Jardena Ovadia

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.

Assisted hatching by partial zona dissection of human pre-embryos in patients with recurrent implantation failure after in vitro fertilization*

OBJECTIVE To examine the potential of the partial zona dissection technique to promote successful implantation by assisting embryo hatching after IVF. DESIGN The study and the control group included 72 and 82 patients, respectively, each had undergone at least three failed IVF-ET attempts. Assisted hatching was performed on four- to six-cell stage embryos by creating a slit in the zona pellucida using the partial zona dissection technique. After 90 minutes incubation (5% CO2, 37 degrees C), the embryos were transferred to the uterus. SETTING Infertility and IVF Unit of an academic tertiary referral medical center. RESULTS In the assisted hatching group, 230 micromanipulated embryos were replaced (3 or 4 treated embryos per patient) compared with 295 nonmanipulated embryos in the control group. Clinical pregnancy rates (PRs) were similar in the assisted hatching and control groups (n = 15; 20.8% and n = 12; 14.6%, respectively). However, the contribution of assisted hatching by partial zona dissection to successful implantation was related to the patientss age: patients older than 38 years showed a markedly higher PR after assisted hatching: 23.9% in the study group compared with only 7% of the controls. CONCLUSIONS These results demonstrate that assisted hatching by partial zona dissection is a quick and efficient method that does not induce any visible damage to the embryos replaced. In a selected group of patients (aged over 38 years, who have failed to conceive in at least three previous IVF attempts) it significantly increases the chances for pregnancy after ET.

The relationship between in vitro fertilization and naturally occurring antibodies: evidence for increased production of antiphospholipid autoantibodies*

OBJECTIVE Assessment of possible effects of ovarian stimulation during in vitro fertilization (IVF) treatment cycles on circulating levels of antiphospholipid and antinuclear autoantibodies. DESIGN The study was performed prospectively. Sera were obtained at three time points along IVF treatment cycle. Levels of autoantibodies directed against nuclear components, mitochondrial antigens, and phospholipids were determined using enzyme-linked immunosorbent assay. PATIENTS Thirty-five patients, who underwent at least one previous IVF attempt, and 36 age- and sex-matched controls were analyzed. All participants were randomly selected. RESULTS The mean levels of antiphospholipid (but not antinuclear) autoantibodies in sera from IVF-treated patients were found to be significantly higher than the corresponding values of the control group (for immunoglobulin [Ig]M isotype: anticardiolipin, antiphosphatidyl L-serine; for IgG isotype: anticardiolipin, antiphosphatidyl L-serine, and antiphosphatidylcholine; P less than 0.0001, assessed by Mann-Whitney test). The autoantibody levels remained more or less constant at different time points along the treatment cycle. No correlation with age and number of previous IVF cycles was demonstrated. CONCLUSIONS Serum levels of antiphospholipid (but not antinuclear) autoantibodies increase after IVF treatment. Based on these preliminary data, it is not yet possible to estimate if the observed changes in autoantibody levels might have any future clinical influence on infertile patients undergoing IVF treatment.

The relationship between sperm ultrastructural features and fertilizing capacity in vitro

OBJECTIVE To evaluate the relationship between ultramorphological features of the human sperm and its fertilizing capacity in vitro. DESIGN The study was performed retrospectively. Ultrastructural features were assessed using scanning and transmission electron microscopes in sperm samples of individuals who underwent an in vitro fertilization (IVF) treatment cycle no more than 6 months before the study. SETTING Institutional clinical care. PATIENTS Fifty-six infertile couples in whom mechanical infertility was diagnosed in the female partner. Patients were categorized as fertilizing when fertilization of at least 30% of the oocytes occurred (n = 27) and nonfertilizing when none of the oocytes fertilized in at least two consecutive IVF treatment cycles (n = 29). RESULTS The two groups differed significantly only in ultramorphological parameters of the sperm head and acrosome (head, F(8,36) = 2.8, P less than 0.02; acrosome, F(4,40) = 2.8, P less than 0.04), and especially in the following malformation patterns: hyperelongated head, acrosome deficiency, and acrosome damage. The suggested score based on these findings was able to predict 90% and 76% of the cases with and without fertilizing potential, respectively. CONCLUSION The ultrastructural morphology of the sperm head components is a key parameter for assessing the sperm fertilizing capacity in vitro.

The grand multipara

Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.

The Neugebauer-Le Fort operation: A review of 118 partial colpocleises

Abstract The Neugebauer—Le Fort operation or partial colpocleisis is a safe, simple and rapid procedure for the repair of uterine prolapse in elderly women who are poor surgical risks. The operation was performed in 118 women with total procidentia. Good anatomic results were obtained in 90.7% of the women. Late complications were rare, including recurrence of prolapse (3 patients), and urinary incontinence (12 patients). Immediate postoperative complications were not common. The main disadvantage is the inaccessibility of the uterus in case of postmenopausal bleeding (2 patients). Partial colpocleisis has a place in the armamentarium of the gynecologist treating isolated cases of prolapse of the uterus, and may be indicated in the elderly woman with total procidentia who is a poor surgical risk and in whom general anesthesia is contraindicated, and who is certain she wants to forego sexual intercourse.

Microalbuminuria as an early predictor of hypertensive complications in pregnant women at high risk

The value of microalbuminuria in predicting hypertensive complications in pregnant patients at high risk was tested in a prospective trial. A secondary aim was to compare the urinary albumin excretion rate between high risk hypertensive pregnant patients (study group) and pregnant patients at high risk of other complications, normal pregnant subjects, and nonpregnant subjects. Over the last 5 years, 276 patients were studied (142 in the study group v 134 controls). Albumin was measured in an 8-hour overnight urine collection throughout pregnancy using a radioimmunoassay technique. The pregnant women in both the study and control groups demonstrated a statistically significant increase in albumin excretion rate in the second and third trimesters compared with the first. Mean albumin excretion rate values were significantly higher in the study group (P = 0.0001). Using logistic and linear regression models, the presence of microalbuminuria in the early third trimester was proven to be predictive of hypertensive complications (odds ratio, 2.1; confidence intervals, 1.26 to 3.53) and birth weight (R2 = 0.7, P < 0.05) in the study group. Intrauterine growth retardation and neonatal outcome were less predictable. With the introduction of radioimmunoassays and in light of these significant clinical results, we believe that high-risk patients in whom abnormal proteinuria develops usually have a microalbuminuric phase weeks earlier, and this test has some predictive value for severe disease. In addition, the accepted definition of gestational proteinuria should be reconsidered.

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.

Malignant Cervical Teratoma of the Fetus

Abstract. Cervical teratomas have been defined and one new case is now added to the 116 cases previously reported. We have been able to find only six reports of malignant teratoma in the literature so far. The problems of diagnosis and obstetrtic management are discussed briefly. The incidence of appearance of the tumor is described and the likelihood of hydramnios or of acute obstructive symptoms of the trachea and esophagus at birth ar discussed. The differential diagnosis includes cystic hygroma, congenital goitre, bronchial cyst, lymphangioma, neuroblastoma, parotid tumor and carcinoma of the thyroid.

Menopausal age in various ethnic groups in Israel

The effects of various parameters on age at menopause have been investigated in five ethnic groups in Israel comprising East European, West European, North African, Israeli and other Middle Eastern (Mediterranean) women, respectively. The data were acquired by means of anonymous questionnaires and were programmed for 1770 women. Correlation coefficients between various variables and age at menopause revealed three variables which have a straight correlation, vis. obesity index, number of children, and years of amenorrhoea (during the reproductive years). The years-of-smoking variable has an inverse correlation with age at menopause. East Europeans have the highest age at menarche. Two-way analysis of variance has shown that the obesity index, years of amenorrhoea, number of children and years-of-smoking parameters are individually more important than ethnic origin. The finding that the age at menopause is highest in the North African group is explained by the higher incidence in this group of high parity, a greater number of amenorrhoea, obesity, and low cigarette consumption. Since many habits (such as smoking, diet, use of contraceptive pills, multiple partners and marital obligations) are subject to frequent change in the modern world, it is of the utmost importance to repeat such a study every few years.