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Biomedical subjects

G P Wager

Publications and source records attributed to G P Wager.

9 recordsLinked to original sources
PubMed1990

Pulsed Doppler umbilical artery waveforms: significance of elevated umbilical artery systolic/diastolic ratios in the normally grown fetus.

Previous studies have demonstrated a high correlation between elevated resistance in the placental circulation, evidenced by abnormal umbilical artery systolic-to-diastolic (S/D) ratios, and the subsequent birth of a small for gestational age (SGA) infant. However, few data exist on the significance of elevated S/D ratios for pregnancies in which outcome does not involve an SGA infant. Pulsed Doppler spectral recordings and level II ultrasound examinations were performed 373 times in 256 referred high-risk patients. Doppler data were not used for patient management decisions. Thirty-two women with elevated umbilical artery S/D ratios of 4.5 or greater (defined as abnormal regardless of gestational age) gave birth to non-SGA infants. The ultrasound characteristics and outcome for this group were compared with those of 200 patients who were also non-SGA but who exhibited normal waveforms and with 24 SGA infants with predominantly abnormal waveforms. Thirty-one percent of the non-SGA infants with abnormal waveforms had structural malformations, a rate significantly higher (P less than or equal to .03) than the 18% malformation rate in the normal-waveform group. Further, the stillbirth rate and number of terminations of pregnancy for lethal anomalies were five times greater in the non-SGA group with abnormal waveforms than in the non-SGA group with normal waveforms (P less than or equal to .001). A wide variety of structural malformations was observed in the abnormal-waveform group, most frequently involving the central nervous system. Amniotic fluid volume tended to be decreased in the SGA group, whereas increased amniotic fluid volume or hydramnios was seen in 23% of the non-SGA abnormal-waveform group.

Amniotic Fluid↗
PubMed1988

The predictability of the small-for-gestational-age infant by real-time ultrasound-derived measurements combined with pulsed Doppler umbilical artery velocimetry.

During a 15-month period 373 level II ultrasound examinations were performed in 256 high-risk patients. In addition, pulsed Doppler spectral recordings of blood flow in the fetal umbilical arteries were made. A systolic/diastolic ratio was then calculated for each fetus. Real-time ultrasound-derived estimated fetal weight with the use of biparietal diameter and abdominal circumference was also calculated. The estimated fetal weights were categorized by placing them in a percentile for gestational age according to published nomograms. Complete birth data and outcomes were obtained in all patients. Both the systolic/diastolic ratio and ultrasound-estimated fetal weight grouped by percentile ranking for gestational age were highly predictive (p = 0.001) of babies who were subsequently born small for gestational age. Seventy-nine percent of the infants small for gestational age had umbilical artery systolic/diastolic ratios greater than or equal to 4, whereas only 21% had normal systolic/diastolic ratios. Forty-three percent of the infants who were small for gestational age had ultrasound-estimated fetal weights less than or equal to 10th percentile for the gestational age at which it was measured. Umbilical artery systolic/diastolic ratios, which reflect an increase in peripheral resistance in the placental circulation, showed a highly predictive and discriminatory index for the evaluation of the fetus suspected of having growth retardation.

Birth Weight↗
PubMed1988

Antenatal ultrasound findings in a case of Uhl's anomaly.

A case of severe congenital Uhl's anomaly is described. Uhl's anomaly is a rare disorder characterized by near total absence of the right ventricular myocardium. Antenatal ultrasound and echocardiographic findings are presented and the differential diagnosis is discussed.

Heart Defects, Congenital↗
PubMed1987

Immunizing the pregnant woman. Risks versus benefits.

No substance should be administered unnecessarily during pregnancy. However, when a pregnant woman is not immune to serious disease, the risk of maternal and fetal infection must be weighed against the risk of vaccination. Whenever possible, an inactivated (killed) vaccine should be selected and immunization delayed until the second trimester. Only rarely is an attenuated (live) vaccine indicated.

Bacterial Vaccines↗
PubMed1985

Evaluation of gas-liquid chromatography for the rapid diagnosis of amniotic fluid infection: a preliminary report.

Gas-liquid chromatography has been proposed as a possible tool in the rapid diagnosis of amniotic fluid infections. The analysis is based on the identification of specific organic acids derived from bacterial metabolism when organisms are present within the amniotic fluid. We retrospectively subjected 69 samples of amniotic fluid which had been obtained by transabdominal amniocentesis to analysis by gas-liquid chromatography. Forty-seven samples were derived from patients who either were in premature labor or had premature rupture of membranes with associated premature labor. Twenty-two specimens which served as a comparison group were obtained from patients who underwent amniocentesis for assessment of fetal maturity. The results obtained from chromatographic analysis are presented, and the possible applications of this technique to the clinical situation are discussed.

Adult↗
PubMed1983

Toxic shock syndrome: a review.

Toxic shock syndrome (TSS) is an acute illness that affects multiple organ systems. It is a disorder of particular interest to obstetricians and gynecologists because it primarily affects otherwise healthy menstruating women who use tampons. The pathogenesis remains unknown. However, Staphylococcus aureus has been isolated from either focal lesions or the vagina in most cases and a staphylococcal exotoxin is believed to be the causative agent. The epidemiologic characteristics, risk factors, clinical findings, criteria for diagnosis, and recommendations for treatment are reviewed.

Diagnosis, Differential↗
PubMed1980

Puerperal infectious morbidity: relationship to route of delivery and to antepartum Chlamydia trachomatis infection.

We investigated the relationship of route of delivery and of antepartum Chlamydia trachomatis cervical infection to selected forms of puerperal infectious morbidity, including intrapartum fever, or early (less than 48 hours) postpartum fever not attributable to infections of sites outside the uterus and late (48 hours to 6 weeks) postpartum endometritis. Infectious morbidity occurred in 27 (44%) of 62 women who underwent cesarean section and in 33 (10%) of 329 who underwent vaginal delivery (p less than 0.001). Postsection infectious morbidity was not correlated with C. trachomatis infection and was largely limited to early postpartum fever. Among women who underwent vaginal delivery, infectious morbidity occurred in 10 (34%) of 29 women with and in 23 (8%) of 300 without C. trachomatis infection (p less than 0.001), and chlamydial infection was associated only with intrapartum fever and late postpartum endometritis. Separate matched case-control analyses confirmed that cesarean section was associated with an increased risk of early postpartum fever (p = 4 x 10(-8)); whereas among women who underwent vaginal delivery, antepartum C trachomatis infection was associated with an increased risk of development of intrapartum fever or late postpartum endometritis (p = 0.002).

Cesarean Section↗