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Biomedical subjects

George S H Yeo

Publications and source records attributed to George S H Yeo.

7 recordsLinked to original sources
PubMed2006

Shoulder dystocia and injuries: prevention and management.

PURPOSE OF REVIEW: Shoulder dystocia is an obstetric emergency that is often unpredictable and unanticipated. Despite the identification of various clinical risk factors, our ability to predict and prevent shoulder dystocia is very limited. Effective and timely clinical management is essential to offer the best chance of a satisfactory outcome. RECENT FINDINGS: Upon diagnosis of the condition, a team working in tandem to resolve the problem is very effective. Use of the McRoberts maneuver, application of suprapubic pressure, with an adequate episiotomy allow resolution of over 50% of cases, with a low risk of fetal injury. Secondary maneuvers include rotation of the shoulders and delivery of the posterior shoulder. These are technically more challenging and may be associated with a higher risk of fetal injury. More drastic action may be considered in dire cases where even secondary maneuvers fail. These include the Zavanelli maneuver, symphysiotomy or iatrogenic clavicular fracture. These techniques, while seldom required, may be lifesaving in extremely severe cases. SUMMARY: Upon resolution of the clinical event, it is essential to document the entire event, and to discuss the clinical problem and management with the parents. These actions will reduce the risk of medical litigation, and improve patient satisfaction with clinical care.

Birth Injuries↗
PubMed2006

Recurrent non-immune fetal hydrops: A case report.

INTRODUCTION: Recurrent non-immune fetal hydrops (NIH) has been reported in the literature but is a rare entity, with fewer than 6 reported cases so far. It has been postulated to be related to a recessive gene. CLINICAL PICTURE: We report a case of recurrent fetal hydrops in a multigravida with no medical history of note. She presented in her current pregnancy with a significant history of having 4 (out of 7) previous pregnancies affected by hydrops. TREATMENT: All the affected pregnancies resulted in mid-trimester pregnancy termination (MTPT) following diagnosis in the second trimester. Previous investigations for hydrops did not yield any obvious cause. OUTCOME: Her most recent pregnancy was unaffected. We discuss the possible differential diagnoses and the likelihood of autosomal recessive metabolic diseases being the aetiological factor. CONCLUSION: Rare causes of fetal hydrops need to be excluded in cases of recurrent non-immune hydrops with no obvious aetiology following routine investigations.

Abortion, Legal↗
PubMed2005

Intrauterine growth restriction.

PURPOSE OF REVIEW: Intrauterine growth restriction remains one of the major problems in obstetrics. Recent published literature on this problem is summarized in this review. RECENT FINDINGS: Intrauterine growth restriction contributes disproportionately to neonatal mortality and morbidity in both preterm and term babies, and is a predisposing factor to major psychiatric sequelae such as depression, suicide and suicidal attempts. More evidence is accumulating to show that fetal Doppler changes of the ductus venosus and umbilical vein are good surrogate markers for fetal academia. The timing of delivery remains controversial, however. The Growth Restriction Intervention Trial showed that delayed delivery in those up to 30 weeks may be associated with lower rates of cerebral palsy and Griffiths development quotient under 70. In dichorionic twins, selective fetocide of one severe intrauterine growth restriction fetus in midtrimester twin pregnancies complicated by severe preeclampsia may abort the disease process and prolong the pregnancy. For monochorionic twins, the finding of intermittent absent or reversed end diastolic flow in the umbilical artery may be a manifestation of the transmission of the bi-directional waveforms of arterio-arterial anastomosis, but has been shown to be associated with an increased risk of intrauterine death in the growth restricted fetus and brain damage in the larger fetus. SUMMARY: The timing of delivery of the preterm growth restricted fetus remains controversial. Intrauterine growth restriction with intermittent absent or reversed end diastolic flow in the umbilical artery of monochorionic twins poses difficulties in assessment.

Adrenal Cortex Hormones↗
PubMed2004

Intracrine control of estrogen action in human gestational tissues at parturition.

OBJECTIVE: We examined whether estrogen action in human parturition is regulated by an intracrine mechanism mediated by target tissue expression of specific 17beta-hydroxysteroid dehydrogenase (17betaHSD) isozymes that interconvert estrone (E1) and estradiol (E2), such that the onset of labor is associated with an increase in local E2 bioavailability. METHODS: The extent of 17betaHSD-1, -2, -3, -4, -5, and -7 expression (measured by quantitative reverse transcriptase polymerase chain reaction) and the capacity to interconvert E1 and E2 were compared in amnion, chorion, placenta, decidua, and myometrium obtained from women at term before (n = 6) and after (n = 6) the onset of labor. RESULTS: In chorion, abundance of 17betaHSD-1 (converts E1 to E2) mRNA decreased 2.7-fold (P <.05) in association with labor onset. In myometrium, 17betaHSD-1 and 17betaHSD-4 (converts E2 to E1) mRNAs increased two-fold and five-fold, respectively, with the onset of labor (P <.05 for each). No other statistically significant labor-associated change in 17betaHSD expression was observed. In chorion, 17betaHSD oxidative (E2 to E1) and reductive (E1 to E2) activities and the net E2 synthetic capacity increased with labor. In decidua, both activities decreased with the onset of labor, but there was no change in net E2 synthetic capacity. The capacity to interconvert E1 and E2 did not change in the other tissues. CONCLUSION: The increase in E2 synthetic capacity in the chorion might contribute to an increase in local estrogen bioactivity in association with the onset of labor. However, it cannot be explained by changes in 17betaHSD isozyme expression and is unlikely to account for the increased estrogen action at parturition. These data show that intracrine mechanisms based on 17betaHSD isozyme expression play a minor role, if any, in controlling estrogen action in gestational tissues during human parturition.

17-Hydroxysteroid Dehydrogenases↗
PubMed2002

Transient hyperthyroidism of hyperemesis gravidarum.

OBJECTIVE: To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum. DESIGN: Prospective observational study. SETTING: Hospital inpatient gynaecological ward. POPULATION: Women admitted with hyperemesis gravidarum and found to have hyperthyroidism. METHODS: Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation. MAIN OUTCOME MEASURES: Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes). RESULTS: Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of > 5% of their pre-pregnancy weight was lower compared with those of women who did not (P = 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile. CONCLUSIONS: In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.

Adult↗
PubMedDate not supplied

Intralobar sequestration of the lung is a congenital anomaly: anatomopathological analysis of four cases diagnosed in fetal life.

The origin of intralobar sequestration of the lung (ILS)-whether congenital or acquired--has often been controversial, since firm anatomical evidence of prenatal origin has been sparse. We describe four cases in which anomalous arterial supply from the aorta to abnormally echogenic lower lung lobes was demonstrated on routine antenatal ultrasound examination, and the diagnosis of ILS was subsequently confirmed by postmortem examination including bronchography of the fetuses at between 20 and 23 wk. One right-sided lesion was supplied from a branch of the coeliac axis, and three left-sided lesions were supplied from the thoracic aorta. In two cases, the arterial supply was shown to be multiple. All lesions were situated in the lower lobes. They showed a cystic transformation of the affected lung tissue which was histologically indistinguishable from cases diagnosed as congenital cystic adenomatoid lesion (CCAM) at the same gestational age, but clearly different from that seen in bronchial obstruction due to laryngeal stenosis at that age. Similar vascular lesions have been reported in otherwise normal lungs. The character of the anomalous arterial vessels is consistent with origin from the embryonic splanchnic plexus. The precise sequence of pathogenetic events is unclear but there appears to be a close relationship of this condition not only with CCAM but also with the condition of anomalous arterial supply to the lower lobe.

Aorta, Thoracic↗