Biomedical subjects
Publications and source records attributed to Jeffrey A Kuller.
Screening for aneuploidy has traditionally been reserved for women of advanced maternal age. More recent advances in serum screening and ultrasound technology have allowed women of all ages to be offered screening in the second and even first trimester. These methods and their effectiveness are discussed.
OBJECTIVE: This study was undertaken to examine neonatal outcomes in karyotypically normal cases of omphalocele with respect to mode of delivery, presence of associated anomalies, presence of extracorporeal liver, and method of abdominal wall closure. STUDY DESIGN: We reviewed 36 cases of omphalocele with delivery at University of North Carolina Hospitals between 1988 and 2001. Elective terminations and pregnancies resulting in miscarriage before 20 weeks' gestation were excluded. RESULTS: Perinatal mortality rate was 19%. Rate of composite neonatal morbidity was 25%. Associated major anomalies were present in 11 (31%) cases and were associated with increased neonatal mortality. Cesarean deliveries were performed in 21 (58%) cases and were not associated with increased primary closure rates or decreased neonatal morbidity and mortality. Extracorporeal liver was present in 27 (75%) cases and was associated with decreased rates of primary closure but did not affect neonatal outcome. CONCLUSION: In cases of ongoing omphalocele, perinatal mortality rates are low in the absence of associated anomalies or genetic defects. Intracorporeal liver was not associated with increased rates of associated anomalies or was it associated with increased neonatal morbidity or mortality.
OBJECTIVES: The purpose of this study was to examine the relationship between labor and ruptured membranes on the neonatal outcome of infants with gastroschisis. STUDY DESIGN: We reviewed the outcomes of 60 neonates who were prenatally diagnosed with gastroschisis and who were delivered at the University of North Carolina Hospitals between June 1989 and April 1999. RESULTS: The mean gestational age at delivery was 36 weeks. Four infants (7%) died in the neonatal period, and 19 infants (32%) had a major morbidity. No significant differences appeared in any of the neonatal outcomes when they were stratified by the presence or absence of labor and presence or absence of ruptured membranes. After being controlled for confounding variables, the risk of neonatal death or major neonatal morbidity because of exposure to either labor or ruptured membranes was no different than the risks caused by no labor or intact membranes, respectively. CONCLUSION: Labor and ruptured membranes do not appear to be associated with increased neonatal morbidity or mortality rates in neonates with gastroschisis.
BACKGROUND: Wernicke's encephalopathy is usually associated with alcohol abuse, but can also occur with hyperemesis gravidarum. The effect of delay in thiamine replacement on fetal outcomes is unknown. We present a case of this complication. CASE: A primipara with hyperemesis was admitted for mental status changes in her 14th week of pregnancy. Physical examination revealed a lethargic patient with ophthalmoplegia, ataxia, and hyporeflexia. Parenteral thiamine therapy was started. The patient improved rapidly although the ataxia persisted. A spontaneous abortion occurred 2 weeks later. CONCLUSION: Wernicke's encephalopathy can complicate hyperemesis gravidarum. Early thiamine replacement may decrease the chances of spontaneous abortion.
Inherited and acquired thrombophilias have been associated with recurrent pregnancy loss. Over recent years our ability to detect protein and genetic abnormalities responsible for thrombotic tendency has improved. We are now left with the task of deciphering which of these thrombophilias carries an increased risk for recurrent pregnancy loss. Acquired thrombophilias including lupus anticoagulant and anticardiolipin antibodies have been linked to recurrent pregnancy loss. However the evidence for the role of inherited thrombophilias such as, heterozygosity for the factor V Leiden, prothrombin G20210A mutation, the methylenetetrahydrofolate reductase (C677T MTHFR) mutation, as well as deficiencies of antithrombin, protein C and protein S is less clear. The methods for diagnosis and the evidence for their associations are discussed in this paper. Treatment modalities independent of those needed to prevent thrombotic events in pregnancy have generally not been studied. Given the present available data, there is insufficient evidence to include inherited thrombophilias in the initial evaluation of RPL. It is important to look for other, more common, causes of recurrent miscarriage in the evaluation of these patients.