Yardena Ovadia

NSAIDs: Maternal and Fetal Considerations

ABSTRACT: Nonsteroidal anti‐inflammatory drugs (NSAIDs) gained popularity in the late 1970s. Inhibition of prostaglandin synthesis with indomethacin has been reported to be effective for prevention of labor and for treatment for symptomatic polyhydramnios. Concern about its possible constrictive effect on the fetal ductus arteriosus has limited its use in pregnancy. Maternal indomethacin therapy has also been associated with reduction in urine production in the fetus and with oligohydramnios.

Obstructive sleep apnea (OSA)-implications in maternal-fetal medicine. A hypothesis

During the past fifteen years the obstructive sleep apnea syndrome (OSAS) has become widely recognized as a quite common disorder with a wide range of serious clinical complications (1, 2, 3). This syndrome arises as a result of sleep related changes in upper airway muscle function and progressive narrowing of the oropharyngeal lumen. The resulting hypoxia (or asphyxia) leads to an arousal response that terminates the initial obstructive event. The exact incidence and prevalence of OSAS is currently unknown. Lavie (4) concluded its prevalence to be 1.26 percent. Others (5, 6) found that the prevalence of heavy regular snoring (taken as an index of at least a partially obstructed airway) increased with age including 40 percent of women and 50 percent of men over 60 years of age. Polygraphically documented OSAS showed incidence of 0.99 percent in an unselected population. Postmenopausal women have frequent episodes. of OSA in contrast with their premenopausal counterparts, who very rarely have any apnea. Since we could not find in the literature any documented OSAS studies in pregnancy, we would like to base our hypothesis on our previously published clinical observations and our recent findings. In the present paper we would like to suggest that pathophysiologic changes of OSAS prolonged throughout many weeks of pregnancy may have an adverse effect upon the feto-placental unit.

Real-time echo-Doppler Duplex Scanner in the evaluation of patients with Poland sequence

In two neonates with partial Poland sequence, an infant with complete Poland sequence and his mother subclavian artery diameter and its flow velocity waveforms were determined by real-time echo-Doppler Duplex Scanner. These measurements were significantly lower than on the normal side in the same patient. Subclavian hypoplasia appears as a local vascular defect which, in addition to thoracic muscle defects and bone defects of the hand, may be one of the main components of the Poland sequence.

Prevention of Post-Hysterectomy Urinary Retention by Alpha-Adrenergic Blocker

Abstract. Micturition difficulties and urinary retention are common complications after abdominal or vaginal hysterectomy. Adrenergic receptors are located in the bladder neck and proximal urethra, and blocking these receptors with al‐pha‐blockers such as phenoxybenzamine (Dibenzyline) may improve micturition and prevent postoperative urinary retention. In a randomized clinical trial, 51 patients who underwent total abdominal hysterectomy, received a prophylactic dose of Dibenzyline 10 μg orally 6‐8 hours after operation and again the next day about 18 hours later. Only 2 of the 51 patients were found to have urinary retention, in comparison with 9 of 48 patients in the control group (p>0.05). Another group of patients who underwent vaginal hysterectomy were treated according to the same protocol. Eight of the 30 patients in this study group required catheterization to drain the overdistended bladder, in comparison with 16 of 26 patients in the control group (p>0.025). It seems from this clinical trial that prophylactic treatment with Dibenzyline is recommended after abdominal hysterectomy or vaginal operation in order to improve micturition and prevent urinary retention.

Up-regulatory effect of triphasic oral contraceptive on platelet 3H-imipramine binding sites

Triphasic oral contraceptive (Logynon) induced a significant increase (36%) in the maximal binding capacity of platelet membranes for [3H]imipramine. The increase was achieved in the second Logynon cycle as compared to pretreatment and first Logynon cycle binding values. The pill contains a combination of ethinyl estradiol and levonorgestrel, and it is as yet unclear which of the two hormones is responsible for the up-regulatory effect. The increase in the density of platelet imipramine binding sites may reflect a similar alteration in brain. The increase in imipramine binding did not correlate with alteration in mood as assessed by Beck Depression Inventory scores.

Antagonism of antihypertensive drug therapy in pregnancy by indomethacin

Two women with preeclampsia treated with pindolol and propranolol became profoundly hypertensive when indomethacin was added because of premature contractions. The interaction of nonsteroidal antiinflammatory agents and beta-blockers and their role in the control of blood pressure in obstetrics are discussed. Indomethacin should not be given to pregnant patients with hypertension treated with beta-blockers.

Accessory ovaries with bilateral dermoid cysts

Abstract A case of bilateral accessory ovaries with bilateral dermoid cysts is described and discussed. To the best of our knowledge, no such case has been published previously in the literature.

Immune Reactivities During the Precancer and Early Cancer Periods: Novel Approaches for Immunomodulation

It is widely accepted that transformation of normal cells is associated with the activation or alteration of cellular oncogenes (1). Transformed cells have also, in many cases, the ability to propagate via an autocrine growth pathway, i.e. to synthesize and utilize their own growth factors (2). Activated one genes and autocrine growth, being intrinsic characteristics of the transformed clone, may not suffice tor such a clone to progress into a fully fledged cancer. The in-vivo progression of the transformed clone would depend, at least so some extent, also on its ability to survive in the milieu provided by the host. Such environmental factors may include angiogenesis (3); interaction with neighbouring tissues and cells (4); supply of growth promoting factors such as hormones (5) and immunological pressure (6). Conceivably, only those transformed cells which are endowed with the capacity to adapt themselves to host-derived environmental factors would be able to progress towards malignancy.

Detachment of posterior uterine cervical lip associated with spontaneous delivery

Various forms of detachment and amputation of the uterine cervix during labor have been described as an unusual and uncommon obstetrical complication (Jeffcoate and Lister, 1952). These cases most probably are not so rare as the few papers dealing with them would suggest. Since most of these papers deal with total amputation (annular detachment) of the uterine cervix and detachment of anterior uterine cervical lip, a case of spontaneous detachment of posterior uterine cervical lip is described.

Impact of Placenta Previa on Intrauterine Fetal Growth

The impact of placenta previa on intrauterine fetal growth was studied over a 10-year period, 1968-77. Fetal growth was assessed at the time of delivery by measurement of four parameters--birthweight, length, and head and chest circumferences. For 129 deliveries associated with placenta previa, these parameters were plotted against gestational age on Usher and McLean intrauterine growth curves. Fetal growth was significantly retarded as judged by all four parameters. When the results were analyzed according to the number of vaginal bleeding episodes, different patterns were found for the parameters studied. Retardation in chest circumference was unrelated to gestational age or number of bleeding episodes. Retardation in weight and chest circumference appeared at an early gestational age (25th week) and was more pronounced in the group with repeated episodes of bleeding. Retardation in head circumference and length appeared later (from the 32nd week of gestation) and was also more pronounced in the group with repeated vaginal bleeding. In women who had only one bleeding episode and in whom gestation continued to the 38th week or longer, birthweight, but none of the other three parameters, was consistent with the week of gestation. The results show that birthweight alone is insufficient to estimate intrauterine fetal growth retardation.