Antepartum diagnosis and management of multiple fetal cardiac tumors.
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Adult↗
Biomedical subjects
P J Weinbaum
Publications and source records attributed to P J Weinbaum.
Antenatal sonographic findings in a case of intra-abdominal pulmonary sequestration.
This report describes the antenatal sonographic identification of a hyperechoic intra-abdominal mass in a 30-week fetus. The mass was proved by autopsy to be an extralobar pulmonary sequestration. Although a rare type of congenital malformation, pulmonary sequestration should be included in the differential diagnosis of an echodense intra-abdominal mass seen during antenatal ultrasound examination.
Abdomen↗
Autosomal recessive Robinow-like syndrome with anterior chamber cleavage anomalies.
We describe 2 sisters with short stature, mesomelic brachymelia, macrocephaly, hypoplastic genitalia, and anterior chamber cleavage anomalies. Many of their manifestations have been described in individuals with Robinow syndrome; however, the anterior chamber cleavage anomalies seen in both girls, hydrocephalus seen in the younger sister, and apparent autosomal recessive inheritance do not characterize the Robinow syndrome. The syndrome present in these sisters most likely represents a previously undescribed autosomal recessive syndrome.
Abnormalities, Multiple↗
The use and misuse of the fetal biophysical profile.
The value of the fetal biophysical profile in determining fetal well-being has been well documented. The increasing clinical use of the fetal biophysical profile, however, has led to the recognition of frequent errors in the interpretation and application of this modality. These errors may result in unnecessary interventions or adverse perinatal outcome. The most frequent errors in the interpretation and application of the fetal biophysical profile are described; in an attempt to minimize the misuse of the fetal biophysical profile, an alternative protocol of antepartum fetal evaluation is suggested based upon the information obtained from the biophysical monitoring of the fetus.
Central Nervous System↗
Preterm premature rupture of the membranes: a risk factor for the development of abruptio placentae.
A retrospective study of 298 patients with preterm premature rupture of the membranes managed expectantly during a 3-year period investigated the association between preterm premature rupture of the membranes and abruptio placentae. Expectant management was associated with the development of abruptio placentae in 19 of these 298 patients (6.3%). The prevalence of abruptio placentae in the entire population during the same 3-year period was 2.7%, whereas in patients without preterm premature rupture of the membranes it was 2%. None of the patients developed clinical or laboratory evidence of disseminated intravascular coagulation and no infection (maternal or neonatal) was noted among the patients who had abruptio placentae. Patients with preterm premature rupture of the membranes and severe oligohydramnios (largest pocket less than 1 cm) seem to be at particular risk for developing this complication. These data suggest that abruptio placentae should be considered as one of the possible risks of expectant management in preterm premature rupture of the membranes.
Abruptio Placentae↗
The fetal biophysical profile in pregnancies with grade III placentas.
The components of the fetal biophysical profile of pregnancies with grade III placentas and good outcome were retrospectively analyzed and compared to the fetal biophysical components of pregnancies with grade 0 to II placentas. The results of the present study suggest that the dynamic components of the fetal biophysical profile (nonstress test, fetal breathing movements, fetal movements, fetal tone) are not altered in the presence of a grade III placenta and good pregnancy outcome; however, a greater incidence of reduced amniotic fluid volume was found in the presence of grade III placenta. The clinical significance of grade III placenta is discussed.
Amniotic Fluid↗
Hydrops fetalis associated with immunologic and nonimmunologic factors.
Described is a pregnancy complicated by severe Rh sensitization and hydrops fetalis which was managed aggressively with frequent intrauterine transfusions initiated at 21 1/2 weeks of gestation. No improvement or only temporary improvement of the fetal hydrops was observed after each intrauterine transfusion. Postmortem examination of the infant revealed the additional presence of nonimmunologic factors involved such as pulmonic atresia and lung hypoplasia. In cases of severe Rh sensitization associated with persistent fetal hydrops despite frequent intrauterine transfusions, the presence of coexistent factors for nonimmunologic fetal hydrops should be considered.
Adult↗
Congenital midline porencephaly. Prenatal sonographic findings and review of the literature.
A case of congenital midline porencephaly, including the prenatal sonographic findings, is presented. A review of the literature showed that six cases of congenital midline porencephaly have been reported, though none had sonographic evaluation in the prepartum period. The prenatal sonographic diagnosis of this rare disorder is discussed along with the clinical and pathologic findings and outcome of all reported cases.
Adult↗
Pregnancy management and successful outcome of Ehlers-Danlos syndrome type IV.
Ehlers-Danlos syndrome type IV (EDS IV) is a rare but serious disorder of connective tissue that is characterized by the abnormal production or secretion of type III collagen. Experience with pregnant patients exhibiting this syndrome is limited. This report describes the successful management of a pregnancy in a woman with EDS IV that included activity restriction and complete bed rest after 32 weeks, use of 1-desamino-8-D-arginine vasopressin (DDAVP) before delivery to improve coagulation, and cesarean section before the onset of labor. The possibility of prenatal diagnosis based on genetic linkage studies also is discussed.
Adult↗
Cytogenetic evaluation of fetal death: the role of amniocentesis.
Fetal death can be associated with chromosomal abnormalities. Because of the degree of tissue maceration and autolysis seen in stillborn fetuses, it is often impossible to successfully culture these tissues for cytogenetic studies. We performed genetic amniocentesis in four cases of fetal death and were successful in obtaining cytogenetic results in all four, whereas the culture of fetal tissues for cytogenetics was successful in only one case. Chromosomal abnormalities were found in three of the four cases, including two fetuses with Down's syndrome and one fetus with Turner's syndrome. Because of the importance of cytogenetic studies in most cases of fetal death, we recommend amniocentesis at the time of diagnosis rather than waiting for delivery of fetal tissues, when postmortem changes may make it impossible to successfully culture fetal cells.
Adult↗
Perinatal management and outcome of fetal ventriculomegaly.
In 20 consecutive cases of fetal ventriculomegaly, diagnosed by antenatal ultrasound examination, hydrocephalus was isolated in six patients (30%) and was associated with other anomalies in 14 (70%). There were no false positive diagnoses of fetal ventriculomegaly in this series. Fetal structural and/or chromosome abnormalities were diagnosed antenatally in 11 of the 14 patients (78.5%) with postnatally documented anomalies. In ten patients (50%), isolated fetal ventriculomegaly or ventriculomegaly associated with spina bifida was diagnosed antenatally, and the perinatal management consisted of frequent ultrasound examinations, weekly fetal biophysical profiles, and delivery by cesarean section after documenting fetal lung maturity. Ventriculo-amniotic shunt placement was not part of the management. The outcomes were induced abortion, four patients (20%); intrapartum death, two patients (10%); postnatal death, five patients (25%); and currently alive, nine patients (45%).
Abnormalities, Multiple↗
Ultrasonic diagnosis of discordant fetal growth in twin gestations.
Forty-three consecutive twin pregnancies were evaluated by ultrasound to establish criteria for antenatal detection of discordant fetal growth. For each fetus an attempt was made to measure the biparietal diameter (BPD), abdominal circumference, and femur length; the estimated fetal weight was also calculated based on published formulas. The intrapair differences in BPD, abdominal circumference, femur length, and estimated fetal weight were evaluated as predictors of discordant fetal growth. Although the intrapair difference in BPD measurement was not a statistically significant predictor, an intrapair difference in abdominal circumference of 20 mm or more was found to have sensitivity 80%, specificity 85%, positive predictive value 62%, and negative predictive value 93%. Intrapair difference in the estimated fetal weight was found to be the best predictor of discordant fetal growth (sensitivity 80%, specificity 93%, positive predictive value 80%, and negative predictive value 93%). These data suggest that the intrapair difference in abdominal circumference measurement could be effectively used as a screening test for the diagnosis of discordant fetal growth. If the intrapair difference in abdominal circumference is 20 mm or greater, further evaluation, by determining the intrapair difference in estimated fetal weight, is indicated.
Embryonic and Fetal Development↗
Antenatal evaluation and management of ultrasonically detected fetal anomalies.
With the advent of improved ultrasound imaging, it is now possible to make an intrauterine diagnosis of many fetal anomalies. The key to an accurate antenatal diagnosis is careful scanning of the fetus and knowledge of the abnormalities that may be associated with a particular anomaly. In the presence of fetal anomalies known to be associated with increased frequency of chromosome abnormalities, fetal karyotyping is indicated, using either amniocentesis or fetal blood sampling, depending upon the urgency of the diagnosis. Fetal echocardiography is mandatory when the ultrasonically detected fetal anomaly is one that is known to be associated frequently with cardiac disease. Based on the antenatal findings, the parents should receive appropriate genetic and perinatal counseling. The management plan should always take into consideration the parents' wishes. Management plans for the most common ultrasonically detected fetal anomalies are presented, based upon review of the literature and authors' experience.
Congenital Abnormalities↗
The use of the nonstress test in patients with premature rupture of the membranes.
The value of the nonstress test in predicting the outcome of infection was determined by a retrospective analysis of 127 consecutive high-risk patients who presented with premature rupture of the membranes and no clinical signs of infection or labor. The last study performed within 48 hours of delivery was used for comparison with the outcome of pregnancy. The relationship between nonstress test results and the outcome of pregnancy, as reflected by the development of clinical amnionitis and/or neonatal sepsis, was determined. The sensitivity and specificity of the nonstress test in predicting infection outcome in patients with premature rupture of the membranes were 78.1% and 86.3%, respectively. These data suggest that the nonstress test is a useful tool for evaluating patients with premature rupture of the membranes.
Birth Weight↗
Telephone transmission of fetal heart rate monitor data. The experience at the University of Connecticut Health Center.
This report reviews the experience at the University of Connecticut Health Center using the Fetal Assessment Consultative Transmission Service (FACTS) system during a 2 1/2-year period. This system, which permits direct transmission of antepartum and/or intrapartum fetal heart rate tracings via a telephone line, allows the obstetric staffs of smaller community hospitals to obtain an immediate consultation from the University of Connecticut Health Center on a 24 hour per day basis. A total of 511 fetal heart rate tracings were analyzed. Two hundred forty-five were intrapartum, 206 antepartum, and 60 were transmitted for educational purposes. The results indicate an imperative need for such a service from a tertiary care center to improve the quality of regional perinatal care and to determine the future direction of the regional educational program for physicians and nurses.
Connecticut↗
Acute development of oligohydramnios in a pregnancy complicated by chronic hypertension and superimposed pre-eclampsia.
Perinatal mortality is significantly increased in pregnancies where pre-eclampsia is superimposed on chronic hypertension. Oligohydramnios and intrauterine growth retardation are common in this setting. Although oligohydramnios generally has been assumed to occur gradually the following report pertains to a case of a rapid development of oligohydramnios.
Acute Disease↗
Prenatal detection of a neural tube defect after fetal exposure to valproic acid.
Fetal exposure to valproic acid has recently been associated with an increased incidence of neural tube defects. The prenatal detection of a fetus with both hydrocephalus and meningomyelocele after valproic acid exposure is presented and specific recommendations made for antepartum evaluation in future pregnancies.
Abortion, Therapeutic↗
Fetal breathing as a predictor of infection in premature rupture of the membranes.
The value of the presence or absence of fetal breathing in predicting infection was determined by a retrospective analysis of 130 patients with premature rupture of the membranes and no clinical signs of infection or labor. The last ultrasound examination performed within 48 hours of delivery was used for comparison to infection outcome, as reflected by the development of clinical amnionitis, possible neonatal sepsis, and neonatal sepsis. The sensitivity and specificity of fetal breathing in predicting infection in patients with premature rupture of the membranes were 91.6 and 64.8%, respectively. These data suggest that the presence of fetal breathing is a good predictor of noninfection outcome (negative predictive value 95.3%), whereas its absence does not necessarily indicate impending infection (positive predictive value 50%).
Apgar Score↗