Biomedical subjects
Publications and source records attributed to R J Stiller.
A pregnancy complicated by dyspnea was associated with agenesis of the right pulmonary artery. The clinical characteristics of the agenesis of the pulmonary artery along with the differential diagnosis from pulmonary embolus are discussed.
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.
Maternal isoimmunization can result in fetal anemia. Current management of isoimmunized pregnancies involves amniocentesis and spectrophotometry. Pulsed Doppler ultrasound can provide fetal blood flow determinations from the fetal umbilical vein. A pregnancy complicated by severe rhesus isoimmunization was studied with Doppler ultrasound. Increased fetal umbilical blood flow was associated with increased fetal hemolysis. Umbilical vein blood flow decreased after intrauterine transfusion. Doppler ultrasound assessment of fetal blood flow is a useful noninvasive adjunct in isoimmunized pregnancies.
A pregnancy was complicated by recurrent episodes of cholecystitis unresponsive to medical management. Total parenteral nutrition (TPN), rather than surgery, was elected to minimize fetal and maternal morbidity.
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A pregnancy complicated by cyanotic heart disease due to single ventricle was recently managed at the authors's institution. Review of the literature showed only five previous case reports. The management of this uncommon disorder is presented along with a review of the literature. The presence of pulmonary hypertension appears to be a major determinant in assessing maternal risk.
Hereditary angioedema is a relatively uncommon disease that may affect women during their reproductive years. A case report of a pregnancy complicated by hereditary angioedema, followed by a review of the literature, is presented. Although the disease usually follows a benign course, maternal mortality has been noted. Features unique to pregnancy are discussed. Knowledge of the pathophysiology and possible complications is essential for the proper management of the pregnancy.
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Explore the source record for details and available documents.
BACKGROUND: Despite the acceptance of protocols for the prevention of group B streptococcal (GBS) sepsis for the newborn, protocol violations, with subsequent failure to initiate intrapartum antibiotic therapy, occur at many institutions. The causes for GBS prophylaxis protocol violations are not well understood. CASES: We report two cases of indicated preterm birth in which appropriate antibiotic prophylaxis for GBS sepsis was not initiated. CONCLUSION: In the setting of indicated preterm birth, GBS prophylaxis may be overlooked. We suspect that the attention given to the medical or fetal complications of indicated preterm birth may contribute to the omission of GBS sepsis prophylaxis in these situations.