Low-molecular-weight heparin for thrombophilia in pregnant women.

Objective: Low-molecular-weight heparin (LMWH) is the anticoagulant of choice during pregnancy because it is associated with a low incidence of osteoporosis and thrombocytopenia. Antithrombotic therapy has recently been used to prevent pregnancy loss in high-risk patients with evidence of acquired or congenital thrombophilia. The aim of the present study was to gain further information on the teratogenic potential of LMWH in this patient group.

Pregnancy outcome in women with primary renal disease.

Background: The preconception and intraconception parameters that are relevant to outcome in women with underlying renal disease remain controversial.

Objectives: To analyze the types and frequencies of short- and long-term (2 years after delivery) maternal and neonatal complications in 38 patients with primary renal disease (46 pregnancies), most of them with mild renal insufficiency.

Methods: Logistic regression models were formulated to predict successful outcome.

Pregnancy outcome in patients with insulin dependent diabetes mellitus and diabetic nephropathy treated with ACE inhibitors before pregnancy.

The preconception and intrapregnancy parameters that are relevant to outcome in women with insulin dependent diabetes mellitus (IDDM) and diabetic nephropathy remain controversial. We analyzed the types and frequencies of maternal and neonatal complications in 24 IDDM patients with diabetic nephropathy (24 pregnancies), all with preserved to mildly impaired renal function. All patients received treatment with captopril for at least six months prior to planned pregnancy and were maintained under strict glycemic control from at least three months before pregnancy to delivery.

Developmental outcome of offspring of pregestational diabetic mothers.

The aim of this study was to investigate the one-year developmental outcome of offspring of mothers with pregestational diabetes mellitus (PGDM). We prospectively evaluated 31 women with PGDM (21 with type 1 DM and 10 with type 2 DM) and 41 nondiabetic controls during pregnancy and for one year follow-up. Data showed that offspring of mothers with PGDM scored lower than controls in all aspects of development--mental, psychomotor, and exploration/orientation.

Evaluation of low serum vitamin B(12) in the non-anaemic pregnant patient.

Low serum vitamin B(12) concentrations in pregnancy may not indicate true megaloblastic anaemia. In the present study we compared biochemical indices of vitamin B(12) deficiency (serum homocysteine and urine methylmalonic acid) in non-anaemic pregnant women with and without low serum vitamin B(12) concentrations. The groups were matched for age, parity and gestational age.

Twinning project: Israel and Georgia--the birth of a diabetes-in-pregnancy centre in Georgia.

Aims: To determine the effectiveness of a joint Israeli-Georgian twinning project aimed at introducing modern methods of perinatal care to Georgian women with pregestational diabetes mellitus.

Methods: A Diabetes-in-Pregnancy Centre was established in Georgia (in the former USSR). Thirty-two women with Type 1 diabetes mellitus participated in the first stage of the study (January 1997-June 1998).

White coat hypertension and pregnancy outcome.

The presence and outcome effect of white coat hypertension in pregnancy was determined with 24-h ambulatory blood pressure (BP) monitoring. Sixty women presenting with high clinic BP (>/=140/90 mm Hg) in the second trimester were included. Patients were divided into two groups based on daytime ambulatory BP findings: <135/85 mm Hg, white coat hypertension (n = 37); >/=135/85 mm Hg, 'true' hypertension (n = 23).

Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester.

Objective: To examine the course of pregnancy and fetal outcome in patients with twin gestations in which one abnormal fetus underwent selective feticide in the third trimester of pregnancy.

Design: A study of 23 consecutive late selective feticide procedures.

Setting: Department of Obstetrics and Gynecology, Rabin Medical Center, Israel.

Fetal middle-cerebral and umbilical artery flow assessments after glucose challenge test.

Objective: To determine whether a change occurs in fetal middle-cerebral and umbilical artery flow after glucose challenge testing.

Method: Fetal middle-cerebral and umbilical artery flow was assessed by Color Dopppler technology in 21 pregnant patients before and after the 50-g glucose challenge test. The resistance index (IR) was evaluated separately for each vessel.

Evaluation of the upper uterine cervix by the location of the vesicocervical fold of the urinary bladder to rule out cervical shortening during pregnancy with and without premature contractions.

Objectives: To measure the length of the upper and lower cervix, as demarcated anatomically by the lowermost edge of the urinary bladder, in second- and third-trimester pregnancies with and without premature contractions. We hypothesized that patients with active premature contractions have a shorter upper cervix, placing them at greater risk of preterm delivery.

Methods: The lengths of the total cervix and of the upper and lower cervix, separately, and funnelling of the internal os, were assessed by endovaginal ultrasonography.

Microalbuminuria after pregnancy complicated by pre-eclampsia.

Background: Microalbuminuria is an important risk factor for underlying vascular disease. Its detection after pregnancy complicated by pre-eclampsia may have predictive value for the later development of chronic hypertension or renal disease.

Method: The study group consisted of 48 women in whom pregnancy had been complicated by pre-eclampsia.

Quality development in perinatal care -- the OBSQID project. OBStetrical Quality Indicators and Data.

This special communication describes the objectives and strategies of the OBStetrical Quality Indicators and Data collection (OBSQID) project, a pan-European network of researchers, healthcare providers, and professional institutions and associations using agreed key quality indicators and served by a common database. OBSQID is based on the general concept of continuous assessment, management and development of quality of care and is geared to perinatal medicine. It allows contributors to measure, on an on-going basis, the outcomes of care they provide against those of other facilities within their own region or country as well as in Europe.

Antepartum management protocol. Timing and mode of delivery in gestational diabetes.

We sought to determine whether strict glycemic control during diabetic pregnancy combined with elective early induction of labor reduces the rate of cesarean delivery and fetal birth trauma. We used a population-based longitudinal design covering three periods corresponding to changes in the management protocol for diabetic pregnancy at our center: 1) 1980-1989: no set level of maternal glycemia, elective cesarean section when estimated fetal weight was 4,500 g or more, and no elective early induction; 2) 1990-1992: desired mean maternal glycemia < or = 5.8 mmol/l, elective cesarean section when estimated fetal weight was 4,000 g or more, and elective early induction at 40 weeks for large-for-gestational-age fetuses; 3) 1993-1995: desired mean maternal glycemia < or = 5.

Pregnancy outcome in familial homozygous hypercholesterolemic females treated with long-term plasma exchange.

Background: The use of plasma-exchange therapy has increased the longevity of patients with homozygous familial hypercholesterolemia (HFH), and pregnancy in affected women is expected to become more common. We describe the clinical course, feasibility and risks of repeated pregnancies in patients with HFH treated by long-term plasma exchange.

Methods: We followed the clinical course of five pregnancies in two HFH patients, with attention to the effect of repeated plasma exchange on maternal and fetal status; specifically, lipid profile, hemodynamics, and uteroplacental circulation on Doppler flow study.

Placental isoferritin in gestational diabetes mellitus.

Background: Serum placental isoferritin, an immunosuppressive cytokine like protein, was found to be elevated in type I diabetes at diagnosis and low in high risk pregnant women. Further to this observation, the possible role of this placental product was assessed in pregnant women with gestational diabetes mellitus.

Methods: A comparative study.

The regulation of platelet aggregation in vitro by interleukin-1beta and tumor necrosis factor-alpha: changes in pregnancy and in pre-eclampsia.

Platelet activation occurs in early pregnancy in women at risk of developing pre-eclampsia. Cytokines have been implicated in the pathogenesis of pre-eclampsia, so we determined the effects of interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) on the in vitro aggregation of human platelets. IL-1beta increased aggregation of platelets from non-pregnant and pre-eclamptic women, and inhibited the aggregation of platelets from normal pregnant women.

Effect on fetal circulation of low-dose aspirin for prevention and treatment of pre-eclampsia and intrauterine growth restriction: Doppler flow study.

The use of low-dose aspirin for the prevention and treatment of pre-eclampsia and intrauterine growth restriction has been studied extensively during the last 10 years. The large clinical trials do not support routine prophylaxis or therapeutic administration of low-dose aspirin in high-risk pregnant patients. We report on 87 Israeli women who were recruited for the CLASP study (a collaborative trial for the prevention and treatment of pre-eclampsia and intrauterine growth restriction).

Prednisone dosage and pregnancy outcome in renal allograft recipients.

Background: The literature contains reports of 2309 pregnancies in some 1600 women who have undergone renal transplantation. Certain pre-pregnancy factors, especially hypertension, renal graft dysfunction, short interval between transplant and pregnancy, and high immunosuppressive drug dosage, appear to increase the neonatal risks.

Method: We describe the outcome of 42 pregnancies in 27 allograft recipients at Rabin Medical Center (Beilinson Campus) in Israel during the last 8 years.

The effect of low-dose aspirin treatment on biochemical markers in pregnant hypertensive patients.

We evaluated the known metabolic effects of aspirin in pregnant hypertensive patients. Eighty-seven pregnant women (12th-24th gestational week) were randomly allocated to low-dose aspirin or placebo treatment. Between the 24th-28th gestational week the following tests were performed: oral glucose tolerance test, venous blood pH and base excess, coagulation profile, platelet count, morning (8 a.

Angiotensin converting enzyme inhibitors use in the first trimester of pregnancy.

Angiotensin Converting Enzyme Inhibitors (ACE-I) have been very effective in treating hypertension. Adverse conditions in the fetus with the use of ACE-I, such as oligohydramnios, intra-uterine growth restriction (IUGR), hypocalvaria, persistent ductus arteriosus with fetal and neonatal death have been rerported. Though the pathophysiology was thought to be a problem with renal hypoperfusion in the fetus, it remained unclear whether the first trimester exposure to these drugs produced a similar pattern.

Diabetes in pregnancy.

Despite the dramatic decline in maternal and perinatal morbidity and mortality over the past few decades, controversy still exists regarding the care of pregnant women with both pregestational and gestational diabetes mellitus. Carbohydrate intolerance is the most common metabolic complication of pregnancy. A review of the literature over the last two decades indicates that the incidence of gestational diabetes mellitus (GDM) varies from 0.

The effects of time interval after venipuncture and of anticoagulation on platelet adhesion and aggregation.

Abnormal platelet function plays an important role in atherosclerosis and thrombotic disorders. Simple in vitro testing of platelet function is preferable to other techniques, and adhesion measurement is especially important because it reflects an immediate platelet response. The time lapse after venipuncture and the anticoagulant may affect platelet function in an as yet unknown way.