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Biomedical subjects

K Kuhlman

Publications and source records attributed to K Kuhlman.

17 recordsLinked to original sources
PubMed2001

Application of three-dimensional ultrasonography in the evaluation of the fetal heart.

The objectives of this study were to determine whether three-dimensional ultrasonography can provide more cardiac views than two-dimensional ultrasonography and to develop a standard technique. Eighteen women, 16 to 26 weeks' gestation, were scanned with two-dimensional ultrasonography for 10 minutes or less to obtain fetal heart views. Three-dimensional ultrasonography was used (< or =10 minutes) to obtain up to 4 acquisitions of the fetal heart: 4-chamber view, left parasagittal, transverse, and longitudinal nonstandard. Views were later extracted from saved volume data, comparing the yields of two- and three-dimensional ultrasonography. The 4-chamber view was obtained in 15 (93%) of 16 cases on both two- and three-dimensional ultrasonography. On two-dimensional ultrasonography, the left outflow tract was obtained in 68% of the cases; on three-dimensional ultrasonography, the left outflow tract was obtained in 46% from the 4-chamber view acquisition and in 100% from the left parasagittal acquisition. On two-dimensional ultrasonography, the right outflow tract was obtained in 68% of the cases; on three-dimensional ultrasonography, the right outflow tract was obtained in 86% from the 4-chamber view acquisition and in 71% from the left parasagittal acquisition. Aortic and ductal arches were obtained in 12% and 18%, respectively, on two-dimensional ultrasonography. On three-dimensional ultrasonography the aortic and ductal arches were obtained in 66% and 86%, respectively, from the 4-chamber view acquisition and in 57% and 71%, respectively, from the left parasagittal acquisition. Three-dimensional ultrasonography permitted a greater number of cardiac views to be extracted from volume data than did two-dimensional ultrasonography.

Echocardiography, Three-Dimensional↗
PubMed2000

Prediction of preterm birth by second trimester cervical sonography in twin pregnancies.

OBJECTIVES: To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation. METHODS: Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation. RESULTS: Sixty-five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length < or = 25 mm and < or = 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0-10.3 and R.R. 3.6, C.I. 1.6-7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02-0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix < or = 30 mm and any funneling were strongly predictive of PTD. CONCLUSIONS: Both cervical length < or = 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth.

Cervix Uteri↗
PubMed2000

Three-dimensional multiplanar ultrasound for fetal gender assignment: value of the mid-sagittal plane.

OBJECTIVE: To evaluate the feasibility and accuracy of fetal gender assignment from three-dimensional ultrasound (3D US) data at 10-24 weeks' gestation. METHODS: Three-dimensional ultrasound volume data on 47 fetuses were reviewed and divided into groups: 10-14, 15-18, and 19-24 weeks. Fetal genitalia were studied in axial and sagittal planes for gender assignment, using published criteria. The most valuable plane for assignment was noted. Gender assignment was compared with gender at birth. RESULTS: Gender assignment was possible in 44 of 47 fetuses; 25 assigned male and 19 female. Between 10 and 14 weeks the mid-sagittal plane alone was diagnostic for all fetuses. Accuracy of assignment between 11 and 14 weeks was 100%. Between 15 and 18 and 19 to 24 weeks, male assignment was 100% accurate. Female assignment was 100% accurate between 15 and 18 weeks. Accuracy decreased to 60% in the 19 to 24 week group, however, in two of the five cases in which gender was wrongly assigned to be male, the assignment was prospectively considered doubtful due to poor resolution of volume data. Excluding these two cases, accuracy for female assignment in the 19-24 week group was 100%. CONCLUSION: Using 3D US, gender assignment was possible in 44 of 47 of fetuses, as early as 11 weeks' gestation. In early gestation, 11-14 weeks, accuracy of male and female gender assignment was 100%.

Feasibility Studies↗
PubMed2000

Three-dimensional multiplanar transvaginal ultrasound of the cervix in pregnancy.

OBJECTIVES: To develop a standard technique for using three-dimensional ultrasound (3D US) to study and evaluate the cervix in pregnant women at high risk for premature delivery, comparing the findings on 3D US with those on conventional two-dimensional ultrasound (2D US). STUDY DESIGN: Twenty-one pregnant women at high risk for premature delivery had a total of 37 transvaginal 2D and 3D US examinations of the cervix between 11 and 32 weeks' gestation. A 3D US vaginal probe (5.0-8.0 MHz, Voluson 530D, Medison, Pleasanton, CA, USA) was used. Measurements made from the 2D and 3D US were compared. RESULTS: Of the 37 cervical length measurements in 3D US sagittal plane, seven were shorter and three were longer than on 2D US (varying by 5-15 mm) indicating that the true mid-sagittal plane was not obtained in ten (27%) of the 37 2D US examinations. Of 21 examinations showing funneling, funneling was seen on both 2D and 3D US in 15, but was seen only on 3D US in six. There was a significant (P < 0.05) difference between funnel width as measured in the coronal 3D plane versus 2D US, as well as between funnel width in the coronal 3D US plane versus sagittal 3D US plane (P < 0.05). The cerclage was seen in its entirety in nine of 10 examinations; the 3D US axial plane was most valuable for imaging the cerclage. CONCLUSIONS: 3D US appears to offer a more complete assessment of the cervix than 2D US. Multiplanar correlation shows that the standard 2D US sagittal view may under- or over-estimate cervical length. Our preliminary data suggest that 3D US has the potential to improve our understanding of cervical morphology.

Adult↗
PubMed2000

Diagnosis of conjoined twins at 10 weeks using three-dimensional ultrasound: a case report.

A case report is presented of the prenatal diagnosis of conjoined twins at 10 weeks and 2 days' gestation using three-dimensional ultrasound (3D US). The multiplanar display coupled with 3D US surface rendering clearly confirmed the presence of craniopagus. The twins were facing in opposite directions with the left occipital region of one embryo fused with the left parietal-temporal region of the other. Additional multiplanar analysis above the level of the biparietal diameter demonstrated brain sharing.

Abortion, Induced↗
PubMed1997

Cervical ultrasonography compared with manual examination as a predictor of preterm delivery.

OBJECTIVE: Our purpose was to compare the accuracy of ultrasonographic and manual cervical examinations for the prediction of preterm delivery. STUDY DESIGN: One hundred two singleton pregnancies at high risk for preterm delivery were followed up prospectively from 14 to 30 weeks with both serial cervical ultrasonography measurements and manual examinations of the length of the cervix. The primary outcome studied was preterm (< 35 weeks) delivery. RESULTS: Excluding six induced preterm deliveries, 96 pregnancies were analyzed. The mean cervical length measured by ultrasonography was 20.6 mm in pregnancies delivered preterm (n = 17) and 31.3 mm in pregnancies delivered at term (n = 79) (p = 0.003); the mean cervical lengths measured by manual examination were 16.1 mm and 18.6 mm in the same preterm and term pregnancies, respectively (not significant). The sixteenth- and twentieth-week ultrasonographic cervical lengths predicted preterm delivery most accurately (p < 0.0005). The 25th percentiles of ultrasonographic (25 mm) and manual (16 mm) cervical lengths showed relative risks for preterm delivery of 4.8 (95% confidence interval 2.1 to 11.1, p = 0.0004) and 2.0 (95% confidence interval 0.5 to 4.7, p = 0.1), respectively; sensitivity, specificity, and positive and negative predictive values were 59%, 85%, 45%, 91%, and 41%, 77%, 28%, and 86%, respectively. CONCLUSION: Cervical length measured by ultrasonography is a better predictor of preterm delivery than is cervical length measured by manual examination. Cervical ultrasonography in patients at high risk for preterm birth seems to be most predictive of preterm delivery when it is performed between 14 and 22 weeks' gestation.

Cervix Uteri↗
PubMed1997

Cervical funneling: sonographic criteria predictive of preterm delivery.

Our objective was to establish sonographic criteria that are predictive of preterm delivery in patients with internal os dilatation (funneling). The study population consisted of patients with cervical funneling identified on translabial or transvaginal ultrasound examination. Funnel length, functional length, percentage funneling and funnel width were evaluated for their predictive values for preterm delivery. In the 43 patients who met the study criteria, funneling was detected at a mean gestational age of 21.4 weeks (range 16-28). Twenty-three of 31 patients (74%), manually examined immediately following the ultrasound examination, had a closed cervix. Preterm delivery occurred in 42% of patients. Funnel length of > or = 16 mm, functional length of < or = 20 mm, funneling of > or = 40% and funnel width of > or = 14 mm correlated significantly with preterm delivery. Patients with funneling of < 25%, 25-50% and > 50% had preterm delivery rates of 17%, 29% and 79%, respectively.

Adult↗
PubMed1995

Correlation of fetal heart rate decelerations following acoustic stimulation with perinatal outcome.

This was a retrospective study of acoustic stimulation response and perinatal outcome of 688 fetuses undergoing nonstress testing. Acoustic stimulation was performed within 7 days of delivery, and responses were classified based on the presence of an acceleration, deceleration, or both. Responses were correlated with perinatal outcome. Abnormal outcome was defined as: cesarean section for nonreassuring fetal heart rate patterns with an acidotic umbilical artery cord gas; delivery at less than 32 weeks for nonreassuring antenatal fetal testing; meconium aspiration syndrome or mechanical ventilation at 36 weeks or greater; neonatal seizures; 5-minute Apgar score less than 7; and stillbirth. Fetuses who demonstrated deceleration responses were significantly more likely to have abnormal perinatal outcomes when compared with those with acceleration responses (p < 0.001). Although combination acceleration-deceleration responses were more often associated with abnormal perinatal outcome when compared with pure acceleration responses, differences were not significant. A deceleration response following acoustic stimulation is associated with increased risk for adverse perinatal outcome and may merit further evaluation.

Acoustic Stimulation↗
PubMed1993

Myoma vs. contraction in pregnancy: differentiation with color Doppler imaging.

During pregnancy, leiomyomas may cause complications such as spontaneous abortion, premature labor, and obstruction of labor. The conventional real-time ultrasound examination usually detects myomas adequately, but, in some cases, a local thickening of the uterine wall persists throughout the examination, interfering with the differentiation between myoma and contraction. In such cases, repeat scanning approximately 30 minutes later differentiates contractions, which usually resolve, from myomas. We examined 10 patients with B mode and color Doppler ultrasonography. In the 5 patients with myoma, we observed splaying of the vessels around the mass, whereas in the 5 patients with contraction, there was no vessel displacement in the area of the local myometrial thickening. The use of color Doppler and observation of these findings may obviate a prolonged ultrasound examination in questionable cases.

Female↗
PubMed1991

Endoluminal gynecologic ultrasound: preliminary results.

Specially developed high-resolution real-time ultrasound transducers (12.5 and 20 MHz) on the tip of endoluminal catheters were inserted into the endometrial canal to evaluate the usefulness of this approach. Uterine abnormalities, most confirmed by biopsy, surgery, or both, were detected in 12 patients, including submucosal myomas, nabothian cysts, endometrial polyps, synechiae, and endometrial and cervical carcinoma. In one case the catheter was directed under hysteroscopic guidance into a fallopian tube, demonstrating its potential usefulness in this region. In 4 of the 12 cases in which a hysterectomy was performed, an in vitro ultrasound examination of the organ was performed, which confirmed the initial in vivo ultrasound impressions. Anatomic cross-sectional slices of the uterus resulted in excellent correlation with the ultrasound findings. These preliminary results suggest that this new sonographic procedure will become an important diagnostic tool, supplementing abdominal and endovaginal ultrasound approaches.

Adult↗
PubMed1990

Usefulness of a short femur in the in utero detection of skeletal dysplasias.

In 28 fetuses studied during a 4 1/2-year period, the initial femur was below 2 standard deviations (SDs) of the mean when compared with the biparietal diameter. These fetuses were considered at risk for skeletal dysplasias and were followed up. Studies were performed at a mean gestational age of 26.7 weeks (range, 15.3-41.0 weeks). Group 1 had a femur length 1-4 mm below the 2-SDs line (range, -2.0 to -4.0 SDs); no other abnormalities were detected. Interval examination of 12 femurs showed that 10 either remained shortened to the same degree or had a growth spurt. At birth, all subjects were healthy except one with mild growth retardation and one with a chromosomal abnormality. Of the two subjects that failed to continue normal growth, one was healthy and the other was a heterozygous achondroplastic dwarf. Group 2 had greater femoral shortness; all measurements were more than 5 mm below the 2-SD line (range, -4.3 to -31.0 SDs). All had fetal abnormalities and significant skeletal dysplasias. The authors conclude that the number of millimeters below the 2-SDs line is an accurate, easy criterion for evaluation of femoral length.

Bone Diseases, Developmental↗
PubMed1985

Is amniotic fluid material in the central circulation of peripartum patients pathologic?

Cytologic findings of amniotic fluid material (AFM) in pulmonary arterial blood (PAB) of survivors of amniotic fluid embolism (AFE) are assumed to be pathologic. However, no cytologic studies of central blood from patients without clinical AFE have been reported. To address this question PAB samples from peripartum patients without clinical AFE were examined for the presence and extent of AFM (including squames, mucin, and lanugo hair). Ten samples were obtained from five patients. All patients had at least one sample postpartum. Peripheral blood from a nonpregnant adult female control was processed similarly. Results were compared to a PAB sample from a patient with clinical AFE. The patient with clinical AFE had many squames, clumps of lanugo hair, and mucin in one sample. In six of ten study samples, there were squames, accompanied in two cases by lanugo hair or trophoblast. In nine of ten samples there was mucin. There appeared to be no difference in cytologic findings in patients according to mode of delivery or sampling time. The control blood sample was negative for amniotic fluid-like material. AFM may be found in peripartum patients without clinical amniotic fluid embolism. A quantitative difference was seen between the index patient and each of our five study patients. These findings suggest that there is a quantitative continuum of AFM transported to the central circulation in peripartum patients which may, in part, explain the varied clinical presentations and severity of AFE.

Adult↗
PubMedDate not supplied

Placenta accreta: comparison of cases managed with and without pelvic artery balloon catheters.

OBJECTIVE: To describe our experience with the use of prophylactic pelvic artery balloon catheters in cases of placenta accreta diagnosed by antenatal ultrasound and to compare these cases with contemporary controls. METHODS: In this prospective study, all patients seen at our institution between January 1994 and August 1997 with the antenatal sonographic diagnosis of placenta accreta were offered prophylactic preoperative pelvic artery balloon catheterization. Patients who were delivered by cesarean hysterectomy for unsuspected placenta accreta in our institution during the same time interval served as controls. Five patients with the sonographic diagnosis of placenta accreta underwent prophylactic pelvic artery balloon catheterization. Surgical outcomes in patients who received balloon catheters were compared with those managed without them. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Five patients with placenta accreta or one of its variants were correctly identified with antenatal ultrasonography. Of the five patients who underwent pelvic artery balloon catheterization, all had placenta accreta and four required cesarean hysterectomy. The mean estimated blood loss, transfusion requirement, and length of hospitalization in patients undergoing hysterectomy managed with and without the balloon catheters was not different (P > 0.06). CONCLUSIONS: Antenatal sonographic diagnosis of placenta accreta enables preoperative planning. In our experience, use of pelvic artery balloon occlusion catheters in patients requiring a cesarean hysterectomy for placenta accreta did not improve surgical outcomes compared with patients managed without them. These preliminary findings are based on a small number of patients; therefore, further investigation is needed.

Adult↗