

ABSTRACT: Nonsteroidal anti‐inflammatory drugs (NSAIDs) gained popularity in the late 1970s. Inhibition of prostaglandin synthesis with indomethacin has been reported to be effective for prevention of labor and for treatment for symptomatic polyhydramnios. Concern about its possible constrictive effect on the fetal ductus arteriosus has limited its use in pregnancy. Maternal indomethacin therapy has also been associated with reduction in urine production in the fetus and with oligohydramnios.

Incisional hernias after laparoscopy.

Laparoscopy, using a two-puncture technique, has been used for a variety of gynecologic indications for more than two decades. The procedure is considered safe and effective, although rare complications, such as incisional hernias, have been reported. In this review, the issue of postlaparoscopic incisional hernias is discussed in terms of incidence, predisposing factors, time of appearance, and preventive measures. With the evolvement of operative laparoscopy, larger trocars and cannulas have been introduced, increasing the incidence of postlaparoscopic incisional hernias. Awareness of the possibility of this complication will lead to the use of proper surgical techniques, as suggested, while knowledge of the postoperative signs and symptoms will lead to early diagnosis and prevention of sequelae.

Sonographic findings in the prenatal diagnosis of bladder exstrophy

A case of bladder exstrophy diagnosed in utero by ultrasonography is reported, and the specific sonographic features of this anomaly are presented. Early predelivery diagnosis led to prompt surgical intervention after birth with good neonatal outcome.

Placental ultrasonographic biochemical and histochemical studies in human fetuses affected with Niemann-Pick disease type A

Placental ultrasonographic, bio- and histochemical studies were performed on four unrelated fetuses affected with Niemann-Pick disease Type A, following prostaglandin-induced abortion at about the 19th week of gestation. An accumulation of sphingomyelin in the placentae of affected fetuses indicates the essential role of the enzyme sphingomyelinase, even during the early stages of gestation. A fair correlation between histochemical localization of sphingomyelin in the placentae and ultrasonographic findings was found, indicating the value of ultrasonic echo wave information in the diagnosis of metabolic disorders.

Three-dimensional modelling of tumor-induced ovarian angiogenesis

It is now well established that unrestricted growth of tumors is dependent upon angiogenesis. However, previous studies on tumor growth have not yet revealed how the transition to an angiogenetic state in ovarian malignancy is reflected in the vascular architecture of the ovary. We report here our preliminary observations based upon three-dimensional imaging of normal and tumor-induced ovarian angiogenesis created with a computer-assisted three-dimensional interactive application. The findings suggest that tumor-induced angiogenesis creates a bizarre vascular architecture, with a possible link to chaotic behavior.

Adverse reactions to antihypertensive drugs in pregnancy

In conclusion from a clinical pharmacological point of view it is stressed that side effects from antihypertensive therapy in part is related to dosage. Increased knowledge should make it possible to reduce the rate of side effects. In the individual case the physician always has to compare a number of factors: general condition of the patient, age, adherence to the prescribed therapy, side effects, and other factors in addition to blood pressure values. With all these limitations in mind there is agreement that the benefit of antihypertensive therapy far out-weigh the negative aspects of such treatment.

The impact ofd-Trp6 LH-RH on plasma lipid levels

AbstractBackground: There is increasing evidence regarding the correlation between the risk of death from cardiovascular disease and low levels of HDL-cholesterol or high plasma concentrations of LDL-cholesterol, total cholesterol, and triglycerides. Gonadotropin releasing hormone (GhRH) analogues are widely used in assisted reproduction programs. Therefore, it seems important to evaluate possible changes in serum lipoprotein levels following treatment with these compounds. Purpose: Our purpose was to assess possible lipoprotein changes following administration of the long-acting GnRH analogue,d-Trp6 luteinizing hormone-releasing hormone (LH-RH). Design: Serum levels of cholesterol, HDL-cholesterol, LDL-cholesterol, and triglicerydes were determined before and after 6 weeks of treatment. Results: No significant changes in either cholesterol or HDL-cholesterol, LDL-cholesterol, or triglicerydes following treatment withd-Trp6 LH-RH were demonstrated in the group of 25 patients investigated. Conclusions: Short-term use ofd-Trp6 LH-RH is not associated with any significant change in plasma lipid levels. Further studies are still required with patients undergoing repeated treatment cycles, especially those who exhibit elevated pretreatment plasma lipid levels, to confirm the long-term safety of GnRH analogues with respect to lipid metabolism.

Inadequate drug information for pregnant or lactating women: teratology information service follow-up

The assessment of the teratogenic risk of many drugs is very difficult or impossible because data are not available, and documentation is insufficient or based on minimal human information. The present study summarizes the outcome of newborns of women who took drugs during pregnancy and/or lactation without receiving adequate counselling. All calls received by the Beilinson Teratology Information Service during the last three years (1991-1993) were analyzed regarding the adequacy of the risk assessment process. These findings were compared to those for two control groups: women exposed to drugs with no known teratogenic effect, and women not exposed to drugs at all. We could not provide adequate counselling for 14 cases (in 1991), 17 (in 1992), and 14 (in 1993), or 6.6%, 4.8%, and 3%, respectively, of the total annual number of calls. The three groups studied proved to be similar in all maternal and neonatal characteristics, except for the number of abortions and prevalence of major congenital malformations which were higher in control group 1. The absence of data for a specific drug is disappointing and stressful for both the woman and her physician. The present small sample showed a good prognosis for the patients receiving inadequate counselling. These findings may provide some reassurance to the parents, but emphasize the need for caution and close monitoring of the fetus and newborn.

Vehicular Trauma in Pregnancy: An Algorithm for Diagnosis and Fetal Therapy

The incidence of motor vehicle accidents resulting in trauma in pregnant women is increasing. The best chance for fetal survival is to ensure maternal survival, so awareness of the types of injuries and their presentation after vehicular trauma is of the utmost importance. An algorithm for the approach to diagnosis and fetal therapy based upon obstetrics and trauma care parameters is hereby presented to the trauma team.