Daniel Weinstein

Expression of the imprinted H19 oncofetal RNA in epithelial ovarian cancer

STUDYnTo examine the expression of the imprinted maternally expressed H19 gene in benign, low malignant potential (borderline) and malignant surface epithelial ovarian tumors.nnnDESIGNnIn situ hybridization for H19 RNA using S-labeled and digoxigenin-labeled probes was performed on paraffin sections of ovarian surface epithelial tumors. The serous tumors included nine section cystadenomas, twelve serous tumors of low malignant potential and twenty serous carcinomas, grade I-IIII (FIGO classification). A smaller group included two mucinous cystadenomas, four mucinous tumors of low malignant potential and two mucinous cystadenocarcinomas.nnnRESULTSnH19 expression was found to be positive in 6/9 (67%) serous cystadenomas, 9/12 (75%) of serous tumors of low malignant potential and 13/20 (65%) of invasive serous carcinomas. Expression in mucinous tumors was confined to the stroma beneath the epithelial lining.nnnCONCLUSIONnH19 is expressed in the majority of serous epithelial tumors. Taking into consideration the high percentage of H19 expressing serous ovarian neoplasms we suggest that H19 RNA may be used as an adjuvant tumor marker for the diagnosis and mainly for staging and follow-up of patients with serous ovarian carcinoma.

Indomethacin for preterm labor: a randomized comparison of vaginal and rectal-oral routes

Objective To compare the efficacy of intravaginal and intra-rectal plus oral indomethacin for the treatment of preterm labor. Methods Between December 1996 and November 1998, 46 eligible gravidas admitted with singleton pregnancies and idiopathic preterm labor before 33 gestational weeks were randomized to receive 200 mg of intravaginal or intrarectal plus oral indomethacin. Results Twenty-three subjects were allocated to each study group. The interval from initiation of treatment to delivery was significantly longer in the intravaginal indomethacin group (26.5 ± 5.7 versus 12.6 ± 3.7 days; P = .007). Delivery was delayed by more than 7 days in 18 of 23 subjects (78%) in the intravaginal indomethacin group compared with ten (43%) in the intrarectal plus oral indomethacin group (P = .03). Birth weights were significantly higher (2306 ± 436 versus 1862 ± 232 g; P = .002) and hospitalization in a neonatal intensive care unit (NICU) (3.1 ± 0.8 versus 9.3 ± 3.7 days; P = .001) and mechanical ventilation (1.4 ± 0.2 versus 5.3 ± 1.6 days; P = .001) were significantly shorter in the intravaginal indomethacin group. Conclusion Intravaginal indomethacin is more effective than intrarectal plus oral application in delaying preterm labor and is associated with higher birth weights, shorter NICU stays, and shorter intervals of mechanical ventilation.

Effect of epidural analgesia on duration and outcome of induced labor

Objective: To evaluate the effect of epidural block on the duration of labor and maternal and fetal outcome in induced‐labor patients. Method: 210 women admitted for induction of labor at a level III university hospital, during the year 1991, were studied. Of these, 112 were given an epidural block and 98 served as controls. Outcome measures studied were: induction time and time in labor, c‐section and instrumental delivery rates, intra‐partum and post‐partum complications, and Apgar scores at 1 and 5 min. Result: Multiple regression analysis revealed that epidural analgesia, before and after adjustment for confounding factors, significantly prolonged labor time (P < 0.0001) and was associated with an increase in instrumental delivery rates (P < 0.04). A significant reduction in intra‐partum complication rate (FHR changes, meconium) was observed (OR = 0.32; P < 0.03), while c‐section rate and Apgar scores were not found to be influenced by epidural analgesia. Conclusion: Epidural anesthesia, significantly prolongs labor time in induced patients. While instrumental delivery was more prevalent in these parturients, c‐section rate was not increased and intra‐partum complications were significantly reduced in these patients.

Vaginal birth after cesarean section: current opinion

Although the current literature attests to the merits of a trial of labor in the patient with a prior cesarean section, some controversies remain. For example, can women with two or more sections be allowed a trial of labor and can patients who undergo a trial of labor receive oxytocin or prostaglandins for induction? Also, do certain indications for previous cesarean section such as relative cephalo‐pelvic disproportion/failure to progress or the diagnosis of breech or twins in the present pregnancy constitute an indication for elective repeat cesarean delivery? These questions along with some other controversies are discussed in the light of newly accumulated data in the English literature and our own experience over the last decade in a major university‐based tertiary medical center.

Intrapartum fetal pulse oximetry: present and future

Pulse oximetry is widely used to monitor the patients well‐being in anesthetic and neonatal practice. As a result of recent technologic and theoretical advances, it has emerged as a clinical tool in intrapartum fetal monitoring. Oximeters record both pulse rate and arterial oxygen saturation of the fetus and they may be adapted to derive an estimate of peripheral perfusion. Reflectance oximetry is more accurate than transmission oximetry in intrapartum fetal management. This method uses the pulsatile changes of red and infrared light reflected from tissue to estimate arterial oxygenation. Pulse oximetry is cheap, non‐invasive, simple to operate, relatively accurate and has a fast response time. Factors adversely affecting the accuracy of the pulse oximeter output include transducer displacement, peripheral vasoconstriction, hypotension, anemia, presence of intravascular dyes, meconium staining, fetal hair and scalp edema. Fetal pulse oximetry is limited by a wide normal range and inadequate calibration. The amniochorionic membranes however do not affect oximetry readings so that this method may be applied before rupture of the membranes, i.e. before labor. Once successfully developed, fetal pulse oximetry could potentially be used in combination with other monitoring techniques to reduce instrumental and operative interventions during labor and improve perinatal outcome.

Sonographic evaluation of fetal head extension and maternal pelvis in cases of breech presentation

Background. To investigate whether sonographic examination of the fetal head extension, pelvic adequacy and fetal position, could replace the traditional x‐ray method in the evaluation of t he breech in labor. Methods. Seventy‐two parturients admitted in labor with a breech presentation were prospectively evaluated by a newly proposed ultrasonographic approach. The head extension, obstetric conjugate and fetal attitude obtained were further compared 10 the gold standard radiologic measurements. Results. A highly significant correlation between ultrasonic and x‐ray measurements for the fetal head extension (r = 0.8696; p<0.00011. obstetric conjugate (r = 0.8931 p<0.0001), as well as high reliability (95.5%)) in diagnosing the breech variant by ultrasound have been found. Conclusions. Ultrasonic evaluation of breech presentation, as performed by the proposed method. is simple, easy to perform aid compares well with the standard radiologic studies. It is suggested that modern ultrasonic technique. which carries no risk of ionizing radiation, may replace traditional x‐ray examination of the breech in labor.

Neonatal Fetal Death Following Cesarean Section Secondary to Hyperextended Head in Breech Presentation

Abstract. There is a general agreement that infants with hy‐perextension in breech presentation should be delivered by Cesarean section in order to prevent spinal cord injuries and neonatal deaths. The following case report illustrates complete spinal cord transection in a fetus with hyperextended head in breech presentation delivered by Cesarean section who died 8 days after delivery.

The synthesis and secretion of human placental lactogen (hPL) in cultured term placenta

We studied the in vitro synthesis and secretion of hPL by human term placental tissue incubated in organ culture. Placental tissue maintains a constant pool of hPL. The synthesis of hPL may be the driving force for its secretion. The de novo synthesis and secretion rates of hPL were also investigated. The higher specific radioactivities of the secreted hPL than those found in the tissue may suggest that newly synthesized hPL is preferentially released. The intracellular distribution of hPL was also compared.

High risk pregnancy outcome by route of delivery.

This review examines the preferred route of delivery in accordance with neonatal and maternal outcome of three high risk pregnancy conditions: multiple pregnancy; delivery after cesarean section; and delivery of infants with macrosomia to mothers with gestational diabetes mellitus. The most common feature of all these conditions is the lack of information, based on large prospective controlled studies, available to the treating physician for choosing the delivery route of choice and for minimizing morbidity and mortality of both infant and mother.

High risk pregnancy outcome following induction of labour.

OBJECTIVEnTo evaluate whether induction of labour, performed in a high risk obstetric population, when medically indicated, carries an increased risk for operative delivery and maternal and fetal complications. The secondary goal was to study the effect of the various induction methods used on these outcomes and labour time.nnnSTUDY DESIGNnThis study was carried out at a level [1] university hospital. A group of 210 women who were induced for various indications, were compared to our general parturient population. Main outcome measures were cesarean section (CS) and instrumental delivery rates, intra-partum and post-partum complications, APGARs 1 and 5 and labour time by induction method.nnnRESULTSnNo significant increase in the rates of primary CS (8.6 vs. 7.1%) and instrumental delivery (15.7 vs. 12.7%), were found in the induction high risk group as compared to our general obstetric population. Intra-partum complications and fetal outcome were comparable in both groups. A comparison of methods of induction used (oxytocin, PgE2, Amniotomy) revealed a less favorable outcome with the oxytocin induction method which showed an elevated intra-partum complication rate (P < 0.01) and a tendency toward lower Apgar scores and higher CS rate.nnnCONCLUSIONSnInduction of labour performed in a high-risk obstetric population is safe, carrying no significant increase in CS and neonatal complication rates. Of the three methods of induction used, oxytocin induction showed the least favorable outcome for both mother and her offspring.