Noah Ben-Aderet

Myotonic dystrophy and pregnancy: A review

The previous reports of 20 women with myotonic dystrophy and pregnancy are reviewed, and a new case report added. Myotonic dystrophy is often unrecognized in early life due to vague symptoms, and is often first diagnosed during pregnancy which is known to worsen the main features of muscular weakness and myotonia. Complications of pregnancy and delivery are frequent and serious and should be known to all those dealing with pregnant women. A history of fetal wastage or a child suffering from symptoms of congenital myotonic dystrophy may be a clue to the diagnosis and these patients should be closely followed until safe delivery. The neonatologist should be involved as feeding and respiratory problems in the neonate may indicate that the infant is affected.

Pregnancy with an artificial pacemaker.

Complete heart block in pregnancy is not a common encounter. The first case was reported in 1914 by Nanta and today some 100 cases are documented. Heart block may be congenital or acquired secondary to cardiac surgery, rheumatic heart disease, or infective disorders. Heart block, whether congenital or acquired, rarely creates any special obstetric problems. Today there is an increasing use of cardiac pacemakers in younger people and the first reported obstetric experience with a cardiac pacemaker implanted before pregnancy was by Shouse and Acker. This review will document the course and outcome of all reported pregnancies in women conceiving with an artificial pacemaker, and discuss complications and principles of management. We will also report our experience with a woman suffering from a complete heart block in whom an internal cardiac pacemaker was inserted before pregnancy.

Prophylactic Single-Dose Co-trimoxazole for Prevention of Urinary Tract Infection after Abdominal Hysterectomy

The efficacy of a preoperative single-dose of co-trimoxazole in reducing postoperative urinary tract infection and febrile morbidity after abdominal hysterectomy was evaluated in a randomized placebo-controlled study of 90 patients undergoing surgery. Among the co-trimoxazole patients, 6.2% developed urinary tract infection compared to 31% in the placebo group (p less than 0.001) and 12.5% febrile morbidity compared to 38% in the placebo patients (p less than 0.025). No adverse side effects of co-trimoxazole were observed and this regimen seems both safe and effective.

Single- versus multiple-dose mezlocillin prophylaxis in emergency cesarean section.

163 patients undergoing emergency cesarean section were prospectively and randomized evaluated to determine the effect of mezlocillin in reducing postoperative morbidity. We compared a single 5-gram preoperative dose and a perioperative 3-dose regimen, each of 2 g, with a placebo. Postoperative morbidity was reduced from 65% in the placebo group to 20% in the groups receiving mezlocillin (p less than 0.005). The incidences of febrile morbidity, endometritis and urinary tract infection were all significantly lower in both groups given mezlocillin. There was no difference in the reduction of morbidity between the two groups receiving mezlocillin. The main advantages of the prophylaxis included a shorter hospitalization and the absence of serious infections in the treated groups.

Sonographic diagnosis of periappendicular abscess in pregnancy

The diagnosis of appendicitis in pregnancy is complex because of altered maternal physiology and anatomy, and definitive therapy is often delayed. Ultrasonic screening is important in either diagnosing or excluding many pathologic conditions that complicate pregnancy and present a clinical picture similar to that of appendicitis. Reported here is a case in which a periappendicular abscess due to a perforated appendix was diagnosed by sonographic screening.

TRANSPERITONEAL OVUM MIGRATION IN WOMEN WITH UNILATERAL CONGENITAL OVARIAN ABSENCE

A rare case of transperitoneal ovum migration resulting in an intra‐uterine pregnancy is presented. A woman with left congenital ovarian absence and a surgically removed right oviduct, conceived following microsurgical repair of left tubal occlusion.

Scleroderma and Pregnancy

We describe a rare case of a pregnancy that occured in a patient with scleroderma, and ended in poor fetal outcome.

Giant fetal abdominal cyst. Ultrasonic diagnosis and management.

A 23-year-old primigravida was referred for an ultrasonic examination because of suspected large for dates uterine size in the 31st week of her pregnancy. Medical and gynecological history was normal. The ultrasonic examination revealed a giant fetal intraabdominal cystic formation thought to arise from the left kidney with no normal renal tissue demonstrated (Fig. 1). The right kidney appeared hydronephrotic (Fig. 2). Age estimation by biparietal diameter (BPO) and femur measurements was 32 weeks. The volume of the cyst was calculated by means of the formula anterior-posterior diameter X superiorinferior diameter X transverse diameter X 0.5233 = volume and was estimated to be 1,300 ml. The fetal thoracic cavity was compressed by the giant cyst (Fig. 3). As amniotic fluid was normal, the function of the right kidney was considered normal, and to avoid further damage to the function of lungs and

Control of prostaglandin induced uterine hyperactivity with intravenous ritodrine

The prostaglandins, F2a and E2a, are in extensive local use for the induction of labor. The main concern with oral and vaginal administration is the difficulty in controlling rapidly progressing labor and uterine hyperactivity. Herein we present a case where intravenous ritodrine was given as soon as hyperactivity and fetal heart rate decelerations were detected. With this treatment, the hyperactivity was controlled, fetal heart rate returned to normal and labor progressed normally to the birth of a healthy infant.

Correlation between the endocrine profile of ovulation and the ultrasonically detected 'double contour' of the preovulatory follicle.

The exact prediction of ovulation is becoming more important in the management of infertile couples. The routine methods used to monitor ovulation are plasma levels of estradiol and luteinizing hormone, and ultrasonic scanning of graafian follicle diameter. Ovulation is known to occur at a wide range of follicular diameters and it cannot be used as a single predictor of ovulation. In a previous study we described the preovulatory double contour of the dominant follicle occurring a few hours before ovulation. The purpose of this study was to correlate this sign with the hormonal profile to determine whether it can be used as a single parameter in predicting ovulation. The results demonstrate a close relationship between the LH peak and the appearance of the double contour which can be used as a reliable predictor of impending ovulation.