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Biomedical subjects

C G Brumfield

Publications and source records attributed to C G Brumfield.

34 records · Page 2Linked to original sources
PubMed1991

Management of prenatally detected nonlethal fetal anomalies: is a karyotype of benefit?

The pregnancy outcomes of 155 women who underwent an amniocentesis for a prenatal karyotype after being diagnosed by ultrasound as having one or more nonlethal structural anomalies are presented. Thirty-three (21%) patients were found to have an abnormal karyotype. Knowledge of the prenatal karyotype was useful in the subsequent management of these pregnancies. A pregnancy with a fetal anomaly diagnosed prior to 24 weeks was more likely to be terminated if an abnormal karyotype was also present. In women who were diagnosed as having a fetal anomaly with an abnormal karyotype at 24 weeks or later, only 3 of 13 (23%) infants survived the neonatal period. Knowledge of the karyotype results influenced decisions regarding the place, timing, and route of delivery in these fetuses. In 32 women, (21%) a karyotype was beneficial by avoiding maternal transport, cesarean delivery, and neonatal expenses at a Level III perinatal center.

Abortion, Induced↗
PubMed1991

Fetal obstructive uropathies. Importance of chromosomal abnormalities and associated anomalies to perinatal outcome.

The ultrasound records of 30 fetuses suspected of having an obstructive uropathy were reviewed retrospectively. A prenatal karyotype was obtained with amniocentesis on each patient. After delivery, neonatal urologic records, renal ultrasound reports and autopsy information were reviewed and compared to the ultrasound records and fetal karyotype results. Chromosomal defects were found in 23% of fetuses with a suspected obstructive fetal uropathy. In five patients the chromosomal abnormality was lethal and caused 45% of the perinatal deaths in this series. If a fetus with an obstructive uropathy was female, there was a significant likelihood of an extrarenal anomaly or a complex genitourinary tract malformation. Seventeen percent of patients with an obstructive uropathy had a coexistent extrarenal defect. A prenatal karyotype should be obtained if a fetal obstructive uropathy is suspected antenatally since lethal chromosomal defects are an important cause of perinatal death. A female karyotype may indicate a fetus at higher risk of extrarenal anomalies or complex genitourinary malformations.

Adult↗
PubMed1990

A comparison between umbilical artery velocimetry and standard antepartum surveillance in hospitalized high-risk patients.

One hundred forty-six women admitted to the high-risk obstetric unit between November 1987 and December 1988 participated in a study designed to compare Doppler umbilical artery flow studies with standard antepartum testing in the prediction of adverse fetal outcome. A Doppler ultrasound examination was considered abnormal when the average systolic/diastolic ratio was greater than or equal to 4. The antepartum testing consisted of a combined use of nonstress testing and contraction stress testing. If both the Doppler systolic/diastolic ratio and the antepartum testing were abnormal, there was a significantly increased incidence of intrauterine growth retardation (47%), fetal distress necessitating cesarean section (67%), and admission to neonatal intensive care (86%). Doppler umbilical artery flow studies are an important adjunct to antepartum fetal surveillance in high-risk patients but should not determine clinical management when standard antepartum surveillance remains normal.

Blood Flow Velocity↗
PubMed1990

The relationship between maternal serum and amniotic fluid alpha-fetoprotein in women undergoing early amniocentesis.

alpha-Fetoprotein levels were measured on 148 paired samples from the maternal serum and amniotic fluid in women greater than or equal to age 35, who were undergoing early amniocentesis (12 to 14 weeks) for chromosomal analysis. These 148 women were white, weighed less than 200 pounds, had no serious medical problems, and did not have a fetal abnormality detected by ultrasonography or karyotype analysis. There was a significant rise in the maternal serum alpha-fetoprotein concentration from 12 to 14 weeks' gestation. Amniotic fluid alpha-fetoprotein peaked at 13 weeks and then significantly declined by 14 weeks' gestation. Similar to reports from normal pregnancies at 16 and 17 weeks, we found no correlation between the maternal serum and amniotic fluid alpha-fetoprotein levels between 12 and 14 weeks. Amniotic fluid alpha-fetoprotein levels cannot be predicted by levels in the maternal serum in pregnancies between 12 and 14 weeks' gestation.

Adult↗
PubMed1990

Screening tests for intrauterine growth retardation: a comparison of umbilical artery Doppler to real-time ultrasound.

In a study designed to compare Doppler umbilical artery velocimetry to ultrasound morphometric measurements in the prediction of intrauterine growth retardation, 636 paired ultrasound and Doppler umbilical artery examinations were performed between 24 and 40 weeks gestational age. Intrauterine growth retardation was defined as birth weight less than the tenth percentile per gestational age and 25 (9.2%) of the infants born in our study met this criteria. In general, when the gestational age was limited to less than 30 weeks, none of the tests were highly predictive of intrauterine growth retardation. Doppler umbilical artery systolic-to-diastolic ratios of greater than 3 had the highest sensitivity. However, due to inclusion of a large number of false-positives, it was considered a poor test. After 30 weeks, fetal abdominal circumference less than the tenth percentile had a greater sensitivity (45%) and positive predictive value (28%) than Doppler systolic-to-diastolic ratios greater than 3 (36% and 18%, respectively). Doppler ultrasound umbilical artery systolic-to-diastolic ratios are not more predictive of intrauterine growth retardation than ultrasound morphometric measurements.

Birth Weight↗
PubMed1989

A comparison of perinatal outcome in patients undergoing contraction stress testing performed by nipple stimulation versus spontaneously occurring contractions.

Perinatal outcomes were analyzed in 848 high-risk pregnancies managed with a prospective weekly contraction stress testing protocol. In 615 patients the last test was performed by a nipple stimulation protocol whereas 233 patients had sufficient spontaneous contractions for performance of the test. All patients were either delivered of their infants or admitted for delivery within 7 days of the last test. The results of the last test were compared to various perinatal outcome parameters. There was no significant difference in perinatal outcomes between the two groups.

Breast↗
PubMed1989

Prematurity, postdates, and growth retardation: the influence of use of ultrasonography on reported gestational age.

The preterm and postterm delivery rates and the percentage of infants with intrauterine growth retardation are dependent on the gestational age recorded at delivery. At our institution a sharp increase in the preterm delivery rate and a coincident decrease in the postterm delivery rate and the rate of intrauterine growth retardation were noted. Over a 3-year period, while the characteristics of the obstetric population changed only slightly, the gestational age distribution shifted, with a decrease in the mean gestational age of about 1 week and a risk in the reported preterm delivery rate from 12% to 17%. About 15% of this rise was explained by an increase in obstetric interventions, and another 15% can be explained by changes in the way physicians rounded off gestational age. The majority of the increase in the preterm delivery rate was related to changes involving ultrasonographic examinations. These changes included a greater percentage of the population examined, trends toward earlier examinations, a tendency for the physicians to use ultrasonography rather than the last menstrual period in choosing the final gestational age, the use of different standards, an increase in the number of structures measured, and the weight given to various structures for determination of gestational age. It is apparent that changes in use of ultrasonography had a profound effect on the reported gestational age distribution at our institution.

Birth Weight↗
PubMed1989

Sonographic measurements and ratios in fetuses with Down syndrome.

Ultrasound measurements of 15 fetuses with trisomy 21 detected during the 17th week of gestation were matched retrospectively to those of 45 normal controls. We compared nine standard ultrasound measurements of the fetal head, abdomen, and femur in these two groups. The fetuses with trisomy 21 had significantly shorter mean femur lengths, narrower occipitofrontal diameters, and increased biparietal diameter (BPD)/femur length and abdominal circumference/femur length ratios. An increased BPD/femur length ratio was the ultrasound finding that best predicted a fetus with Down syndrome. A BPD/femur length ratio of 1.80 or higher was 40% sensitive and 97.8% specific in predicting Down syndrome, and had a false-positive rate of only 2.2%. An increased second-trimester BPD/femur length ratio measured by ultrasound may prove beneficial as an additional screening test for Down syndrome.

Down Syndrome↗
PubMed1987

Amniotic fluid alpha-fetoprotein levels and pregnancy outcome.

Elevated and low levels of maternal serum alpha-fetoprotein in the midtrimester of pregnancy have been linked with adverse events in later gestation, such as fetal and neonatal deaths, chromosomal abnormalities, and low birth weight infants. It is not known if this same association with poor pregnancy outcome is also true of amniotic fluid alpha-fetoprotein. In this study, alpha-fetoprotein was obtained from the fluid of 1060 women undergoing genetic amniocentesis for advanced maternal age. Poor pregnancy outcome was defined as (1) a fetal or neonatal death, (2) preterm delivery, or (3) low birth weight infants. Amniotic fluid alpha-fetoprotein was compared to each type of adverse outcome. No significant association with a poor pregnancy outcome in later gestation was noted. Although serum alpha-fetoprotein in the midtrimester of pregnancy may relate to certain poor outcomes in later gestation, midtrimester amniotic fluid alpha-fetoprotein offers no predictive value for the course of events in later gestation.

Amniocentesis↗
PubMed1984

A delayed hemolytic transfusion reaction after partial exchange transfusion for sickle cell disease in pregnancy: a case report and review of the literature.

A delayed hemolytic transfusion reaction that occurred after a prophylactic partial exchange transfusion for sickle-cell disease in pregnancy is described. The clinical presentation and laboratory findings of delayed transfusion reactions are discussed, with special emphasis on problems associated in the sickle-cell disease patient. Suggestions on how to minimize the risk of transfusion reactions in the pregnant sickle-cell disease patient are given.

Adult↗
PubMedDate not supplied

72-hour discharge after cesarean delivery: results in a selected Medicaid population.

The purpose of this study was to determine the safety and cost savings of discharging low income patients at 72 hours following cesarean delivery. Predetermined criteria were used to allow discharge. Selection criteria were no medical problems, an afebrile postoperative course, documented bowel function, to have tolerated at least one regular meal, and to have reached 72 hours postdelivery by 6 o'clock PM at discharge. Each patient returned to clinic 2-3 days postdischarge for staple removal. Physicians also discharged some low income patients home at 72 hours even though strict eligibility criteria were not met. Maternal outcome and financial data were compared between patients discharged after meeting eligibility criteria versus those who did not. Of 1,299 cesareans performed from July 1, 1993-July 31, 1995, 906 (70%) were performed in low income patients and 399 (44%) of these women were discharged at 72 hours. Twenty-seven women were lost to follow-up and 286 (77%; Group A) met the eligibility criteria for 72-hour discharge. Eighty-six women (23%; Group B) who did not meet criteria were also discharged at 72 hours. When maternal outcome data from the two groups were compared, Group B patients (did not meet criteria) were more likely to have been readmitted at < or = 30 days (7 of 86; 8% vs. 8 of 286; 3%; P = 0.05) and had longer hospital stays (27 days vs. 22 days) than Group A patients (met criteria). Net cost savings in 2 years was $448 per discharge for Group A, but only $333 per discharge for Group B. In our selective 72-hour discharge program, failure to abide by predetermined guidelines established to select only low risk, afebrile patients for 72-hour discharge resulted in more hospital readmissions, and longer stays and thus was not as cost effective.

Adult↗
PubMedDate not supplied

Prenatally diagnosed hypoplastic left heart syndrome--outcomes after postnatal surgery.

OBJECTIVE: To identify prenatally diagnosed cases of hypoplastic left heart syndrome (HLHS) and then to determine postnatal outcomes after surgical interventions. METHODS: An ultrasound and pediatric cardiology database was used to identify all fetuses diagnosed prenatally from 1991-1996 with HLHS. Fetal karyotypes were performed on cultured amniocytes. After diagnosis, parents were given several management options: pregnancy termination before 22 weeks, postnatal hospice care, or surgery using the Norwood procedure or cardiac transplantation. Ultrasound and echocardiography findings were later compared to karyotype results and postnatal outcome data. RESULTS: Fifteen fetuses with HLHS were identified. Two (16%) chromosome abnormalities and three (20%) structural defects were detected. Three mothers (20%) opted for pregnancy termination, two (13%) chose postnatal hospice care, and one aneuploid fetus had an intrauterine death. Nine parents (60%) chose surgery for their infants; however, one infant was not an appropriate surgical candidate due to a coexisting diaphragmatic hernia. Eight infants underwent surgery and two survived (25%). Of the four infants scheduled to undergo the Norwood procedure, one died preoperatively, two died intraoperatively, and one infant survived and is doing well at age 8 months. Of the four infants scheduled for cardiac transplantation, two died awaiting transplant and one died postoperatively. One infant survived cardiac transplantation but has microcephaly and developmental delay at age two. CONCLUSIONS: In prenatally diagnosed HLHS at our institution, the survival rate following surgery for infants felt to be the best candidates was only 25%.

Abortion, Legal↗