Biomedical subjects
Publications and source records attributed to K R Gottesfeld.
Hematotrachelos, the engorgement of the cervix uteri with retained blood, is discussed with reference to clinical presentation, ultrasonographic findings, and etiologies. Other disease processes related to hematotrachelos such as hematometra, hematocolpos, and hydrocolpos are also reviewed.
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Ultrasound was used as a diagnostic tool in 859 patients for the localization of the placenta in the second trimester prior to genetic amniocentesis. A greater incidence of total placenta previa was found in the study group (5.6%) than is reported for the general population (0.25-0.5%). Maternal age greater than 35 years was the indication or co-factor in 59% of the patients studied, which might explain this difference. It was possible to predict total placenta previa at term early in the second trimester. It was demonstrated that if a placenta was located centrally over the cervical os and did not change position with variations in the degree of bladder-filling or changes in uterine position, the risk of having a total placenta previa at term increased from 1/143 to 1/8 pregnancies.
Since the advent of gray scale, more detail is available on sonograms and the products of conception are more readily seen. The gestational sac can be seen at about the fifth week of gestation and the fetal parts can be recognized around the seventh week of gestation. The gestational sac, fetal parts, and the placenta can be followed all the way through pregnancy without any "blind periods." In the first three months of pregnancy, gestational age can be determined by measuring the size of the gestational sac in centimeters and adding 2 to that number. From then on the head and chest measurements can be used for a more accurate determination of gestational age.
Placental positions in 214 patients scheduled for genetic amniocentesis were reviewed. Forty-five percent were found to have ultrasound findings of a low-lying placenta or partial or total placenta previa. At term, none of these patients required intervention for bleeding or placenta previa. Parity of 4 or more, but not age, correlated with an increased incidence of partial or total placenta previa, but not with a low-lying placenta. Low-lying placenta or placenta previa may be a normal variant in early pregnancy, suggesting that failure of the placenta to relinquish this position can result in an abnormally implanted placenta at term.
The use of gray scale B mode provides more effective visualization for sonographic evaluation of fetal ascities. Two cases of severely Rh isoimmunized fetuses with hydrops and one fetus with hydrops secondary to chylous ascites are presented to show the ultrasonic features of diagnosis of fetal edema and ascities. Thus, ultrasonic evaluation in known cases of Rh isoimmunization or diabetes provides additional information on the status of the fetus in utero and rapid recognition of fetal hydrops. This additional information aids in the management of the pregnancy and in the determination of the time of delivery.
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