PubMed Health⌕ Search

Biomedical subjects

L M Hill

Publications and source records attributed to L M Hill.

At least 19 recordsLinked to original sources
PubMed1996

Severity of polyhydramnios does not affect the prevalence of large-for-gestational-age newborn infants.

The purpose of this study was to evaluate the relationship between the severity of polyhydramnios with or without maternal diabetes and the prevalence of large-for-gestational-age newborn infants. A case control design was used. The study group consisted of 275 singleton pregnancies with an amniotic fluid index > or = 25.0 cm. An equal number of controls was matched for maternal age, gravidity, parity, and gestational age. Polyhydramnios was categorized into three groups by severity: mild (amniotic fluid index 25 to 30 cm.); moderate (amniotic fluid index, 30.1 to 35.0 cm); and severe (amniotic fluid index > or = 35.1 cm). Among our study group, 72.7%, 19.7%, and 7.6% of cases had mild, moderate, and severe polyhydramnios, respectively. Patients with polyhydramnios had a significantly higher prevalence of large-for-gestational-age neonates (27%) than did controls (10%) (P < 0.001). No correlation was seen between the severity of polyhydramnios and neonatal delivery weight. The prevalence of gestational and class > or = B diabetes mellitus was significantly higher among patients with polyhydramnios (17.7%) than among controls (7%) (P < 0.003). Once polyhydramnios was diagnosed sonographically, however, maternal diabetic status did not affect the prevalence of large-for-gestational-age newborn infants. We conclude that the prevalence of large-for-gestational-age neonates is 2.7 times greater when polyhydramnios is present than when the amniotic fluid volume is normal. Neither the severity of polyhydramnios nor the presence of maternal diabetes mellitus strengthens the relationship between polyhydramnios and large-for-gestational-age newborn infants.

Case-Control Studies↗
PubMed1996

Effect of indomethacin on individual amniotic fluid indices in multiple gestations.

To determine the effect of indomethacin on the amniotic fluid index of individual fetuses in multiple gestations, we evaluated seven sets of twins and two sets of triplets in preterm labor (eight cases) or with polyhydramnios (one case). The dose of oral indomethacin was either 25 mg every 12 hours or 25 mg every 6 hours. The amniotic fluid volume of individual amniotic sacs was estimated serially by the amniotic fluid index. When an oral dose of indomethacin of 25 mg every 6 hours was used, oligohydramnios eventually occurred in five of eight amniotic sacs and a subjective decrease in amniotic fluid occurred in one sac. Oligohydramnios was detected in only one of 13 amniotic sacs when the dose of indomethacin was 25 mg every 12 hours. The amniotic fluid volume returned to normal in these seven amniotic sacs within 4 days of discontinuing indomethacin. We conclude that maternal indomethacin therapy has a variable effect on the individual amniotic fluid volumes in multiple gestations.

Amniotic Fluid↗
PubMed1995

The natural history of fetal cytomegalovirus infection as assessed by serial ultrasound and fetal blood sampling: a case report.

A patient in whom intrauterine fetal cytomegalovirus (CMV) infection was diagnosed at approximately 25 weeks' gestation is presented. The fetus was evaluated by serial fetal blood samplings and ultrasound examinations. The fetus manifested evidence of severe thrombocytopenia and hepatic inflammation, with recovery over a period of approximately 8 weeks. The initial sonographic findings of marked fetal ascites and cardiomegaly gradually resolved; ventriculomegaly developed during the third trimester. At delivery, the baby was morphologically normal with the exception of mild ventriculomegaly. Cord blood was negative for CMV IgM but urine was culture-positive for CMV. At age 3, the child has a severe but stable unilateral hearing deficit and is otherwise developmentally normal. This case demonstrates the utility of serial ultrasound and fetal blood sampling in the prenatal diagnosis and management of fetal CMV infection.

Adult↗
PubMed1995

The association between polyhydramnios and preterm delivery.

OBJECTIVE: To determine whether an association exists between the severity of polyhydramnios and the frequency of preterm delivery. METHODS: The study group consisted of 275 singleton pregnancies with polyhydramnios as defined by an amniotic fluid index (AFI) of at least 25 cm. Polyhydramnios was arbitrarily categorized into three groups by severity: mild (AFI 25-30 cm), moderate (AFI 30.1-35 cm), and severe (AFI greater than 35.1 cm). A delivery was considered preterm if it occurred before 37 weeks' gestation. RESULTS: Fifty-two of 275 (18.9%) women delivered before 37 weeks' gestation. Preterm delivery occurred in 37 of 199 (18.5%) cases with mild polyhydramnios, 12 of 55 (21.8%) with moderate polyhydramnios, and three of 21 (14.3%) with severe polyhydramnios (no statistically significant difference). Fetuses with congenital malformations (16 of 41, 39%) and those of diabetic mothers (ten of 45, 22.2%) had a significantly higher incidence of preterm delivery than did cases with unexplained polyhydramnios (24 of 190, 12.6%; P < .001). The prematurity rate in cases with idiopathic polyhydramnios was no higher than the overall rate for our hospital. CONCLUSION: The underlying cause of polyhydramnios, rather than the relative excess of amniotic fluid as defined by this study, appears to determine when preterm labor will occur.

Adolescent↗
PubMed1995

Transvaginal sonographic evaluation of first-trimester placenta previa.

Our objective was to determine the relationship between the placenta and the internal cervical os in the first trimester. This study included ultrasound examinations performed between 9 and 13 weeks' gestation over a 28-month period. The position of the lower edge of the placenta with respect to the internal cervical os was recorded for each transvaginal ultrasound examination. A total of 77 out of 1252 (6.2%) patients had a first-trimester placenta previa; four cases persisted until term. There were no false-negative diagnoses. Our conclusion is that approximately 6.2% of patients will have a placenta previa in the first trimester. Transvaginal sonography can exclude a diagnosis of placenta previa after 9 weeks' gestation. The likelihood that a placenta previa will persist until term increases if the placenta covers the internal cervical os by > or = 1.6 cm.

Female↗
PubMed1994

Sonographic determination of first trimester umbilical cord length.

Umbilical cord length was measured sonographically in 53 normal fetuses and 15 fetuses with an intrauterine demise. The age of the fetuses ranged from 6.1 weeks to 11 weeks, menstrual age. Intra- and interobserver differences in measurements were not significantly different from zero. A close linear relationship (r2 = 0.89) was found between umbilical cord length and menstrual age in the normal group. The cord lengths of 9 of 15 fetuses (60%) with an intrauterine fetal demise were more than 2 SD below the expected value for menstrual age in normal fetuses.

Female↗
PubMed1994

Second-trimester echogenic small bowel: an increased risk for adverse perinatal outcome.

2267 singleton fetuses who had one ultrasound examination between 15 and 21 weeks' gestation were prospectively evaluated for echogenic small bowel. Thirty-two cases of echogenic small bowel were detected--a prevalence of 1.4 per cent. Echogenic fetal small bowel was divided into two grades: grade 1, where the small bowel was more echogenic than the liver; and grade 2, where the small bowel had the echogenicity of bone. In contrast to 19/23 fetuses with grade 1 small bowel echogenicity, only 2/9 fetuses with grade 2 echogenic bowel had a normal pregnancy outcome (Fisher's exact test; P < or = 0.01). Complications associated with second-trimester echogenic small bowel included in utero cytomegalovirus infection, second-trimester growth restriction, intrauterine fetal demise, and chromosomal abnormalities. Second-trimester fetal echogenic small bowel is associated with an increased risk of an adverse outcome. The prevalence of perinatal and neonatal complications is significantly greater when small bowel echogenicity approaches that of bone.

Adult↗
PubMed1994

Ratios between the abdominal circumference, head circumference, or femur length and the transverse cerebellar diameter of the growth-retarded and macrosomic fetus.

The purpose of our investigation was twofold: to provide normative data for the ratios between head circumference and cerebellum, abdominal circumference and cerebellum, and femur length and cerebellum; and to evaluate the predictive accuracy of an abnormal ratio in the detection of growth retardation and macrosomia. Data on 675 women with normal gestations between 14 and 42 weeks were used to estimate reference curves for the three ratios to be evaluated. We then compared the ratios of 34 fetuses with intrauterine growth retardation and 28 macrosomic fetuses to the control group. Of the three ratios that we investigated, abdominal circumference to transverse cerebellar diameter was the most efficacious. However, the sensitivity of this ratio for the detection of intrauterine growth retardation and macrosomia was only 52.9% and 46.6%, respectively. A ratio between head circumference, abdominal circumference, or femur length and the transverse cerebellar diameter cannot reliably distinguish between normally growing fetuses and those that are growth retarded or macrosomic.

Abdomen↗
PubMed1994

Persistent right umbilical vein: sonographic detection and subsequent neonatal outcome.

OBJECTIVE: To review our experience with antenatal detection and subsequent neonatal outcome of fetuses with a persistent right umbilical vein. METHODS: In a prospective observational study, 33 cases of persistent right umbilical vein were detected during 15,237 obstetric ultrasound examinations performed after 15 weeks' gestation. RESULTS: Persistent right umbilical vein was detected at a rate of one per 476 obstetric ultrasound examinations. Six of 33 (18.2%) fetuses with a persistent right umbilical vein had additional important congenital malformations. CONCLUSIONS: Careful second- and third-trimester ultrasound examinations can detect a persistent right umbilical vein. When this particular anomaly is detected, a thorough fetal anatomic survey, including echocardiography, should be performed to rule out more serious congenital malformations.

Abortion, Eugenic↗
PubMed1994

Carotidynia: a pain syndrome.

Carotidynia is a common neck pain syndrome first described by Temple Fay in 1927. The pain is typically dull, throbbing, continuous, and localized over the carotid bifurcation, but may radiate to the ipsilateral mandible, cheek, eye, or ear. Symptoms are frequently aggravated by swallowing, chewing, and contralateral head movements. The cardinal physical finding is tenderness on palpation of the carotid bulb, sometimes accompanied by prominence or throbbing of the carotid pulse. Although several serious conditions should be excluded, most cases follow a benign course.

Adult↗
PubMed1994

The sonographic assessment of twin growth discordancy.

OBJECTIVE: To determine: 1) the frequency with which standard fetal biometry (head circumference [HC], abdominal circumference [AC], and femur length [FL]) and the transverse cerebellar diameter can be measured in twin pregnancies; and 2) the efficacy of fetal biometry using these measures in the detection of twin growth discordancy. METHODS: The study population consisted of 203 twin pregnancies reviewed retrospectively. The frequency with which standard biometry and the transverse cerebellar diameter could be obtained was recorded. Forty-nine twin pairs who were delivered within 3 weeks of their last ultrasound examination were divided into three groups based on birth weight differences: 20% or more, 10-19%, and less than 10%. The sensitivity, specificity, and predictive values of the specific fetal biometric measurements and of the sonographic estimation of fetal weight were assessed for this subgroup for the prediction of twin discordancy. RESULTS: The FL could be measured consistently throughout gestation, but the ability to measure the AC decreased after 35 weeks' gestation. The frequency with which HC and transverse cerebellar diameter could be measured decreased with advancing gestation. The transverse cerebellar diameter could be measured only in 91 of 151 and 14 of 49 pregnancies at 31-35 and 36-40 weeks' gestation, respectively. An intra-pair AC difference of 20 mm or more had a sensitivity and a positive predictive value of 83% for the detection of twin discordancy, defined as at least a 20% difference in birth weight. Estimated fetal weight had a sensitivity and positive predictive value of 92.9 and 72%, respectively. In contrast, a difference of 4 mm or more in the intra-pair transverse cerebellar diameter had a sensitivity of 28% and a positive predictive value of 50% in detecting twin weight discordancy. CONCLUSIONS: Appropriate twin fetal biometry can be measured throughout gestation. Estimated fetal weight has a higher sensitivity but a lower positive predictive value than AC for predicting twin growth discordancy.

Anthropometry↗
PubMed1994

Antenatal diagnosis of fetal pelvic kidneys.

OBJECTIVE: To review our experience with the antenatal detection and subsequent neonatal outcome of fetuses with a pelvic kidney. METHODS: A retrospective review of 25,551 obstetric ultrasound examinations performed after 16 weeks' gestation identified 13 cases of fetal pelvic kidneys (one per 1965 examinations). RESULTS: Three pelvic kidneys were dysplastic; the remainder appeared sonographically normal. Seven pelvic kidneys were measured; five were smaller than expected for gestational age. Associated anomalies were detected in three cases. CONCLUSIONS: Careful second- and third-trimester ultrasound examinations can detect an absence of the kidney in the renal fossa. Evaluating the migratory path of the kidney from the pelvis to the renal fossa will frequently result in detection of an ectopic kidney.

Female↗
PubMed1994

Nonsurgical management of placenta percreta: a case report.

BACKGROUND: Although placenta percreta is rare, its sequelae include potentially lethal hemorrhage and loss of reproductive function. Therapy directed toward control of life-threatening hemorrhage frequently includes emergency hysterectomy. CASE: A woman with placenta percreta, suspected clinically and documented radiographically, was treated nonsurgically. Following delivery, the placenta was left in situ and methotrexate chemotherapy was initiated to aid destruction of the trophoblastic tissue. Eight months later, hysteroscopy showed a normal uterine cavity with only a small area of calcification at the presumed implantation site. Two years later, the patient had a normal pregnancy and vaginal delivery. CONCLUSION: Placenta percreta can be managed with preservation of the uterus, but careful follow-up may be required until the entire placenta has resorbed.

Adult↗
PubMed1993

Fetal heart circumference as a predictor of menstrual age in fetuses affected by disturbances in growth.

OBJECTIVE: The purpose of this study was twofold: (1) to evaluate the relationship between fetal heart circumference and gestational age and (2) to determine the effect, if any, of disturbances in fetal growth on heart circumference. STUDY DESIGN: Heart circumference was measured in 262 women with normal gestations (control group) and in two study groups consisting of 52 large-for-gestational age 32 small-for-gestational age fetuses. Standardized, gestational age-adjusted values in the two study groups were compared with normative data provided by the control group. RESULTS: There was a close correlation (R2 = 0.94) between heart circumference and gestational age in normally growing fetuses. Disturbances of fetal growth (i.e., macrosomia and growth retardation) were found to have an inconsistent effect on heart circumference. CONCLUSION: Heart circumference cannot be used as an independent parameter for gestational age evaluation in fetuses with disturbances of growth.

Animals↗