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R Depp

Publications and source records attributed to R Depp.

At least 37 records · Page 2Linked to original sources
PubMed1985

A hypothetical model suggesting suboptimal intrauterine growth in infants delivered preterm.

Infants delivered preterm often reflect accelerated maturation. The present study examines the occurrence of suboptimal intrauterine growth in infants delivered preterm by comparing their birth weights to the weights sonographically predicted for in utero fetuses at similar gestational ages but who ultimately deliver at term. Two weight-predicting formulas based on different sonographic parameters were used. In the fifth, tenth, and 50th percentiles of birth weight, the predicted weights were persistently and significantly greater than the actual birth weights between 24 and 31 weeks' gestation. The results of this model support the concept that the growth of infants delivered prematurely has been suboptimal. The authors hypothesize that preterm delivery may be in some instances another manifestation of the same underlying stress that hastens pulmonary and neurologic maturity.

Birth Weight↗
PubMed1984

Placenta previa: aggressive expectant management.

We report the outcomes of 95 expectantly managed cases of placenta previa; all were diagnosed after 21 weeks' gestation. Patients at risk for preterm delivery because of hemorrhage or preterm labor received aggressive care, including multiple transfusions, volume expansion and tocolytic therapy, and amniotic fluid surfactant determinations, to achieve the goal of delivery at 37 weeks' gestation with mature fetal lung function. We present guidelines for outpatient management and double setup examination prior to delivery. The role of ultrasound in diagnosis (three asymptomatic cases; 13 cases with preterm labor) and serial placental localization to determine the timing, route, and place of delivery is presented. Eighty-six percent of 19 infants born weighing less than 2500 gm were managed expectantly. Hemorrhage was the determinant in delivery timing in 50 cases. All four deaths were neonatal with birth weights less than 2200 gm. This is the lowest perinatal mortality rate (4.2%) published to date. Use of this aggressive approach is particularly suitable for patients cared for in a teritary center.

Adolescent↗
PubMed1984

Diminished growth in fetuses born preterm after spontaneous labor or rupture of membranes.

We examined biparietal diameter, abdominal circumference, and birth weight in 148 preterm infants to assess fetal growth. A statistically significant proportion of preterm fetuses had biparietal diameter and abdominal circumference values below the fiftieth and tenth percentile levels as compared with that expected in normal fetuses. Similarly, birth weight of infants in the study fell significantly below the fiftieth and tenth percentiles relative to Brenner's curve. We conclude that diminished fetal growth is associated with early delivery secondary to preterm labor or preterm premature rupture of membranes or both. Additionally, since biparietal diameters in preterm fetuses are smaller than those of normal fetuses the prediction of gestational age by cephalometry should be advanced by 7 to 10 days.

Birth Weight↗
PubMed1984

Urinary estriols in diabetic pregnancy: a reappraisal.

The clinical usefulness of serial urinary estriols was tested in 138 insulin-dependent diabetic pregnant women. No action was taken on an estriol drop if fetal well-being was demonstrated by a reactive nonstress test and/or negative contraction stress test within 24 hours. Of 3085 estriol values, a greater than or equal to 40% estriol drop, confirmed by a greater than or equal to 40% decrease in the estriol-creatine ratio, was observed in 21 tests. In only two of these tests, was fetal distress indicated by a nonstress test or contraction stress test. A significant linear correlation was demonstrated between the mean level of estriol excretion and birth weight, placental weight, and fetal abdominal circumference measured by ultrasound. Chronically low estriol excretion (less than 12 mg per 24 hours at greater than 36 weeks' gestation) related to smaller placentas but not to fetal jeopardy.

Apgar Score↗
PubMed1983

Fetal surgery for hydrocephalus: successful in utero ventriculoamniotic shunt for Dandy-Walker syndrome.

The diagnosis of fetal hydrocephalus based on dilation of the ventricular system presents a broad range of management decisions. The options are presented and a case of Dandy-Walker syndrome managed by fetal ventriculoamniotic shunt placement is presented as an example. Under ultrasonic guidance, a shunt was placed at 30 weeks' gestation by later newborn Dubowitz examination. Delivery was delayed for five weeks, one to two weeks following probable shunt malfunction, after achieving fetal lung maturation. Follow-up six months after definitive neonatal ventricular shunting and three weeks after shunt revision revealed a socially active male infant with a motor development index of 87 and a psychomotor development index of 95. Potential advantages of fetal surgery including achievement of term gestation are presented. Proposed guidelines for determining the benefit of such procedures are also presented.

Adult↗
PubMed1982

Fetal treatment 1982.

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Congenital Abnormalities↗
PubMed1982

The effect of gestational age on amniotic fluid glucose in pregnancy complicated by diabetes mellitus.

Amniotic fluid glucose was measured in 189 amniotic fluid samples from 117 well-controlled Class A to F diabetic pregnant women from 32 to 40 weeks' gestation. A simultaneous maternal plasma glucose level was determined at each amniocentesis. Samples were obtained with the mother in the fasting or nonfasting (3.8 hours after breakfast) state. Amniotic fluid glucose correlated significantly with simultaneous maternal glucose (r = 0.562; p = 0.001). A significant downward linear trend of mean amniotic fluid glucose with advancing gestational age was demonstrated (p less than 0.01). No trend of mean simultaneous maternal glucose with gestational age was seen. These results were not affected by maternal prandial status at the time of amniocentesis. It is concluded that amniotic fluid glucose decreases with advancing gestational age in well-controlled diabetic pregnant women independent of maternal glycemic levels. Studies of amniotic fluid glucose and/or its relationship to other metabolic hormones must take this into account.

Amniocentesis↗
PubMed1981

Psychiatric risk factors in the pregnant diabetic patient.

One hundred pregnant diabetic patients have been prospectively studied in the first large-scale systematic evaluation of emotional behavior and psychosocial factors influencing psychiatric behavior in the pregnant diabetic patient. A Psychiatric Risk Scale including ten weighted medical and psychosocial factors has been developed to identify patients at high risk for psychiatric illness or poor compliance. This scale significantly increases the data base of classic "neglector" characteristics described by Pederson in 1965. Early identification of psychiatrically high-risk patients in concert with brief relevant psychodynamic exploration offers the potential of more directed care to a subset of patients at increased risk for poor perinatal performance.

Adolescent↗
PubMed1979

Fetal baseline heart rate variability estimation. I. Comparison of clinical and stochastic quantification techniques.

Baseline fetal heart rate variability is an important parameter in the evaluation of fetal status during the intrapartum period. Prior descriptions of variability have largely been either visual-subjective or stochastic in nature. Unfortunately, correlation between the two has not been substantiated. Sample heart rate tracings were evaluated for variability by a panel of nine experts. Interobserver agreement in the evaluation of variability was high; correlation between visual subjective and stochastic methods was low. The implications are discussed.

Arrhythmias, Cardiac↗
PubMed1979

The Northwestern University Multihospital Twin Study. II. Mortality of first versus second twins.

The results of a multihospital study involving a total of 588 twin pairs born in Chicago in 1970-1975 are reported, with special respect to differences in mortality between first and second twins by time as well as by cause of death. Mortality was higher in second than in first twins and most commonly occurred after delivery and was the result of immaturity and of respiratory distress syndrome.

Asphyxia Neonatorum↗
PubMed1978

Fetal heart rate patterns and development in the first year of life.

The development of 50 high-risk infants who were provided intrauterine monitoring during labor was prospectively evaluated. Twelve infants had normal fetal heart rate patterns, 16 moderate-severe variable patterns, and 22 severe variable or late deceleration patterns. The parity, socioeconomic status, race of the mothers, and sex of the infants were similar in each group. The infants were examined neurologically 48 to 72 hours after birth and at 2, 4, 6, 9, and 12 months of age. Denver Developmental Standard testing was performed at 2, 4, 6, 9, and 12 months of age. A statistically significant developmental bias was seen favoring those infants with normal fetal heart patterns. Fetal heart rate patterns predicted abnormal performance more accurately than did Apgar scores. Although this data is incomplete, the duration of ominous fetal heart rate patterns appears to adversely affect development.

Apgar Score↗
PubMed1978

Indications for early exchange transfusion in patients with erythroblastosis fetalis.

The postnatal rate of rise of the undirect bilirubin concentration was compared with cord hematocrit and bilirubin values in 44 newborn infants with Rh isoimmune hemolytic disease. Cord blood values failed to predict the severity of hyperbilirubinemia with sufficient accuracy to warrant their use as therapeutic guidelines. A statistically significant positive correlation was found between the cord serum indirect bilirubin concentration and its subsequent rise in 19 infants who had received antenatal phenobarbital therapy, but this relationship was not observed in untreated infants. The phenobarbital-treated infants had a slower postnatal rise of indirect bilirubin than did nontreated controls. There was no reliable indicator of the severity of hyperbilirubinemia other than careful monitoring of the serum bilirubin concentration during the early hours of life.

Bilirubin↗
PubMed1978

Growth adjusted sonographic age. A simplified method.

It recently has been shown that the sonar predictive accuracy of gestational age can be markedly enhanced by separating fetuses into one of three cephalic growth patterns, namely, large, average, and small. In this way it becomes possible to adjust fetal age in relation to biparietal diameter (BPD) growth. In this report we are defining the application of a growth adjusted sonographic age (GASA). Additionally, we are introducing a table which simplifies the assignment of GASA on a routine basis.

Cephalometry↗