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W H Persutte

Publications and source records attributed to W H Persutte.

At least 19 recordsLinked to original sources
PubMed2001

The impact of prenatal alcohol exposure on frontal cortex development in utero.

OBJECTIVE: Whether prenatal alcohol exposure was associated with a reduction in the frontal cortex was examined. STUDY DESIGN: Pregnant women (n = 167) received multiple ultrasonographic assessments. During the assessment, brain structures were visualized and measured, including the distance from the posterior margin of the cavum to the calvarium, the distance from the posterior margin of the thalamus to the calvarium, the transcerebellar diameter, and the biparietal diameter. RESULTS: Regression analyses and odds ratios demonstrated that alcohol exposure was associated with a reduction in the frontal cortex, but not other brain structures. Strikingly, the percent of fetuses with a frontal cortex below the 10th percentile increased from 4% for nonexposed fetuses to 23% for heavily exposed fetuses. CONCLUSION: There was a relationship between frontal brain size and maternal alcohol consumption, suggesting that ultrasonography may be a sensitive tool for detecting alcohol-induced changes in the fetal brain.

Adult↗
PubMed2000

Striking findings concerning the variability in the measurement of the fetal renal collecting system.

OBJECTIVE: Using strict thresholds of normality, investigators have reported associations between fetal pyelectasis and aneuploidy, obstructive uropathy, postnatal pyeloplasty and vesicoureteral reflux. Although evidence continues to mount regarding the importance of fetal pyelectasis, little is known of the variability of collecting system measurements. To investigate the short-term variability and its relationship to bladder dilatation, the following study was conducted. DESIGN: During May and June 1996, 20 mid- and late-trimester patients with varying degrees of fetal pyelectasis were recruited into this study. Each consented to undergo periodic (every 15 min for 2 h) ultrasound measurements of the fetal renal collecting systems and bladder. To account for anatomic and technical variability in measurement, we used both the sum of the transverse and anterior-posterior (AP) measurements of the collecting systems, and AP measurement alone for comparison. The variability of the collecting system measurements was assessed based upon gestational age, magnitude of pyelectasis and fetal bladder size. RESULTS: We investigated 38 renal units in 20 patients (eight in the second trimester and 12 in the third). The mean(SE) AP diameter of all kidneys was 5.89(2.49) mm (range 15 (2-17) mm), and the sum of transverse and AP renal collecting system diameters was 13.91(5.73) mm (range 26 (4-31) mm). These data were normally distributed. When assessing the variability in individual kidneys over time, we found the mean variation (minimum to maximum) for the sum of the AP and transverse measurement to be 7.61(4.26) mm and for the AP measurement alone to be 3.80(2.49) mm. No relationship was found between variability of dilatation, magnitude of dilatation or fetal bladder size. Cyclic dilatation of the fetal bladder was observed in all cases. The mean time from maximal to minimal dilatation was 20 min (1.34 observations; range 12-30 min). CONCLUSIONS: We found the size of the fetal renal collecting system to be highly variable over the course of a 2-h period. Seventy per cent of cases (14 of 20) had both normal (< 4 mm) and abnormal values (> or = 4 mm) during the 2-h study period. Significant caution should be used when considering the implications of renal collecting system dilatation based upon a single AP measurement.

Female↗
PubMed1999

Advanced-practice sonography in obstetrics and gynecology: a pilot study investigating the efficacy of the ultrasound practitioner.

Advanced-practice (AP) ultrasonography by an AP sonographer or ultrasound practitioner is an emerging allied health profession. The efficacy of this professional in sonographic diagnosis has not been evaluated. This report describes a comparison of the efficacies of diagnosis using a traditional approach and diagnosis by the AP sonographer. Between 1991 and 1995, the authors performed a retrospective, case-controlled study. Patients were evaluated with either (1) a sonographer-based method (limited supervision with perinatal consultation as necessary) or 2) a sonologist-dominant method (direct supervision by a radiologist). Demographic information, ultrasonographic findings, delivery information, and data outcomes were compared. Multiple statistical methods were used and p < 0.05 was considered significant. Of 840 patients studied, 420 were evaluated with the sonographer-based method and 420 with a sonologist-dominant method. There was no significant difference in any potentially predisposing maternal risk factor (except maternal age and education), medical history, variable relevant risk factors associated with the current pregnancy, characteristics associated with delivery, or prenatal ultrasonographic variable. The evaluation of diagnostic efficacy for birth defects showed no difference. The sensitivity and specificity of diagnosis using the sonographer-based method were 100% and 94.7% for the detection of fetal abnormalities, respectively, and 100% and 91.4%, for the sonologist-dominant method. The diagnostic efficacy of the AP sonographer or ultrasound practitioner was found to be similar to that of the traditional sonographer-sonologist model. While, intuitively, there are significant advantages to multiple observers, the experienced, well-trained AP sonographer can function independently, with only discretionary consultation and assistance.

Adult↗
PubMed1998

Microcephaly--no small deal.

Anatomic shortening of the fetal frontal lobe seems to precede microcephaly. Brain size determines the size of the calvarium. The report by Pilu and colleagues provides a physiological basis for recent anatomical observations made regarding microcephaly. Biometry of the frontal lobe of the fetal brain may be a valuable tool for the identification of the fetus at risk for microcephaly. A thorough investigation of the subtle brain anatomy of the developing fetus is necessary in suspicious cases. Prenatal studies have suggested that abnormalities of neurocranial architecture occur in approximately two-thirds of cases. Steinlin and colleagues found a much higher incidence in children (90%) affected by microcephaly. Either the progressive nature of the condition or the improved sensitivity of childhood magnetic resonance imaging (used in their study) over prenatal ultrasonography for the detection of subtle brain abnormalities may account for this difference. However, high-resolution ultrasonographic instruments should allow for the detection of many accompanying neuroanatomic abnormalities, possibly before the markedly small calvarium is seen. Finally, Pilu and colleagues have shown that the underlying conditions that may predispose to brain atrophy may be recognizable with Doppler ultrasonography.

Female↗
PubMed1997

Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant.

Isolated 'mild renal collecting system dilatation' (mild pyelectasis) is a common prenatal sonographic finding. An association between mild pyelectasis and fetal aneuploidy has been established, but in the absence of a concomitant anomaly, mild pyelectasis is usually regarded as benign and of no clinical consequence, and follow-up is often not obtained after the initial ascertainment. To test this, we investigated the relationship between mild pyelectasis and (1) progression to hydronephrosis; (2) postnatal vesicoureteral reflux (VUR); and (3) postnatal surgery. Between 1 January 1992 and 1 January 1995, we performed 453 prenatal sonographic examinations of 306 patients with mild fetal pyelectasis and no other anomalies. During the course of a routine sonographic examination, we performed a detailed evaluation of the fetal genitourinary tract, Mild pyelectasis was defined as a pelvocalyceal fluid-filled space with the smallest of two transverse perpendicular sonographic measurements of > or = 4 mm and < 10 mm. Hydronephrosis was defined similarly, but with a measurement of > or = 10 mm. Postnatal urological assessment was obtained with routine renal ultrasonography, and voiding cystourethrography (VCUG), measurement of 99mTc-labelled diethylenetriamine pentaacetic acid (DPTA) mercaptacetyltriglycerine (MAG3), and intravenous pyelogram, as necessary. After exclusion criteria were applied, 294 (96%) patients with isolated fetal pyelectasis were considered. A total of 251 (82%) of these were followed with ultrasonography prenatally and during the postnatal period. Two or more prenatal examinations were carried out in 129 patients (51%) and in 35 (27%) of these cases the biometry progressed to frank hydronephrosis (> 10 mm). In only six (5%) of the cases followed prenatally did the measurement diminish to < 4 mm. We found a greater variability in prenatal renal biometry throughout gestation in infants found to have VUR, when compared with those who had no VUR. On postnatal follow-up, 84 patients had VCUG. Sixteen of these patients (6% of all patients [16/251] and 19% [16/84] of those who had the test) were found to have an abnormal finding. Whereas the prenatal appearance of mild pyelectasis improved in only a small number of cases, we found that it progressed to hydronephrosis in 27% of cases. Postnatal evaluation found VUR to be common in apparent uncomplicated mild prenatal pyelectasis. Although postnatal surgery was necessary in only a small number of cases, surgical intervention was necessary in 33% (four of 12) of those with VUR.

Adolescent↗
PubMed1997

Correlation of fetal frontal lobe and transcerebellar diameter measurements: the utility of a new prenatal sonographic technique.

Several authors have reported the value of the sonographic assessment of both the fetal frontal lobe and the cerebellum. Both frontal lobe shortening and cerebellar hypoplasia have been associated with fetal aneuploidy. We anecdotally observed that the distance between the calvarium and the posterior cavum septum pellucidum (frontal lobe) closely approximated the transcerebellar diameter. This study was undertaken to investigate this relationship. Between 1 July 1994 and 1 January 1996, the frontal lobe (posterior cavum septum pellucidum to the inner calvarium) and transcerebellar diameter were measured in patients referred to two prenatal ultrasound laboratories in Denver, Colorado, USA. All pregnancies had certain dates and were uncomplicated. Statistical comparison was completed using interval polynomial regression analysis. During the study period, we performed 221 detailed ultrasound examinations in which the frontal lobe and the transcerebellar diameter were measured. We found a correlation coefficient of 0.950 when comparing the two variables (p < 0.0001). Some conditions (Down's syndrome, lethal trisomies and pathological microcephaly) have differential effects on the frontal lobe and the transcerebellar diameter. Our preliminary judgement is that this new technique may prove to be a useful tool in assessing the relative effect of these conditions on structural neuroanatomy.

Adult↗
PubMed1995

Failure of amniotic-fluid-cell growth: is it related to fetal aneuploidy?

We investigated outcome in patients whose amniotic-fluid-cell samples showed unexplained growth failure in culture. 32 of 7872 amniocentesis samples were classified as unexplained growth failures. 10 women did not have repeat cytogenetic testing, but among their pregnancies there were 4 abnormal outcomes (1 fetal bladder-outlet obstruction, 2 stillbirths, and 1 acardiac twin). Of the 22 patients who had repeat karyotypic analysis, 18 had normal fetal karyotypes. However, 4 fetuses were aneuploid (2 trisomy 21, 1 trisomy 13, and 1 Pallister-Killian syndrome).

Amniocentesis↗
PubMed1994

Transverse umbilical arterial diameter: technique for the prenatal diagnosis of single umbilical artery.

We investigated the relationship between the transverse umbilical arterial diameter and the presence of a single umbilical artery. Further, we speculated that fetal physiologic and hemodynamic limitations in pregnancies complicated by a single umbilical artery would result in larger umbilical arterial diameters than the typical three-vessel cord. The identification of a sufficiently large umbilical artery may be pathognomonic for single umbilical artery. The transverse umbilical arterial diameter was obtained in 100 consecutive, uncomplicated singleton pregnancies between 20 and 38 weeks' gestation. These measurements were compared with the transverse umbilical arterial diameter of 23 pregnancies in which a single umbilical artery was identified with ultrasonography and postnatal examination. Transverse umbilical arterial diameter measurements of the two groups were compared. Before 36 weeks' gestation, all pregnancies with a single umbilical artery had a transverse umbilical arterial diameter measurement > 4 mm and all pregnancies with two umbilical arteries had a transverse umbilical arterial diameter measurement < or = 4 mm. Because oligohydramnios, multiple pregnancy, or suboptimal cord position may obscure the expeditious identification of the number of umbilical cord vessels, measurement of the transverse umbilical arterial diameter may prove useful in the identification of single umbilical artery. On the basis of this preliminary evaluation, we suggest that a transverse umbilical arterial diameter measurement > 4 mm is predictive of single umbilical artery between 20 and 36 weeks' gestation.

Female↗
PubMed1993

Conversion from a failed transcervical zygote intrafallopian transfer to a successful delayed uterine embryo transfer.

Transcervical ZIFT is an alternative to IVF-ET and laparoscopic GIFT. However, tubal catheterization cannot be accomplished in all cases. We describe a successful twin pregnancy that resulted from delayed uterine transfer of four embryos following unsuccessful TC-ZIFT transfer. Further data are needed to determine optimal management in cases of failed transcervical tubal transfer procedures.

Adult↗
PubMed1993

Ultrasound-guided transcervical tubal catheterization for assisted reproduction: a learning program using laparoscopy for confirmation.

The result of this pilot study confirmed that the US-directed transcervical tubal catheterization procedure for assisted reproduction can be learned over a short period of time and may well produce comparable PRs as seen with laparoscopic transfer. However, practice in the technique with confirmation of placement by laparoscopy is advised before incorporating this procedure into a program of assisted reproduction.

Animals↗
PubMed1990

Prenatal diagnosis of autosomal dominant microcephaly and postnatal evaluation with magnetic resonance imaging.

A case of fetal autosomal dominant microcephaly was prenatally diagnosed with ultrasonography in a woman with previously undiagnosed microcephaly. At the time of initial ultrasonographic assessment, the mother was identified to have a markedly small cranium, consistent with maternal microcephaly. The ultrasonographic examination showed the fetal head size to be four standard deviations below the mean for gestational age. Gestational dating from the other biometric parameters and from the last menstrual period was consistent with 31 weeks' gestation. Neurosonographic evaluation of the fetus revealed no obvious structural abnormalities. Serial ultrasonographic examinations at 35 and 38 weeks' gestation showed no changes in the fetal head size. A 2.64 kg male fetus was delivered at term. Neonatal assessment showed the fetal head circumference to be less than the second percentile for gestational age. Neurologic assessment of the neonate with magnetic resonance imaging showed abnormal development of the brain, with small cerebellar and cerebral hemispheres, and pachygyria. These images are compared with the magnetic resonance images of the mother. Our findings of maternal and fetal microcephaly are consistent with autosomal dominant microcephaly. To our knowledge, this is the first report of the prenatal diagnosis of autosomal dominant microcephaly.

Adult↗
PubMed1990

Ultrasonographic assessment of intestinal damage in fetuses with gastroschisis: is it of clinical value?

In cases of gastroschisis detected prenatally it has been proposed that ultrasonographic criteria may play an important role in the decision for early delivery. We evaluated five cases of gastroschisis diagnosed before birth and found a correlation between prenatally detected small bowel dilatation and severe intestinal damage. However, from the limited data available these in utero measurements seem to be ineffective as indicators for delivery intervention (1) because not all fetuses with bowel dilatation have postnatal evidence of intestinal damage, (2) because some infants with intestinal damage and a poor postnatal outcome may show no in utero evidence of bowel dilatation, (3) because initial bowel dilatation may occur before a gestational age when lung maturity is achieved, and (4) because, in those cases in which bowel dilatation did correlate with intestinal damage, the bowel was already beyond the point of salvage and the infant required bowel resection.

Abdominal Muscles↗