PubMed Health⌕ Search

Biomedical subjects

E A Reece

Publications and source records attributed to E A Reece.

At least 91 records · Page 5Linked to original sources
PubMed1988

Sonographic assessment of the fetal frontal lobe: a potential tool for prenatal diagnosis of microcephaly.

A prospective ultrasound evaluation of 150 normal pregnant women was conducted between 15 and 40 weeks' gestation. A variety of biometric measurements were obtained that included measurements of the frontal lobe distance (the anterior edge of the frontal horns of the lateral ventricles to the frontal bone) and the thalamic frontal lobe distance (measured from the posterior edge of the thalami to the frontal bone). Analysis of these data revealed a high degree of correlation between the gestational age and the frontal lobe distance (R2 = 0.89, p less than 0.0001), and between the gestational age and thalamic frontal lobe distance (R2 = 0.93, p less than 0.0001). Similarly, a high degree of correlation was also found between the biparietal diameter and the frontal lobe distance (R2 = 0.95; p less than 0.0001), between the biparietal diameter and the thalamic frontal lobe distance (R2 = 0.90, p less than 0.0001), and between the frontal lobe distance and the thalamic frontal lobe distance (R2 = 0.92, p less than 0.0001). The relationships between femur length and frontal lobe distance (R2 = 0.89, p less than 0.0001) and between the femur length and the thalamic frontal lobe distance (R2 = 0.945, p less than 0.0001) were also evaluated. Nomograms for the relationships between gestational age and frontal lobe distance and thalamic frontal lobe distance were generated and included the mean +/- SD and the percentile distributions. Growth of the frontal lobe was best described by a first-degree linear equation. The results of this study demonstrate the pattern of growth of the frontal lobe and the high rate of correlation between growth of the frontal lobe and the gestational age and the biparietal diameter. These findings offer a potential method by which the decreasing size of the frontal lobe, as shown in three cases described herein, can be evaluated prenatally and thus serve as a useful tool in the prenatal diagnosis of microcephaly.

Female↗
PubMed1987

Can ultrasonography replace amniocentesis in fetal gender determination during the early second trimester?

Fetal gender was prospectively determined by ultrasonography in 115 patients with singleton pregnancies between 16 and 20 weeks of gestation. Gender determination was performed as a part of the sonographic examination preceding genetic amniocentesis, and the results were compared to the amniotic fluid fetal karyotype results. Our rate of visualization of the fetal external genitalia was 83.5%. The accuracy rate for gender determination was 90% in male infants and 100% in female infants, with an overall rate of prediction of 92.7%.

Amniocentesis↗
PubMed1987

Embryonic trunk circumference: a new biometric parameter for estimation of gestational age.

One hundred thirty-one uncomplicated, singleton pregnancies between 7 and 12 weeks of gestation were ultrasonically examined. Evaluation included confirmation of cardiac activity and measurements of fetal crown-rump length and trunk circumference. Both crown-rump length and trunk circumference were curvilinearly correlated with gestational age. A second- and third-degree polynomial equation best described this curvilinear relationship between trunk circumference and gestational age and between crown-rump length and gestational age. The crown-rump length and trunk circumference were similar in their prediction of gestational age, but the combination of the two parameters did not improve the prediction of gestational age. A nomogram of gestational age as predicted by trunk circumference was generated. These data provide an additional measurement for the estimation of gestational age in the first trimester of pregnancy.

Biometry↗
PubMed1987

Cerebellar measurements with ultrasonography in the evaluation of fetal growth and development.

A prospective study of ultrasonography was conducted in 371 normal pregnant women, with gestational ages ranging from 13 weeks to 40 weeks. Several biometric measurements were obtained including the transverse cerebellar diameter, the biparietal diameter, the occipitofrontal diameter, and the calculated head circumference. Curvilinear relationships were found between the transverse diameter of the cerebellum (measured in millimeters), and the gestational age (R2 = 0.948; P = 0.001), the biparietal diameter (R2 = 0.956; P = 0.0001), and the head circumference (R2 = 0.969; P = 0.0001). A nomogram of cerebellar measurements estimating gestational age and predicting the biparietal diameter and head circumference was generated. Throughout pregnancy the establishment of normative cerebellar measurements allows for the estimation of gestational age that is independent of the shape of the fetal head and offers potential for evaluation of abnormal fetal growth and anomalous development of the central nervous system.

Anthropometry↗
PubMed1987

Screening for gestational diabetes: one-hour carbohydrate tolerance test performed by a virtually tasteless polymer of glucose.

Although the 1-hour 50 gm blood glucose screening test is an effective way of detecting diabetes in pregnancy, the taste of available glucose drinks often creates gastrointestinal symptoms and leads to refusal of the patient to be tested. The efficacy of a virtually tasteless glucose polymer in testing carbohydrate tolerance in pregnancy was determined. Sixty-one pregnant patients undergoing screening for gestational diabetes underwent a 1-hour carbohydrate tolerance test of both glucose and a glucose polymer within 3 days of each other. Analysis of the data revealed a high degree of agreement between the results of the 1-hour carbohydrate tolerance test (kappa = 0.62, p less than 0.0001). These data suggest that glucose polymer can be used effectively in screening for gestational diabetes.

Blood Glucose↗
PubMed1987

Fetal cerebellar growth unaffected by intrauterine growth retardation: a new parameter for prenatal diagnosis.

Nineteen pregnant women with a clinical suspicion of intrauterine growth retardation and with gestational age confirmed by early ultrasound examination were referred to our departments for sonographic evaluations. Multiple biometric parameters were obtained, including the transverse cerebellar diameter by use of the electronic calipers of the machine. A prenatal diagnosis of intrauterine growth retardation was made in all cases based on: (1) the transverse cerebellar diameter being consistently correlated with gestational age as predicted by the last menstrual period, whereas most of the other measurements were consistently discrepant with the transverse cerebellar diameter by more than 2.5 weeks (i.e., more than 2 SD above the mean), and (2) the estimated fetal weight of all fetuses being equal to or less than the tenth percentile for gestational age. Neonatal examination confirmed all fetuses to be growth retarded with birth weights at or below the tenth percentile for gestational age. These findings indicate that growth of the transverse cerebellar diameter is unaffected by intrauterine growth retardation; thus this sonographic measurement may serve as an independent and reliable correlate of gestational age against which potential deviations of growth may be compared.

Cerebellum↗
PubMed1987

A hypothesis concerning the general basis of organogenetic congenital anomalies.

Evidence supports the idea that it is the degree of metabolic imbalance present in diabetic gravid women during the period of organogenesis that accounts for organogenetic congenital defects. In light of the proved and inferred metabolic instability occurring during early pregnancy, we propose that metabolic imbalances may occur that result in organogenetic congenital defects in offspring of apparently normal gravid women.

Abnormalities, Multiple↗
PubMed1987

Effect of diabetic nephropathy on pregnancy.

Because the metabolic changes in normal pregnancy are diabetogenic, pregnancy imposes a severe stress on the metabolic milieu of diabetic patients. Moreover, some patients with long-standing diabetes have vascular complications, including renal insufficiency and hypertension, that represent separate risk factors for optimal fetal development. During the past two to three decades, maternal mortality has been eliminated and perinatal deaths have been reduced in all classes of diabetic patients, including those with diabetic nephropathy, to a level approaching that of normal pregnant women. Fetal and neonatal morbidity have also been reduced, although rates of congenital abnormalities and respiratory disease syndrome remain high. In patients with significant vascular complications, such as nephropathy and retinopathy, pregnancy evidently does not alter the natural course of these complications. With meticulous metabolic control and fetal surveillance, however, women with diabetic nephropathy without severe renal insufficiency or severe hypertension can anticipate a pregnancy outcome similar to that of other insulin-dependent diabetic patients.

Diabetic Nephropathies↗
PubMed1987

Managing diabetic patients with nephropathy and other vascular complications.

Since the metabolic changes in normal pregnancy are diabetogenic, pregnancy imposes a severe stress on the metabolic milieu of diabetic patients. Moreover, many patients with long-standing diabetes have vascular complications, including retinopathy, renal insufficiency, nephrotic syndrome and hypertension, that represent separate risk factors for optimal fetal development. Recent experience has suggested that maternal hyperglycaemia, and associated fetal hyperinsulinaemia, may represent an important factor in the development of fetal complications. During the past two to three decades the incidence of perinatal deaths has been reduced in all cases of diabetics to a level that approaches the rate in healthy gravidas when severe congenital anomalies are excluded. Fetal and neonatal morbidity have also been reduced, although rates of congenital anomalies, polyhydramnios and respiratory distress syndrome remain high. In patients with significant vascular complications, especially nephropathy and retinopathy, there is no evidence that pregnancy alters the natural course of these complications. Although the morbidity associated with oedema formation and hypertension is elevated, with meticulous management of patients with diabetic nephropathy, especially in the absence of severe renal insufficiency and/or severe hypertension, pregnancy performance and outcome can be similar to other insulin-dependent diabetics.

Diabetic Nephropathies↗
PubMed1987

Intrinsic intrathoracic malformations of the fetus: sonographic detection and clinical presentation.

Intrinsic intrathoracic malformations are a rare group of congenital anomalies associated with high fetal and neonatal mortality rates. The antenatal sonographic appearance and the adequacy of diagnosis in 15 affected fetuses were evaluated. An accurate prenatal diagnosis was made in 12 cases; the precise nature of the intrathoracic defect was incorrectly categorized in two fetuses, and the defect was missed entirely in one affected fetus. Antenatal detection and characterization of intrinsic intrathoracic congenital malformations seems possible, but requires a high index of suspicion, familiarity with their sonographic appearances, and meticulous attention to detail.

Bronchogenic Cyst↗
PubMed1987

Growth of the fetal stomach in normal pregnancies.

Fetal stomach dimensions were measured sonographically in 152 fetuses with gestational ages ranging from nine to 40 weeks. Nomograms of the mean +/- 2 standard deviations (SD) for the longitudinal, anteroposterior, and transverse diameters of the fetal stomach were generated throughout pregnancy. A linear growth function was observed across gestational age, and a high degree of correlation existed between gestational age and the transverse (r = 0.809, P less than .0001), anteroposterior (r = 0.798, P less than .0001), and longitudinal (r = 0.749, P less than .0001) diameters. These data provide a method by which variations from the norm can be assessed, and offer potential prenatal diagnosis of a variety of gastrointestinal lesions.

Embryonic and Fetal Development↗
PubMed1987

Estimated fetal weight in the evaluation of growth in twin gestations: a prospective longitudinal study.

A prospective longitudinal study was conducted in order to determine by sonographically estimated fetal weight the patterns of fetal growth in twins. Thirty-five healthy women with normal twin pregnancies were examined every three weeks from the 15th week of gestation to delivery. Among the measurements obtained were the biparietal diameter (BPD), the abdominal circumference, and the calculated fetal weight. From 15-28 weeks, the growth velocity of the BPD and abdominal circumference remained fairly constant, with a steady increase in incremental growth. Beyond this age, we observed a slowing in growth of the BPD, while the abdominal circumference continued at a constant rate. The growth velocity of the weight steadily increased throughout pregnancy. Although greater biologic variability in weight between twin A and B was observed as gestational age progressed, the overall mean weights of twin A and B were not statistically different. We have generated a nomogram of fetal weight gain throughout pregnancy.

Body Height↗
PubMed1987

Severe fetomaternal hemorrhage. A report of four cases.

Four cases of severe fetomaternal hemorrhage (FMH) presented with severe anemia and signs of circulatory failure. One of the patients developed the syndrome of persistent fetal circulation. The diagnosis of FMH was confirmed in all using Kleihauer-Betke tests, which demonstrated abundant fetal erythrocytes in the maternal circulation. Three infants survived after prompt volume replacement and correction of anemia. The only fatality was related to an underlying chromosomal disorder. The majority of reported neonatal deaths due to FMH have occurred when shock was the presenting manifestation.

Adult↗
PubMed1987

Persistent pulmonary hypertension: assessment of perinatal risk factors.

Persistent pulmonary hypertension of the neonate, a disease of unknown etiology, is associated with a mortality rate as high as 50%. We conducted a retrospective study (1979-1983) to identify antenatal events that may be associated with this disease. Thirty-seven mothers of neonates with this disorder were compared with 150 randomly selected control patients. Logistic regression analysis revealed that meconium, maternal fever (caused by urinary tract infection, upper respiratory infection, chorioamnionitis, and unknown causes), maternal anemia (caused by abruptio placentae, placenta previa, and unknown causes), and maternal pulmonary disease (caused by asthma and/or pneumonia) were associated with persistent pulmonary hypertension of the neonate. The computed odds ratios for the variables associated with this disease were increased significantly above the controls. In addition, cesarean section, nonvertex presentation, fetal distress, and vaginal bleeding were found to be significant on univariate analyses. The cesarean section rate in the study group was 59%, with the primary indications of fetal distress and/or third-trimester bleeding in 77.3% of instances. These data suggest that antenatal risk factors and the computed odds ratio may help identify pregnancies likely to produce infants at high risk for persistent pulmonary hypertension of the neonate.

Asphyxia Neonatorum↗
PubMed1986

A randomized clinical trial of the insulin pump vs intensive conventional therapy in diabetic pregnancies.

Improved perinatal outcome is associated with the prevention of hyperglycemia during pregnancy in diabetic women. To determine whether the method of insulin administration influences the degree of diabetic control obtained, we randomized 22 pregnant diabetic women to intensive conventional insulin therapy (N = 11) and insulin pump therapy (N = 11). Frequent outpatient visits; home glucose monitoring, at least six times daily; and frequent telephone contact were offered to all subjects. Patients were hospitalized in the inpatient clinical research center each trimester for a 24-hour metabolic profile. There were no differences between the two treatment groups with respect to outpatient mean glucose levels, symptomatic hypoglycemia, or glycosylated hemoglobin levels, or with respect to inpatient mean glucose level, glycemic excursions, chemical hypoglycemia, or hyperglycemia. Excellent metabolic control was achieved with both treatment methods.

Adult↗