Avi Tsafrir

Rudimentary horn pregnancy: First-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging

Two cases of rudimentary horn pregnancy diagnosed in the first trimester by sonography and confirmed by magnetic resonance imaging (MRI) are reported. We suggest criteria for early, prerupture sonographic diagnosis of this rare condition.

Prognostic parameters for successful external cephalic version

Objective. To improve patient consultation before external cephalic version (ECV) attempt at term by defining prognostic parameters for the success of the procedure. Methods. This was a prospective observational study set in a university teaching hospital. We prospectively collected demographic and obstetric data from 603 ECV attempts at our center for the period between January 1997 and June 2005. Analysis was performed by stepwise logistic regression of the demographic and obstetric parameters. The main outcome measure was success of ECV attempt. Results. Success rates were 72.3% and 46.1% for multiparas and nulliparas, respectively. Prognostic parameters associated with successful ECV were amniotic fluid index > 7 cm, multiparity, non-frank breech, non-anterior placental location, and body mass index < 25. Conclusion. Prognostic parameters, particularly amniotic fluid index and multiparity, can help physicians in counseling parturients before deciding on ECV.

Alloreactivity of umbilical cord blood mononuclear cells: specific hyporesponse to noninherited maternal antigens

Earlier studies noted that patients who underwent cord blood (CB) transplantation had a lower incidence of graft-versus-host disease (GVHD) than those who underwent bone marrow transplantation (BMT). The premise that the immune reactivity of CB mononuclear cells (CB-MNC) to HLA mismatched combinations and to noninherited maternal antigens (NIMA) may be one of the factors involved in this phenomenon is still debatable. In this study we have attempted to evaluate the alloresponse and alloreactivity induced by CB-MNC by means of the standard mixed lymphocyte reaction test (SMLR) and the more sensitive, modified mixed lymphocyte reaction test (MMLR). Both techniques were used to test CB-MNC (n = 28) against HLA class II mismatched MNC from mothers (n = 26), fathers (n = 12), and unrelated individuals (n = 60) who served as controls. Alloresponse capabilities and stimulation capacities of CB-MNC in the SMLR were similar to those of control MNC: relative response (RR) = 73 vs. 65 and 58 vs. 65, respectively. Similar results were obtained in the MMLR. CB-MNC responded weakly to the maternal MNC in comparison with control MNC (RR = 47 vs. 73 [p = 0.0099]), while a stronger response was noted to the paternal than the maternal MNC (RR = 72 vs. 47 [p = 0.045]). Our results demonstrate that CB-MNC both respond to and induce alloresponse in HLA mismatched combinations. Moreover, the hyporesponse of CB-MNC to maternal cells that we observed suggests a form of tolerance to NIMA, which is probably due to the fetuss exposure to these antigens in its intrauterine life.

Induction of labor in breech presentation

Objective: Induction of labor in breech presentation, although not contraindicated, has rarely been reported. We have undertaken to evaluate the safety and outcome of this practice in two Israeli institutions along with a literature review of this controversial subject. Method: The research design was a retrospective case control study covering the years: 1980–1999. We have studied 53 term (>37 weeks) breech deliveries induced for various medical and obstetrical reasons, in two major regional hospitals in Israel. Induction was performed with prostaglandin E2 for the unripe cervix and with oxytocin for induction or augmentation when the cervix was ripe. Six women were induced by nipple stimulation. Controls were 53 women with spontaneous labor in breech presentation that had a trial of vaginal delivery, and 54 women with breech presentation who delivered by elective cesarean section. Result: No significant difference in the various maternal and fetal outcomes was observed. CS rate was comparable in both study and control groups (34% vs. 32%) and two‐thirds gave birth vaginally. Conclusions: In properly selected and carefully managed cases of breech presentation, induction of labor seems a safe and reasonable option.

Ovarian stimulation for oocyte cryopreservation for prevention of age-related fertility loss: one in five is a low responder

Abstract Oocyte cryopreservation for age-related fertility loss is gaining interest considering the tendency to postpone motherhood in many societies. Little is currently known about the actual efficiency of this approach. We aimed to explore ovarian response of presumably fertile women undergoing in vitro fertilization for this indication. A total of 105 women underwent 151 stimulation cycles at mean age 37.7u2009±u20092.4. None had known infertility. Mean daily starting FSH dose was 371u2009±u2009110 (225–600). Mean number of mature oocytes cryopreserved at the first completed cycle was 9.7u2009±u20097.5 (0–43). However, 21% of started cycles were either cancelled before egg retrieval or resulted in 0–3 mature oocytes retrieved. Therefore, women considering oocyte cryopreservation for prevention of age-related fertility decline should be encouraged to perform this procedure at younger age than, preferably before 35.

Severe fetomaternal hemorrhage confirmed and quantified by flow cytometry using anti fetal hemoglobin antibodies

Severe fetomaternal hemorrhage (FMH) is a rare but potentially life-threatening perinatal complication (1). The traditional method for diagnosis of this situation is the acid elution (Kleihaur–Betke) test. However, this technique is relatively insensitive and non-specific, and does not allow quantification of the hemorrhagic process. We report a case of severe FMH confirmed and quantified by means of flow cytometric analysis using specific staining for cells containing fetal hemoglobin (HbF) in maternal circulation. We believe that this method is more sensitive, more specific and allows accurate quantification of FMH.