PubMed Health⌕ Search

Biomedical subjects

W A Campbell

Publications and source records attributed to W A Campbell.

At least 19 recordsLinked to original sources
PubMed1998

Iatrogenic monoamniotic twins as a complication of therapeutic amniocentesis.

BACKGROUND: Therapeutic amniocentesis has been accepted widely as a safe and efficacious way to treat the polyhydramnios-oligohydramnios sequence associated with twin-twin transfusion syndrome. CASE: A 28-year-old woman, gravida 2, para 1, diagnosed with twin-twin transfusion syndrome at 28 weeks' gestation was treated with serial amniocenteses. The dividing membrane was ruptured inadvertently during therapeutic amniocentesis, with subsequent complete disruption of the amniotic membrane. Iatrogenic monoamniotic twins with cord entanglement and knotting resulted. CONCLUSION: Creation of monoamniotic twins by disruption of the dividing membrane can be a complication of therapeutic amniocentesis for twin-twin transfusion syndrome. Such disruption may result in the same morbidity and mortality that are seen in naturally occurring monoamniotic twins.

Adult↗
PubMed1997

Monoamniotic twins: improved perinatal survival with accurate prenatal diagnosis and antenatal fetal surveillance.

OBJECTIVE: Our goal was to report our 10-year experience with monoamniotic twins and to compare that experience with cases reported in the literature. STUDY DESIGN: Records of all monoamniotic twin pregnancies managed at the University of Connecticut Health Center from March 1986 to August 1996 were reviewed. A MEDLINE search from January 1966 to August 1996 was performed, and each report was screened for accuracy of diagnosis. Only cases with umbilical cord entanglement of nonconjoined like-sex twins, the obstetrician's confirmation at delivery, or pathologic confirmation of monoamniotic placentation were included. Data collected were as follows: birth outcome, gestational age at delivery, birth weight, gender, Apgar scores, hematocrit, cord knotting, and neonatal complications. Cases from the literature were divided into those with prenatal diagnosis and those without. RESULTS: Thirteen monoamniotic pregnancies resulting in 26 infants who were born alive were managed at our center. The average gestational age at diagnosis was 16.3 weeks. All had antenatal fetal surveillance including serial sonograms and nonstress tests. The average gestational age and birth weight at delivery were 32.9 weeks and 1669 gm, respectively. Cord entanglement was noted in all cases, with knotting in 8 of 13. Two pairs of 26 newborns had evidence of twin-twin transfusion syndrome. Eight of 13 monoamniotic pregnancies were delivered because of nonreassuring results of nonstress test, two because of preterm labor, two electively because of lung maturity, and one because of intrauterine growth restriction. Two of the 26 infants died in the neonatal period, one of congenital heart disease and one of sepsis and asphyxia. The MEDLINE search revealed 96 articles with a total of 202 sets of monoamniotic twins. Comparison of cases (13 sets) with the historic control group without prenatal diagnosis (77 sets) showed a 71% reduction in relative risk of perinatal mortality. CONCLUSIONS: With accurate prenatal diagnosis, intensive fetal surveillance, and appropriately timed delivery, perinatal survival of monoamniotic twins is improved; it was 92% in this series.

Female↗
PubMed1997

Iliac wing angle as a marker for trisomy 21 in the second trimester.

OBJECTIVE: To evaluate the fetal iliac wing angle in detecting trisomy 21 in the second trimester of pregnancy. METHODS: Using an axial view of the fetal pelvis, the angle between the right and left iliac wings (iliac wing angle) was measured ultrasonographically at the time of the second-trimester ultrasound or genetic amniocentesis in 377 singleton fetuses. Trisomy 21 was diagnosed by karyotype results from the amniocentesis or newborn examination with karyotype if trisomy 21 was suspected based on phenotypic features. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were calculated using multiple cutoff points. A receiver operating characteristic (ROC) curve was used to identify the optimum iliac wing angle. Descriptive statistics and Student t test were utilized for analyses with a P of less than .05 considered significant. RESULTS: The average gestational age was 18.8 weeks (range 13-32). Karyotypes were available in 128 fetuses. The overall prevalence of trisomy 21 was 11 of 377 (2.9%). The mean (+/-standard deviation) iliac wing angle in the normal fetuses was 68.2 degrees (+/-15.4 degrees) and 98.5 degrees (+/-11.3 degrees) in fetuses with trisomy 21 (P < .001). Using an ROC-derived absolute cutoff of 90 degrees, an abnormal iliac wing angle had sensitivity of 90.9% (ten of 11), specificity of 94.5% (346 of 366), NPV of 99.7% (346 of 347), and PPV of 33.3% (ten of 30) to detect trisomy 21. CONCLUSION: Fetuses with trisomy 21 have greater iliac wing angles than do normal fetuses. Using an ROC-derived absolute cutoff of 90 degrees, we could detect 90.9% of fetuses with trisomy 21 with a PPV of 33% in our high-risk population. These findings suggest that iliac wing angle is a useful marker in antenatal screening for trisomy 21.

Adolescent↗
PubMed1997

Second-trimester ultrasound markers for detection of trisomy 21: which markers are best?

OBJECTIVE: To investigate which second-trimester ultrasound markers for aneuploidy are the most diagnostically efficient in detecting fetal trisomy 21. METHODS: All second-trimester genetic sonograms performed since November 1, 1992 for women at increased risk for fetal trisomy 21 were analyzed retrospectively. Statistical analysis included descriptive statistics, the test of proportions, and univariate and multivariable logistic regression analysis using trisomy 21 as the dependent variable and ten aneuploidy ultrasound markers as independent variables. RESULTS: There were 581 normal fetuses, 23 with trisomy 21 and four with other chromosomal abnormalities. When one or more abnormal ultrasound markers were present, the sensitivity and false-positive rate for trisomy 21 were 87% and 13.4%, respectively. After adjusting for confounders, multivariate logistic regression analysis showed the best combination of ultrasound markers for detecting trisomy 21 to be nuchal fold thickening (relative risk [RR] 85.5; 95% confidence interval [CI] 20.4, 357.7), pyelectasis (RR 25.2; 95% CI 6.7, 95.0), and short humerus (RR 20.4; 95% CI 4.5, 92.1). The model combining these three ultrasound markers yielded a sensitivity of 87% and a false-positive rate of 6.7%. CONCLUSION: By using only three ultrasound markers (combination of nuchal fold thickening, pyelectasis, and short humerus) the false-positive rate is decreased from 13.4% to 6.7% without any compromise in the sensitivity (87%). The clinical usefulness of evaluating the various second-trimester ultrasound markers needs to be evaluated in prospective studies.

Confidence Intervals↗
PubMed1996

Atypical presentation of preeclampsia in high-order multifetal gestations.

OBJECTIVE: To describe our experience with preeclampsia in high-order multifetal gestations. METHODS: Records for all triplet and quadruplet pregnancies delivered after 24 weeks' gestation from January 1988 through June 1994 were reviewed. All patients were treated with bed rest from 20 weeks' gestation onward and received corticosteroids weekly beginning at 24 weeks. Tocolytics were used as needed. RESULTS: Twenty-one triplet and eight quadruplet pregnancies were studied. The mean gestational age at delivery was 32.3 and 27.9 weeks, and mean birth weights were 1547 and 1028 g, respectively. Seventeen of 29 patients developed preeclampsia, 14 of the 21 triplet mothers and three of the eight quadruplet mothers. Among 16 patients who were delivered for preeclampsia, only eight had blood pressure (BP) elevation before delivery, whereas ten had epigastric pain, visual disturbances and/or headache; nine had elevated liver enzyme levels; and seven had low platelet counts. Only three patients had proteinuria, and only six had edema. Five women developed the syndrome of hemolysis, elevated liver enzymes, and low platelets postpartum, all of whom had normal BP before delivery. Two patients developed preeclampsia after delivery. A total of 95 infants were delivered, all by cesarean, of whom 93 (98%) survived. CONCLUSION: Preeclampsia is common in high-order multifetal gestations and often presents in an atypical manner. Hypertension is not always the presenting sign, and symptoms consistent with severe preeclampsia and abnormal laboratory values predominate.

Adult↗
PubMed1996

The use of second-trimester genetic sonogram in guiding clinical management of patients at increased risk for fetal trisomy 21.

OBJECTIVE: To test the efficacy of ultrasound in detecting fetuses with trisomy 21. METHODS: From November 1, 1992, to December 31, 1995, a second-trimester genetic sonogram was offered to all women with singleton fetuses at increased risk (at least 1:274) for trisomy 21, who had either declined genetic amniocentesis or chose to have a sonogram before deciding whether to undergo an amniocentesis. In addition to standard fetal biometry, the following ultrasound markers for aneuploidy were evaluated: structural anomalies (including face, hands, and cardiac [four-chamber view and outflow tracts]), short femur, short humerus, pyelectasis, nuchal fold thickening, echogenic bowel, choroid plexus cysts, hypoplastic middle phalanx of the fifth digit, wide space between the first and second toes, and two-vessel umbilical cord. Outcome information included the results of genetic amniocentesis, if performed, or the results of postnatal pediatric assessment and follow-up. RESULTS: Five hundred seventy-three patients had a genetic sonogram between 15 and 23 weeks' gestation: 378 patients had advanced maternal age (at least 35 years), 141 had abnormal serum biochemistry, and 54 had both. The majority (495, or 86.3%) had a normal genetic sonogram (absence of abnormal ultrasound markers); 51 (9%) had one marker present, and 27 (4.7%) had two or more markers present. Outcome was obtained on 422 patients (the remaining were ongoing pregnancies or were lost to follow-up). Twelve of 14 fetuses with trisomy 21, one fetus with trisomy 13, and one fetus with triploidy had two or more abnormal ultrasound markers present; one fetus with trisomy 21 had one abnormal marker and one had a completely normal ultrasound. When one or more abnormal ultrasound markers were present, the sensitivity, specificity, and positive and negative predictive values for trisomy 21 were 92.8%, 86.7%, 19.4%, and 99.7%, respectively. When two or more abnormal ultrasound markers were present, the corresponding values were 85.7%, 96.8%, 48%, and 99.5%. In the study population, the amniocentesis rate was 12.7% overall and 17.3% in cases with known outcome. CONCLUSION: Second-trimester genetic sonogram may be a reasonable alternative for patients at increased risk for fetal trisomy 21 who wish to avoid amniocentesis. In experienced hands, this approach may result in a high detection rate of trisomy 21 (93%), with an amniocentesis rate of less than 20%.

Adult↗
PubMed1996

Adjusting the risk for trisomy 21 by a simple ultrasound method using fetal long-bone biometry.

OBJECTIVE: To establish the efficacy of second-trimester fetal long-bone biometry (femur, humerus, tibia, and fibula length) in detecting trisomy 21 and to generate tables for adjusting the risk of trisomy 21 according to long-bone biometry. METHODS: Four long-bones--femur, humerus, tibia, and fibula--were measured ultrasonically in singleton fetuses before genetic amniocentesis. Fetuses with normal karyotypes were used to derive regression equations describing predicted lengths on the basis of the biparietal diameter measurement. The efficacy of each abnormally short bone, alone and in combination, was determined in 22 fetuses with trisomy 21 encountered during the study period. After the sensitivity and specificity of long-bone biometry were established, appropriate tables were generated by Bayes' theorem to adjust the risk of trisomy 21 in the second trimester depending on long-bone biometry. RESULTS: Of 515 patients between 14 and 23 weeks' gestation, 493 had normal fetal karyotypes and 22 had trisomy 21. The sensitivity of an abnormal ultrasound, as defined by the presence of one or more short bones, was 63.6% and the specificity was 78.5%. According to Bayes' theorem, genetic amniocentesis may not be recommended for women less than 40 years old in the presence of normal long-bone biometry (ie, all four bones normal). CONCLUSION: Second-trimester fetal long-bone biometry is useful in detecting trisomy 21 and may be used to adjust the a priori risk of both high- and low-risk women for trisomy 21 and, therefore, the need for genetic amniocentesis.

Anthropometry↗
PubMed1996

Prenatal diagnosis of intracranial lipoma associated with agenesis of the corpus callosum.

BACKGROUND: Lipoma of the corpus callosum is a congenital malformation present in 1:1700 individuals. Only three cases of prenatal sonographic diagnosis have been described. CASES: Two cases of prenatal sonographic diagnosis of intracranial lipoma are described. The first case was visible at 26 weeks' gestation and was associated with partial agenesis of the corpus callosum, a characteristic midline gyral pattern, and fetal colpocephaly. The second case was an isolated lipoma diagnosed at 37 weeks. In both cases transvaginal scanning and color Doppler studies were useful adjuncts in making the diagnosis. CONCLUSION: Prenatal sonographic diagnosis of intracranial lipoma associated with agenesis of the corpus callosum is possible as early as 26 weeks' gestation. Because prognosis depends on associated anomalies, a detailed examination of fetal intracranial anatomy and a complete anatomic survey should be performed. Awareness of this lesion can be expected to increase its detection on prenatal sonography.

Adult↗
PubMed1996

Predicting pregnancy outcome from the degree of maternal serum alpha-fetoprotein elevation.

OBJECTIVE: To determine if a correlation exists between the level of maternal serum alpha-fetoprotein (MSAFP) elevation and the rate of adverse pregnancy outcome, to examine the timing of pregnancies ending in fetal or neonatal death, and to develop a protocol for antepartum surveillance in an effort to prevent these adverse outcomes. STUDY DESIGN: Singleton pregnancies with a single second-trimester elevated MSAFP > or = 2.0 multiples of the median (MoM) were eligible if a targeted ultrasound evaluation (< 24 weeks) was in agreement with the dates and no fetoplacental anomaly was detected. Three groups were established based on the second-trimester MSAFP elevation: 2.0-2.49, 2.5-2.99 and > or = 3.0 MoM. RESULTS: Among the 383 patients enrolled, delivery data were available on 333 infants. Stratified by MSAFP elevations of 2.0-2.49, 2.5-2.99 and > or = 3.0 MoM, the rates of adverse pregnancy outcome were: (1) preterm birth: 14.3%, 15.6%, 20.3%; (2) small for gestational age at birth: 7.4%, 11.1%, 22.2%; and (3) perinatal deaths (neonatal and fetal): 2.6%, 3.3%, 5.6%. Seven pregnancy losses (three neonatal and four fetal deaths) occurred prior to 28 weeks. Of these seven, six fetuses exhibited intrauterine growth retardation by 23-26 weeks' gestation, and five of six were associated with MSAFP levels > or = 2.5 MoM. Four losses (two neonatal and two fetal deaths) occurred after 28 weeks. Of these, three involved structurally normal infants with normal growth who died after 34 weeks. All three of these pregnancies exhibited MSAFP elevations < 2.5 MoM. CONCLUSION: In pregnancies with an unexplained elevated second-trimester MSAFP, the rate of adverse pregnancy outcomes is increased with higher elevations. Any proposed program to improve pregnancy outcome in patients with unexplained MSAFP elevations must include efforts aimed at preventing preterm delivery, repeat ultrasound at 24-26 weeks to rule out early-onset intrauterine growth retardation in pregnancies with elevations > or = 2.5 MoM and fetal biophysical monitoring, even in normally grown fetuses, instituted at 32 weeks to detect fetuses at risk for intrauterine death.

Adolescent↗
PubMed1995

A new method for on-screen ultrasonographic determination of fetal cardiac axis.

OBJECTIVE: Our purpose was to develop an ultrasonographic method of using multiple electronic calipers for on-screen measurement of fetal cardiac axis. STUDY DESIGN: Two hundred low-risk patients who were seen for antenatal ultrasonography were studied. Standard biometry, anatomic survey, and echocardiography were performed on all fetuses. By use of a four-chamber view fetal cardiac axis was measured with electronic calipers. A table, derived from a trigonometric formula, was created to convert the caliper measurements to cardiac axis in degrees. The results were compared with a protractor-determined fetal cardiac axis. RESULTS: All echocardiograms had normal results. Fetal cardiac axis (+/- 2 SD) by the ultrasonographic method was 43 degrees (+/- 16 degrees) versus 43 degrees (+/- 14 degrees) by the protractor method. This difference was not significant. CONCLUSION: An on-screen method to determine fetal cardiac axis by use of multiple calipers is described. It is comparable to a protractor-measured fetal cardiac axis.

Echocardiography↗
PubMed1995

Gender-specific second-trimester biometry.

OBJECTIVE: This study was designed to evaluate the significance of gender differences for commonly used biometric parameters obtained ultrasonographically from second-trimester euploid fetuses. STUDY DESIGN: Gender-specific linear regression equations were developed for gestational age dependent and independent biometry from second-trimester ultrasonographically normal singleton euploid fetuses by use of biparietal diameters and femur and humerus lengths. Regression lines for male fetuses were compared with those for females by determining overlap of 95% confidence intervals at specific points. RESULTS: A total of 288 male fetuses (mean gestational age 16.7 +/- 1.0 weeks) and 251 female fetuses (mean gestational age 16.8 +/- 1.2 weeks) (not significant) were evaluated. Small statistically significant gender differences in fetal biometry were identified. The largest gender difference for gestational age-dependent parameters was a biparietal diameter difference of 1.15 mm at 21 weeks. The largest gender difference for gestational age-independent parameters was a femur length difference of 1.7 mm at a biparietal diameter of 50 mm. CONCLUSION: Statistically, but not clinically, significant gender differences of small magnitude exist for second-trimester fetal biometry, suggesting that gender-specific nomograms may be of limited value.

Biometry↗
PubMed1995

Second-trimester abortion by intramuscular 15-methyl-prostaglandin F2 alpha or intravaginal prostaglandin E2 suppositories: a randomized trial.

OBJECTIVE: To compare intramuscular (IM) prostaglandin 15 methyl-F2 alpha (15M-PGF2 alpha) with prostaglandin E2 (PGE2) vaginal suppositories for second-trimester abortion in terms of efficacy and side effects. METHODS: Fifty-one women were randomized to receive either 15M-PGF2 alpha IM injections or PGE2 intravaginal suppositories for second-trimester abortion. Efficacy and side effects of the two agents were analyzed by two-tailed t tests, chi 2 analysis with Fisher exact test, and survival analysis. RESULTS: The mean times to rupture of membranes, delivery of fetus, and delivery of placenta were significantly less for women receiving PGE2 vaginal suppositories. The cumulative abortion rate after 24 hours for the PGE2 group was 96%, compared with 69% for the 15M-PGF2 alpha group. Although there were few differences in side effects, the 15M-PGF2 alpha group had significantly fewer headaches, fevers, and chills. CONCLUSION: Intravaginal PGE2 is superior to IM 15M-PGF2 alpha for second-trimester abortion.

Abortion, Induced↗
PubMed1995

Low-dose aspirin therapy and placental pathology in women with poor prior pregnancy outcomes.

PROBLEM: To determine if low dose aspirin therapy improves placental histology in women with a prior complicated pregnancy demonstrating uterine vascular pathology. METHOD: A retrospective chart review identified patients with a prior complicated pregnancy with placental changes showing uterine vascular pathology (control pregnancy, CP). In the treated pregnancy (TP), 81 mg/day of ASA was started prior to 10 weeks. Placental reports from the CP and TP were reviewed. Pregnancy outcomes and placental histology from the CP were compared to the TP for each patient. RESULTS: Thirteen patients were enrolled. The majority of patients (8/13, 61.5%) exhibited recurrent, histologic evidence of uterine vascular pathology in the TP. The TP was more likely to be uncomplicated (P < 0.05), delivered after 36 weeks (P < 0.05), and result in the delivery of a viable infant (P < 0.05) compared to the CP. CONCLUSIONS: Despite an improvement in outcomes in the aspirin treated pregnancy, histologic evidence of uterine vascular pathology persisted in the majority of women with a prior complicated pregnancy demonstrating similar placental lesions. Abnormal placental histology may be useful in identifying a group of women with poor obstetrical histories who could benefit from low-dose aspirin therapy.

Adolescent↗
PubMed1994

Use of the transverse cerebellar diameter/abdominal circumference ratio in pregnancies at risk for intrauterine growth retardation.

A prospective study was conducted to evaluate the ability of the transverse cerebellar diameter/abdominal circumference ratio to identify growth-retarded fetuses. Of the cases analyzed, 48 of 87 (55%) were growth retarded by birth weight. The transverse cerebellar diameter/abdominal circumference ratio identified growth retardation with a sensitivity of 71%, specificity of 77%, positive predictive value of 79%, and negative predictive value of 68%. Fourteen growth-retarded fetuses were missed by the ratio; however, 57% of the missed cases were severely growth retarded. The transverse cerebellar diameter/abdominal circumference ratio can be useful for the assessment of fetal growth retardation; however, the ratio may be normal in cases of severe fetal growth retardation.

Abdomen↗
PubMed1994

Incarceration of the gravid uterus.

Retroversion of the first trimester uterus occurs in 6 to 19 per cent of all pregnancies and usually does not cause problems. If the uterus remains retroverted as the pregnancy advances, it may become wedged into the pelvic cavity. This complication is referred to as uterine incarceration which can lead to spontaneous abortion, preterm labor, uterine dystocia, and inadvertent incision into the cervix or the bladder during cesarean section in cases of unrecognized incarceration. Seven cases of uterine incarceration are presented with a detailed review including clinical signs and symptoms, physical findings, ultrasound findings, and treatment modalities for each stage of pregnancy. Moreover, we present a new method of treatment for second trimester uterine incarceration.

Adult↗
PubMed1994

Non-oral pyogenic granuloma in pregnancy: a report of two cases.

BACKGROUND: Pyogenic granulomas are benign vascular lesions of the skin or mucous membranes. Oral lesions are believed to occur in up to 2% of pregnancies. To the best of our knowledge, non-oral lesions in pregnancy have not been reported in the obstetric literature. CASES: We report two cases of non-oral pyogenic granuloma in pregnancy. The first, involving a finger lesion in a woman with triplets, demonstrated rapid growth and recurred after surgical excision. The second was an inguinal crease lesion, which was excised successfully after becoming symptomatic. CONCLUSION: Clinical experience suggests that the prevalence of pyogenic granulomas in pregnancy is not as high as has been reported in the literature. The relation of non-oral lesions to pregnancy is unknown.

Adult↗
PubMed1992

Tests of fetal well-being in premature rupture of membranes.

In summarizing the published data on the use of amniocentesis and fetal biophysical assessment in managing patients with PROM the following conclusions may be drawn: 1. Both amniocentesis and fetal biophysical assessment are reasonably good methods to predict the fetus who is doing well and could therefore safely remain in utero, as well as the fetus who is at high risk for developing sepsis and therefore in need of delivery. 2. Consideration of routine transabdominal amniocentesis for Gram stain and cultures in patients with PROM is reasonable. Measurements of glucose levels, esterase activity, or cytokines are only investigational, and their use in patient management cannot be advocated at this time. 3. Although there are no prospective controlled randomized trials to prove improved pregnancy outcome by the use of either amniocentesis or frequent biophysical assessment, nonrandomized comparative trials as well as trials using historic controls suggest that the use of either or both techniques in combination may be beneficial in managing PROM.

Amniocentesis↗