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Biomedical subjects

J A Copel

Publications and source records attributed to J A Copel.

At least 127 records · Page 7Linked to original sources
PubMed1988

Diagnostic fetal umbilical blood sampling in the management of isoimmunization.

Current management of isoimmunization in pregnancy is predicted on the assumption that all sensitized women carry antigen-positive fetuses. In addition, management is based on indirect predictors of the magnitude of the fetal hemolytic disease. We present a preliminary report using a new approach of direct fetal blood sampling for the diagnosis and treatment of these patients. This form of evaluation provides specific information about fetal red blood cell antigen status and the degree of fetal anemia at an earlier gestational age than that validated by the Liley curves and eliminates empiricism from both the diagnosis and treatment of the isoimmunized pregnancy. The use of such a management protocol reduces the need for multiple invasive procedures in fetuses at little risk for disease and provides specific information about the status of those fetuses truly at risk.

Blood Group Incompatibility↗
PubMed1988

The use of percutaneous umbilical blood sampling in immune thrombocytopenic purpura.

Maternal immune thrombocytopenic purpura has been associated with profound fetal and neonatal thrombocytopenia. Percutaneous umbilical blood sampling offers a reliable method of determining the fetal platelet count antenatally and optimizing obstetric management. We present our experience with this technique in 19 gestations.

Blood Specimen Collection↗
PubMed1988

The use of intravenous pancuronium bromide to produce fetal paralysis during intravascular transfusion.

Intravascular fetal transfusion can be complicated by difficulty in maintaining vascular access because of fetal movements. Treatment by intramuscular pancuronium bromide has been proposed as a means of arresting fetal movements, although this treatment requires a separate puncture for injection. We report in this article our experience with intravenous fetal injection of pancuronium bromide to produce muscular paralysis during fetal transfusion.

Blood Transfusion, Intrauterine↗
PubMed1988

Malignant mixed müllerian tumor of the uterus arising in association with a viable gestation.

Malignant mixed müllerian tumors of the uterus are rare neoplasms occurring predominantly in postmenopausal women. We report the prenatal course and diagnosis of a stage III malignant mixed müllerian tumor at cesarean section in a 35-year-old woman. Despite aggressive radiation and chemotherapy, the patient died 14 weeks after diagnosis and initial surgical therapy. The premature infant had an uneventful course.

Adult↗
PubMed1988

Prevention of Rh isoimmunization and treatment of the compromised fetus.

Intrauterine intravascular transfusion for the treatment of severe erythroblastosis fetalis has resulted in a number of benefits: (a) Direct access to the fetal vasculature allows an accurate assessment and prompt correction of anemia, albeit temporary. In contrast, intraperitoneally transfused blood may be absorbed erratically, especially in the face of ascites. (b) Intravascular treatments can be performed, in general, as early as 17 weeks of gestation, earlier than intraperitoneal approaches permit. (c) Reversal of hydrops along with the correction of anemia and hypoproteinemia has significantly reduced neonatal morbidity and mortality. None of the surviving neonates in our series required either thoracentesis or paracentesis following delivery, and 40% did not require neonatal exchange transfusion. (d) Treatments may be safely performed until pulmonic maturity has been established and/or an EFW of greater than 2,000 g has been reached, reducing problems of prematurity. (e) Central vein and umbilical vein hypertension may be arrested or prevented, thereby allowing fetal liver function to return to normal. While isoimmunization stands as a disease that has been quite successfully reduced in frequency and severity by the careful attention and treatment by obstetricians, cases still occur. Due to the reduced frequency of severe disease, fewer physicians are trained and experienced in performing this difficult procedure. As fewer transfusions are required, the value of regionalized treatment centers will have to be considered carefully, in order to maximize the experience and efficiency of the intravascular intrauterine transfusion treatment teams.

Blood Transfusion, Intrauterine↗
PubMed1987

Fetal echocardiographic screening for congenital heart disease: the importance of the four-chamber view.

The four-chamber view of the heart has been proposed as a screening method for obstetrical sonographers to assess the fetus for the presence of congenital heart disease. We examined the fetuses in 1022 pregnancies and found 74 structurally abnormal hearts. Seventy-one of these (96%) were found to have an abnormality as seen in the four-chamber view. The four-chamber view of the heart had 92% sensitivity and 99.7% specificity in the detection of congenital heart disease. The positive predictive value was 95.8%, and the negative predictive value was 99.4%. We conclude that the four-chamber view may be a useful screen for the presence of congenital heart disease and should be included as a part of all routine obstetric ultrasound examinations.

Echocardiography↗
PubMed1987

Combined echocardiographic and Doppler assessment of fetal congenital atrioventricular block.

Fetal heart rate monitoring was combined with fetal echocardiography for examination of atrial reactivity during labour in five fetuses with second or third degree heart block. Alterations in vagal tone accompanying uterine contraction influence atrial rate, even when the ventricle is not under atrial 'control'. Fetal echocardiography enabled diagnosis of the underlying basis of the arrhythmia and located the optimal position for recording atrial activity with an external heart rate monitor. External and internal monitoring of atrial activity demonstrated reactivity during labour. Two patients were delivered vaginally after monitoring throughout labour. One mother preferred elective caesarean delivery. Caesarean section was required in another for cephalopelvic disproportion and in the remaining woman for late decelerations. These monitoring techniques provide an assessment of fetal well-being in the presence of fetal bradycardia due to variable degrees of heart block.

Adult↗
PubMed1986

Congenital heart disease and extracardiac anomalies: associations and indications for fetal echocardiography.

Fetal echocardiography is a well-established technique for the prenatal identification of congenital heart disease. One of the indications for its use is the presence of extracardiac anomalies, as such coexistent defects may have important implications for obstetric and neonatal management. We have reviewed the obstetric and pediatric literature to examine reported associations. If a fetus is suspected to have hydrocephalus, microcephaly, holoprosencephaly, agenesis of the corpus callosum, Meckel-Gruber syndrome, esophageal atresia, duodenal atresia, diaphragmatic hernia, omphalocele, or renal dysplasia, cardiac evaluation should be pursued. Furthermore, echocardiography may be of help in differential diagnosis of some anomalies (for instance, skeletal dysplasias). Maternal diabetes and phenylketonuria, as well as exposure to phenytoin, trimethadione, or isotretinoin, may result in multiple systemic defects, including congenital heart disease.

Abdominal Muscles↗
PubMed1986

The value of serial human chorionic gonadotropin testing as a diagnostic tool in ectopic pregnancy.

This study examines the sensitivity of serial human chorionic gonadotropin determinations in the detection of ectopic pregnancy for patients who present with human chorionic gonadotropin titers less than 6500 mIU/ml. A log human chorionic gonadotropin time curve was used to calculate the slope of change. A slope below 0.11 (85% confidence limit for intrauterine gestations) is used as the cutoff value. Of 50 patients with serial titers at sampling intervals of 2 to 5 days, 26 (49%) had falling values and 22 had subnormal slopes. Only five had initially normal slopes and two of these patients eventually had falling titers. The sensitivity of an abnormal slope (below 0.11) in the detection of ectopic pregnancy was 90%. A 12.5% false positive rate was found in a group of 24 intrauterine pregnancies.

Chorionic Gonadotropin↗
PubMed1986

The impact of fetal echocardiography on perinatal outcome.

Fetal echocardiograms were performed in 266 gravidae over a one-year period for a variety of previously identified indications. The largest group consisted of 112 patients referred because of other family members with congenital heart disease (CHD). Of these, only one fetus had CHD. The groups with the highest incidence of CHD were those suspected on general obstetrical scan to have structural cardiac disease (50% abnormal) and those scanned after extracardiac anomalies were found (26% abnormals). Forty rhythm abnormalities were encountered, 85% isolated premature atrial extra-systoles. We conclude that fetal echocardiography should be part of the prenatal evaluation of fetuses with extracardiac anomalies and of those with nonimmune hydrops. Any fetus suspected to have an abnormality of cardiac structure from the four-chamber view of the heart usually visualized while obtaining the abdominal circumference should also be evaluated.

Arrhythmias, Cardiac↗
PubMed1986

Percutaneous umbilical blood sampling in the management of Kell isoimmunization.

As the use of Rhesus immune globulin has decreased the incidence of Rh sensitization, other red blood cell antigen systems have become relatively more common. The most common of these is the Kell antigen, which often produces unexpectedly severe fetal disease. High-resolution ultrasound was used to guide in the sampling of fetal blood directly from the umbilical cord as an aid in the management of these patients.

Adult↗
PubMed1986

Antenatal diagnosis and obstetric management of Dandy-Walker syndrome.

Real-time ultrasound equipment has the potential for investigating the fetal neural axis and allows the diagnosis of many anomalies arising from this area. Five cases of Dandy-Walker syndrome, one of the major causes of congenital hydrocephalus, were diagnosed antenatally. In all cases ultrasound allowed specific recognition of the defect in the cerebellar vermis. This defect connected the fourth ventricle to a posterior fossa cyst in four cases and to an occipital meningocele in one case. In three cases the diagnosis was made prior to viability, and the parents elected termination of pregnancy. In two cases recognized in the third trimester, neurosurgical care was provided soon after delivery.

Brain↗
PubMed1985

Hermansky-Pudlak syndrome in pregnancy: two case studies.

Pregnancies in two patients with Hermansky-Pudlak syndrome, oculocutaneous albinism with hemorrhagic diathesis, are presented. Outcomes were good despite prior reports of postpartum hemorrhage in patients with this syndrome. This autosomal recessive disease is relatively common in parts of Puerto Rico. Suspected patients should be screened with platelet aggregation studies.

Adolescent↗
PubMed1985

The effect of different human chorionic gonadotropin assay sensitivity on screening for ectopic pregnancy.

The distribution of human chorionic gonadotropin levels in 184 patients with ectopic pregnancy is examined. The impact of changing the sensitivity of human chorionic gonadotropin testing on the incidence of false negative results is discussed. Pregnancy blood tests with a detection threshold of 200 mIU/ml were associated with an 11.9% incidence of false negative results.

Chorionic Gonadotropin↗
PubMed1985

Sonographic monitoring to guide the performance of postabortal uterine curettage.

This communication describes a technique of sonographically monitored uterine curettage. This method is of particular value in the management of postabortal endomyometritis associated with retained products of conception or in any situation in which anatomic variation (for instance, retroversion) makes curette insertion difficult.

Dilatation and Curettage↗
PubMed1985

Treatment of fetal supraventricular tachyarrhythmias.

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm. The 14th patient underwent successful therapy after birth. All 14 fetuses survived despite severe fetal hydrops at the time of diagnosis in 13 of 14. The four remaining fetuses had either atrial flutter (3) or fibrillation. Two of the fetuses with atrial flutter died at birth, the 3rd survived after electrical cardioversion at birth. The fetus with atrial fibrillation converted to normal sinus rhythm and survived after maternal administration of digoxin. Using M-mode and pulsed Doppler echocardiography, the nature and electrophysiologic mechanism of the arrhythmia may be deduced. The latter information is reviewed along with the fetomaternal pharmacology of various antiarrhythmic agents to devise a rational antiarrhythmic treatment program.

Anti-Arrhythmia Agents↗