Biomedical subjects
Daniel McKenna
Publications and source records attributed to Daniel McKenna.
Ultrasonic evidence of placental calcification at 36 weeks' gestation: maternal and fetal outcomes.
BACKGROUND: To determine the significance of an inappropriately mature placenta on ultrasound examination (Grannum classification), in a low-risk obstetric population. Scans were performed at 36 weeks' gestation. The study group comprised patients demonstrating a grade III placenta, and the control group comprised patients not demonstrating a grade III placenta. METHODS: A total of 1802 low-risk patients were scanned using serial directed real-time ultrasound at 36 weeks' gestation to determine placental maturity. RESULTS: The incidence of a grade III placenta at 36 weeks' gestation was 3.8% (68/1802). A grade III placenta was associated with young maternal age and cigarette smoking, p < 0.01. The incidence of proteinuric pregnancy-induced hypertension in the study and control groups was 7.4% (5/68) and 1.56% (27/1734), respectively, p < 0.01. The proportion of infants with a weight less than the 10th centile at birth in the study and control groups was 17.6% (12/68) and 5.6% (97/1734), respectively, p < 0.01. CONCLUSIONS: Ultrasound detection of a grade III placenta at 36 weeks' gestation in a low-risk population helps to identify the "at-risk" pregnancy. It helps to predict subsequent development of proteinuric pregnancy-induced hypertension and may help in identifying the growth-restricted baby.
A randomized trial using ultrasound to identify the high-risk fetus in a low-risk population.
OBJECTIVE: To evaluate the effect of introducing two biophysical ultrasound examinations in a low-risk antenatal population. Scans were performed at 30-32 weeks' gestation and 36-37 weeks' gestation. METHODS: Scans assessed placental maturity, amniotic fluid volume, and estimated fetal weight. One thousand nine hundred ninety-eight low-risk patients were randomized at 30 weeks' gestation to a control group receiving standard antenatal care, or to the study group who also received an ultrasound scan. Outcome measures were frequency of small for dates (less than 10th percentile at birth), intervention rates, and admissions to neonatal intensive care. RESULTS: The proportion of infants assessed as small for dates at birth in the study group was 6.9% (69 of 994) compared with 10.4% (104 of 999) in the control group (P =.008). The rates of intervention in the study and control groups were 31.3% (313 of 999) and 16.9% (169 of 999), respectively (P <.001). Twenty-eight (2.8%) neonates in the study group were admitted to the neonatal unit compared with 34 (3.4%) in the control group (P =.532). CONCLUSION: Introduction of an ultrasound scan at 30-32 weeks' and 36-37 weeks' gestation may reduce the risk of a growth-restricted infant and increases antenatal interventions. Rates of admission to a neonatal unit are not significantly affected.
Helicobacter pylori infection and dyspepsia in pregnancy.
OBJECTIVE: To investigate the relationship of Helicobacter pylori infection with dyspeptic symptoms in early and late pregnancy. Infection with H pylori and pregnancy outcome were also assessed. METHODS: H pylori seropositivity was determined in 416 antenatal patients at 10 to 14 weeks' gestation. Dyspeptic symptoms were recorded at 10 to 14 weeks' gestation and at 30 to 32 weeks' gestation by means of a well-validated questionnaire. Details of pregnancy outcome were recorded from patients' case notes. RESULTS: The incidence of H pylori infection in our population was 41.8% (164 of 404). Patients infected with H pylori were no more likely than controls to experience dyspepsia at 10 to 14 weeks' or at 30 to 32 weeks' gestation (P =.75 and.43, respectively). CONCLUSION: H pylori infection was not associated with preterm delivery, non reassuring fetal status in labor, or birth weight less than the 10th centile (P =.17,.57, and.19, respectively).H pylori infection is not associated with an increase in dyspepsia or with maternal or neonatal morbidity.
A case of lymphoma occurring in an ovarian teratoma.
BACKGROUND: We describe the discovery, by pathology, of a totally unexpected diagnosis involving an ovarian teratoma. CASE: A middle-aged woman underwent routine total abdominal hysterectomy and bilateral salpingoophrectomy for ultrasonically diagnosed uterine fibroids and a coexistent benign right ovarian cyst. The operative findings were of fibroid uterus and right ovarian teratoma. However, pathology revealed a malignant lymphoma occurring in, and arising from, the teratoma. CONCLUSION: The routine removal of a presumed ovarian teratoma may yield unexpected results. Ovarian teratomas are indeed cellular chimeras.
Domestic violence in late pregnancy and splenic injury: delayed presentation.
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