Shlomo Maschiach - Academia.edu (original) (raw)
Papers by Shlomo Maschiach
PubMed, Mar 1, 1988
Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in preg... more Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in pregnant moderately uremic women is debatable. We chose regular hemodialytic treatments in 2 pregnant patients with stable renal failure with the aim of improving fetal outcome. The first patient with reflux nephropathy arrived at our clinic in the 18th week of her second pregnancy, having a serum creatinine level of 4.5 mg/100 ml and a creatinine clearance (Ccr) of 15 ml/min. Regular hemodialysis was carried out from the 29th gestational week until delivery. A healthy female infant was born weighing 1,095 g at the end of the 36th week of pregnancy. The second patient had an immune complex nephritis with a serum creatinine of 4.2 mg/100 ml and a Ccr of 18 ml/min. Hemodialysis was performed regularly from the 13th gestational week until the 37th week and stopped when normal labor developed and a healthy female infant weighing 2,145 g was born. We believe that the early initiation of regular hemodialysis in these 2 patients contributed significantly to the successful outcome of their pregnancies.
Human Reproduction, 1986
In view of the studies demonstrating the involvement of eicosanoids (prostaglandins and hydroxype... more In view of the studies demonstrating the involvement of eicosanoids (prostaglandins and hydroxyperoxides, including leukotrienes) in ovulation in several mammalian species, we have examined the activity of the two enzyme systems, lipoxygenase and cyclooxygenase in human granulosa cells obtained from women undergoing in-vitro fertilization--embryo transfer. The activity of cyclooxygenase was assessed by radioimmunoassay of prostaglandin E and of 6-keto-prostaglandin F1 alpha, the conversion product of prostacyclin, accumulated in the culture medium of granulosa cells. Lipoxygenase activity was detected by the conversion of [14C]arachidonic acid into its products (hydroxyperoxides and leukotrienes) separated by reversed phase high-performance liquid chromatography. The results confirmed the activity of cyclooxygenase in human granulosa cells, production in vitro of prostaglandin E and prostacyclin and demonstrated the presence of active lipoxygenase enzymes. These results support the possible involvement of eicosanoids in ovulation of the human.
Fertility and Sterility, 1991
Objective: To assess the comparative contribution of endometrial and oocytic aging to the decline... more Objective: To assess the comparative contribution of endometrial and oocytic aging to the decline in fertility with age. Design: Retrospective analysis of conception and abortion rates in an egg donation program, with respect to donor and recipient ages. Patients: All oocyte recipients had ovarian failure. Donors were women undergoing in vitro fertilization who contributed up to a third of retrieved oocytes. Interventions: None. Results: Thirty pregnancies (28 intrauterine) were recorded in 169 reception cycles originating from 91 donation cycles. Women who conceived were younger than those who did not (median age 31 versus 37; P < 0.046), with no difference in age of donors. There was a significant difference in spontaneous abortion rate by age of donor rather than by age of recipient. Donors to successful pregnancies were younger than donors to aborted pregnancies (median age 27.5 versus 33; P < 0.0211), but the 11 women with aborted pregnancies did not differ in age from the 17 women with successful pregnancies. Conclusions: In women, endometrial function as expressed by conception rate in the recipients declines with age, whereas it is oocyte age that primarily influences risk of abortion.
Clinical nephrology, 1988
Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in preg... more Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in pregnant moderately uremic women is debatable. We chose regular hemodialytic treatments in 2 pregnant patients with stable renal failure with the aim of improving fetal outcome. The first patient with reflux nephropathy arrived at our clinic in the 18th week of her second pregnancy, having a serum creatinine level of 4.5 mg/100 ml and a creatinine clearance (Ccr) of 15 ml/min. Regular hemodialysis was carried out from the 29th gestational week until delivery. A healthy female infant was born weighing 1,095 g at the end of the 36th week of pregnancy. The second patient had an immune complex nephritis with a serum creatinine of 4.2 mg/100 ml and a Ccr of 18 ml/min. Hemodialysis was performed regularly from the 13th gestational week until the 37th week and stopped when normal labor developed and a healthy female infant weighing 2,145 g was born. We believe that the early initiation of regular h...
GnRH Analogues in Reproduction and Gynecology, 1990
The day of oocyte retrieval is the most important day in vitro fertilization (IVF) programs. It i... more The day of oocyte retrieval is the most important day in vitro fertilization (IVF) programs. It involves the coordination of the clinical, surgical and laboratory staff, thereby allowing only a limited number of cases to be performed daily. The day of retrieval depends on the day of menstruation and the individual ovarian response to medication, hence it is variable and can usually be anticipated only in the last few days of treatment. Some of these disadvantages can be overcome by fixing the day of retrieval in advance as in a “programmed cycle”. Programmed IVF cycles include; suppression of the hypothalamic-pituitary-ovarian axis by oral contraceptives or gonadotropin releasing hormone (GnRH) analogues and a predetermined day for ovum pick-up. The method has been shown to be technically feasible and logistically desirable and can result in a clinical pregnancy rate equivalent to the more conventional individualized approaches to ovulation induction [1–6].
Reproductive BioMedicine Online, 2002
Recent policy in this clinic is to transfer two embryos in patients up to 35 years, and three for... more Recent policy in this clinic is to transfer two embryos in patients up to 35 years, and three for older patients, and those failing to conceive. Four are transferred, if available, for patients >42 years.
Obstetrical & Gynecological Survey, 1995
All cases of combined vaginal-abdominal deliveries at the Department of Obstetrics and Gynecology... more All cases of combined vaginal-abdominal deliveries at the Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, over an eight-year period (1984-1991) were reviewed. During this period a total of 38,821 deliveries took place. Of 722 (1.9%) twin deliveries, 354 (48.8%) were by cesarean section; 19 were combined deliveries, including 5% of all twins delivered by cesarean section and 2.6% of all twins delivered. High transverse lie and prolapse of the umbilical cord were the main indications for delivery by cesarean section of the second twin. In order to diminish the number of combined deliveries and to increase obstetric skills and experience, a program or protocol for vaginal twin deliveries is indicated.
Journal of Medical Genetics, 1983
The Journal of Clinical Endocrinology & Metabolism, 1990
Steroid synthesis in luteal/granulosa cells harvested after follicular aspiration in a patient wi... more Steroid synthesis in luteal/granulosa cells harvested after follicular aspiration in a patient with 17 alpha-hydroxylase deficiency was investigated. Follicular stimulation with purified FSH after the suppression of ACTH and gonadotropin secretion by corticoid analogs and superactive GnRH agonist permitted ovum pick-up and the study of steroid synthesis in the obtained granulosa cells. Progesterone synthesis was elevated while 17 alpha-hydroxy progesterone, testosterone, androstenedione, and estrogen production was minimal. Aromatase activity was retained in these cells, as demonstrated by the 100-fold increase in estrogen levels after the addition of androgens. Progesterone levels in follicular fluids were in the normal range, while estrogen, 17 alpha-hydroxy progesterone, and androgen levels were minimal. These results provide in vitro evidence of 17 alpha-hydroxylase deficiency in the granulosa cells of this patient.
Human Reproduction, 2002
BACKGROUND: We aimed to evaluate the effect of the levonorgestrel-releasing intrauterine system (... more BACKGROUND: We aimed to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on the uterine vasculature and the endometrium. METHODS: The study was a prospective controlled study evaluating the local effects of LNG-IUS compared with the copper intrauterine device (IUD). Forty-seven women carrying LNG-IUS (group A) were compared with 35 women carrying copper IUD in a control group (group B). Clinical measures of menstrual bleeding, endometrial thickness and Doppler flow of the cervical branch of the uterine artery and spiral artery were evaluated and compared between the two groups. RESULTS: Doppler flow in the cervical branch of the uterine artery did not reveal any changes between the groups (resistance index ⍧ 0.6 ⍨ 0.01 in both groups). Endometrial width was significantly thinner in group A (4.1 ⍨ 0.2 mm) compared with group B (7.3 ⍨ 0.2 mm) (P < 0.0001). Subendometrial flow in the spiral artery was significantly reduced in 35 women of group A (75%) and in none of group B (P < 0.0001). CONCLUSIONS: The present study offers an explanation for the oligomenorrhoea in LNG-IUS users, i.e. a local progestational effect on the endometrium with no change in the blood flow in the uterine artery. This should be presented to the women in the pre-contraceptive counselling in order to lessen the discontinuation rate.
Fertility and Sterility, 2002
Whitney U test for continuous variables and Chi-square test for categorical variables. Results: F... more Whitney U test for continuous variables and Chi-square test for categorical variables. Results: Forty-six patients were enrolled in the study and randomized to two groups (active medication and placebo)containing 23 subjects each. The groups were similar in age, number of prior vaginal deliveries, and menopausal status. The groups did not differ for time of dilation (p ϭ 0.830), time of hysteroscopy (p ϭ 0.243), dilator with first resistance (p ϭ 0.402), ease of the procedure (p ϭ 0.302) or pain rating after surgery (p ϭ 0.880). Discomfort and side effects were similar in both groups. One cervical laceration and one false track were found in the misoprostol group. There were no uterine perforations. Conclusions: Although possibly limited by sample size, this pilot study failed to demonstrate any clinical benefit for oral administration of misoprostol with regard to time needed for dilation, time needed for hysteroscopy, dilator with first resistance, ease of procedure, and post-operative pain. Further investigation with a larger sample size is needed for verification of these findings.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2001
The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management prese... more The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management presents a clinical dilemma. We report what appears to be the ®rst case of a triplet pregnancy with two anencephalic fetuses complicated by premature contractions and severe polyhydramnios. Its management, which results a healthy newborn weighing 1385 g is discussed.
Archives of Gynecology and Obstetrics, 1990
We briefly present our experience with trial labour in the presence of a Caesarean section scar a... more We briefly present our experience with trial labour in the presence of a Caesarean section scar and review some of the literature on the management of such patients.
Archives of Gynecology and Obstetrics, 1989
Acta Obstetricia et Gynecologica Scandinavica, 1994
The objective of this study was to determine whether the circulatory levels of endothelins, poten... more The objective of this study was to determine whether the circulatory levels of endothelins, potent vasoconstrictor polypeptides produced mainly by endothelial cells, are increased in growth-retarded fetuses. Fetal venous serum samples, withdrawn by ultrasound-guided cordocentesis from 11 growth-retarded fetuses and 10 normally-growing fetuses who underwent the procedure because of other unrelated indications, were examined for immunoreactive endothelin-1,2 by radioimmunoassay. Higher mean endothelin-1,2 levels were found in the sera of growth-retarded fetuses than in controls (16.8 +/- 4.2 versus 10.9 +/- 4.3 fmol/ml, p = 0.008). Within the growth-retarded group, there were no differences in endothelin-1,2 levels in the presence of either abnormal umbilical Doppler, asymmetry of growth-retardation, maternal signs of preeclampsia, or fetal acidosis. High levels of endothelin-1,2 in the fetoplacental circulation may be pathophysiologically important in fetal growth retardation. However, the clinical significance of these elevated levels is yet to be determined.
Annals of the New York Academy of Sciences, 1988
Human Reproduction, 2002
BACKGROUND: Our objective was to evaluate the use of cervical suture in cervical pregnancy. METHO... more BACKGROUND: Our objective was to evaluate the use of cervical suture in cervical pregnancy. METHODS AND RESULTS: All cases of cervical pregnancy diagnosed and treated in the gynaecological department at the Sheba Medical Center between 1994-2000 were included in the study. Eight such cases were diagnosed. The first four cases were treated medically. The last four cases (the study group) of cervical pregnancy, including one case of heterotopic pregnancy, were treated successfully with placement of Shirodkar cerclage. CONCLUSION: Cervical cerclage may be considered as the treatment of choice in cases of cervical pregnancies. It may be the only therapy in cases of heterotopic pregnancies (intrauterine and cervical pregnancy).
Acta Obstetricia et Gynecologica Scandinavica, 1989
During the last decade, 154 patients treated with human menopausal gonadotropin human chorionic g... more During the last decade, 154 patients treated with human menopausal gonadotropin human chorionic gonadotropin developed hyperstimulation necessitating hospitalization in 201 cycles. Moderate ovarian hyperstimulation occurred in 116 of the patients and severe ovarian hyperstimulation in 34. Sixteen patients underwent operative procedures. Twelve patients underwent puncture of the pleura or abdomen to drain symptomatic hydrothorax or ascites, with clinical improvement of the symptoms in all of them. Three patients had coagulation abnormalities, and 1 patient had thromboembolic phenomena. Hyperstimulation seems to be associated with an increased pregnancy rate, since seventy-five pregnancies (35%) occurred in the study group. Appropriate monitoring can reduce the rate of OHSS but it should be kept in mind that death due to OHSS may occur.
Fertility and sterility, 1994
To clarify how often infertile men should have intercourse to achieve conception, the effect of s... more To clarify how often infertile men should have intercourse to achieve conception, the effect of sequential ejaculation on total motile sperm counts was investigated. Case-control study. Infertility and IVF unit, tertiary care center. Five hundred seventy-six men who produced two closely spaced sequential ejaculates. The total motile sperm counts of the second ejaculates were compared with the total motile sperm counts of the first ejaculates. In normospermic men (n = 359), the total motile sperm counts decreased significantly from 93 (18 to 601) (median [minimum to maximum] x 10(6)) in the first ejaculate to 42 (1.2 to 387) in the second ejaculate, produced 24 hours later. In contrast to the normospermic men, in the asthenospermic group (24 hours difference, n = 81) and in both oligospermic groups, (1 to 4 hours difference, n = 27; and 24 hours difference, n = 45), there were no significant changes in the total motile sperm counts (24 [5.9 to 229] versus 30 [0.8 to 150], 6 [0.8 to 1...
PubMed, Mar 1, 1988
Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in preg... more Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in pregnant moderately uremic women is debatable. We chose regular hemodialytic treatments in 2 pregnant patients with stable renal failure with the aim of improving fetal outcome. The first patient with reflux nephropathy arrived at our clinic in the 18th week of her second pregnancy, having a serum creatinine level of 4.5 mg/100 ml and a creatinine clearance (Ccr) of 15 ml/min. Regular hemodialysis was carried out from the 29th gestational week until delivery. A healthy female infant was born weighing 1,095 g at the end of the 36th week of pregnancy. The second patient had an immune complex nephritis with a serum creatinine of 4.2 mg/100 ml and a Ccr of 18 ml/min. Hemodialysis was performed regularly from the 13th gestational week until the 37th week and stopped when normal labor developed and a healthy female infant weighing 2,145 g was born. We believe that the early initiation of regular hemodialysis in these 2 patients contributed significantly to the successful outcome of their pregnancies.
Human Reproduction, 1986
In view of the studies demonstrating the involvement of eicosanoids (prostaglandins and hydroxype... more In view of the studies demonstrating the involvement of eicosanoids (prostaglandins and hydroxyperoxides, including leukotrienes) in ovulation in several mammalian species, we have examined the activity of the two enzyme systems, lipoxygenase and cyclooxygenase in human granulosa cells obtained from women undergoing in-vitro fertilization--embryo transfer. The activity of cyclooxygenase was assessed by radioimmunoassay of prostaglandin E and of 6-keto-prostaglandin F1 alpha, the conversion product of prostacyclin, accumulated in the culture medium of granulosa cells. Lipoxygenase activity was detected by the conversion of [14C]arachidonic acid into its products (hydroxyperoxides and leukotrienes) separated by reversed phase high-performance liquid chromatography. The results confirmed the activity of cyclooxygenase in human granulosa cells, production in vitro of prostaglandin E and prostacyclin and demonstrated the presence of active lipoxygenase enzymes. These results support the possible involvement of eicosanoids in ovulation of the human.
Fertility and Sterility, 1991
Objective: To assess the comparative contribution of endometrial and oocytic aging to the decline... more Objective: To assess the comparative contribution of endometrial and oocytic aging to the decline in fertility with age. Design: Retrospective analysis of conception and abortion rates in an egg donation program, with respect to donor and recipient ages. Patients: All oocyte recipients had ovarian failure. Donors were women undergoing in vitro fertilization who contributed up to a third of retrieved oocytes. Interventions: None. Results: Thirty pregnancies (28 intrauterine) were recorded in 169 reception cycles originating from 91 donation cycles. Women who conceived were younger than those who did not (median age 31 versus 37; P < 0.046), with no difference in age of donors. There was a significant difference in spontaneous abortion rate by age of donor rather than by age of recipient. Donors to successful pregnancies were younger than donors to aborted pregnancies (median age 27.5 versus 33; P < 0.0211), but the 11 women with aborted pregnancies did not differ in age from the 17 women with successful pregnancies. Conclusions: In women, endometrial function as expressed by conception rate in the recipients declines with age, whereas it is oocyte age that primarily influences risk of abortion.
Clinical nephrology, 1988
Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in preg... more Successful pregnancies in uremic women are rare. Early initiation of regular hemodialysis in pregnant moderately uremic women is debatable. We chose regular hemodialytic treatments in 2 pregnant patients with stable renal failure with the aim of improving fetal outcome. The first patient with reflux nephropathy arrived at our clinic in the 18th week of her second pregnancy, having a serum creatinine level of 4.5 mg/100 ml and a creatinine clearance (Ccr) of 15 ml/min. Regular hemodialysis was carried out from the 29th gestational week until delivery. A healthy female infant was born weighing 1,095 g at the end of the 36th week of pregnancy. The second patient had an immune complex nephritis with a serum creatinine of 4.2 mg/100 ml and a Ccr of 18 ml/min. Hemodialysis was performed regularly from the 13th gestational week until the 37th week and stopped when normal labor developed and a healthy female infant weighing 2,145 g was born. We believe that the early initiation of regular h...
GnRH Analogues in Reproduction and Gynecology, 1990
The day of oocyte retrieval is the most important day in vitro fertilization (IVF) programs. It i... more The day of oocyte retrieval is the most important day in vitro fertilization (IVF) programs. It involves the coordination of the clinical, surgical and laboratory staff, thereby allowing only a limited number of cases to be performed daily. The day of retrieval depends on the day of menstruation and the individual ovarian response to medication, hence it is variable and can usually be anticipated only in the last few days of treatment. Some of these disadvantages can be overcome by fixing the day of retrieval in advance as in a “programmed cycle”. Programmed IVF cycles include; suppression of the hypothalamic-pituitary-ovarian axis by oral contraceptives or gonadotropin releasing hormone (GnRH) analogues and a predetermined day for ovum pick-up. The method has been shown to be technically feasible and logistically desirable and can result in a clinical pregnancy rate equivalent to the more conventional individualized approaches to ovulation induction [1–6].
Reproductive BioMedicine Online, 2002
Recent policy in this clinic is to transfer two embryos in patients up to 35 years, and three for... more Recent policy in this clinic is to transfer two embryos in patients up to 35 years, and three for older patients, and those failing to conceive. Four are transferred, if available, for patients >42 years.
Obstetrical & Gynecological Survey, 1995
All cases of combined vaginal-abdominal deliveries at the Department of Obstetrics and Gynecology... more All cases of combined vaginal-abdominal deliveries at the Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, over an eight-year period (1984-1991) were reviewed. During this period a total of 38,821 deliveries took place. Of 722 (1.9%) twin deliveries, 354 (48.8%) were by cesarean section; 19 were combined deliveries, including 5% of all twins delivered by cesarean section and 2.6% of all twins delivered. High transverse lie and prolapse of the umbilical cord were the main indications for delivery by cesarean section of the second twin. In order to diminish the number of combined deliveries and to increase obstetric skills and experience, a program or protocol for vaginal twin deliveries is indicated.
Journal of Medical Genetics, 1983
The Journal of Clinical Endocrinology & Metabolism, 1990
Steroid synthesis in luteal/granulosa cells harvested after follicular aspiration in a patient wi... more Steroid synthesis in luteal/granulosa cells harvested after follicular aspiration in a patient with 17 alpha-hydroxylase deficiency was investigated. Follicular stimulation with purified FSH after the suppression of ACTH and gonadotropin secretion by corticoid analogs and superactive GnRH agonist permitted ovum pick-up and the study of steroid synthesis in the obtained granulosa cells. Progesterone synthesis was elevated while 17 alpha-hydroxy progesterone, testosterone, androstenedione, and estrogen production was minimal. Aromatase activity was retained in these cells, as demonstrated by the 100-fold increase in estrogen levels after the addition of androgens. Progesterone levels in follicular fluids were in the normal range, while estrogen, 17 alpha-hydroxy progesterone, and androgen levels were minimal. These results provide in vitro evidence of 17 alpha-hydroxylase deficiency in the granulosa cells of this patient.
Human Reproduction, 2002
BACKGROUND: We aimed to evaluate the effect of the levonorgestrel-releasing intrauterine system (... more BACKGROUND: We aimed to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on the uterine vasculature and the endometrium. METHODS: The study was a prospective controlled study evaluating the local effects of LNG-IUS compared with the copper intrauterine device (IUD). Forty-seven women carrying LNG-IUS (group A) were compared with 35 women carrying copper IUD in a control group (group B). Clinical measures of menstrual bleeding, endometrial thickness and Doppler flow of the cervical branch of the uterine artery and spiral artery were evaluated and compared between the two groups. RESULTS: Doppler flow in the cervical branch of the uterine artery did not reveal any changes between the groups (resistance index ⍧ 0.6 ⍨ 0.01 in both groups). Endometrial width was significantly thinner in group A (4.1 ⍨ 0.2 mm) compared with group B (7.3 ⍨ 0.2 mm) (P < 0.0001). Subendometrial flow in the spiral artery was significantly reduced in 35 women of group A (75%) and in none of group B (P < 0.0001). CONCLUSIONS: The present study offers an explanation for the oligomenorrhoea in LNG-IUS users, i.e. a local progestational effect on the endometrium with no change in the blood flow in the uterine artery. This should be presented to the women in the pre-contraceptive counselling in order to lessen the discontinuation rate.
Fertility and Sterility, 2002
Whitney U test for continuous variables and Chi-square test for categorical variables. Results: F... more Whitney U test for continuous variables and Chi-square test for categorical variables. Results: Forty-six patients were enrolled in the study and randomized to two groups (active medication and placebo)containing 23 subjects each. The groups were similar in age, number of prior vaginal deliveries, and menopausal status. The groups did not differ for time of dilation (p ϭ 0.830), time of hysteroscopy (p ϭ 0.243), dilator with first resistance (p ϭ 0.402), ease of the procedure (p ϭ 0.302) or pain rating after surgery (p ϭ 0.880). Discomfort and side effects were similar in both groups. One cervical laceration and one false track were found in the misoprostol group. There were no uterine perforations. Conclusions: Although possibly limited by sample size, this pilot study failed to demonstrate any clinical benefit for oral administration of misoprostol with regard to time needed for dilation, time needed for hysteroscopy, dilator with first resistance, ease of procedure, and post-operative pain. Further investigation with a larger sample size is needed for verification of these findings.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2001
The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management prese... more The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management presents a clinical dilemma. We report what appears to be the ®rst case of a triplet pregnancy with two anencephalic fetuses complicated by premature contractions and severe polyhydramnios. Its management, which results a healthy newborn weighing 1385 g is discussed.
Archives of Gynecology and Obstetrics, 1990
We briefly present our experience with trial labour in the presence of a Caesarean section scar a... more We briefly present our experience with trial labour in the presence of a Caesarean section scar and review some of the literature on the management of such patients.
Archives of Gynecology and Obstetrics, 1989
Acta Obstetricia et Gynecologica Scandinavica, 1994
The objective of this study was to determine whether the circulatory levels of endothelins, poten... more The objective of this study was to determine whether the circulatory levels of endothelins, potent vasoconstrictor polypeptides produced mainly by endothelial cells, are increased in growth-retarded fetuses. Fetal venous serum samples, withdrawn by ultrasound-guided cordocentesis from 11 growth-retarded fetuses and 10 normally-growing fetuses who underwent the procedure because of other unrelated indications, were examined for immunoreactive endothelin-1,2 by radioimmunoassay. Higher mean endothelin-1,2 levels were found in the sera of growth-retarded fetuses than in controls (16.8 +/- 4.2 versus 10.9 +/- 4.3 fmol/ml, p = 0.008). Within the growth-retarded group, there were no differences in endothelin-1,2 levels in the presence of either abnormal umbilical Doppler, asymmetry of growth-retardation, maternal signs of preeclampsia, or fetal acidosis. High levels of endothelin-1,2 in the fetoplacental circulation may be pathophysiologically important in fetal growth retardation. However, the clinical significance of these elevated levels is yet to be determined.
Annals of the New York Academy of Sciences, 1988
Human Reproduction, 2002
BACKGROUND: Our objective was to evaluate the use of cervical suture in cervical pregnancy. METHO... more BACKGROUND: Our objective was to evaluate the use of cervical suture in cervical pregnancy. METHODS AND RESULTS: All cases of cervical pregnancy diagnosed and treated in the gynaecological department at the Sheba Medical Center between 1994-2000 were included in the study. Eight such cases were diagnosed. The first four cases were treated medically. The last four cases (the study group) of cervical pregnancy, including one case of heterotopic pregnancy, were treated successfully with placement of Shirodkar cerclage. CONCLUSION: Cervical cerclage may be considered as the treatment of choice in cases of cervical pregnancies. It may be the only therapy in cases of heterotopic pregnancies (intrauterine and cervical pregnancy).
Acta Obstetricia et Gynecologica Scandinavica, 1989
During the last decade, 154 patients treated with human menopausal gonadotropin human chorionic g... more During the last decade, 154 patients treated with human menopausal gonadotropin human chorionic gonadotropin developed hyperstimulation necessitating hospitalization in 201 cycles. Moderate ovarian hyperstimulation occurred in 116 of the patients and severe ovarian hyperstimulation in 34. Sixteen patients underwent operative procedures. Twelve patients underwent puncture of the pleura or abdomen to drain symptomatic hydrothorax or ascites, with clinical improvement of the symptoms in all of them. Three patients had coagulation abnormalities, and 1 patient had thromboembolic phenomena. Hyperstimulation seems to be associated with an increased pregnancy rate, since seventy-five pregnancies (35%) occurred in the study group. Appropriate monitoring can reduce the rate of OHSS but it should be kept in mind that death due to OHSS may occur.
Fertility and sterility, 1994
To clarify how often infertile men should have intercourse to achieve conception, the effect of s... more To clarify how often infertile men should have intercourse to achieve conception, the effect of sequential ejaculation on total motile sperm counts was investigated. Case-control study. Infertility and IVF unit, tertiary care center. Five hundred seventy-six men who produced two closely spaced sequential ejaculates. The total motile sperm counts of the second ejaculates were compared with the total motile sperm counts of the first ejaculates. In normospermic men (n = 359), the total motile sperm counts decreased significantly from 93 (18 to 601) (median [minimum to maximum] x 10(6)) in the first ejaculate to 42 (1.2 to 387) in the second ejaculate, produced 24 hours later. In contrast to the normospermic men, in the asthenospermic group (24 hours difference, n = 81) and in both oligospermic groups, (1 to 4 hours difference, n = 27; and 24 hours difference, n = 45), there were no significant changes in the total motile sperm counts (24 [5.9 to 229] versus 30 [0.8 to 150], 6 [0.8 to 1...