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R J Bolognese

Publications and source records attributed to R J Bolognese.

At least 19 recordsLinked to original sources
PubMed1997

Cervical ultrasonography compared with manual examination as a predictor of preterm delivery.

OBJECTIVE: Our purpose was to compare the accuracy of ultrasonographic and manual cervical examinations for the prediction of preterm delivery. STUDY DESIGN: One hundred two singleton pregnancies at high risk for preterm delivery were followed up prospectively from 14 to 30 weeks with both serial cervical ultrasonography measurements and manual examinations of the length of the cervix. The primary outcome studied was preterm (< 35 weeks) delivery. RESULTS: Excluding six induced preterm deliveries, 96 pregnancies were analyzed. The mean cervical length measured by ultrasonography was 20.6 mm in pregnancies delivered preterm (n = 17) and 31.3 mm in pregnancies delivered at term (n = 79) (p = 0.003); the mean cervical lengths measured by manual examination were 16.1 mm and 18.6 mm in the same preterm and term pregnancies, respectively (not significant). The sixteenth- and twentieth-week ultrasonographic cervical lengths predicted preterm delivery most accurately (p < 0.0005). The 25th percentiles of ultrasonographic (25 mm) and manual (16 mm) cervical lengths showed relative risks for preterm delivery of 4.8 (95% confidence interval 2.1 to 11.1, p = 0.0004) and 2.0 (95% confidence interval 0.5 to 4.7, p = 0.1), respectively; sensitivity, specificity, and positive and negative predictive values were 59%, 85%, 45%, 91%, and 41%, 77%, 28%, and 86%, respectively. CONCLUSION: Cervical length measured by ultrasonography is a better predictor of preterm delivery than is cervical length measured by manual examination. Cervical ultrasonography in patients at high risk for preterm birth seems to be most predictive of preterm delivery when it is performed between 14 and 22 weeks' gestation.

Cervix Uteri↗
PubMed1993

Increased risk of aneuploidy in women having unsuccessful chorionic villus sampling procedures.

OBJECTIVE: To determine the incidence of fetal aneuploidy in women who had unsuccessful chorionic villus sampling (CVS) procedures. DESIGN: Retrospective study. SETTING: Pennsylvania Hospital, Philadelphia, Pennsylvania, USA. SUBJECTS: Two thousand six hundred and sixty-eight women who underwent chorionic villus sampling, in 78 (2.9%) of whom villi could not be obtained. INTERVENTIONS: Sixty-nine of 78 (88%) women who had an unsuccessful CVS procedure underwent a subsequent amniocentesis later in the same pregnancy. MAIN OUTCOME MEASURES: The incidence of aneuploidy identified from amniotic fluid chromosome analysis in the 69 women who had an unsuccessful CVS procedure compared to the frequency of aneuploidy in women having a successful CVS procedure. RESULTS: Of the 69 women who underwent a post-CVS amniocentesis because of failure to obtain chorionic villi, six aneuploid pregnancies were identified (8.7%). The frequency of aneuploidy in the 2590 successfully sampled CVS patients was 2.5%. This difference was statistically significant (P = 0.009) by Fisher's exact test (two-tailed). CONCLUSIONS: Women having an unsuccessful CVS procedure should be informed that they may be at increased risk for carrying an aneuploid fetus.

Amniocentesis↗
PubMed1988

Percutaneous fetal umbilical blood sampling: procedure safety and normal fetal hematologic indices.

Percutaneous umbilical blood sampling allows direct access to the fetal circulation. We describe our experience with the procedure in the first 100 patients whose fetuses were at risk for hemolytic anemia, chromosomal abnormalities, coagulopathy, or intrauterine infection. Hematologic indices, including hemoglobin, hematocrit, red blood cell count, white blood cell count, and platelet count, were analyzed from 50 of the fetuses who were normal at delivery. Normal values and gestational age regression curves (from 17 to 37 weeks' gestation) are presented. The technique and complications of the procedure are described. Percutaneous umbilical blood sampling affords useful information in prenatal diagnosis and entails a low rate of complications.

Blood Cell Count↗
PubMed1988

Prolonged fetal ritodrine exposure and immediate neonatal outcome.

Ritodrine hydrochloride was administered over a period of two years to a total of 200 women in premature labor. One hundred sixty-two (81 per cent) of the women carried pregnancy to 35 weeks or longer. To determine the effect of ritodrine on the neonates, the duration and amount of exposure, onset of exposure, and interval between cessation of exposure and delivery were correlated with gestational age, birth weight, Apgar scores, mortality, and the presence of hypoglycemia, hyperbilirubinemia, respiratory distress, and intrauterine growth retardation. Infants exposed for six weeks or more (long-term exposure) were significantly heavier than those exposed for shorter periods (short-term exposure), a difference that was possibly attributable to differences in gestational age at birth. Infants who were exposed as fetuses to ritodrine beginning at 30 weeks' or less gestation needed phototherapy more often than did infants whose fetal exposure began at after 30 weeks' gestation. Neither duration of exposure nor gestational age at birth was a significant factor in hyperbilirubinemia. Of infants delivered at or after 35 weeks' gestation, 32 (20 per cent) experienced early hypoglycemia; and 26 of these (81 per cent) were exposed up to the day of delivery. This outcome differed significantly from that of infants whose exposure stopped at least one week before delivery. In addition, respiratory distress syndrome was more common in those infants exposed up until delivery (34 of 36).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1987

Ultrasonic ratio of fetal thoracic to abdominal circumference: an association with fetal pulmonary hypoplasia.

Real time ultrasound was used in pregnant women who were considered to be at risk for development of pulmonary hypoplasia (n = 26). The population consisted of women who had either premature rupture of membranes (n = 16) or oligohydramnios (n = 10). The ratio calculated by comparing the fetal thoracic circumference to abdominal circumference was obtained in all cases within 10 days of delivery. This ratio correlated strongly with neonatal outcome. Multivariate regression models of neonatal outcome were developed to analyze the relationship of gestational age at which premature membrane rupture occurred, the duration of premature rupture, date of birth, and prenatal diagnosis. The addition of the thoracic circumference to the abdominal circumference ratio increased significantly the proportion of explained variability. Application of this ratio should be considered in evaluating fetal status in oligohydramnios and in the expectant management of premature rupture of membranes.

Amniotic Fluid↗
PubMed1987

Doppler evaluation of umbilical venous and arterial blood flow in the second and third trimesters of normal pregnancy.

Duplex Doppler ultrasound was used to measure umbilical venous blood flow in 209 normal pregnant women between 20-40 weeks' gestation. The relationship between umbilical venous blood flow and gestational age increased with gestational age, and is described by the equation y = -187.02 + 12.7x. The relationship between flow per kilogram fetal weight and gestational age (y = 198.629 - 2.24x) yielded values of 153 mL/minute/kg at 20 weeks, 131 mL/minute/kg at 30 weeks, and 108 mL/minute/kg at 40 weeks. Doppler ultrasound was also used to evaluate umbilical arterial waveforms (systolic/diastolic ratio) in 171 normal pregnant women between 20-40 weeks. The relationship between systolic/diastolic ratios and gestational age (y = 6.46 - 0.12x) decreased with advancing gestational age, yielding mean systolic/diastolic ratios (+/- 2 SD) of 4.1 (5.6, 2.6) at 20 weeks, 3.6 (5.1, 2.1) at 24 weeks, 3.1 (4.6, 1.6) at 28 weeks, 2.6 (4.1, 1.1) at 32 weeks, 2.1 (3.6, 0.6) at 36 weeks, and 1.7 (3.1, 0.1) at 40 weeks.

Blood Flow Velocity↗
PubMed1987

Duplex Doppler ultrasound in the evaluation of growth in twin pregnancies.

Fifty-six multiple pregnancies were evaluated for evidence of discordant growth using traditional ultrasonic methods and duplex Doppler ultrasound. The pregnancies consisted of 52 sets of twins and four sets of triplets. Duplex Doppler ultrasound predicted normal growth in 44 of 45 normal sets of fetuses, and correctly predicted discordant growth in nine of 11 discordant sets of twins. Among those nine abnormal sets, Doppler ultrasound predicted that six would become discordant before this was recognized by traditional ultrasonic measurements. Duplex Doppler ultrasound is useful in predicting and confirming concordant and discordant growth, and defining the cause of fetal discordancy.

Adult↗
PubMed1987

Percutaneous umbilical blood sampling. A new technique for prenatal diagnosis.

Direct access to fetal blood during the second and third trimesters of pregnancy opens new fields of prenatal diagnosis and in utero fetal treatment. Percutaneous umbilical blood sampling, a method that involves ultrasonographically guided needle insertion into the umbilical vein, appears to have an acceptable complication rate. This technique has tremendous potential for use in evaluating fetal status.

Adult↗
PubMed1986

The "vanishing twin": ultrasonographic assessment of fetal disappearance in the first trimester.

Review of the sonographic findings of 1000 pregnancies with viable gestations in the first trimester revealed a minimum incidence of twinning of 3.29%. Of these, 21.2% demonstrated the "vanishing twin" phenomenon, often with associated bleeding, but with a good prognosis for the remaining fetus. Ovulation induction did not appear to alter these data. The sonographic criteria for "vanishing twin" are discussed. The incidence of multiple gestation is 3.29% to 5.39%, higher than previously believed.

Diagnostic Errors↗
PubMed1984

Does early diagnosis and delivery in acute fatty liver of pregnancy lead to improvement in maternal and infant survival?

Two cases of acute fatty liver of pregnancy resulting in maternal and infant survival are described. There have only been six such cases reported previously. The two described here are unique because the diagnosis was made prepartum by an oil red O stain of a frozen section of a liver biopsy, and the patients were promptly delivered by cesarean section under spinal anesthesia. The role of early diagnosis and delivery in this disease is discussed.

Acute Disease↗
PubMed1982

Carbon monoxide intoxication in early pregnancy.

Carbon monoxide exposure has been described as having both acute and chronic effects; acute intoxication early in pregnancy has not been previously reported, however. A case of carbon monoxide poisoning at 8 weeks' menstrual age is described with good fetal outcome. Appropriate literature is briefly reviewed.

Adult↗
PubMed1980

Antenatal diagnosis and treatment of a fetal goiter.

The sonographic diagnosis of a fetal goiter, confirmed at delivery, is described in a fetus exposed to large doses of propylthiouracil, which was administered to the mother. The pregnancy was also complicated by recalcitrant premature labor secondary to polyhydramnios. The intraamniotic instillation of thyroxine decreased the size of the fetal goiter, and numerous therapeutic amniocenteses permitted continuation of the pregnancy, so a mature infant with a goiter but no airway obstruction was delivered. Amniotic fluid reverse-T3 assays confirmed fetal utilization of the thyroxine. Fetal thyroid physiology is discussed briefly along with the benefits of the antenatal sonographic diagnosis of fetal goiter.

Adult↗
PubMed1979

Use of intramuscular 15(S)-15-methyl prostaglandin F2alpha in failed abortions.

Forty-five of 49 patients were aborted successfully with 15(S)-15-Me-PGF2alpha after previous techniques to induce abortion had met with failure in 39. Nine patients had spontaneous premature rupture of membranes without onset of labor. The majority of patients aborted within 7 hours following initiation of this method of treatment.

Abortion, Induced↗
PubMed1978

Ibuprofen therapy for dysmenorrhea.

Thirty-three dysmenorrheic patients were given ibuprofen, aspirin and a placebo in a double-blind crossover study, with each drug taken during one of three successive menstrual cycles in random sequence. Paired drug comparisons demonstrated the statistical superiority of ibuprofen, as compared with the other two, for the relief of pain. Data evaluated according to patient drug preference showed similar results. The role of nonsteroidal antiinflammatory drugs in therapy for dysmenorrhea is discussed.

Adult↗