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Biomedical subjects

B Bromley

Publications and source records attributed to B Bromley.

At least 55 records · Page 3Linked to original sources
PubMed1995

Fetal lung masses: prenatal course and outcome.

We describe 25 cases of echogenic or complex fetal lung masses seen sonographically and suspected of being cystic adenomatoid malformations or sequestrations of the lung. On the basis of prenatal sonographic appearance, 40% of fetuses were suspected of having type 1, 20% type 2, and 40% type 3 cystic adenomatoid malformations or sequestrations. Sixteen (64%) of the 25 fetuses with lung masses survived the perinatal period, and 80% of the nonaborted fetuses survived. Eleven infants (69% of liveborns) had no respiratory symptoms at birth. Nine of the survivors underwent surgical resections of their masses after birth, whereas the other seven children are being followed conservatively. The postnatal diagnoses revealed that four of the fetuses had sequestrations, one had a sequestration with elements consistent with cystic adenomatoid malformation, and two who were thought to have type 1 cystic adenomatoid malformation had an esophageal duplication cyst and a thoracic neuroblastoma, respectively. All the other infants who had a pathologic diagnosis or postnatal imaging had cystic adenomatoid malformations. Increasing mediastinal shift was associated with decreasing survival as 90% of fetuses with no mediastinal shift are alive, whereas 50% of the nonaborted fetuses with a severe mediastinal shift survived. Follow-up scans in utero were available in 15 cases. The size of the mass became smaller in 53% during gestation. Seventy-one percent of pregnancies had normal amniotic fluid volumes and 29% were complicated by polyhydramnios. Survival of nonaborted fetuses was 100% in pregnancies with normal amniotic fluid compared with 50% in those with polyhydramnios. Eight percent of the fetuses with chest masses had additional structural abnormalities and were karyotypically abnormal. In conclusion, many fetuses with lung masses show improvement of the sonographic findings in utero, and many infants may not be symptomatic at birth. Of the survivors in this series, only slightly greater than half underwent surgery.

Abortion, Spontaneous↗
PubMed1995

Can the presumed risk of autosomal trisomy be decreased in fetuses of older women following a normal sonogram?

Previous studies showed that a sonographic scoring system can be used to identify women under age 35 who are at an increased risk for a fetal autosomal trisomy. We propose to use the same scoring system to select women over age 35 who are at a decreased risk of a fetal autosomal trisomy because the ultrasonogram is normal. We reviewed the sonographic scores of 97 trisomic and 694 normal control fetuses from two previously published consecutive series designed to identify women at increased risk for an affected fetus. Using the same scoring index in this study, we calculated the sensitivity and specificity of a score = 0 zero for identifying fetuses with autosomal trisomy. We then applied Bayes' theorem to determine the probability of an autosomal trisomy at various maternal ages, given a sonographic score of 0. Of the 97 fetuses with an autosomal trisomy, 83 had a score of > or = 1, for a sensitivity of 86% (95% CI 77-92%). Of the 694 control fetuses with normal karyotype, 606 had a score of 0, for a specificity of 87% (95% CI 83-89%). A 42 year old woman's probability of an autosomal trisomy if the sonographic score is 0 becomes equivalent to the age-specific probability for a 35 year old woman. Using the lower limit of the CIs for sensitivity and specificity, we calculated that the probability of having a fetus with an autosomal trisomy falls from 18.8 in 1000 to 5.3 in 1000 for a 40 year old woman with a sonographic score of 0.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Difficulties in the prenatal diagnosis of microcephaly.

Our objective was to determine whether the diagnosis of microcephaly present at birth is apparent using standard biometry in the second trimester. Fetuses with prenatally suspected microcephaly (biparietal diameter > or = 3 standard deviations below mean) who had a first sonogram prior to 22 weeks' gestation and a confirmation of microcephaly after birth were included in the study. We excluded all fetuses who had neural tube defects or other major associated abnormality that would lead to a suspicion of microcephaly. We therefore included fetuses who either had normal-appearing brains sonographically or intracranial calcifications as the only sonographic abnormality seen prior to 22 weeks' gestation. Seven fetuses met these criteria. One fetus was diagnosed as having microcephaly prior to 22 weeks' gestation. The other six fetuses had a normal head size prior to 22 weeks' gestation and were diagnosed as having microcephaly at 27 weeks' gestation and later. Only one of the seven fetuses had a karyotypic abnormality. We conclude that the prenatal diagnosis of microcephaly is not excluded by normal biometry on second trimester sonography.

Adult↗
PubMed1995

Using the number of yolk sacs to determine amnionicity in early first trimester monochorionic twins.

The purpose of this study was to evaluate the relationship between the number of yolk sacs and amnionicity in monochorionic twin pregnancies scanned early in the first trimester. We retrospectively reviewed images of all monochorionic twins scanned between 6 and 9.5 weeks' gestation and with pathologic or sonographic confirmation of chorionicity-amnionicity. Each film was reviewed for the number of yolk sacs present, as well as for the gestational age at which the amniotic membrane was first visualized. Twenty monochorionic-diamniotic pregnancies and two monochorionic-monoamniotic pregnancies met the criteria for inclusion in the study. In diamniotic pregnancies scanned at less than 8 weeks' gestation, only the yolk sacs were identified; none of the dividing amniotic membranes were detected. Two yolk sacs were identified in all but one case. In this case, although one yolk sac was seen at 6 weeks, follow-up scanning at 8 weeks revealed two yolk sacs. In each of the monochorionic-monoamniotic twin pregnancies, one yolk sac was seen at 9 weeks and a single amnion encircled both embryos. We conclude that the sonographic identification of two yolk scas in monochorionic twins enables us to make the diagnosis of diamniotic twins early in the first trimester, before the amniotic membrane can be imaged. The presence of one yolk sac should prompt a follow-up ultrasonogram to assign amnionicity definitively.

Adult↗
PubMed1995

The ultrasonographic appearance and outcome for fetuses with masses distorting the fetal face.

Our objective was to determine the appearance, cause, and outcome of fetal face masses diagnosed antenatally by ultrasonography. Over a 6 year period, 10 consecutive fetuses with facial masses were identified. Ultrasonographic findings, neonatal pathologic findings, and outcome data were correlated. Four (40%) of the 10 fetuses died, including one with a palatal teratoma associated with a Dandy-Walker malformation and three with intracranial teratomas--one of which was associated with hydrops fetalis. Among the survivors, one fetus had a dacryocystocele that was managed conservatively and one had drainage of a salivary gland cyst. The remaining four neonates had successful excision of their tumors in the neonatal period and survived; these infants had a nasal teratoma, a thyroid teratoma, a gingival granular cell tumor, and a scalp hemangioma. Four of the 10 pregnancies had associated polyhydramnios, three of which ended in stillbirth or neonatal death. In conclusion, 40% of the fetuses with antenatal diagnosis of fetal facial masses did not survive. If those with intracranial teratomas are removed from this group, one of seven (14%) fetuses with extracranial masses died. The intracranial teratomas were uniformly fatal. Polyhydramnios was associated with poor outcome.

Facial Neoplasms↗
PubMed1995

Prenatal sonographic detection of genital malformations.

Postnatal clinical and pathological correlation of sonographically identified genital malformations in 17 fetuses was undertaken to determine the outcome of these findings. Diagnoses confirmed at autopsy or by postnatal examination and surgery included male (XY) pseudohermaphroditism in 2 cases, hypospadias with chordee in 3, microphallus in 2, cloacal anomaly in 2, congenital adrenal hyperplasia in 3, penoscrotal transposition in 2, intra-abdominal testes in 1, megalourethra in 1 and cloacal exstrophy variant in 1. Additional abnormalities included congenital heart defects, cleft palate, and renal, anorectal, cranial and cerebral malformations. Four fetuses with a sonographically abnormal appearing phallus were found to have an endocrine disorder (3 congenital adrenal hyperplasia and 1 panhypopituitarism). Outcomes included 2 abortions and 1 neonatal death with the remaining neonates undergoing medical and reconstructive treatment. Prenatal detection of genital abnormalities can be helpful in evaluating those fetuses with severe multi-system anomalies as well as lesions more amenable to correlation in the neonatal period. Detection is particularly important in neonates with endocrine disorders, and complex genitourinary and anorectal malformations.

Female↗
PubMed1994

The role of Doppler velocimetry in the structurally normal second-trimester fetus with elevated levels of maternal serum alpha-fetoprotein.

Umbilical and uterine artery velocimetry was performed in 199 second-trimester pregnancies undergoing sonographic examination for unexplained elevated levels of maternal serum alpha-fetoprotein in order to evaluate the efficacy of Doppler waveforms for the prediction of adverse perinatal outcome. A total of 169 pregnancies resulted in term deliveries of infants with appropriate growth for age, and 30 pregnancies (15%) had adverse outcomes, including preterm delivery, growth retardation and death. The umbilical artery systolic/diastolic ratio was not statistically different in the two groups (3.9 vs. 4.2, p = 0.16). The uterine artery systolic/diastolic ratio was slightly greater in the group with abnormal outcome (5.7) than in the group with normal outcome (3.3), but the difference was not significant (p = 0.11). Forty-six patients had uterine artery waveforms that exhibited an early diastolic notch. Of these, 31 had a grade 1 notch in which the lowest part of the notch was not greater than one half of the diastolic frequency shift. Fifteen patients had a severe or grade II notch in which the deepest part of the diastolic notch was less than half of the diastolic flow. In patients with either no diastolic or grade I uterine artery notch, the incidence of adverse outcomes was 23/184 (12.5%). In patients with a grade II notch, 7/15 (47%) had a poor outcome. The rate of adverse outcome in patients with a grade II notch was more than three times that observed in women without severe uterine notch, yielding a relative risk of 3.4 (95% CI 1.9-6.0). Thus, the presence of a grade II uterine artery notch on second-trimester sonographic evaluation is associated with an increased risk for adverse perinatal outcome over unexplained elevated levels of maternal serum alpha-fetoprotein.

Journal Article↗
PubMed1994

Second trimester sonographically diagnosed placenta previa: prediction of persistent previa at birth.

OBJECTIVES: We sought to determine the natural history of second trimester sonographically diagnosed placenta previa, and to ascertain whether the position of the placenta with respect to the cervical os at second trimester sonography can accurately predict persistence of the placenta previa at term. METHODS: The study population included all women consecutively diagnosed by ultrasound with placenta previa between 14 and 20 weeks' gestation. Medical records of the patients requiring cesarean section were reviewed to determine the presence of placenta previa. We reviewed the second trimester sonogram of patients who underwent abdominal delivery for placental and nonplacental indications to determine whether the central (symmetrical) versus the partial (asymmetrial) position of the placenta with respect to the internal os predicted the presence of placenta previa at delivery. RESULTS: A total of 925 second trimester- patients were sonographically identified as having placenta previa. Two hundred and sixty seven patients underwent cesarean delivery, 43 of which had placenta previa (43/925 or 4.6%). Twenty-two of the 43 were asymptomatic without antepartum bleeding. Analysis of the second trimester position of the placenta revealed that symmetry of the placenta with respect to the internal os at second trimester scan had a sensitivity of 49% for prediction of placenta previa at birth. CONCLUSIONS: The degree of placental symmetry with respect to the internal os during the second trimester successfully predicted the previas most likely to persist at delivery with a sensitivity of 49% (95% CI 34-64) and specificity of 93%.

Cesarean Section↗
PubMed1994

Identification of second-trimester fetuses with autosomal trisomy by use of a sonographic scoring index.

PURPOSE: To evaluate the ability to identify fetuses with autosomal trisomy by use of sonographic features in the form of a scoring system. MATERIALS AND METHODS: The presence of nuchal thickening, long-bone shortness, pyelectasis, hyperechoic bowel, choroid plexus cyst, and major anatomic defects was prospectively evaluated in 60 trisomic fetuses aged 14-21 weeks and 106 second-trimester control fetuses. RESULTS: Forty-five fetuses had Down syndrome, 13 had trisomy 18, and two had trisomy 13. Based on previous criteria for short femur and humerus, pyelectasis, nuchal thickening, echogenic bowel, and choroid plexus cysts, a scoring system for detection of aneuploidy was developed. It enabled identification of 33 fetuses with Down syndrome (73%), 11 (85%) with trisomy 18, two (100%) with trisomy 13, and four control fetuses with abnormality (4%). The positive predictive value in patients in 1/250, 1/500, and 1/1,000 risk groups was 7.2%, 3.7%, and 1.9% for identification of a fetus with Down syndrome. CONCLUSION: These sonographic markers seem to be sensitive for the detection of chromosomal abnormalities.

Chromosomes, Human, Pair 13↗
PubMed1994

Closure of the cerebellar vermis: evaluation with second trimester US.

PURPOSE: To evaluate with sonography the normal development of the fetal cerebellum in the second trimester. MATERIALS AND METHODS: The study included all patients undergoing second trimester genetic amniocentesis who had structurally normal fetuses, in whom the posterior fossa was adequately seen and in whom the karyotype was later determined to be normal. Views of the cerebellum were obtained prospectively, and the inferior vermis was determined to be open or closed at the time of the initial scan. Follow-up was obtained by means of subsequent scans and review of the pediatric record. RESULTS: Of 897 fetuses that met the inclusion criteria, 147 had an open vermis at initial scanning. At 14 weeks gestation, 56% of fetuses had an open vermis, decreasing to 23% at 15 weeks and 6% at 17 weeks. In utero follow-up sonograms were obtained in 79% of fetuses with an initially open vermis and demonstrated closure in all but one fetus. The remaining 21%, without sonographic follow-up, were normal as newborns. CONCLUSION: The prenatal diagnosis of Dandy-Walker variant should not be made before 18 weeks gestation because the development of the cerebellar vermis may be incomplete at that time.

Cerebellum↗
PubMed1994

Solid masses on the fetal surface of the placenta: differential diagnosis and clinical outcome.

We identified 10 cases of solid masses on the fetal surface of the placenta prospectively that were thought to represent chorioangiomas. Pathologic assessment of the placenta revealed five chorioangiomas and five placental hemorrhages. The five chorioangiomas ranged in size from 4 to 10 cm and four of these five fetuses were delivered uneventfully at term. Only one fetus showed evidence of cardiac decompensation and did not survive. Three of the five women with placental bleeds delivered their infants between 33 and 34 weeks' gestation, but all five infants did well. This series shows that the sonographic appearance of chorioangioma was indistinguishable from placental hemorrhage, and even large chorioangiomas may be associated with good neonatal outcome.

Diagnosis, Differential↗
PubMed1994

Fetal micrognathia: associated anomalies and outcome.

The purpose of this study was to evaluate the spectrum of sonographic findings, karyotypic abnormalities, and clinical outcome in cases of fetal micrognathia. Twenty fetuses with sonographically identified micrognathia were identified between 15 weeks' gestation and term. Five of 20 fetuses (25%) had abnormal karyotypes, including three with trisomy 18 and one each with trisomy 13 and trisomy 9. Sixteen of the 20 fetuses (80%) did not survive: Ten died in utero or during the neonatal period, and six pregnancies were terminated electively. Three of 20 fetuses (15%) had micrognathia as the sole sonographic finding. Two of these fetuses survived, one with growth retardation and one with Pierre Robin syndrome. Thirteen of 20 pregnancies were complicated by polyhydramnios. The diversity of the syndromes represented in our cases of micrognathia indicates a wide breadth of possible diagnoses when micrognathia is encountered prenatally. The poor prognosis and associated karyotypic and lethal anomalies are remarkable, with survival of only four of 20 fetuses in this report.

Abnormalities, Multiple↗
PubMed1994

Comparison between sonographic morphology and Doppler waveform for the diagnosis of ovarian malignancy.

OBJECTIVE: To assess the accuracy of pelvic sonography in distinguishing benign from malignant lesions in postmenopausal women, using morphologic criteria and Doppler flow characteristics. METHODS: All postmenopausal patients scanned from March 1992 to April 1993 with sonographically identified and pathologically confirmed adnexal masses formed the study group. The adnexal lesions were morphologically categorized prospectively as benign or malignant, and pulsed Doppler flow studies were measured using the lowest resistance index obtained from each mass. The sensitivity and specificity were determined for morphologic and Doppler flow assessments, as well as for a combination of these methods, for predicting the presence of malignancy. RESULTS: Thirty-three postmenopausal patients formed the study group; 12 lesions were malignant and 21 were benign pathologically. Using morphologic criteria alone, the sensitivity in detecting malignancy was 91% and specificity was 52%. Using pulsed Doppler alone with a resistance index limit of 0.6, the sensitivity in predicting malignancy was 66%, with a specificity of 81%. If a resistance index limit of 0.8 were used, the sensitivity and specificity would be the same as those for morphology alone. Combining morphology and resistance index, a single malignancy would still have been missed (sensitivity 91%). CONCLUSION: In our experience, Doppler flow studies did not add substantially to the prediction of malignancy using morphologic assessment alone.

Diagnosis, Differential↗
PubMed1994

Is fetal hyperechoic bowel on second-trimester sonogram an indication for amniocentesis?

OBJECTIVE: To determine the clinical significance of hyperechoic bowel seen sonographically in second-trimester fetuses. METHODS: Fifty fetuses (0.6%) with echogenic bowel were identified sonographically from a population of 8680 consecutive second-trimester fetuses over 21 months. The fetal bowel was considered hyperechoic if its echogenicity was similar to that of surrounding bone. Follow-up was obtained through medical record review. RESULTS: Twenty-nine of 50 fetuses (58%) were normal; eight (16%) were aneuploid, including six Down syndrome, one trisomy 13, and one Turner syndrome. All eight fetuses with aneuploidy had sonographic anomalies in addition to the echogenic bowel. Eight of 50 fetuses (16%) were growth-retarded, and five others (10%) had normal karyotypes but are still undelivered. Among the eight growth-retarded fetuses, there were five intrauterine or neonatal deaths, one elective abortion, and two survivors. In addition, the six fetuses with Down syndrome and echogenic bowel represented 12.5% of all second-trimester Down syndrome fetuses karyotyped in our laboratory during the study period. Combining results from the present study (six Down syndrome fetuses) with three studies from the literature (21 additional Down syndrome fetuses), a total of 27 fetuses with echogenic bowel and Down syndrome were identified, 11 (40.7%) of whom had no other sonographic findings. We calculate that if 1,000,000 second-trimester fetuses were scanned, 5105 would have hyperechoic bowel as the only finding, of whom 71 would have Down syndrome and 5034 would not. The risk of Down syndrome in fetuses with isolated hyperechoic bowel is, therefore, 71 in 5105 or 1.4%. CONCLUSION: The finding of isolated hyperechoic bowel in the second trimester should prompt genetic counseling and consideration of karyotypic analysis.

Amniocentesis↗
PubMed1993

Biometric measurements in fetuses of different race and gender.

Sonographic fetal biometric measurements on 6082 low-risk patients were compared in the second and third trimesters of pregnancy with respect to fetal race and gender. Ultrasonic measurements were obtained from fetuses of women participating in the Routine Antenatal Diagnostic Imaging with Ultrasound Study (RADIUS), who underwent both an early sonographic evaluation between 15 and 22 weeks' gestation and a later scan between 31 and 35 weeks' gestation. In the 16-21-week scans, male fetuses had significantly larger biparietal diameter measurements compared to female fetuses (estimated difference 0.852 mm, 95% CI 0.737-0.967). There was only minimal difference in biparietal diameter between Black and White fetuses. Femur length was similar in both female and male fetuses, but longer in Black compared to White fetuses (estimated difference 0.808 mm, 95% CI 0.539-1.078). During the 31-35-week scans, male fetuses continued to have larger biparietal diameter measurements compared to female fetuses (estimated difference 1.22 mm, 95% CI 1.04-1.40), and femur lengths were persistently longer in Black compared to White fetuses (estimated difference 0.563 mm, 95% CI 0.234-0.893). Further investigation is necessary to evaluate the effect of these slight differences in morphometric fetal measurements between races and genders, so that we can determine how best to use them for optimizing prenatal care.

Journal Article↗