Shlomo Ariely

Ripening the Highly Unfavorable Cervix With Extra-Amniotic Saline Instillation or Vaginal Prostaglandin E2 Application

&NA; Extra‐amniotic saline instillation using a 26‐gauge Foley catheter and vaginal application of prostaglandin E2 (PGE2) were compared. Among 52 cases treated with extra‐amniotic saline instillation, the mean Bishop score increased from 1.7 to 7.8 in a mean of 2.8 hours. In all cases but one, an increase of the Bishop score of three or more points occurred during a 6‐hour period. Prostaglandin E2 tablets (3 mg) applied in the posterior vaginal fornix (once or twice) resulted in an increase in the Bishop score of three or more points in 39 of 54 cases during the 12‐hour study period. The mean Bishop score in these “successful” ripenings using PGE2 increased from 1.9 to 5.6 points during a mean time of 8.5 hours. No severe side effects were registered in either procedure. (Obstet Gynecol 73:938, 1989)

Changes in Uterine Artery Doppler Flow Velocity Waveforms during the Third Stage of Labor

Transabdominal Doppler velocity waveform measurements of the uterine arteries during the third stage of labor were performed upon 25 patients with uncomplicated vaginal deliveries and 5 with prolonged third stage in order to further assess third-stage mechanisms. Based on Doppler flow measurements, three phases of the third stage of labor were observed: (1) a latent phase with a systolic/diastolic ratio (S/D) and a pulsatility index (PI) of 2.14 +/- 0.49 and 0.89 +/- 0.17, respectively; (2) a contraction and detachment phase with an S/D and PI of 2.53 +/- 0.53 and 1.28 +/- 0.37, respectively, and (3) an expulsion phase with an S/D and PI of 2.20 +/- 0.34 and 0.91 +/- 0.20, respectively (p < 0.05). During the third stage of labor, it was shown that uterine contractions squeezed the uterine vessels as they traversed the myometrium, leading to an increase in the extrinsic resistance, which was reflected by high resistance flow. Following placental separation and changes in the placental-site wall, there was slight uterine relaxation resulting in decreased uterine vessel resistance. This observation encourages the authors to continue investigating the contribution of ultrasound and Doppler flow for studies of the postpartum period.

Severe peripheral arteriospasm following oxytocin administration.

A parturient patient with imminent gangrene of the extremity caused by oxytocin-induced arteriospasm is described. The appliance of conventional measures such as anticoagulation and vasodilatation produced an immediate and sustained reversal of the arteriospasm together with dramatic relief of symptoms and signs.

Sonographic assessment of cervical changes during pregnancy and delivery: Current concepts

Correct detection of premature contractions and incompetent uterine cervix is still a challenging obstetrical problem since these factors remain a major cause of perinatal loss. Ultrasonography offers additional important data for the prediction of these pathologies which have common sonographic patterns; shortening of the cervical length, funneling of the membranes and dilatation of the endocervical canal. The first section of this review highlights sonography of normal cervical anatomy, while the second section focuses on recent advances in sonographic detection of premature contractions and incompetent cervix. It is believed that due to its accuracy and reproducibility, this noninvasive technique should become more integrated into this aspect of antenatal care.

Plasma Steroids and Human Placental Lactogen Level Changes in Late Pregnancy in Association with Intravenous Ritodrine Administration

The effects of intravenous ritodrine upon plasma levels of free estradiol, estriol, estetrol, progesterone and human placental lactogen were investigated in ten third trimester pregnancies. Ritodrine

Erythema nodosum associated with pregnancy: Case reports

Four cases of erythema nodosum associated with pregnancy are reported and the literature reviewed. Erythema nodosum in pregnancy is a self-limited condition requiring minimal supportive treatment. No adverse effects upon pregnancy course or fetal outcome were noted. It is suggested that pregnancy may serve as an etiological basis for the disease.

Influence of ritodrine on plasma steroids and human placental lactogen levels in third-trimester pregnancies.

The effects of ritodrine, administered by intravenous, intramuscular or per os routes, upon plasma levels of unconjugated estriol, estradiol, progesterone and human placental lactogen (HPL) were investigated in 24 third-trimester pregnancies. Ritodrine administered at a constant rate of 200 micrograms/min for 3 h, injected intramuscularly 8 x 10 mg/day for 5 days or given orally in doses of 6 x 20 mg/day for 10 days resulted in a significant decrease in the steroid hormone concentration and a significant elevation of HPL levels.

Colposuspension for urinary stress incontinence in postmenopausal patients

Eighty-seven postmenopausal patients had a colposuspension for urinary stress incontinence. A significant postoperative reduction (p<0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained. The cure rate for urinary incontinence was 77%. Twenty patients were found to be wet postoperatively, 8 due to stress incontinence and 12 due to detrusor instability, 9 of whom had detrusor instability preoperatively.No differences were found pre- and postoperatively in the cystometric and uroflowmetric values or in the urethral pressure profile measurements. The pressure transmission ratios were significantly improved postoperatively.During operation and postoperatively, minor complications occurred in this group of patients. In 5 patients blood transfusion was needed. Urinary tract infection was diagnosed in 21 patients, wound infections in 4 patients and enterocele in 5 patients.Colposuspension for urinary stress incontinence in postmenopausal patients is a safe procedure with a reasonable cure rate indicating that a surgical approach should be adopted in such patients.

Improved techniques for first-trimester fetal reduction using simultaneous abdominal and transvaginal ultrasonographic guidance. Preliminary report.

Simultaneous transabdominal injection of potassium chloride (KCl) assisted by transvaginal ultrasonographic guidance was evaluated in 5 patients who conceived due to various assisted reproductive techniques and ovarian stimulation. All 5 underwent first-trimester fetal reduction for multiplicity of high-order pregnancies. Four sets of triplets were reduced to twin, and 1 twin pregnancy was reduced to a singleton. Less than 2 ml of 2 mEq/ml KCl per fetus was needed for each case. No fetal or maternal complications nor technical failure attributable to the procedure were recorded. All pregnancies were delivered > or = 35 weeks of gestation. Transabdominal fetal reduction using simultaneous transvaginal ultrasonographic guidance for selective feticide combines the benefits of both the transabdominal and transvaginal approaches, mainly in selected cases in which some experts prefer the abdominal route, but find it technically difficult to practice. Further experience is needed to confirm our encouraging preliminary results before drawing any definitive conclusions.