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Biomedical subjects

D M Sherer

Publications and source records attributed to D M Sherer.

At least 73 records · Page 4Linked to original sources
PubMed1998

Uncomplicated baseline fetal tachycardia or bradycardia in postterm pregnancies and perinatal outcome.

OBJECTIVE: to assess perinatal outcome in post-term pregnancies in which fetal heart rate (FHR) monitoring revealed either uncomplicated baseline fetal tachycardia (> or = 160 bpm) or fetal bradycardia (< or = 120 bpm). STUDY DESIGN: We performed a case-control study of patients who underwent fetal assessment between July 1989 and June 1995, as part of post-term evaluation. Inclusion criteria consisted of nonlaboring afebrile patients with singleton post-term pregnancies > or = 41 weeks of gestation by strict dating criteria (last menstrual period consistent with ultrasound biometric parameters obtained prior to 20 weeks' gestation), normal fetal anatomy, intact membranes, and reactive nonstress test with no evidence of chorioamnionitis. Patients with fetal tachy or brady arrhythmias, FHR decelerations, or loss of short-term beat-to-beat variability were excluded. Baseline FHR was recorded retrospectively by an observer blinded to maternal and neonatal clinical outcome. For each case of uncomplicated baseline fetal tachycardia (> or = 160 bpm) or bradycardia (< or = 120 bpm), either two or three control cases (matched for maternal age and parity), with FHR > 120 bpm and < 160 bpm, were identified. Outcome variables assessed included: incidence of cesarean delivery, nuchal cord at delivery, meconium-stained amniotic fluid (AF), 5-min Apgar score < 7, fetal growth restriction (< 10th percentile for 41 weeks' gestation), meconium aspiration syndrome, and neonatal intensive care unit (NICU) admission. Statistical analysis included two-tailed t-test and chi2 test when appropriate, with p < 0.05 considered significant throughout. RESULTS: During the study period 1390 post-term patients (6.81% of the general population) were assessed. Of these, 31 (2.23%) fetuses exhibited baseline FHR > or = 160 bpm, and 76 fetuses (5.46%) exhibited baseline FHR < or = 120 bpm. No significant differences were noted in the incidence of cesarean delivery, presence of nuchal cord at delivery, meconium-stained AF, 5-min Apgar scores < 7, fetal growth restriction, meconium aspiration syndrome, or the incidence of NICU admissions between the groups of patients with fetal tachycardia, bradycardia, and their respective controls. CONCLUSIONS: Uncomplicated baseline fetal tachycardia or bradycardia in postterm patients are not associated with an increase in the incidence of adverse perinatal outcome.

Bradycardia↗
PubMed1998

Antepartum fetal intracranial hemorrhage, predisposing factors and prenatal sonography: a review.

Our objective was to review current literature pertaining to antepartum fetal intracranial hemorrhage. To this goal we selected all manuscripts published in the English language regarding this topic obtained from a MEDLINE search for 1966 through January 1998. Additional sources were identified through cross-referencing. Antenatal fetal intracranial hemorrhage may occur spontaneously, or occur in association with various maternal or fetal conditions. Predisposing maternal conditions at risk for this occurrence include alloimmune and idiopathic thrombocytopenia, von Willebrand's disease, specific medications (warfarin) or illicit drug (cocaine) abuse, seizures, severe abdominal trauma inflicting subsequent fetal injury, amniocentesis, cholestasis of pregnancy and febrile disease. Predisposing fetal conditions include congenital factor-X and factor-V deficiencies, hemorrhage into various congenital tumors, twin-twin transfusion, demise of a co-twin, or fetomaternal hemorrhage. Currently, antepartum fetal intracranial hemorrhage may be diagnosed by imaging techniques including ultrasonography and less frequently, magnetic resonance imaging. Early real-time sonographic signs of intracranial hemorrhage consist of irregular echogenic patterns representing the associated hematoma that may clearly distort normal intracranial structures. Recent reports have suggested Doppler flow velocimetry and color Doppler imaging as additional tools in detecting fetal intracranial hemorrhage. Various types of antenatal fetal intracranial hemorrhages that have been visualized sonographically include intraventricular, periventricular, subependymal, parenchymal, subdural, and intracerebellar events. Active hemorrhages may be associated with fetal distress manifested by fetal heart rate changes. Infrequently, antenatal ultrasonographic depiction of intracranial hemorrhage may precede devastating sequelae such as hydrocephalus, hydranencephaly, porencephaly, or microcephaly. Due to the significant associated neonatal neurological impairment and potential medicolegal implications of antepartum fetal intracranial hemorrhage, it follows that obstetricians and sonographers should be familiar with predisposing factors and typical diagnostic imaging findings of these events.

Cerebral Hemorrhage↗
PubMed1998

Rapid marked response of severe hyperemesis gravidarum to oral erythromycin.

A recent report has noted an association between Helicobacter pylori and hyperemesis gravidarum. We present two cases in which first-trimester patients with severe hyperemesis gravidarum requiring intravenous fluid replacement were placed on oral erythromycin therapy for other nonrelated conditions. Surprisingly, marked rapid improvement of the hyperemesis gravidarum was observed with complete resolution of all symptomatology. Both these patients tested seropositive for Helicobacter pylori. These unexpected, marked therapeutic responses are consistent with the recently reported association between hyperemesis gravidarum and Helicobacter pylori and possibly suggest a new therapeutic modality for similar patients.

Administration, Oral↗
PubMed1998

Prenatal sonographic findings associated with malignant astrocytoma following normal early third-trimester ultrasonography.

We present an unusual case in which sonographic assessment at 33 weeks' gestation, 5 weeks following a normal fetal anatomical survey and biometry, demonstrated a large, irregular-shaped, echogenic, suprasellar midline intracranial mass occupying the anterior and middle fossas. Associated severe obstructive hydrocephalus with "dangling" choroid plexus bilaterally was noted with a markedly thin cortical mantle and increased cranial biometry. Elective cesarean delivery was performed due to the associated craniomegaly at 37 weeks' gestation. Although breathing spontaneously at delivery, the infant subsequently required mechanical ventilation and developed neonatal seizures. A ventriculoperitoneal shunt was placed on Day 3 of life. Transcranial needle biopsy demonstrated malignant astrocytoma (glioblastoma multiforme). This case suggests the rapid development of an intracranial malignant astrocytoma over a relatively short period of time. The significant ultrasonographic finding of an intracranial, destructive fetal deformation, following a normal examination 5 weeks previously, demonstrates the limitations of screening ultrasonography in predicting perinatal outcome.

Adult↗
PubMed1998

Blunted fetal response to vibroacoustic stimulation following chronic exposure to propranolol.

A recent, prospective randomized trial has suggested that long-term use of prophylactic beta-adrenergic blocking agents may slow the rate of aortic dilation in those patients with Marfan's syndrome exhibiting evidence of existing dilation. Accordingly, administration of such medication from the midtrimester onward has been advocated in these patients. Acute oral administration of propranolol (80 mg) has been shown to depress fetal heart rate response to vibroacoustic stimulation. We present a case in which chronic administration of propranolol 150 mg/day to a patient with Marfan's syndrome with existing aortic root dilation was associated with repeated abnormal intrapartum fetal heart rate responses to vibroacoustic stimulation. Subsequent delivery of a nonhypoxic, nonacidotic infant suggests that maternal administration of beta-blockers should be considered in the interpretation of results of fetal vibroacoustic stimulation. This case also supports that in similar clinical presentations, ultrasonographic confirmation of the fetal startle response, or alternatively observation of the resulting fetal recoil may be utilized rather than the fetal heart rate, which may be modulated by maternal medications.

Adrenergic beta-Antagonists↗
PubMed1998

Intra- and early postpartum ultrasonography: a review. Part I.

The objective of this article is to review current literature pertaining to intra- and early postpartum sonography. All the manuscripts published in the English language regarding this topic were selected from a MEDLINE search from 1966 through August 1997. Additional sources were identified through cross-referencing. Currently, intra- and early postpartum sonography may be performed for either maternal or fetal indications. Maternal indications include cervical assessment in preterm labor/rupture of membranes, assessment of the lower uterine segment, size and position of uterine fibroids, guided-placement of central venous or pulmonary artery catheters, detection of intraoperative venous air embolism, deep venous thrombosis, assist management of the third-stage of labor, postpartum hemorrhage or febrile morbidity. Fetal indications include an anatomical survey in patients presenting without prenatal care, verification of fetal presentation, estimated fetal weight, assessment of the breech-presenting fetus, external cephalic version, management of delivery of the second-twin, and internal podalic version. Doppler flow velocimetry is a useful tool in depicting both maternal and fetal intrapartum physiologic changes. We conclude that intra- and early postpartum sonography is an established versatile diagnostic and interventional-guiding modality for many obstetric conditions and should be readily available on labor and delivery suites.

Cesarean Section↗
PubMed1998

Intra- and early postpartum ultrasonography: a review. Part II.

Part II is a continuation of the preceding segment, which appeared in the previous issue (Survey 1998;53:000-000). This part presents data pertaining to ultrasound-guided procedures (invasive and noninvasive), physiology (fetal behavior), intrapartum hemorrhage, the third stage of labor, post-partum hemorrhage, and postcaesarean ultrasonography. In addition, this article includes data regarding nonobstetric ultrasound including anesthesiology, catheter placement, venous air embolism, effect of epidural anesthesia on uterine blood flow, and urinary retention. Finally, this part presents ultrasonographic data of the maternal cerebral circulation in preeclampsia/eclampsia and of the maternal deep venous system.

Amniotic Fluid↗
PubMed1998

First trimester ultrasonography of multiple gestations: a review.

The objective was to review current literature pertaining to first trimester ultrasonography of multiple gestations. To this goal, all manuscripts published in the English language regarding this topic were selected and reviewed in a MEDLINE search from 1966 through May 1998. Additional sources were identified through cross-referencing. Current widespread application of first trimester ultrasonography and especially transvaginal sonography has introduced a new dimension in both diagnostic and management aspects of multiple gestations. Application of first trimester ultrasonography in multiple gestations enables an earlier and more precise depiction of important anatomical details regarding fetal viability, chorionicity, pregnancy outcome, structural abnormalities, pathophysiology of developmental disorders (such as twin reverse arterial perfusion [TRAP] sequence), early sonographic signs associated with fetal aneuploidy (nuchal translucency and abnormal crown-rump length), and potential fetal growth discordancy. First trimester ultrasonography also assists in guiding operative procedures including: amniocentesis, chorionic villus sampling, and selective fetal reduction. Enhanced information obtained with high-resolution, first trimester transvaginal ultrasonography is rapidly becoming a standard for establishing critical information that will assist clinicians to stratify management of multiple gestations. Given the increasing incidence of multiple gestations because of various assisted reproductive technology modalities, it is important that obstetricians become aware of the potential advantages of first trimester ultrasonography in clinical management of multiple gestations.

Female↗
PubMed1997

Angiogenesis in primary and metastatic epithelial ovarian carcinoma.

OBJECTIVE: Our goal was to evaluate angiogenesis in the ovaries and omental metastases as a prognostic indicator in patients with epithelial ovarian carcinoma. STUDY DESIGN: Ovarian specimens of 42 consecutive patients with primary epithelial ovarian carcinoma (stages I to IV) and omental metastases of 19 of these patients with stage IIIB or stage IIIC disease were stained immunohistochemically for factor VIII-related antigen. Microvessel counts were tested for correlation with patient age, stage of disease, type of tumor, preoperative serum CA 125 level, tumor size, tumor resectability, patient survival, and omental microvessel counts. Statistical analysis included parametric (factorial analysis of variance) and nonparametric (Mann-Whitney and Kruskal-Wallis) group comparison tests, parametric (Pearson) and nonparametric (Spearman) correlation tests, and parametric (Cox proportional hazards) and nonparametric (Kaplan-Meier) survival analysis with p < 0.05 considered significant throughout. RESULTS: Microvessel counts of omental metastases in patients with stage IIIB or stage IIIC ovarian carcinoma were significantly correlated with preoperative serum CA 125 level (p = 0.028) and patient survival (p = 0.019). Microvessel counts of the ovaries examined were not correlated with patient age, stage of disease, type of tumor, preoperative serum CA 125 level, tumor size, tumor resectability, patient survival, or microvessel count of the corresponding omental metastases. CONCLUSION: Microvessel count of omental metastases is an independent prognostic indicator of survival in patients with advanced epithelial ovarian carcinoma and correlates with preoperative serum CA 125 level.

Adult↗
PubMed1997

Angiogenin: a marker for preterm delivery in midtrimester amniotic fluid.

OBJECTIVE: Neovascularization is a response of tissue to ischemic damage. Placental ischemia is thought to underlie a significant portion of preterm deliveries. Our objective was to evaluate whether angiogenin, a potent inducer of neovascularization, is increased in midtrimester amniotic fluid of patients destined to be delivered preterm. STUDY DESIGN: We designed a case-control study of singleton gestations undergoing midtrimester amniocentesis for standard genetic indications. Inclusion criteria were (1) pregnancy outcome information available, (2) gestational age at amniocentesis 15 to 20 weeks, (3) no evidence of fetal structural or chromosomal anomalies, and (4) absence of conditions associated with preterm delivery. Amniotic fluid angiogenin levels were measured by immunoassay and normalized by natural log transformation for statistical analysis. RESULTS: Eleven patients with preterm deliveries were matched with 33 controls. Amniotic fluid angiogenin levels were significantly higher in patients with preterm deliveries compared with controls (median 30.1 ng/ml [range 13.6 to 71.0 ng/ml] vs 17.8 ng/ml [7.8 to 43.3 ng/ml], p = 0.002). Demographic data were not significantly different. The association between angiogenin levels and preterm delivery persisted after small-for-gestational-age neonates were excluded (p = 0.02). Receiver-operator characteristic curve analysis showed that an angiogenin level of 31.0 ng/ml was the optimal cutoff point for prediction of preterm delivery (sensitivity 45.5%, specificity 91.0%, p = 0.03, odds ratio 6.0). CONCLUSIONS: Midtrimester amniotic fluid angiogenin levels are elevated in patients with preterm delivery. This supports the theory that preexisting intrauterine ischemia and inflammation are important risk factors for preterm delivery and may be already present in the early midtrimester.

Adult↗
PubMed1997

Transvaginal sonographic imaging of early second-trimester fetal anatomy assisted by uterine fundal pressure.

OBJECTIVE: To assess the advantage of applying uterine fundal pressure to assist transvaginal sonographic imaging of early second-trimester fetal anatomy. METHODS: One hundred consecutive patients with singleton fetuses underwent routine transvaginal sonographic assessment of fetal anatomy between 13 and 17 weeks' gestation. If the entire fetal anatomy including cardiac outflow tracts was not depicted, uterine fundal pressure was applied with the operator's nonscanning hand in a bimanual fashion, to facilitate transvaginal imaging. Transabdominal sonography was performed when visualization of the entire fetal anatomy was not obtainable with transvaginal or uterine fundal pressure-assisted transvaginal sonography. Observed fetal structures with and without fundal pressure were compared. Factors assessed that may have modified the value of fundal pressure included patient weight, gestational age, fetal presentation, previous abdominal surgery, and the presence of uterine fibroids. Statistical analysis included McNemar test, chi 2, Fisher exact test, and t test, with P < .05 considered significant. RESULTS: Visualization of lower limbs, head (including intracranial structures), upper limbs, kidneys, spine, gender, feet, hands (digits), face, four-chamber view, and cardiac outflow tracts was significantly enhanced by uterine fundal pressure-assisted versus nonassisted transvaginal sonography. Uterine fundal pressure improved transvaginal sonographic imaging in 91% of subjects, and in 51% of all subjects, a complete examination was thus obtained. In 20% of all subjects, transabdominal sonography was required to complete the examination. Complete fetal anatomic scanning was unobtainable despite uterine fundal pressure supplemented by transabdominal sonography in 29% of cases. Completion of the transvaginal sonographic fetal anatomic survey with uterine fundal pressure was related to gestational age (P < .02) and maternal weight (P < .05) yet not related to fetal presentation (P = .13), previous abdominal surgery (P = .06), or uterine fibroids (P = .26). CONCLUSION: Uterine fundal pressure applied during early second-trimester transvaginal sonographic evaluation of fetal anatomy significantly improves visualization of fetal structures otherwise located beyond the effective range of the transvaginal transducer.

Adolescent↗
PubMed1997

Color Doppler aided prenatal diagnosis of a type 1 cystic sacrococcygeal teratoma simulating a meningomyelocele.

Type 1 cystic sacrococcygeal teratomas, usually associated with good outcome following neonatal resection, must be differentiated at the time of prenatal diagnosis from sonographically similar meningomyeloceles, which carry a grave prognosis. We present an unusual case in which color Doppler imaging assisted correct midtrimester prenatal diagnosis of a large type 1 cystic sacrococcygeal teratoma closely simulating a meningomyelocele.

Adult↗
PubMed1997

Increased incidence of fetal growth restriction in association with breech presentation in preterm deliveries < 32 weeks.

Breech presentation and fetal growth restriction (FGR) are each related independently with preterm delivery. This study was designed to assess the possible relationship between breech presentation and FGR in deliveries at < 32 weeks' gestation. From an established database of 465 consecutive deliveries at < 32 weeks of nonhypertensive, nondiabetic patients with singleton nonanomalous fetuses, those in whom birth weight, body length, fetal presentation (vertex or breech), and amniotic fluid volume (AFV) had been assessed were studied. Fetal growth restriction (defined as symmetric if both birth weight and body length were < 10th percentile and asymmetric if only the birth weight was < 10th percentile) was studied in relation to maternal age, parity, tobacco use, fetal presentation, AFV, membrane status, and gestational age at delivery. Statistical analyses included contingency tables and analysis of variance, with p < 0.05 considered significant. Two hundred ninety-eight patients met the inclusion criteria. In these patients 85 (28.5%) fetuses were breech and 213 (71.5%) cephalic. A total of 56 (19%) fetuses were growth restricted. Of these, 31 (10.4%) were symmetrically and 25 (8.3%) asymmetrically growth restricted. The incidence of symmetric growth restriction in the breech-presenting fetuses was 16% (n = 14) versus 8% (n = 17) in the cephalic-presenting fetuses, and of asymmetric growth restriction 12% (n = 10) versus 7% (n = 15), (overall p = 0.03). Fetal growth restriction was not associated with significant differences in maternal age, parity, smoking, AFV, membrane status, or gestational age at delivery (each p > 0.10). In preterm deliveries at < 32 weeks' gestation, breech presentation is associated with an increased incidence of intrauterine growth restriction, independent of clinical confounders.

Amniotic Fluid↗