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Biomedical subjects

E Z Zimmer

Publications and source records attributed to E Z Zimmer.

At least 19 recordsLinked to original sources
PubMed2004

Sonographic imaging of cervical scars after Cesarean section.

OBJECTIVE: To investigate whether uterine contractions at the time of a Cesarean section have an impact on future presence and location of a cervical Cesarean scar. METHODS: A targeted transvaginal ultrasound examination of the fetus, uterus and cervix was done in 2973 consecutive women at 14-16 weeks' gestation. The sonographer was blinded to the women's previous obstetric histories. The presence and location of a sonographic cervical hypoechogenic line, which probably represented a Cesarean scar, was recorded. RESULTS: There were 180 women with a previous Cesarean section performed before the start of uterine contractions and 173 with a Cesarean section performed during contractions in labor. The cervical hypoechogenic line was more common in sections performed during contractions (75.7% vs. 52.7%; P < 0.001) and was more distally located from the internal os (17.9 +/- 9.4 vs. 14.6 +/- 9.1 mm; P = 0.01). A hypoechogenic line was observed in 21/2620 women without a previous Cesarean section, representing a false-positive rate of 0.8%. CONCLUSION: Cesarean sections, especially those done during uterine contractions, are actually performed through cervical tissue. This finding is in agreement with the physiological process of cervical effacement during contractions.

Cervix Uteri↗
PubMed2002

The sonographic approach to the detection of fetal cardiac anomalies in early pregnancy.

BACKGROUND: Transvaginal sonography enables imaging of the fetal heart in various planes and directions in early pregnancy. This study summarizes our experience in early detection of fetal cardiac anomalies. METHODS: Transvaginal sonographic examination was performed in 36 323 consecutive fetuses in both high- and low-risk pregnancies. More than 99% of cases were evaluated at 14-16 weeks' gestation. Examination of the cardiovascular system did not rely on still images of the classic views but instead was performed in a dynamic mode visualizing the heart and great vessels from different directions and in various scanning planes. RESULTS: Cardiac anomalies were detected in 173 fetuses, giving an overall incidence of 1 in 210 pregnancies. In 44% of these, the cardiac anomaly was isolated. An abnormal karyotype was detected in 27 of the 72 cases that underwent chromosomal analysis. An abnormal nuchal translucency finding was observed in 59 fetuses. The sonographic diagnosis was confirmed after delivery or at postmortem in 90 cases. Ten fetuses had a cardiac anomaly which differed from the anomaly suggested by sonography. In the remaining cases, a postmortem examination was not possible because termination of pregnancy was performed by dilatation and curettage. In four cases we did not detect the cardiac anomaly in early pregnancy. Two of them were detected at rescanning in mid-pregnancy. CONCLUSION: Early detection of fetal cardiac anomalies is now possible. Most anomalies occur in low-risk pregnancies. We suggest performing a detailed early multidirectional dynamic continuous sweep ultrasound examination of the fetal cardiovascular system in all pregnancies.

Coronary Vessel Anomalies↗
PubMed2001

Pain perception in women with dysmenorrhea.

OBJECTIVE: To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS: Twenty-two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra-threshold magnitude estimation to heat stimuli, pain-evoked potentials by laser stimuli, and anxiety scores four times across their menstrual cycles. RESULTS: Significant differences were found between dysmenorrheic and nondysmenorrheic women. In all four examinations across the menstrual cycle, dysmenorrheic women had longer latencies of pain-evoked potentials (383.08 +/- 6.8 msec versus 345.05 +/- 7.0 msec, P <.001), higher magnitude estimations on visual analog scale of supra-threshold pain (83.29 +/- 2.87 versus 63.50 +/- 3.82, P <.001), and higher state anxiety scores (37.69 +/- 1.7 versus 29.20 +/- 1.9, P =.002). CONCLUSION: Women with dysmenorrhea show enhanced pain perception compared to nondysmenorrheic women. This augmentation of pain perception may be part of the development of dysmenorrhea.

Adult↗
PubMed2001

Variables associated with meconium aspiration syndrome in labors with thick meconium.

OBJECTIVE: To examine the possible maternal and fetal variables associated with meconium aspiration syndrome in labors with thick meconium. STUDY DESIGN: The fetal heart rate tracings, cord pH, Apgar scores and maternal risk factors were evaluated in singleton pregnancies with vertex presentation and thick meconium in labor. The study included 33 consecutive fetuses which developed a moderate or severe meconium aspiration syndrome and 104 consecutive fetuses which had a favorable outcome. RESULTS: Significant differences between fetuses with meconium aspiration syndrome and healthy fetuses were found in the following parameters: baseline FHR (154+/-17 vs. 136+/-10, P<0.0001), small accelerations/30 min (1.47+/-1.52 vs. 3.04+/-1.2, P<0.0001), large accelerations/30 min (1.46+/-1.96 vs. 3.5+/-2.31, P<0.0003), decelerations/30 min (4.9+/-3.9 vs. 2.4+/-2.1, P<0.0034), number of fetuses with reduced beat-to-beat variability (9/33 vs. 0/104, P<0.0001), cord pH (7.21+/-0.09 vs. 7.33+/-0.08, P<0.0013) and Apgar scores at 1 min (5+/-2 vs. 8+/-1, P<0.0001) and Apgar scores at 5 min (8+/-2 vs. 9.7+/-0.6, P<0.0001). Maternal risk factors were found in two of 33 sick infants and in 13 of 104 healthy infants. CONCLUSION: Thick meconium by itself is not associated with adverse fetal outcome. However, the incidence of meconium aspiration syndrome increases in cases of a non-reassuring FHR.

Apgar Score↗
PubMed2001

Isolated hyperechogenic foci in the fetal thalamus in early pregnancy.

OBJECTIVE: To describe the sonographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region. METHODS: A detailed sonographic survey was performed in 46,244 consecutive pregnancies. Both low- and high-risk pregnancies were included. Transvaginal examinations were performed at 14-16 weeks' gestation, while transabdominal examinations were performed after 18 weeks' gestation. RESULTS: Isolated hyperechogenic foci in the thalamic region were observed in seven fetuses. All cases were diagnosed at 14-16 weeks' gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2-4 mm. A serologic work-up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid-pregnancy in all cases, and fetuses were normal at delivery and on follow up to the age of 9 years. CONCLUSIONS: Isolated hyperechogenic foci in the thalamic region in early pregnancy are probably benign in nature.

Female↗
PubMed2000

Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant.

OBJECTIVE: To evaluate outcomes of fetuses with antepartum sonographic diagnoses of persistent intrahepatic right umbilical veins. METHODS: A detailed fetal sonographic examination was done in 30,240 consecutive pregnancies at 14-26 weeks' gestation. High- and low-risk pregnancies were included and persistent right umbilical veins specifically were recorded. RESULTS: Sixty-nine fetuses had persistent intrahepatic right umbilical veins, of which 60 had no additional sonographic abnormalities, four had transient nuchal findings, and four had minor anomalies or anatomic variants. Only one of the 69 fetuses had a major anomaly (diaphragmatic hernia), and died after surgery. The remaining 68 fetuses were normal and healthy after birth. CONCLUSION: Persistent intrahepatic right umbilical vein is a fetal anatomic variant that is not rare and usually associated with a favorable outcome.

Female↗
PubMed2000

Computerized analysis of fetal heart rate after maternal glucose ingestion in normal pregnancy.

OBJECTIVE: To examine the effect of maternal oral glucose ingestion on antepartum FHR indices in normal pregnancies at term. STUDY DESIGN: A prospective study was performed on 44 non-laboring healthy women with normal singleton pregnancy at 37-40 weeks gestation. All women had a normal oral glucose tolerance test at 24-28 weeks gestation. FHR was recorded with the Sonicaid Fetal Monitor System (Oxford 8000), for 30 min prior to and 60 min following oral ingestion of 50 g of glucose in the study group of 27 women, and following water ingestion in a control group of 17 women. RESULTS: All pregnancies had a normal outcome. The maternal blood glucose levels before and 30 and 60 min after glucose ingestion were 70+/-14, 107+/-121, and 106+/-22 mg/dl, respectively (P<0.001). A significant negative correlation was found between the changes in maternal blood glucose levels 30 min after glucose ingestion and the changes in the number of large FHR accelerations at 30 and 60 min after glucose ingestion (r=-0.44, P<0.01 and r=-0.42, P<0.01, respectively). A significant correlation was found between the changes in maternal blood glucose levels 30 min after glucose ingestion and changes in episodes of low FHR variation at this time period (r=0.45, P<0.01). No significant changes in any of the FHR variables were noted in the control group. CONCLUSION: In normal pregnancies FHR indices of variation tend to decrease after maternal oral ingestion of glucose.

Blood Glucose↗
PubMed2000

Oral analgesia in the treatment of post-cesarean pain.

OBJECTIVE: Cesarean section is one of the most common operations. The new technologies of postoperative pain treatment such as patient-controlled analgesia, are expensive and may limit women caring for their newborns shortly after delivery. The present study assessed patient satisfaction with oral analgesia following cesarean section. STUDY DESIGN: An open prospective study was conducted on all women who had a cesarean section with epidural analgesia, during two consecutive periods of 3 months each. In the first group of 109 women, an oral solution of 1 g dipyrone was allowed every 4 h, upon patient request. Patients requesting additional analgesia were administered a tablet of 30 mg immediate-release morphine sulfate. In the second group of 90 women, the same protocol was used; however, oral morphine was the drug of choice and dipyrone was used for rescue analgesia. Pain intensity and satisfaction were self-evaluated by patients using a visual analog scale. RESULTS: The results of each study period were independently evaluated. The demographic and obstetrical variables were similar in both groups. The duration of analgesic effect of dipyrone was 6.5 h and the satisfaction score was 90. The duration of analgesic effect of oral morphine was 5.05 h and the satisfaction score was 83.7. Overall, patients in both groups requested only 25% of the permissible dosage of analgesia. CONCLUSIONS: Oral analgesia following cesarean section provides satisfactory pain relief, is easily administered, and is a substantially less costly alternative to the new pain treatment technologies currently in use.

Adult↗
PubMed2000

Adverse effects of epidural analgesia in labor.

OBJECTIVE: To examine the influence of epidural analgesia on labor and delivery in nulliparous and multiparous women. DESIGN: Data were collected on 847 consecutive parturients with singleton pregnancy and vertex presentation (384 nulliparous and 463 multiparous). The obstetrical and labor characteristics including maternal age, parity, gestational age, previous cesarean section, instrumental delivery, mode and timing of analgesia, mode of delivery, indications for cesarean section or instrumental delivery were analyzed comparing patients who received epidural analgesia with women who received systemic analgesia. RESULTS: Epidural analgesia was administered in 233 nulliparous and 141 multiparous women. A stepwise logistic regression analysis revealed that epidural analgesia independently affected the rate of non-spontaneous delivery and the duration of the second stage of labor in nulliparous (P=0.0017 and P=0.0036, respectively) and multiparous (P=0.001 and P=0.0081, respectively) women. Epidural analgesia independently affected the duration of labor only in nulliparous women (P=0.0001). CONCLUSION: Women should be informed that prolongation of labor and increase in nonspontaneous deliveries should be expected when choosing epidural analgesia in labor.

Adult↗
PubMed2000

Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety study.

OBJECTIVE: This study was undertaken to compare the efficacy and safety of intravenous administration of atosiban versus ritodrine for the treatment of preterm labor. STUDY DESIGN: Women with preterm labor and intact membranes diagnosed at 23 to 33 gestational weeks (n = 247) were randomly assigned to treatment arms and received atosiban (6.75 mg intravenous bolus, 300 microg/min for 3 hours, then 100 microg/min intravenously) or ritodrine (0.10-0.35 mg/min intravenously) for as long as 18 hours. Tocolytic effectiveness was assessed in terms of the numbers of women who had not been delivered after 48 hours and after 7 days. Safety was assessed in terms of maternal side effects and neonatal morbidity. Secondary outcomes included mean gestational age at delivery and mean birth weight. An intent-to-treat analysis was performed with the Cochran-Mantel-Haenszel test. RESULTS: The proportion of women who had not been delivered at 48 hours was 84.9% (n = 107) in the atosiban group and 86.8% (n = 105) in the ritodrine group. At 7 days 92 women had still not been delivered in both the atosiban (73.0%) and ritodrine (76.0%) groups. Neither of these differences was statistically significant. The incidence of maternal cardiovascular side effects was substantially lower in the atosiban group (4.0% vs 84.3%, P <.001). In addition, intravenous therapy was terminated more frequently as a result of maternal adverse events in the ritodrine group (29.8%) than in the atosiban group (0.8%). The overall occurrences of fetal adverse events in the two treatment groups were comparable. Neonatal morbidity was similar between the treatment groups after adjustment for unbalanced enrollment of women with multiple pregnancies and for gestational ages within treatment groups. CONCLUSION: Atosiban was comparable in clinical effectiveness to conventional ritodrine therapy but was better tolerated than ritodrine, with no evidence of significant maternal or fetal adverse events. Neonatal morbidity, which was similar between the two treatment arms, was apparently related to the gestational age of the infant rather than to the exposure to either tocolytic agent.

Adult↗
PubMed2000

Fetal polydactyly diagnosis during early pregnancy: clinical applications.

OBJECTIVES: This study was undertaken to assess the incidence of fetal polydactyly observed by ultrasonography and to evaluate the outcome of these fetuses. STUDY DESIGN: Detailed ultrasonographic examinations were performed in 17,760 consecutive pregnant women. Both low- and high-risk pregnancies were included in the study. Most examinations were carried out at 14 to 16 weeks' gestation. RESULTS: Twenty-six fetuses with polydactyly were observed. Ten fetuses had either associated anomalies or polydactyly of the feet, or both, and those pregnancies were terminated. The other 16 fetuses had isolated polydactyly and a normal karyotype. Fourteen of them had postaxial polydactyly type B. The outcomes of fetuses with isolated polydactyly were usually favorable. There was 1 intrauterine death and there were 2 terminations of pregnancy. Four infants were born with polydactyly. In utero autoamputation of extra digits occurred in 2 cases, whereas in the remaining infants only a small residual bump was noted. CONCLUSIONS: Isolated fetal postaxial polydactyly type B is associated with a favorable outcome.

Abortion, Induced↗
PubMed1999

The possible impact of a myomatous uterus on the accuracy of fetal biometric measurements.

OBJECTIVE: The propagation speed of ultrasound beams changes in different media. The aim of the study was to assess the possible measurement error of fetal biometry performed in cases of a myomatous uterus. DESIGN: Three iron phantoms of 30 mm, 50 mm and 70 mm were measured by ultrasound. Each phantom was measured by three different transducers of 3.5 MHz, 6.5 MHz and 7.5 MHz. Measurements were performed in a water bath and the intraobserver variability was assessed. Thereafter phantoms were measured with one of their edges covered by a specimen of a myomatous uterus while their other edge was covered with water. RESULTS: Artifactual lengthening of the phantoms' size was observed in measurements performed with the uterine myoma. The measurement errors were inversely related to the length of the phantoms and became statistically significant in the phantoms of 30 mm (13.15 +/- 3.16% without the myoma vs. 17.38 +/- 4.39% with the myoma; p < 0.0001). Measurement errors were independent of the transducer type (p = 0.001, p = 0.01 and p = 0.014 for the 3.5-MHz, 6.5-MHz and 7.5-MHz transducers, respectively). CONCLUSIONS: Ultrasound measurement errors are expected while examining small fetal organs which are partially overshadowed by a myoma.

Embryonic and Fetal Development↗
PubMed1999

Natural history of fetal simple renal cysts detected in early pregnancy.

PURPOSE: In this 12-year prospective, longitudinal study we investigated the natural history of fetal simple renal cysts identified by ultrasonography in early pregnancy. MATERIALS AND METHOD: A detailed sonographic examination of the fetus was performed between January 1987 and June 1998 in 29,984 consecutive pregnancies at 14 to 16 weeks of gestation. Amniocenteses and chromosomal investigations were done in all cases in which a simple renal cyst was detected in the fetus. Followup sonography was done in all cases of renal cyst during pregnancy, infancy and, when indicated, childhood. RESULTS: Simple renal cysts were diagnosed at 14 to 16 weeks of gestation in 28 fetuses (1/1,100 pregnancies, 0.09%). In 25 fetuses the cysts resolved during pregnancy. In 2 fetuses the cysts remained benign but persisted postnatally and in 1 a renal cyst that was initially defined as simple was the first sign of unilateral multicystic dysplastic kidney. Except for nonseptated cystic hygroma in 1 fetus, none of the others had associated anomalies of the urinary or other organ systems and no chromosomal anomalies. Postnatal followup in all cases revealed healthy children. CONCLUSIONS: A fetal simple renal cyst can be identified by ultrasonography in early pregnancy. In the absence of associated anatomical or chromosomal abnormalities, the majority of cysts will resolve during pregnancy without any sequelae. Given the transient nature of most fetal simple renal cysts detected in early pregnancy, it is possible that these cysts represent a distinct entity within the spectrum of cystic kidney diseases.

Female↗