Dan Peleg

Early diagnosis and successful nonsurgical treatment of viable combined intrauterine and cervical pregnancy

Cervical pregnancy is a rare form of EP often resulting in an obstetric catastrophe. We report a case of a combined viable IUP and cervical pregnancy resulting from IVF-ET treatment and which was diagnosed during the 7th week of gestation. Nonsurgical treatment consisting of selective intra-arterial catheterization and administration of MTX directly into the uterine arteries was carried out successfully. Complications were avoided, and the patients reproductive capability was preserved.

Sexual function, pregnancy and delivery in spinal cord injured women.

Complete spinal cord injury results in abolition of motor, sensory and autonomic functions. Among the autonomic functions, the sexual system is seriously disturbed. The spinal cord injury with its many complications offers a challenge to the rehabilitation team, and the sexual problem is one of its most important aspects. For the female paraplegic, rehabilitation of sexual functions is an essential part in the building of a positive new self-image. In this review, we try to summarize the gynecological and obstetrical aspects of spinal cord injured women. Although the innervation of the reproductive system is damaged, this system continues to function and the menstrual cycle resumes its normal course after a while. Ovulation takes place regularly and pregnancy is possible. Today the general opinion is that the pregnant paralyzed woman can deliver vaginally and not by cesarean section as was believed before. We emphasize the importance of special medical care before, during and after delivery. The cooperation between physiatrist and gynecologist is mandatory.

Fetal deglutition: a study of the anencephalic fetus

The deglutition of amniotic fluid in utero by the anencephalic fetus is a controversial subject. We have studied 7 anencephalic pregnancies complicated by hydramnion in their third trimester of gestation. Fetographies revealed that 6 out of 7 anencephalic monsters showed signs of swallowing of the contrast material after only 3 h. The baby which was born dead could not swallow at all. The fact that the babies studied swallowed amniotic fluid shortly after injection of contrast media seems to confirm the opinion that fetal deglutition contributes only little to the mechanism of amniotic fluid volume regulation.

Partner's presence during initiation of epidural labor analgesia does not decrease maternal stress: a prospective randomized controlled trial.

BACKGROUND: Epidural analgesia reduces pain and anxiety during childbirth. In this randomized controlled trial, we sought to determine whether partner presence during the initiation of epidural analgesia reduces stress of both the mother and her partner and their perception of maternal pain. METHODS: Healthy, nulliparous women who were accompanied by their partners and requested neuraxial analgesia were enrolled into the study. The study took place in the Labor and Delivery Unit of a large tertiary hospital in Israel. Upon request for epidural analgesia, both partners were assessed for baseline anxiety (numerical rating scale, 0 to 10), systolic blood pressure, heart rate, estimated contraction pain of parturient (verbal rating scale for pain, 0 to 10), and salivary amylase. After measurements, couples were randomized into 1 of 2 groups: “partner in” and “partner out.” Immediately after epidural catheter insertion, anxiety, arterial blood pressure, heart rate, and salivary amylase were measured again in both partners. Both partners were asked to complete the State Anxiety Inventory questionnaire measuring current anxiety. The parturient was asked to rate the pain of epidural catheter insertion. The primary outcome measurement was parturient and partner anxiety as assessed by the numerical rating scale. RESULTS: Eighty-four couples were randomized (partner in 41, partner out 42, protocol violation 1). At baseline there was no difference in self-reported anxiety of parturients between the partner-in and partner-out groups (median interquartile range 7.5 [6.0 to 9.0] versus 7.0 [3.5 to 8.5]; P = 0.26, difference in medians = −1.0; 95% confidence interval [CI] of difference −2.0 to 1.0). After epidural catheter insertion, parturients in the partner-in group had a higher level of anxiety than those in the partner-out group (8.0 [7.0 to 10.0] versus 7.0 [5.0 to 9.0]; P = 0.03, difference in medians −1.0; 95% CI of difference −2.0 to 0.0). Pain scores during epidural catheter placement were higher in partner-in than in partner-out groups (7.0 [4.0 to 8.0] versus 4.0 [3.0 to 6.0]; P = 0.004, difference in medians = −2.0; 95% CI of difference −3.0 to −1.0). CONCLUSION: Partner presence during epidural catheter insertion for labor analgesia did not decrease anxiety levels. To the contrary, anxiety and pain of epidural catheter placement were greater if the partner remained in the room.

Holoacardius: radiologic investigation

A case of holoacardius is presented from a monozygotic twin pregnancy of 20 weeks, in which the other twin was normal. The classification is reviewed. While the physiology and anatomy of these malformations are known, the etiology remains obscure. Theories of etiology may be divided in two groups: that the primary deficiency is a failure of the parts to develop; and the belief that the acardius is due to an abnormal vascular communication with secondary atrophy of the formed parts. The abnormal twin in the case studied was diagnosed by ultrasound prenatally and investigated radiologically post-mortem.

Massive Extraperitoneal Bleeding—A Rare Complication of Amniocentesis

Amniocentesis is a widely used procedure, infrequently associated with complications. A patient in the 16th week of pregnancy is described, in whom amniocentesis for the purpose of genetic counselling was complicated by severe extraperitoneal bleeding into the abdominal wall, necessitating the surgical evacuation of a large hematoma. The bleeding most probably resulted from the accidental puncture of the right deep epigastric artery.

Ovarian vascular accidents: a complication of anticoagulant therapy

Ovarian vascular accidents are usually more severe when the patient is being kept on anticoagulant therapy following cardiac surgery or for other reasons. 4 cases of massive hemoperitoneum are reported. Rupture of the corpus luteum and corpus luteum cyst and an ovarian ectopic pregnancy were responsible for massive hemoperitoneum. All 4 patients survived and recovered.

The assessment of lung maturity in infants of diabetic mothers, by means of L/S ratio determination in tracheo-pharyngeal aspirate

The respiratory distress syndrome is more common in the newborns of diabetic mothers. The comparatively high rate of incidence of this syndrome depends neither on gestational age nor delivery route. In view of these facts, the evaluation of fetal lung maturation of diabetic mothers seems to be of the utmost importance. The methods usually employed for the determination of fetal lung maturation are of limited value, because occasionally L/S ratio values, which usually indicate fetal lung maturation, may fall to below critical levels. It is, therefore, extremely important to assess lung maturity in the newborn of a diabetic mother at the time of delivery. In 15 pregnancies complicated by diabetes mellitus of all degrees of severity (A-D), according to the classification of P. WHITE, L/S ratio in amniotic fluid prior to delivery was determined. L/S ratio was determined in tracheopharyngeal aspirate, as well, soon after delivery. In all cases the foam stability test was done in the amniotic fluid before delivery and, when there was a sufficient quantity, also in the tracheo-pharyngeal aspirate. According to the foam test and L/S ratio in the amniotic fluid, all fetuses supposedly had normally matured lungs. Nevertheless, according to these two tests in the tracheopharyngeal aspirate, results indicate lack of full lung maturity in four cases. In fact, all these four newborns developed the respiratory distress syndrome. This test appears to be reliable, simple and non-invasive, and is therefore recommended in babies with diabetes of all degrees of severity, and in all gestational ages.

Arteriography and chemotherapy in localized trophoblastic disease, by means of local- (pelvic-) intraarterial infusion.

Abstract. In spite of considerable progress in systemic chemotherapy in malignant throphoblastic disease, there remains a small group of patients who fail to respond to this type of therapy. Here the trophoblastic process may be localized by means of an arteriography, and treated by a local, intraarterial infusion of cytotoxic compounds in high concentration. The latter makes possible the treatment of processes localized in essential organs which are hard to remove, as well as in young women wishing to preserve their reproductive capacity.

Role of Fetal Adrenal Glands

The role of fetal adrenals in the maturation of fetal lungs is not clear as yet. The anencephalic baby, with rudimentary adrenal glands, may be considered an excellent model for the study of this subject. The maturation of fetal lungs was determined in 3 anencephalic monsters and in 2 microencephalic babies. As a measure of fetal pulmonary maturation the foam test and lecithin/sphingomyelin ratio (L/S) were used, as determined in the amniotic fluid. In the anencephalic babies, fetal pulmonary maturation was lacking, while in the microencephalic infants there were definite signs of lung maturation.