Biomedical subjects
Publications and source records attributed to P Grannum.
The pathogenesis of the prune belly syndrome is unclear. The proposed etiologies include a distal obstructive uropathy or a mesodermal defect of the anterior abdominal wall and urinary tract. Detection of increased intravesicular pressure might identify those fetuses with an obstructive etiology who, therefore, would benefit from shunting.
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Bilateral multicystic kidney disease is a congenital disorder that is fatal in the newborn period. A series of nine cases of bilateral multicystic kidney disease diagnosed prenatally by ultrasound is presented. Ultrasound criteria necessary for the diagnosis are bilateral multicystic kidneys, loss of renal architecture, nonvisualization of the fetal bladder, and absence of amniotic fluid. Seven of the nine cases had autopsy confirmation of the diagnosis. Three cases had other associated congenital anomalies. Precise prenatal diagnosis may allow patients the option of elective abortion or may prevent unnecessary obstetric intervention. We propose that a reliable diagnosis can be made with prenatal ultrasound.
The sites of obstruction found during development are reviewed: high (uretero-pelvic junction), mid (ureterovesical junction) and low (posterior urethral valves). Diagnostic evaluation of the fetal urinary tract is reviewed. The management of obstructive uropathies is briefly outlined and centres around the level of the lesion and whether the obstruction is unilateral or bileteral. Antenatal intervention is indicated whenever the function of both kidneys is threatened. The amount of amniotic fluid remains a good guide to renal function. The role of fetal urinary electrolytes as a prognostic indicator is not yet clarified.
Bilateral renal agenesis is a lethal congenital anomaly. A reliable prenatal diagnosis is extremely important, since it may offer options for pregnancy termination or may change obstetric management in the third trimester. This study examined the accuracy of ultrasound in making an antenatal diagnosis of bilateral renal agenesis in three different populations: (1) patients with a family history of bilateral renal agenesis, (2) patients diagnosed during the course of a routine scan, and (3) patients referred because of a previous suspicious ultrasound examination in a level I ultrasound facility. In group A there were three true positive, 13 true negative, no false negative, and no false positive diagnoses. In group B there were three true positive and no false positive diagnoses. In group C there were 12 true positive, 17 true negative, one false negative, and no false positive diagnoses. The value and potential pitfall of the different diagnostic criteria are discussed. We conclude that ultrasound is a valuable tool in the detection of intrauterine renal failure, although there are limitations to a specific diagnosis of bilateral renal agenesis.
Normal values for fetal spleen dimensions are proposed, including longitudinal, coronal, and transverse diameters, the perimeter, and the estimated volume. Similar values were then obtained in cases of Rh-immunization and prolonged premature rupture of the membranes. A good correlation between amniotic fluid optical density and fetal spleen size was found. Only severely affected fetuses showed splenic values above the upper limit. Since sonographic examination can be regarded as a reliable method, nomograms can be useful in detecting growth disorders of the fetal spleen and thus provide a new complementary method to identify possible fetal diseases of genetic disorders.
The use of ultrasound to identify the fetus at risk for postmaturity among postterm pregnancies was evaluated. The ultrasound findings in 85 postterm pregnancies were reviewed. No grade 0 or grade 1 placentas were observed and grade 2 and 3 placentas were found with similar frequency. The incidence of advanced postmaturity was 12.9%. Advanced postmaturity was found with grade 2 and 3 placentas. Oligohydramnios was very common (81.8%) among pregnancies resulting in postmaturity. The neonatal ponderal index was higher with grade 2 placentas than with grade 3 placentas. The presence of immature placentas (grade 0 or 1) is rare after 42 weeks of gestation. Placental grading cannot be used to predict postmaturity.
The rates of intraoperative complications (dry and bloody taps) of two amniocentesis techniques were compared in 1300 patients undergoing second trimester procedures for genetic indications. The sonographically guided technique consisted of the selection of a site for needle insertion with ultrasound, removal of the transducer, and immediate amniocentesis. The sonographically monitored technique consisted of the continuous visualization of the needle during the entire procedure. Six hundred twelve amniocenteses were performed with the sonographically guided technique and 688 with the sonographically monitored technique. There was a statistically significant decrease in the incidence of bloody and dry taps of the first needle insertion (relative risk = 38%, P less than .0001) and also in the number of patients that required multiple needle insertions (relative risk = 42%, P less than .0001) with the sonographically monitored technique.