Biomedical subjects
Publications and source records attributed to R H Picker.
This case report documents fetal death in utero at 30 weeks' gestation due to subdural and subarachnoid haemorrhages, resulting from a motor vehicle accident in which the mother sustained 'seat belt' and facial injuries. There was no evidence of placental abruption. The causes of fetal deaths in utero following maternal involvement in motor vehicle accidents are discussed.
The waveforms of vessels supplying the ovaries of women on an in-vitro fertilization (IVF) programme were studied using transvaginal B-mode and Doppler ultrasound. There were 125 scans recorded in 65 women at weekly intervals from 3 days after embryo transfer or 5 days after gamete intrafallopian transfer (GIFT) until confirmation of pregnancy or onset of menses. At each examination the signals obtained from vessels supplying the ovaries were recorded and quantified using a resistance index (RI). Fifteen patients became pregnant of whom one has subsequently miscarried. There was a highly significant difference in the RI values between patients who became pregnant and those who did not; no patient who became pregnant had a RI greater than 0.5. Oestrogen to progesterone ratios were calculated in the subgroup of non-pregnant patients and there was no correlation between these values and the RI values. This new technique enables prediction of IVF treatment failure earlier than has been reported previously and may reflect the inadequacy of the corpus luteum.
The results of laparoscopic (lap) and transvaginal (TV) oocyte pickups (OPUs) performed concurrently for in vitro fertilization in 232 consecutive treatment cycles have been reviewed. The patients were compared for age, preoperative estradiol concentration, luteal-phase support, and number of follicles aspirated and were found to be similar but were not matched for cause of infertility. The lap OPU group had more oocytes recovered per follicle aspirated (P less than 0.001), but because of a lower fertilization rate (P less than 0.01), the number of embryos transferred was similar. Nevertheless, more (P less than 0.05) pregnancies occurred in the TV OPU group. Patients were subgrouped so that comparisons of patients with the same cause of infertility, tubal disease alone, were considered. This showed that the pregnancy rate was still higher in the TV OPU group (P less than 0.05). TV OPU was less painful and not associated with increased morbidity, and since the data suggest that TV OPU was at least as successful as lap OPU, it is recommended that all oocyte pickups in the future be performed transvaginally.
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Successful pregnancies have been achieved after in vitro fertilization of oocytes obtained by an ultrasound-guided transvesical approach, as well as with the traditional laparoscope. With the use of the same laboratory facilities, success rates for each retrieval method were evaluated in an established in vitro fertilization program. There was a significantly increased cancellation rate and a decrease in oocyte/follicle rate in the transvesical group, but there was a greater fertilization rate with possible improved embryo quality. Although the transfer rates were similar, the pregnancy rate appeared lower in the transvesical group. A valid comparison of these data is not possible because the two groups are dissimilar for factors known to influence oocyte development and recovery. Different criteria were applied to patient selection and treatment, and operation expertise differed between the two groups.
A review of 2003 consecutive amniocenteses performed in late pregnancy under ultrasonic control is presented. No perinatal mortality was encountered. On this evidence the method described is suggested to be the safest available for obtaining liquor in late pregnancy.
The timing of ovulation was studied daily during the periovular period in 19 women attending an artificial insemination clinic during 24 menstrual cycles; B-mode ultrasound examination and plasma estradiol (E2) determinations were used. The maximum diameters of the ovarian follicles and the peak plasma E2 determinations all occurred within 2 days prior to and including the day of ovulation, as determined by conventional means, in the 12 normal cycles studied. The average values on the day prior to ovulation (day -1) for maximum follicle size and peak E2 determination were 2.5 cm and 1660 pmole/liter, respectively. Two definite ultrasonic patterns were noted after ovulation: The follicle either disappeared or filled with internal echoes. It is concluded from the preliminary study that ultrasound examination and plasma E2 determinations are equally effective in predicting the time of ovulation.
A preliminary report of the use of ultrasonic scans to locate parathyroid tissue before neck exploration is presented. Three patients suffering from hyperparathyroidism had abnormal parathyroid tissue located before surgery. These findings were confirmed at operation. The role of ultrasonic scans of the neck before exploration is discussed.
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A method to estimate intrauterine fetal weight by calculating fetal volume from simple parameters measured on echograms is described. The comparison between assesed weight of 50 fetuses and actual birth weight is presented.
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Two hundred consecutive amniocenteses for lecithin/sphingomyelin (L/S) determination in late pregnancy are reviewed. These procedures were performed under ultrasonic control before induction of labor or elective cesarean section in a prospective study to determine a safe method for aminocentesis. Complications included 3 failures, 14 blood-stained samples, 2 cases of labor occuring within 24 hours after amniocentesis, and 1 maternal abdominal wall hematoma. There was no cases of perinatal morbidity or mortality. It is proposed that this is a safe method of abdominal amniocentesis for L/S determination in late pregnancy.