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Biomedical subjects

P G Pryde

Publications and source records attributed to P G Pryde.

At least 19 recordsLinked to original sources
PubMed2004

Meconium staining of amniotic fluid correlates with intestinal peel formation in gastroschisis.

Several studies in animal models demonstrate that peel formation in gastroschisis is due to the accumulation and activation of intestinal waste products (IWP) in the amniotic fluid. We reviewed our recent experience with gastroschisis and asked the following questions: First, does staining of the bowel and amniotic fluid with IWP correlate with intestinal peel formation? Second, what prenatal ultrasound findings indicate that peel formation is occurring in utero? Over two years, 16 neonates were treated for gastroschisis; twelve had been diagnosed by prenatal ultrasound and followed closely. Patients were grouped based on the presence of IWP in the amniotic fluid at the time of delivery (staining or no staining), and outcomes were reviewed. All neonates in the staining group (n=7) had a fibrinous peel present at the time of birth whereas a peel was absent in all neonates in the no-staining group (n=9). Matting of the bowel was seen by prenatal ultrasound in four patients in the staining group (0/8 in the no-staining group) and correlated with peel formation (Fisher's exact test p =0.007). Primary closure was done in 14 of the infants, and two required silo closure. In neonates with gastroschisis, staining of the amniotic fluid and bowel serosa with IWP correlated with intestinal peel formation. The ultrasound findings of matting correlated with both peel formation and staining with IWP. These results suggest that spillage of IWP into the amniotic fluid is one of the factors in peel formation in gastroschisis. Identification of matting of the bowel by prenatal ultrasound indicates formation of a peel.

Amniotic Fluid↗
PubMed2001

Umbilical cord serum ionized magnesium level and total pediatric mortality.

OBJECTIVE: To estimate whether higher magnesium levels in umbilical cord blood at delivery are associated with increased total pediatric (fetal + neonatal + postneonatal) mortality. METHODS: During the Magnesium and Neurologic Endpoints Trial, in addition to randomizing mothers having preterm labor into arms containing magnesium sulfate, other tocolytic agents, or saline controls, we obtained biologic specimens at delivery, including umbilical cord venous blood on which was determined the serum ionized magnesium level using the AVL 988-4 analyzer (Graz, Austria). Laboratory results were then matched with the pediatric mortalities. The study power was based on the anticipated reductions in neonatal intraventricular hemorrhage related to magnesium usage from 18.9% to 4.4%. For alpha =.05, 1-beta (power)=80%, two tailed, the total number of infants needed would be 140. RESULTS: Of 149 mothers who gave permission for randomization, ionized magnesium levels were available for 82 children. Seven deaths occurred (one immediately before delivery, three as neonates, and three in the postneonatal period). The median level of ionized magnesium among the seven dead children was 0.76 mmol/L; among the 75 survivors, the median level of ionized magnesium was 0.55 mmol/L (Mann-Whitney U test, P =.03). Using multivariable logistic regression analysis, the association remained statistically significant when controlling for possible confounding factors (adjusted odds ratio 7.7, 95% confidence interval 1.2, 47.6, P =.03). CONCLUSION: These findings of a dose response between serum ionized magnesium and deaths in children increase our concern about the improper use of tocolytic magnesium.

Adult↗
PubMed2001

Adverse and beneficial effects of tocolytic therapy.

In addition to questions raised about the efficacy of many tocolytics, appropriate concern has been voiced about the safety of these potent drugs. Although some degree of risk for adverse effects with drugs promising a strong therapeutic effect can be accepted, caution needs to be exercised when benefits are marginal or unproven. Unfortunately, some of the tocolytics, most notably the betamimetics and magnesium sulfate, have been found to have considerable potential for adverse maternal cardiovascular and respiratory effects. Although less clearly established, the use of indomethacin appears to be associated with increased fetal and neonatal risks. Concerning magnesium sulfate, in addition to the well-known maternal effects, the accumulating evidence showing an increased frequency of adverse outcomes in the fetus and neonate has led to the recommendations to abandon its use entirely as a tocolytic. Given the limitations of our current state of knowledge, nifedipine would appear to be among the more efficacious and safer tocolytics available to use when properly indicated.

Adrenergic beta-Agonists↗
PubMed2001

Color Doppler ultrasonography for distinguishing myomas from uterine contractions in pregnancy.

OBJECTIVE: To determine the applicability and reliability of color Doppler ultrasonography (US) for distinguishing a uterine myoma from a focal myometrial contraction. STUDY DESIGN: Images from 36 patients with uterine thickenings were classified as myomas when color Doppler US demonstrated no centralized flow with a circumscribed vessel pattern at the border. Thickenings were classified as focal myometrial contractions when there was demonstrable vascular flow throughout the thickening. RESULTS: Using these diagnostic criteria, images from 36 patients were reliably characterized as representing myomas or contractions. The diagnosis was made more reliable by using the lowest velocity settings and exclusion of power Doppler US in nonretroplacental lesions. CONCLUSION: Color Doppler US is a sensitive and reliable tool for distinguishing uterine myomas from focal myometrial contractions.

Adult↗
PubMed2000

Perinatal death and tocolytic magnesium sulfate.

OBJECTIVE: To determine whether there is a significant association between perinatal mortality and exposure to total doses of tocolytic magnesium sulfate larger than 48 g. METHODS: We did a case-control study in which cases were defined as neonates or fetuses who died after being exposed to tocolytic magnesium sulfate and controls were those who survived exposure. The study included fetuses and neonates who weighed between 700 and 1249 g and whose mothers had received tocolytic magnesium sulfate at Chicago Lying-in Hospital between January 1, 1986, and March 31, 1999. We excluded women who received prophylactic magnesium sulfate for preeclampsia or preeclampsia superimposed on chronic hypertension, and fetuses or neonates with major congenital anomalies. Data were analyzed by Fisher exact test, chi(2) test, Student t test, Mann-Whitney U test, multivariable logistic regression, and Cochrane-Armitage trend test. RESULTS: Controlling for birth weight or gestational age, year of delivery, receipt of betamethasone, acute maternal disease, and maternal race in a multivariable model, we found that exposure to total doses of tocolytic magnesium sulfate exceeding 48 g was significantly associated with increased perinatal mortality (adjusted odds ratio 4. 7; 95% confidence interval 1.1, 20.0; P =.035). Using the Cochrane-Armitage trend test, we found that a significant dose response was present (P =.03), but one that was most consistent with a threshold effect. CONCLUSION: Our findings support the hypothesis that high doses of tocolytic magnesium sulfate are associated with increased perinatal mortality among fetuses and neonates weighing 700-1249 g.

Adult↗
PubMed2000

An overview of the possible relationship between antenatal pharmacologic magnesium and cerebral palsy.

Magnesium sulfate is currently being used in obstetric practice for either eclamptic seizure prophylaxis or for tocolysis, in some countries. Evidence for its use in preeclampsia is credible, whereas the evidence for its use as a tocolytic is limited, if not absent. Of interest, the findings of two epidemiologic studies have suggested a third possible use for antenatal pharmacologic magnesium sulfate, namely, as a neuroprotectant against the later development of cerebral palsy in the newborn. In support of this hypothesis are laboratory data, much of which have to do with the modulation of cellular membrane receptors. Unfortunately, during the Magnesium and Neurologic Endpoints Trial (MagNET), while attempting to confirm the neuroprotective effect of magnesium sulfate, the occurrence of excess total pediatric mortality in those children exposed to magnesium led to early termination of the trial. Nonetheless, despite the alarming findings in MagNET, it is conceivable that exposures to doses of magnesium sulfate less than those often used for aggressive tocolysis may be neuroprotective without being lethal. Other randomized controlled trials now underway may answer this important question.

Cerebral Palsy↗
PubMed1996

Hyperemesis gravidarum. Effects on fetal outcome.

OBJECTIVE: To study perinatal outcomes in pregnancies complicated by hyperemesis gravidarum (HG) as compared to controls. STUDY DESIGN: Between 1984 and 1991, 138 patients were diagnosed with HG according to Fairweather's criteria. Subjects were stratified into groups of mild and severe HG according to the presence of at least one of the following criteria: ketonuria, increased blood urea nitrogen and hematocrit, and/or abnormal electrolytes. All patients without HG on whom records were available and who delivered during the study period were included as controls. Multiple gestations and stillbirths were excluded from the analysis. Student's t test and X2 were used for statistical analysis. RESULTS: Demographic data were not significantly different between the groups. Forty patients were diagnosed as having mild HG and 98 patients as having severe; 12,335 patients were defined as controls. Mean fetal birth weights were 3,110, 3,093, and 3,160 g in the mild, severe and control groups, respectively. The incidence of congenital anomalies was 2.5%, 2.0% and 1.6%, respectively. The incidence of prematurity was 17.5%, 11.2% and 10.7% in mild and severe HG and controls, respectively. None of the outcome variables for mild or severe HG were significantly different as compared to the controls. Differences in other neonatal outcomes, including frequency of five-minute Apgar score < 7 and neonatal intensive care unit admissions, were not significantly different between the three groups. CONCLUSION: In contrast to previous reports, this study demonstrated that fetuses of gravidas admitted for HG are not at increased risk of growth retardation, congenital anomalies or prematurity. No beneficial effect on pregnancy outcome was detected.

Adult↗
PubMed1994

Prenatal diagnosis of umbilical cord pseudocyst.

The association between umbilical cord anomalies and chromosomal abnormalities has received little attention in the literature. In this report, we present two cases of umbilical cord pseudocyst incidentally detected by ultrasound prior to genetic amniocentesis performed for the indication of advanced maternal age. In the first case it was only the initial abnormal finding in a 21-week fetus ultimately found to have a trisomy 18. In the second case, detected at 26 weeks, the karyotype was normal and a healthy normal neonate was delivered at term. The finding of a umbilical cord cystic mass during prenatal sonographic examination should alert the clinician to the increased risk of aneuploidy.

Journal Article↗
PubMed1994

Prenatal diagnosis of sirenomelus with color Doppler ultrasonography.

Sirenomelus is an invariably lethal congenital anomaly characterized by complete or nearly complete fusion of the lower extremities that occurs in 1 of 60,000 births. In about 50% of cases this condition cannot be diagnosed prenatally because of the associated oligohydramnios that precludes a detailed examination of the fetus. We present a case of sirenomelus in which prenatal diagnosis was aided by color Doppler ultrasonography; visualization of the vitelline artery as a single, large intraabdominal vessel that did not branch in the fetal pelvis but rather coursed ventrally into the umbilical cord proved to be diagnostic of this rare condition. Color Doppler flow ultrasonography is a valuable tool for the prenatal diagnosis of sirenomelus.

Adult↗
PubMed1994

In utero surgical treatment of fetal obstructive uropathy: a new comprehensive approach to identify appropriate candidates for vesicoamniotic shunt therapy.

OBJECTIVES: We present a new approach to prenatal evaluation and prediction of renal function and long-term outcomes for fetuses considered candidates for in utero surgery. STUDY DESIGN: A review of 34 cases of obstructive uropathies was made, with analysis of our approach to prenatal evaluation, the predictive value of urinary electrolytes and protein analysis in identifying renal dysplasia, and the outcomes of cases with and without in utero surgical intervention. RESULTS: Ten of 11 pregnancies that were terminated had dysplasia; one female had cloacal dysgenesis. In three of eight unshunted cases megacystis resolved after vesicocentesis. Eight of 15 shunted fetuses survived. Of those predicted to have good postnatal outcome, six of six demonstrated good postnatal renal function. Of those predicted to have poor outcomes, two of two had poor postnatal renal function and dysplasia. Seven of 15 shunted fetuses died, four of four predicted to have dysplasia were confirmed, and three died of nonrenal causes. CONCLUSIONS: Our prenatal approach successfully differentiated fetuses with underlying renal dysplasia from those without irreversible damage who subsequently benefited from in utero vesicoamniotic shunt placement.

Congenital Abnormalities↗
PubMed1994

Constriction of the umbilical cord leading to fetal death. A report of three cases.

Constriction of the umbilical cord is characterized by localized absence of Wharton's jelly, leading to narrowing of the cord, thickening of the vascular walls and narrowing of the vascular lumens. This may result in a compromised fetal blood supply, leading to fetal anoxia and eventual fetal death. Approximately 50 cases have been reported in the world literature over the last three centuries. Three cases of umbilical cord constriction leading to intrauterine fetal demise are reported. Two of the patients presented during the late second trimester with loss of sensation of fetal movements. Intrauterine fetal demise was diagnosed, and autopsy revealed constricted umbilical cords associated with torsion. The third patient is unique in that fetal death was precipitated by a routine, technically uncomplicated, transplacental amniocentesis procedure performed in the early second trimester. At the time of termination of the pregnancy we found marked stenosis with torsion over a 1-cm segment of the umbilical cord juxtaposed against the fetal insertion site. Umbilical cord constriction is a rare, almost invariably fatal condition, usually undiagnosed antenatally. In case 3, disruption of the placenta by amniocentesis may have initiated a terminal event in a fetus already compromised by a cord constriction. Three possible mechanisms could have contributed to the fetal death after amniocentesis in the presence of cord constriction: acute vasospasm, acute oligohydramnios and uterine contraction, or an obliterating thrombus.

Adult↗
PubMed1994

Gastroschisis: can antenatal ultrasound predict infant outcomes?

OBJECTIVE: To test previously proposed but unproven antenatal ultrasound prognostic criteria in fetal gastroschisis. METHODS: Thirty consecutive gastroschisis-affected pregnancies and their outcomes were reviewed retrospectively. Data were tabulated by review of antenatal ultrasound videotapes, with blinded comparison to indicators of short- and long-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their ability to prognosticate effectively. RESULTS: Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant outcomes. However, a stricter 17-mm criterion for clinically important bowel dilatation provided prognostic information, with remarkable improvement in specificity (75 versus 37%) and positive predictive value (55 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%). CONCLUSIONS: Bowel dilated more than 17 mm on antenatal ultrasound appears to be associated with increased short- and long-term infant morbidity. Whether this finding warrants obstetric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.

Congenital Abnormalities↗
PubMed1994

Maternal neurosurgical shunts and pregnancy outcome.

OBJECTIVE: To assess pregnancy outcome in women with ventriculoperitoneal or lumboperitoneal shunts. METHODS: Charts were reviewed retrospectively for mothers with ventriculoperitoneal or lumboperitoneal shunts delivered at Hutzel Hospital from 1976-1992. Patients were identified by cross-referencing medical records from Children's Hospital Neurosurgical Division and medical records at Hutzel Hospital during this period. RESULTS: Eight patients with 25 pregnancies were identified from 1976-1992. Indications for shunt placement were pseudotumor cerebri (four with lumboperitoneal shunts) and congenital hydrocephalus (four with ventriculoperitoneal shunts). Pregnancy outcomes were two elective abortions, five spontaneous abortions, two preterm vaginal deliveries, one mid-forceps rotation, two primary low transverse cesareans, two repeat low transverse cesareans, and 11 spontaneous vaginal deliveries. No patient received prophylactic antibiotics during labor and vaginal delivery because of the shunt. There were no shunt-related complications. CONCLUSIONS: This series doubles the number of previously reported pregnancy outcomes in women with neurosurgical shunts. Contrary to the literature suggesting cesarean delivery and prophylactic antibiotics for all patients, our experience suggests that vaginal delivery can be considered and that prophylactic antibiotics are not an absolute necessity in uncomplicated vaginal deliveries.

Adolescent↗
PubMed1993

Prenatal diagnosis of nonrhizomelic chondrodysplasia punctata (Conradi-Hünermann syndrome).

Chondrodysplasia punctata has been classified into two major types including the rare autosomal recessive "rhizomelic type" and a more common but genetically heterogenous nonrhizomelic type (referred to by some authors as "Conradi-Hünermann (CH) type"). The former is typically lethal, manifesting serious anomalies, and allowing several instances of confident prenatal diagnosis. The latter being milder has more subtle anomalies and prenatal diagnosis has been uncommonly reported (confined to cases diagnosed incidentally by flat-plate X-ray examination of the mother in late third trimester, and a case found by directed ultrasound performed in a Mendelian affected mother). Cases included 1) a young primigravida thought to be affected with Conradi-Hünermann syndrome presented at 16 weeks gestation for prenatal diagnosis and counseling. Ultrasound examination of the fetus detected assymetric limb shortness allowing the presumptive diagnosis of an affected fetus which was confirmed after delivery near term. 2) A normal 38-year-old multipara with unremarkable family history underwent routine fetal ultrasound evaluation at 18 weeks gestation. Disorganization of the spine, premature echogenicity of femoral epipheses, and frontal bossing with depressed nasal bridge were described. Neonatal examination confirmed suspicion of CH. Case 1 demonstrates the importance of solid clinical diagnosis in Mendelian malformation-affected parents for directing prenatal diagnostic efforts. Case 2 represents the first index case of CH diagnosed antenatally by ultrasound. Diagnostic clues which must be considered in establishing these diagnoses are discussed, as are some of the difficulties and limitations in antenatal counseling such cases.

Adult↗
PubMed1993

Two consecutive hydrolethalus syndrome-affected pregnancies in a nonconsanguinous black couple: discussion of problems in prenatal differential diagnosis of midline malformation syndromes.

Hydrolethalus syndrome is a rare autosomal recessive (AR) disorder characterized by polyhydramnios, CNS abnormalities, cleft lip/palate, micrognathia, and polydactyly. Its molecular basis is unknown and prenatal diagnosis is challenging due to phenotypic overlap with several other midline malformation syndromes. A 34-year-old G3P2, nonconsanguinous, married, African-American woman was referred at 19 weeks of gestation after ultrasound findings of "multiple congenital anomalies." A previous pregnancy had been terminated following ultrasound findings of polyhydramnios, cleft lip/palate, polydactyly, severe hydrocephalus, and a Dandy-Walker malformation (DWM). Level II ultrasound evaluation of the current pregnancy demonstrated all of the anomalies which had been present in her previous pregnancy. Karyotype of amniocytes was 46,XX. Autopsy following pregnancy termination confirmed ultrasound findings. The pedigree, sonographic, and autopsy findings in this case were most consistent with hydrolethalus syndrome, although other AR multiple midline malformation syndromes were considered. Our case was detected by 19 weeks. Confident differential diagnosis is difficult for the geneticist and even more so for the sonologist given the technical limitations of ultrasound. It is uncertain whether these mendelian midline malformation syndromes represent slightly different phenotypic expressions of a common genetic defect or are manifestations of allelic and or locus heterogeneity. We suggest that for prenatal diagnostic purposes, in the absence of knowledge of the molecular basis of these disorders, the fine distinctions are not crucial as long as their mendelian inheritance is recognized and presence or absence of manifestations which make them severe are ascertained.

Abnormalities, Multiple↗
PubMed1993

Effects of hydralazine on pregnant rats and their fetuses.

OBJECTIVE: We conducted this study to assess potential teratogenic or fetotoxic effects of in utero hydralazine exposure in the rat. STUDY DESIGN: Pregnant rats were treated with hydralazine (0, 15, or 30 mg/kg/day) by either gavage or subcutaneous injection during gestation days 8 through 19, inclusively. Surviving animals were killed, uterine contents examined, and fetuses evaluated by Wilson's method for teratologic examination. RESULTS: Oral administration did not affect maternal weight gain or fetal or placental weights. Subcutaneous administration decreased fetal and placental weights but only in dams given the highest dose subcutaneously; significantly increased maternal mortality and reduced maternal weight gain were also observed. There was no increased incidence of fetal anomalies in any group. CONCLUSION: Hydralazine does not have teratogenic or fetopathic effects when given to rats in dosages that are nontoxic to the mother.

Abnormalities, Drug-Induced↗