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排序方式: 共有202条查询结果,搜索用时 15 毫秒
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Sheiner E Walfisch A Hallak M Harlev S Mazor M Shoham-Vardi I 《The Journal of reproductive medicine》2006,51(2):115-119
OBJECTIVE: To evaluate possible risk factors for spontaneous and induced perineal damage during vaginal delivery. STUDY DESIGN: A prospective, observational study was conducted with 300 patients at 37-42 weeks of singleton gestation who presented in active labor. Sociodemographic data, birth circumstances and past medical history were obtained upon admission. Perineal damage was assessed before repair and 24 hours postpartum. A multiple logistic regression model was constructed to investigate independent risk factors for spontaneous perineal lacerations. RESULTS: Of 300 women included, 139 were primiparas. Episiotomy was performed in 32% of the population (62% in primiparas, 6% in multiparas). Spontaneous perineal tears requiring suturing occurred in 28%. Severe perineal tears (grades 3 and 4) occurred in 1%. Risk factors for adverse perineal outcome in the nonepisiotomy group included younger maternal age, non-Israeli ethnic background, use of epidural analgesia, nulliparity, shorter interval since last vaginal delivery, longer active phase and prolonged second stage. Prolonged second stage (> 40 minutes) and low parity were independent risk factors for perineal tears in a multivariable analysis. CONCLUSION: Identifying women in specific subgroups at high risk for perineal lacerations may minimize perineal damage. Women with a prolonged second stage of labor and low parity are prone for spontaneous damage and therefore deserve special attention. 相似文献
84.
Uri Chavkin Tamar Wainstock Ruslan Sergienko Asnat Walfisch 《The journal of maternal-fetal & neonatal medicine》2019,32(2):198-202
Objective: The objective of this study is to investigate whether an abnormal birthweight at term, either small for gestational age (SGA,?5th centile for gestational age) or large for gestational age (LGA,?>?95th centile for gestational age), is a risk factor for perinatal complications as compared with birthweight appropriate for gestational age (AGA).Methods: A population-based retrospective cohort analysis of all singleton pregnancies delivered between 1991 and 2014 at Soroka Medical Center. Congenital malformations and multiple pregnancies were excluded. A multivariable generalized estimating equation regression model was used to control for maternal clusters and other confounders.Results: During the study period, 228,242 births met the inclusion criteria, of them 91% were AGA (n?=?207,652), 4.7% SGA, and 4.3% LGA. SGA significantly increased the risk for perinatal mortality (aOR 5.6, 95%CI 4.5–6.8) and low 5-min Apgar scores (aOR 2.2, 95%CI 2.0–2.4), while LGA did not. SGA and LGA were both significant risk factors for cesarean delivery. LGA was significantly associated with shoulder dystocia and post-partum hemorrhage (aOR =13.6, 95%CI 10.9–17.0, and aOR 1.7, 95%CI 1.2–2.6, respectively).Conclusions: Extreme birthweights at term are significantly associated with adverse maternal and neonatal outcomes. As opposed to SGA, LGA is not independently associated with perinatal mortality. 相似文献
85.
Noa Leybovitz-Haleluya Tamar Wainstock Eyal Sheiner Idit Segal Daniella Landau Asnat Walfisch 《The journal of maternal-fetal & neonatal medicine》2019,32(10):1609-1614
Introduction: Low Apgar scores (<7) measured at age 5?minutes can predict short-term infant morbidity and mortality. Although an association exists between low Apgar scores and neuropsychological disorders, other childhood disorders were not thoroughly studied. We aimed to study the possible association between low 5-minute Apgar scores in term newborns and their long-term childhood gastrointestinal (GI) morbidity.Methods: A population-based cohort analysis was performed comparing total and different subtypes of GI-related pediatric hospitalizations among newborns with normal (≥7) and low (<7) 5-minute Apgar scores. The analysis included all term singletons born between the years 1999 and 2014 at a single tertiary regional medical center. Infants with congenital malformations, multiple gestations, and all perinatal deaths were excluded from the analysis. GI-related morbidities included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital computerized files. A Kaplan–Meier survival curve was constructed to compare the cumulative GI morbidity, and a Cox proportional hazards model was used to adjust for confounders.Results: The study population, including 223 244 term singletons, was followed for an average of 10.02?±?6.0 years (0–18 years, median 10.25) following discharge from birth hospitalization. Low 5-minute Apgar scores were recorded in 585 (0.3%) newborns. Incidence of GI-related hospitalizations was higher among the low versus the normal 5-minute Apgar score group (7.4 versus 5.2%; 8.6/1000 person years (PY) versus 5.2/1000 PY, respectively; p?=?.02; odds ratio =1.66, 95%CI 1.36–1.96). The association remained significant and independent while adjusting for gestational age, fetal weight, offspring gender, maternal age, maternal smoking, hypertension, and diabetes (Adjusted HR =1.57, 95%CI 1.16–2.12, p?=?.003).Conclusions: Low 5?minutes Apgar score is associated with an increased risk for long-term pediatric GI morbidity of the offspring. Our results suggest that Apgar scores can be used as a possible predictor for long-term pediatric morbidities and thus may necessitate appropriate surveillance in this vulnerable group of children. 相似文献
86.
Or Maoz Tamar Wainstock Eyal Sheiner Asnat Walfisch 《The journal of maternal-fetal & neonatal medicine》2019,32(11):1847-1852
Objective: To investigate whether postterm pregnancy (≥42 0/7 weeks’ gestation) increases the risk for adverse perinatal outcome.Study design: In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks’ gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded. The association between postterm and adverse perinatal outcomes was evaluated using a general estimation equation (GEE) multivariable analyses.Results: During the study period, 226,918 deliveries were included in the analysis. Of them, 95.9% (n?=?217,544) were term and 4.1% (n?=?9374) were postterm. Post-term pregnancies were more likely to be complicated with oligohydramnios, macrosomia, meconium stained amniotic fluid, shoulder dystocia, low Apgar scores, and hysterectomy (p?.05 in all). Perinatal mortality rates were significantly higher at postterm as well. Using the GEE model, the association between postterm and total perinatal mortality persisted (OR?=?1.73, 95%CI 1.2–2.4), as well as specifically intrauterine fetal death (OR?=?1.76, 95%CI 1.1–2.7) and intrapartum death (OR?=?3.71, 95%CI 1.3–10.4).Conclusions: Post-term delivery involves higher rates of adverse perinatal outcomes and is independently associated with significant perinatal mortality. 相似文献
87.
Adva Cahen-Peretz Eyal Sheiner Michael Friger Asnat Walfisch 《The journal of maternal-fetal & neonatal medicine》2019,32(1):51-57
Introduction: Deviation in the development of the female reproductive organs from the normal anatomy has been shown to have an impact on obstetrical outcomes and neonatal morbidity.Material and methods: In this retrospective population-based cohort study, short-term neonatal morbidity and mortality were compared in pregnancies of women with and without uterine anomalies. The analysis included deliveries that occurred between the years 1991 and 2013 in a tertiary medical center. Statistical analysis included multiple logistic regression models.Results: During the study period, 256,299 deliveries met the inclusion criteria; 0.49% (n?=?1251) of which occurred in women diagnosed with Müllerian anomalies. In the regression model, Müllerian anomalies were noted as an independent risk factor for placental abruption (adjusted odds ratio, 1.9; 95% confidence interval, 1.3–2.8; p?=?.001), intrauterine growth restriction (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.4; p?.001), pathological presentation (adjusted odds ratio, 13.5; 95% confidence interval, 11.9–15.1; p?.001) and cesarean delivery (adjusted odds ratio, 13.4; 95% confidence interval, 11.5–15.6; p?.001) while controlling for multiple confounders. Perinatal mortality, however, was not found to be increased in the exposed group in a model controlled for gestational age and weight (adjusted odds ratio, 0.6; 95% confidence interval, 0.4–1.02; p?=?.061).Conclusion: Women with Müllerian anomalies are at an increased risk for multiple adverse pregnancy outcomes, including preterm delivery and intrauterine growth restriction. Perinatal mortality, however, is not increased when controlled for gestational age and weight suggesting that mortality in these pregnancies is mediated by preterm delivery and small for gestational age. 相似文献
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89.
Extended sperm preparation: an alternative to testicular sperm extraction in non-obstructive azoospermia 总被引:2,自引:9,他引:2
Ron-El R; Strassburger D; Friedler S; Komarovski D; Bern O; Soffer Y; Raziel A 《Human reproduction (Oxford, England)》1997,12(6):1222-1226
Testicular sperm retrieval for the treatment of non-obstructive azoospermia
requires the execution of an invasive procedure, with all its possible
attending complications and subsequent long-term effects. This study
suggests a new non-invasive approach for collection of spermatozoa in these
patients: the extended sperm preparation (ESP). ESP consists of conducting
a thorough microscopic search through many droplets of ejaculate sediment.
ESP was performed for 49 patients; in 17 patients (35%), spermatozoa were
found and subsequently used in intracytoplasmic sperm injection (ICSI). Of
these preparations, five yielded fewer motile spermatozoa than the number
of corresponding oocytes available, and in one patient only non-motile
spermatozoa were recovered. The remaining 32 ESP-negative patients
underwent testicular sperm extraction (TESE) from testicular biopsy.
Spermatozoa were found in 16 of 32 biopsies (50%) and subsequently used in
ICSI. Fertilization and cleavage rates were comparable in both ESP and TESE
groups, yielding four clinical pregnancies in each group (27 and 29%
respectively). Embryo morphology was defined as excellent in significantly
more cases in the ESP group than the TESE group, and implantation rate
appeared somewhat higher in the ESP group (16%) than the TESE group (13%).
The ESP technique yields results similar to TESE, and can be applied in
cases of non-obstructive azoospermia as a prerequisite modality enabling us
to avoid testicular biopsy in 35% of cases.
相似文献
90.
Serial sonography and colour flow Doppler imaging following testicular and epididymal sperm extraction 总被引:8,自引:8,他引:0
Ron-El R; Strauss S; Friedler S; Strassburger D; Komarovsky D; Raziel A 《Human reproduction (Oxford, England)》1998,13(12):3390-3393
Percutaneous epididymal sperm aspiration (PESA), percutaneous testicular
sperm aspiration (TESA) and testicular sperm extraction (TESE) are invasive
procedures and their consequences on the testis have not been clearly
defined. In order to relate the sonographic and colour Doppler flow changes
to the clinical data, 14 patients with non- obstructive and six with
obstructive azoospermia were examined by the same roentgenologist
immediately before, at 5 days, 2 weeks, 2 and 6 months after the surgical
procedure. Testicular volumes remained unchanged during the follow-up
period in both the non-obstructive and obstructive groups. Of the
non-obstructive group, focal testicular lesions were seen in 20 of the 26
testes (77%) 5 days after the procedure and in 54% by 6 months. Ten were
hypoechoic, of which six converted to echogenic foci, three remained
hypoechoic and one disappeared at 6 months. The other 10 were echogenic
lesions, three of which were no longer visible at 6 months and the
remainder were unchanged. In the obstructive azoospermic group, focal
lesions were not found. Extratesticular abnormality consistent with
haematoma was demonstrated in four non-obstructive cases, which disappeared
at the 6 month examination, and in none of the obstructive azoospermic
patients. Whether residual focal lesions in the testes have long-term
effects remains to be evaluated. In the obstructive azoospermic group, the
aspirations performed did not leave any sonographic abnormalities.
相似文献