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Biomedical subjects

H J Finberg

Publications and source records attributed to H J Finberg.

At least 19 recordsLinked to original sources
PubMed1998

Chronic abruption-oligohydramnios sequence.

OBJECTIVE: To determine outcome in patients with chronic abruption. STUDY DESIGN: A retrospective review was performed of all patients delivering at a tertiary medical center during a 54-month period. All patients with a diagnosis of placental abruption with oligohydramnios or ruptured membranes were included. Chronic abruption-oligohydramnios sequence (CAOS) was defined by the following criteria: (1) clinically significant vaginal bleeding in the absence of placenta previa or other identifiable source of bleeding, (2) amniotic fluid volume initially documented as normal, and (3) oligohydramnios (amniotic fluid index < or = 5) eventually developing without concurrent evidence of ruptured membranes. RESULTS: Twenty-four patients with CAOS were identified. Fourteen had first evidence of abruption at < 20 weeks' gestational age. A clot was identified between the chorion and uterus in 18/24. The mean gestational age at the first bleeding episode was 19.4 +/- 5.5 (SD) weeks, with the mean gestational age at delivery 28.1 +/- 4.5 weeks. Preterm premature membrane rupture occurred in 15/24. In these 15 there was a mean of 11.5 +/- days between the diagnosis of oligohydramnios and of ruptured membranes. Patients whose first blood occurred at < 20 weeks' gestation delivered at a gestational age of 26.1 +/- 3.9 weeks versus 33.0 +/- 5.3 weeks for the control group. CONCLUSION: CAOS can occur in pregnancies complicated by abruptio placentae. If it develops, the mean gestational age at delivery is 28 weeks.

Abruptio Placentae↗
PubMed1995

Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations.

OBJECTIVE: The purpose of this investigation was to determine the value of biophysical profile testing in preventing intrapartum death in patients with high-order multiple gestations (triplets or quadruplets). STUDY DESIGN: A retrospective review was performed of patients with triplets and quadruplets cared for by Phoenix Perinatal Associates from October 1988 to December 1991. Biophysical profile testing was used as the primary method of fetal surveillance in these pregnancies. Fetal heart rate monitoring on an external monitor was used as back-up and in cases sent to labor and delivery for problems. The ultrasonographic parameters of the biophysical profile score were used without the nonstress test component because of technical difficulty with that test in high-order multiple pregnancies. A score of 6 to 8/8 was therefore considered reassuring, 4/8 equivocal, and 0 or 2/8 possibly abnormal. Testing was done twice per week. RESULTS: Eighteen patients with triplets and six patients with quadruplets constituted the study group. The last biophysical profile before delivery was examined to evaluate the value of the test. There were no antepartum deaths in these 78 babies. The last biophysical profile score was 2/8 in nine fetuses of five triplet pregnancies and two fetuses of one quadruplet pregnancy. These six pregnancies (25%) were delivered on the basis of biophysical profile results and clinical circumstances. There was no morbidity or mortality in the 19 babies delivered because of abnormal biophysical profile testing. Four pregnancies had poor outcome at delivery in spite of 8/8 biophysical profile scores on all babies within 4 days of delivery. Of these four, two patients had worsening pregnancy-induced hypertension, one had abruptio placentae, and one had a severely growth-retarded infant. CONCLUSION: There were no stillbirths in this series. Twenty-five percent of these pregnancies eventually were delivered for nonreassuring biophysical profile testing, with good outcome. Four pregnancies had poor neonatal outcome in spite of normal biophysical profile testing. All of these pregnancies had active changes in physiologic features leading to delivery (two worsening pregnancy-induced hypertension, one abruptio placentae, one spontaneous rupture of membranes and labor). The biophysical profile appears to be a reliable antepartum test of fetal well-being in triplets and quadruplets.

Female↗
PubMed1994

Antepartum diagnosis of noncoiled umbilical cords.

OBJECTIVE: The null hypothesis is that fetuses with noncoiled umbilical cords diagnosed in the antepartum period will have outcomes no different from those with normally coiled cords. STUDY DESIGN: We prospectively gathered data from Jan. 1 through May 18, 1992, from all fetuses undergoing routine ultrasonographic evaluation. The outcomes of fetuses noted to have noncoiled umbilical cords were compared with those of a control group of fetuses with normally coiled cords. The control group consisted of those subjects undergoing ultrasonography during the study period who were ultimately transferred to our perinatal practice for the remainder of the pregnancy (i.e., the highest-risk patients). Two outcome parameters were selected for comparison: fetal anomalies and fetal death. RESULTS: Six hundred eighty-seven consecutive ultrasonographic examinations were performed. Twenty-five subjects (3.7%) had noncoiled umbilical cords identified ultrasonographically (mean gestational age at diagnosis 20.3 +/- 3.5 [SD] weeks). The control group had 197 subjects. The combined incidence of fetal anomalies or death in the noncoiled group (16%) was significantly greater (p < or = 0.05, relative risk 4.6 [95% confidence interval 1.41 to 14.15]) than that of the control group (3.5%). The noncoiled group had two fetal deaths (8%), whereas two deaths (1%) occurred among controls (p < or = 0.05, relative risk 8 [95% confidence interval 1.16 to 50]). Two (8%) fetal anomalies (anencephaly, prune-belly syndrome) occurred in the noncoiled group, whereas the controls (n = 197) had five fetuses (2.5%) with anomalies (not significant). CONCLUSION: The antepartum identification of noncoiled umbilical cords appears to be a risk factor for suboptimal pregnancy outcome.

Case-Control Studies↗
PubMed1992

The "twin peak" sign: reliable evidence of dichorionic twinning.

In twin pregnancies with a single placental zone, the presence of a triangular projection of placental tissue beyond the chorionic surface, extending between the layers of the intertwin membrane, has provided reliable evidence that there are two fused placentas (dichorionic, diamniotic) rather than a single shared placenta (monochorionic, diamniotic). This observation, dubbed the "twin peak" sign, was identified in 15 twin pregnancies, all proven to be dichorionic at birth, and in five triplet pregnancies, all proven to be trichorionic. This finding is produced by proliferating chorionic villi growing into the potential space between the two layers of chorion in the intertwin membrane. The single chorion of a monoplacental twin pregnancy serves as an intact barrier, preventing villi from growing between the two amniotic layers. A decision sequence incorporating the use of the twin peak sign is described for determining the type of twinning that has occurred.

Chorion↗
PubMed1992

Avoiding ambiguity in the sonographic determination of the direction of umbilical cord twists.

The helical twisting pattern of umbilical cord vessels is a well-recognized phenomenon, and the direction of twisting can be easily determined by gross pathologic inspection. With the cord held vertically, vessels along the anterior surface that spiral downward from high left to low right, angled like the left side of the letter V, indicate a left helix. Those angled like the right side of the V form a right helix. However, confusion can occur in determining the direction of spiraling on prenatal sonographic images depending on whether the image plane transects the cord along the surface toward or away from the observer. For correct identification of the direction of the cord twist, images must be obtained along the nearer surface.

Female↗
PubMed1992

Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section.

A prospective evaluation for possible placenta accreta was performed in 34 patients with placenta previa and a history of one or more cesarean sections. Sonographic criteria used included (1) loss of the normal hypoechoic retroplacental myometrial zone, (2) thinning or disruption of the hyperechoic uterine serosa-bladder interface, and (3) presence of focal exophytic masses. Of 18 patients with positive sonographic results, 14 had proof of placenta accreta and 16 of the patients underwent hysterectomy. Of 16 patients with negative sonographic results, only one had placenta accreta, and two patients required hysterectomy. Presence of numerous intraplacental vascular lacunae appears to be an additional risk criterion for placenta accreta, separate from the other criteria listed above.

Cesarean Section↗
PubMed1991

Unilateral hydrocephalus: prenatal sonographic diagnosis.

We studied six cases of unilateral hydrocephalus detected prenatally to analyze the sonographic features of the abnormality and to determine the cause and clinical outcome. In all cases, third-trimester sonograms showed marked unilateral lateral ventriculomegaly (mean atrial width, 4.4 cm) and normal contralateral lateral, third, and fourth ventricles. Five of the six cases had marked thinning of the cortical mantle on the affected side and shift of midline structures to the contralateral side. The causes of unilateral hydrocephalus were agenesis or stenosis of the foramen of Monro in three cases, transient obstruction of the foramen in one fetus with an intraventricular hematoma, underlying brain dysplasia in one fetus with a variant of holoprosencephaly, and undetermined in one case. All six neonates had placement of a ventriculoperitoneal shunt catheter; four of these have had normal cognitive development at follow-up. The remaining two infants have moderate to severe developmental impairment. Unilateral hydrocephalus is a rare anomaly that can be recognized by prenatal sonography. Even though unilateral ventriculomegaly may be marked, early diagnosis and treatment may result in a favorable clinical outcome.

Adult↗
PubMed1991

Uterine synechiae in pregnancy: expanded criteria for recognition and clinical significance in 28 cases.

Amniotic sheets caused by preexisting uterine synechiae may be recognized in pregnancy by presence of a bulbous free edge containing a hypoechoic zone and Y-shaped splitting of the sheet at the endometrial margin. The placenta is contiguous with, is indented by, or extends along the synechia in up to two third of cases. In 28 cases, amniotic sheets did not cause fetal damage, but they did lead to a significantly higher primary cesarean section rate by causing fetal malpresentation and possibly by contributing to low placental implantations and bleeding. Previous curettage had been done in 78% of these patients.

Cesarean Section↗
PubMed1990

Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism.

Newborn screening programs for the detection of congenital hypothyroidism have dramatically shortened the time before treatment is begun. However, concern still exists about central nervous system sequelae which may persist due to a period of untreated intrauterine hypothyroidism. Presence of polyhydramnios led to the ultrasound diagnosis of a fetal goiter. Hypothyroidism was confirmed at 34 weeks gestation by percutaneous fetal blood sampling, which revealed an elevated TSH (186 mU/L) and a low T4 (19.3 nmol/L). Intraamniotic fluid injections of 500 micrograms levothyroxine sodium (T4) every 10-14 days increased fetal serum T4 (59.2 nmol/L), decreased fetal serum TSH (14 mU/L), decreased amniotic fluid TSH, and decreased the size of the fetal goiter. The infant was born at term without perinatal complications. Thyroid function studies on cord blood were normal (T4, 109.4 nmol/L; TSH, 1.3 mU/L), and the infant was discharged on oral T4. Follow-up examination at age 6 weeks revealed that the infant was developmentally normal and clinically and chemically euthyroid. Intrauterine T4 therapy can suppress fetal TSH and treat fetal hypothyroidism despite hypothyroid levels of serum T3. Highly sensitive TSH assays may allow the use of amniotic fluid TSH as a marker for fetal hypothyroidism.

Adult↗
PubMed1990

The biophysical profile. A literature review and reassessments of its usefulness in the evaluation of fetal well-being.

Antenatal monitoring studies to assess fetal well-being and to identify the compromised fetus are in widespread use. This literature review analyzes the theoretical basis for fetal monitoring and the clinical research that has defined its utility, and it discusses the variations in protocols and scoring systems for the biophysical profile. While recognizing that there, is as yet, no consensus on the optimal monitoring protocol, the authors espouse one approach in which the cardiac nonstress test and the amniotic fluid volume are the initial tests, with full biophysical profile reserved for abnormal test outcomes. This approach to monitoring should be expeditious without diminishing its predictive value.

Embryonic and Fetal Development↗
PubMed1989

Fetal goitrous hypothyroidism. A new diagnostic and therapeutic approach.

We present a first case in whom fetal hypothyroidism with goiter was both successfully diagnosed and treated in utero. An obstetrical sonogram at 33 weeks revealed a bilobed fetal neck mass, compatible with enlarged thyroid gland, associated with neck hyperextension, reduced gastric fluid, and polyhydramnios. Umbilical blood sampling after volume reduction amniocentesis confirmed fetal hypothyroidism with a euthyroid mother. Fetal T4 measured 1.3 micrograms/dl, free T4 0.3 ng/dl, and thyroid-stimulating hormone 186 microU. Intraamniotic levothyroxine, 500 micrograms, was given twice with a 14-day interval. The head flexed, gastric fluid increased, and amniotic fluid levels returned to normal. Prenatal (36 weeks) and neonatal blood sampling demonstrated return to euthyroid indices. Ultrasonic estimates of thyroid volume decreased by over 50%. Vaginal delivery at 39 weeks was uncomplicated. The newborn appeared normal and is being maintained on thyroid replacement therapy.

Adult↗
PubMed1988

Heterotopic pregnancy: report of four cases.

Four patients with heterotopic (combined) pregnancies were treated at one institution during the period of a year. The use of fertility agents, infertility surgery, and pelvic inflammatory disease may be risk factors predisposing to an increasing incidence of such pregnancies. Combined pregnancy may reasonably belong in the differential diagnosis in certain clinical settings.

Adult↗
PubMed1984

Direct prenatal chromosome diagnosis of a malignancy.

A fetal tumor was suspected at 31 weeks of gestation. The occurrence of polyhydramnios led to an ultrasound examination, which revealed deformation of the fetal head, face, eye, and neck. This was confirmed by computerized tomography. Amniocentesis yielded cells with an inverted duplication of chromosome #1. This abnormality of chromosome #1 marked the malignant teratoma cells in the amniotic fluid. Cytogenetic analysis of tumor tissue and of normal tissue obtained postnatally confirmed that the abnormality of chromosome #1 observed in amniotic fluid cells was confined to the tumor. The constitutional karyotype was normal. To our knowledge, this is the first report of the direct chromosomal detection of malignancy before birth.

Adult↗