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F D Frigoletto

Publications and source records attributed to F D Frigoletto.

At least 73 records · Page 4Linked to original sources
PubMed1988

Electronic fetal heart rate monitoring: why the dilemma?

As medical technology becomes more and more complex, both the benefits and risks increase. Perhaps we have misled ourselves and, unwittingly, our patients into expecting the perfect outcome by complication-free care. As we learn more about the pathophysiology of disease it becomes apparent that our expectations are unrealistic. In addition, as clinicians we have become more sophisticated about the utility of clinical testing. We have learned that the predictive value of a test is related to its sensitivity and specificity, and to the prevalence of the disease in the population being tested. We have also seen that the prevalence of intrapartum asphyxia is low and the prevalence of hypoxic-ischemic encephalopathy perhaps even lower. Therefore, the positive predictive value for an ominous fetal heart rate pattern in a low-risk patient to be indicative of fetal asphyxia is probably quite low, even if confirmed by a low fetal scalp pH. In practical terms, a number of emergency cesarean sections will be done unnecessarily, at least in retrospect. Collectively, society is concerned about the high and rising cesarean section rate, although the individual patient "knows" that the "brain-damaged" infant can be prevented by intrapartum fetal heart rate monitoring and emergency section. The reality is that from the best studies available it has yet to be demonstrated that routine EFM in the low-risk patient has provided a benefit. We continue to imply a benefit by its widespread use and wonder why the dilemma. Should our patients expect less? Should the lawyers expect less? Even our experts can not agree. Good practice is our goal. We can accept nothing less.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Fetal abnormalities: diagnosis or treatment with percutaneous umbilical blood sampling under continuous US guidance.

Percutaneous umbilical blood sampling has become an important tool in maternal-fetal medicine and allows direct access to fetal blood. In 52 patients, 100 successful consecutive blood sampling procedures were done for a variety of indications, including 20 intravascular intrauterine fetal transfusions for isoimmune disease. Indications, technique, and complications in this series of percutaneous umbilical blood sampling procedures are described.

Blood Specimen Collection↗
PubMed1988

Early amniocentesis for prenatal cytogenetic evaluation.

Early amniocentesis at 11-14 weeks gestation was evaluated in 100 consecutive patients to see how this technique compares with later amniocentesis. There were no complications as a consequence of the procedure or related pregnancy losses of chromosomally normal fetuses. Samples obtained from three (3%) patients showed insufficient cell growth; two of these patients elected a repeat procedure, which yielded a normal karyotype in each case. There were five abnormal karyotypes, one of which was a culture artifact; in the latter case, repeat amniocentesis at 15 weeks yielded a normal result. Of the 95 pregnancies with normal karyotypes, 94 were progressing normally at follow-up, and one patient elected pregnancy termination because of maternal indications. It appears that early amniocentesis may be an attractive alternative to traditional amniocentesis, in that it provides results at an earlier gestational age and may avoid certain disadvantages of chorionic villus sampling.

Amniocentesis↗
PubMed1987

Sonographic identification of second-trimester fetuses with Down's syndrome.

Fetuses with Down's syndrome are more likely than normal fetuses to have a thickened nuchal skin fold and relatively short femurs on ultrasound examination in the second trimester. We evaluated these measures in more than 5500 fetuses, including 28 who were later found to have Down's syndrome by means of amniocentesis with cytogenetic analysis. Normal femur length was established as a function of biparietal diameter in 192 of the normal fetuses. We found that with use of a nuchal skin-fold thickness of 6 mm or more and a ratio of actual to expected femur length of 0.91 or less, fetuses with Down's syndrome could be identified with a sensitivity of 75 percent and a specificity of 98 percent. When other anomalies, such as an atrioventricular canal and meconium peritonitis, were added to these two criteria, the sensitivity of sonographic detection of Down's syndrome in the second-trimester fetus rose to 82 percent. The potential predictive value of these sonographic signs far exceeds that of advanced maternal age and low alpha-fetoprotein levels, which currently identify only 10 to 30 percent of affected fetuses. We recommend that fetuses with a thickened nuchal skin fold or shortened femurs on ultrasound examination be evaluated for Down's syndrome by amniocentesis and cytogenetic analysis.

Amniocentesis↗
PubMed1987

Reliable criteria for the prenatal sonographic diagnosis of alobar holoprosencephaly.

A series of 10 consecutive cases of alobar holoprosencephaly is described. The disorder was diagnosed prenatally by ultrasound according to two criteria: a large central fluid collection in the fetal head, with no visible midline structures but with the presence of a mantle around the fluid collection and fusion of the thalami and corpus striatum, and sonographic abnormalities of the face, including hypotelorism, central clefts, facial asymmetry, and abnormal orbits.

Brain↗
PubMed1987

Acute fetal distress associated with percutaneous umbilical blood sampling.

Percutaneous umbilical blood sampling is emerging as an important procedure in the armamentarium of the obstetrician involved with prenatal diagnosis. It has apparent low morbidity and can be accomplished with relative ease by the experienced operator. We report a series of 42 successful percutaneous umbilical blood sampling procedures in 22 patients and describe the indications and gestational ages of the fetuses undergoing the blood-sampling procedures. Nine of the procedures involved intravascular transfusions. In one of our 42 cases, acute fetal distress developed in a manner similar to that of a previously reported case that was likewise associated with a compromised fetus and ended in death. Because of prompt and immediate delivery, the infant described in this series survived and, although this procedure appears to be relatively safe in experienced hands, it is imperative that the associated complications be duly recorded.

Blood Specimen Collection↗
PubMed1987

Soft tissue nuchal fold in the second-trimester fetus: standards for normal measurements compared with those in Down syndrome.

There are several reports describing the sonographic sign of a thickened nuchal fold for the prenatal sonographic detection of Down syndrome in the second trimester. We prospectively obtained normative data on the nuchal folds of 303 consecutive normal fetuses undergoing genetic amniocentesis between 15 and 20 weeks' gestation. The data show that the width of the nuchal fold was consistently between 1 and 5 mm regardless of gestational age (15 to 20 weeks).

Down Syndrome↗
PubMed1987

Down syndrome: sonographic sign for diagnosis in the second-trimester fetus.

In an expanded series of patients a sonographic sign was found to correlate well with the diagnosis of Down syndrome in second-trimester fetuses. The sign is characterized by soft-tissue thickening at the back of the fetal occiput. Sonographic evaluation for this sign was done in 2,121 consecutive fetuses between 15 and 20 gestational weeks of age at the time of genetic amniocentesis. The mothers were 35 years old or older or were otherwise at increased risk for fetal trisomies. Ten fetuses had Down syndrome by karyotype and four of these (40%) had thickened soft tissues (6 mm or more) at the back of the neck or occiput. When these data are combined with those in series previously reported by the authors, similarly collected consecutively, total second-trimester fetuses studied equals 3,825. Nine of the 21 (42%) Down syndrome fetuses by karyotype from this 3,825 had the positive sonographic sign described.

Down Syndrome↗
PubMed1987

Prenatal sonographic diagnosis of isolated congenital cystic hygroma, unassociated with lymphedema or other morphologic abnormality.

We report the prenatal sonographic diagnosis of five cases of isolated cystic hygroma (lymphangioma), unassociated with lymphedema or other morphological abnormalities. This type of cystic hygroma appears different from the ones occurring at the back of the neck, which have other lymphatic anomalies and a poor prognosis. Four of the five fetuses did well after surgery. We describe the sonographic appearance of this type of cystic hygroma, which is different from the nuchal type as it is primarily complex.

Edema↗
PubMed1987

Cardiac output in a fetus with erythroblastosis fetalis: assessment using pulsed Doppler.

Pulsed Doppler studies of left and right ventricular outputs were obtained over time in a hydropic fetus with erythroblastosis fetalis. Despite severe anemia, cardiac outputs were within the normal range and remained normal after in utero percutaneous intravascular transfusions, which reversed the hydrops. The measurement of cardiac output in utero provides direct evidence that high-output failure due to anemia is not the mechanism for hydrops in erythroblastosis fetalis.

Adult↗
PubMed1986

Ultrasonographic fetal surveillance in the management of the isoimmunized pregnancy.

During the past 20 years the management of pregnancies involving rhesus sensitization has been based on determinations of the optical density of amniotic fluid as an index of the bilirubin concentration and the degree of hemolysis. High values have dictated intervention in the form of delivery or intrauterine transfusion, depending on the gestational age. Since 1982 intensive surveillance with ultrasound imaging and electronic monitoring of the fetal heart rate have become useful in decisions about the timing of intervention. Using these tools, we followed 11 fetuses who would previously have been treated by multiple intrauterine transfusions or early delivery, for 8 to 63 days without treatment. All were born alive, in good condition and without hydrops, at gestational ages of 30.5 to 36.0 weeks. The lengths of stay for the neonates ranged from 8 to 48 days, and all were discharged alive. We conclude that rhesus sensitization in a select group of fetuses, who according to former standards would have been candidates for earlier delivery or intrauterine transfusion, can be managed expectantly for longer periods by careful observation with modern techniques of surveillance.

Cesarean Section↗
PubMed1986

Use of a small-gauge needle for intrauterine fetal transfusions.

Intraperitoneal intrauterine fetal transfusions have generally been performed with large-gauge Tuohy needles, which increase the risk of traumatic fetal complications. We feel that this technique can be improved by use of a small-gauge needle and continuous ultrasound visualization. A series of 20 transfusions is presented.

Blood Transfusion, Intrauterine↗
PubMed1986

Decreased fetal cord prolactin concentration in diabetic pregnancies.

Infants of diabetic mothers are known to have a greater incidence of respiratory distress syndrome than normal control infants. Fetal lung maturation is modulated by a large number of hormones. To further investigate a possible role of hormonal modulators of lung maturation in infants of diabetic mothers, fetal cord prolactin, estrone, estradiol, thyroxine, triiodothyronine, and triiodothyronine-resin uptake index levels were measured in infants of diabetic mothers (n = 40) and nondiabetic mothers (n = 40) at term. Infants of diabetic mothers had significantly lower mixed-cord serum prolactin levels (p less than 0.0005) than control infants. There was no significant difference in cord serum thyroxine, triiodothyronine-resin uptake index, triiodothyronine, estrone, or estradiol levels between the infants of diabetic mothers and the infants of control mothers. These findings raise the possibility that decreased fetal prolactin levels may be associated with, or contribute to, the delayed lung maturation reported with diabetic pregnancies.

Amniotic Fluid↗
PubMed1986

Elevated concentrations of the beta-subunit of human chorionic gonadotropin and testosterone in the amniotic fluid of gestations of diabetic mothers.

Hyperplasia of testicular Leydig cells and ovarian theca-lutein cells is a common histologic finding in infants of diabetic mothers. The functional correlates of this histologic finding were investigated by measurement of the beta-subunit of human chorionic gonadotropin, testosterone, dihydrotestosterone, androstenedione, estradiol, and estrone in the amniotic fluid compartment of gestations with male and female fetuses in diabetic mothers (N = 34) and control women (N = 34) at term. When compared with those of control subjects, gestations of diabetic mothers had significantly higher amniotic fluid concentrations of the beta-subunit of human chorionic gonadotropin. Gestations with either male or female fetuses in diabetic mothers had significantly higher amniotic fluid testosterone and dihydrotestosterone levels when compared with those of their respective gender controls. In gestations with male fetuses in diabetic mothers there was a significant positive correlation between the beta-subunit of human chorionic gonadotropin and testosterone. There was no significant difference in amniotic fluid androstenedione, estradiol, or estrone levels between the gestations of diabetic mothers and those of control women. These results suggest that the testicular Leydig cell and ovarian theca-lutein cell hyperplasia seen in infants of diabetic mothers is due, in part, to elevated levels of human chorionic gonadotropin and is associated with elevated testosterone and dihydrotestosterone concentrations in the amniotic fluid.

Amniotic Fluid↗
PubMed1986

Diagnosis and management of fetal facial clefts.

Fetal facial clefts were identified sonographically in 12 cases, 10 (83%) of which had other structural anomalies. When a facial cleft is diagnosed prenatally a careful search of the fetus for associated anomalies is indicated. With the finding of an autosomal trisomy in four of the 10 cases (40%) with associated anomalies, cytogenetic amniocentesis is desirable to aid in diagnosis and subsequent obstetric management of these patients.

Adult↗