Biomedical subjects

G Megerian

Publications and source records attributed to G Megerian.

5 recordsLinked to original sources

PubMed1999

Monoamniotic twins: case series and proposal for antenatal management.

OBJECTIVE: To present a case series of antenatally suspected monoamniotic twin gestations managed by a similar set of guidelines. METHODS: Eight women with antenatally suspected monoamniotic twins were identified between 1994 and 1996 in a single perinatal referral area. All were diagnosed sonographically. Management included serial ultrasound studies, frequent nonstress testing, and weekly steroid therapy. Elective cesarean delivery was recommended at 32 weeks unless obstetrically indicated at an earlier age. RESULTS: Monochorionic monoamniotic twins were confirmed at delivery in six women, and one had a pseudomonoamniotic twin. One woman was found to have a monochorionic diamniotic pregnancy at delivery. Of the eight women, three were delivered by elective cesarean at 32 weeks, including the falsely diagnosed case. Three were delivered before 32 weeks because of nonreassuring fetal testing. One was delivered at 25 weeks secondary to hemolysis, elevated liver enzymes, low platelets, and disseminated intravascular coagulation. One was delivered at 33 weeks, after declining elective delivery at 32 weeks, because of death of one twin and nonreassuring testing of the other twin. Morbidity among the live-born infants included severe bronchopulmonary dysplasia (25-week twins), large-bowel perforation (30-week infant), and respiratory distress syndrome and mild bronchopulmonary dysplasia (one 32-week pair). CONCLUSION: Monoamniotic twin pregnancies can be diagnosed reliably by ultrasound alone in most cases. Frequent antenatal testing may show signs of cord compression that may prompt delivery but will not prevent sudden fetal death. Fetal death can occur at greater than 32 weeks' gestation despite intensive fetal surveillance. Elective preterm delivery could be considered to eliminate the uncertain risk of fetal death.

Adult↗

PubMed1997

Haloperidol overdose during pregnancy.

BACKGROUND: Suicide attempts during pregnancy are rare. Over-the-counter and psychotropic medications are most commonly used. Although intentional overdose of haloperidol has been reported in nonpregnant adults, it has not, to our knowledge, been reported previously during pregnancy. In this case of suicide attempt by haloperidol overdose, maternal and fetal responses were studied extensively. CASE: Intentional ingestion of 300 mg haloperidol by a pregnant woman at 34 weeks' gestation caused maternal unresponsiveness, an extrapyramidal reaction, temporary fetal akinesia, and a nonreactive nonstress test. The mother recovered in 48 hours. The fetus did not reach a biophysical profile score of ten until 5 days after presentation. CONCLUSION: Haloperidol overdose during pregnancy causes a maternal extrapyramidal reaction, temporary fetal akinesia, and prolonged fetal neuromuscular depression.

Adult↗

PubMed1995

Ultrasound-adjusted risk and spectrum of fetal chromosomal abnormality in women with elevated maternal serum alpha-fetoprotein.

OBJECTIVE: To determine the incidence of chromosomal abnormality in sonographically normal fetuses after amniocentesis for elevated maternal serum alpha-fetoprotein (MSAFP), and to compare the spectrum of abnormality with that seen in women undergoing amniocentesis for advanced maternal age. METHODS: Cytogenetic and sonographic findings from women undergoing amniocentesis for elevated MSAFP (at least 2.0 multiples of median) between 1988-1992 were reviewed retrospectively. The literature was reviewed and data compiled regarding the risk of chromosomal abnormality for women with elevated MSAFP levels. RESULTS: The incidence of abnormal karyotype among all women with elevated MSAFP was 1.23% (nine of 733). The risk of an abnormal karyotype with a normal ultrasound examination was 1.01% (seven of 696). This included three fetuses with sex chromosome abnormalities, three with de novo, apparently balanced rearrangements, and one with an unbalanced structural rearrangement. CONCLUSIONS: The risk of chromosomal abnormality in nonselected patients, predominantly younger than 35 years of age, with elevated MSAFP and a sonographically normal fetus is 0.6%, based on a compilation of our data and reports published previously. The spectrum of abnormality in women with elevated MSAFP differs from that in women of advanced maternal age. Patients should be specifically counseled regarding this difference.

Adult↗

PubMed1994

Pregnancy outcome following Mustard procedure for transposition of the great arteries: a report of five cases and review of the literature.

OBJECTIVE: To review outcomes and complications of pregnancies in women with transposition of the great arteries who had undergone the Mustard procedure. METHODS: Four women with transposition of the great arteries who had undergone Mustard procedures in childhood received their obstetric care for five pregnancies at three institutions in the greater Philadelphia area between 1990-1992. Pregnancy complications and outcomes were reviewed. RESULTS: The most common maternal complication in pregnancy following performance of the Mustard procedure was cardiac arrhythmia, which required treatment in two of four patients. Late-onset fetal growth restriction requiring induction occurred in two of five pregnancies. Third-trimester oligohydramnios requiring induction occurred in one patient, and her second pregnancy was complicated by preterm labor and premature rupture of the membranes (PROM) at 33 weeks. One patient with a twin pregnancy developed mild preeclampsia, preterm labor, and PROM at 30 weeks. There were no neonatal or perinatal deaths or significant morbidity. CONCLUSION: If a patient with transposition of the great arteries who underwent the Mustard procedure is hemodynamically stable before pregnancy, good maternal and fetal outcome can be expected.

Adolescent↗

PubMed1994

Role of cordocentesis in perinatal medicine.

Cordocentesis is a feasible, reliable, and safe method for fetal evaluation of a wide variety of disorders. It has allowed for in-utero treatment of fetal red cell isoimmunization and opened future routes for other fetal therapies. In this review, results of a multicenter intrauterine fetal blood sampling registry will be presented, outlining current indications, techniques, and complications of the procedure. In addition, current research in the assessment and treatment of fetal erythrocyte isoimmunization and infection, as well as the role of cordocentesis in rapid genetic karyotyping, work-up of non-immune hydrops, fetal platelet abnormalities, and fetal growth restriction will be reviewed. Recent work using cordocentesis to better understand fetal metabolism, endocrinology, and immunology will also be reviewed.

Cordocentesis↗