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W H Sepúlveda

Publications and source records attributed to W H Sepúlveda.

25 records · Page 2Linked to original sources
PubMed1989

Prenatal sonographic diagnosis of congenital sacrococcygeal teratoma and management.

Teratomas are tumors containing tissues derived from all three germinal cell layers. Most teratomas arise in the sacrococcygeal region, with a reported incidence of 1/40,000 births. During labor, severe dystocia may occur in infants with large tumors if delivered vaginally, with an extremely high fetal morbidity and mortality rate. Reported is a case of a large congenital sacrococcygeal teratoma diagnosed antepartum by sonography at 36 weeks pregnancy. This sonographic finding allowed us to avoid traumatic delivery. Cesarean section was performed, with the delivery of a 4.050-g female infant with a large sacrococcygeal tumor. Resection of the sacral mass was performed on the 5th day of life. Pathologic examination showed a mature sacrococcygeal teratoma weighing 620-g, and measuring 14-cm by 11-cm by 9-cm. The infant had an uneventful recovery. This report agrees with previous reported cases in which successful management of sacrococcygeal teratomas could be achieved with accurate prenatal diagnosis, atraumatic delivery, and prompt surgical intervention. The role of sonography in the management of these cases is stressed.

Female↗
PubMed1989

Prenatal ultrasonographic diagnosis of thoracopagus conjoined twins.

Conjoined twins are a rare obstetric event occurring 1/50,000 to 1/60,000 deliveries as a result of incomplete fission of the embryonic disc before the third week of pregnancy. They belong to the monochorionic-monoamniotic type of monozygotic twins and are classified according to the area of union, the most common site being the chest and upper abdomen (thoracopagus). Reported are two cases of thoracopagus twins in which the diagnosis was made prenatally by ultrasound in the second trimester of pregnancy. The most significant ultrasound findings included the demonstration of a single cardiac activity, the inability to separate the fetal bodies at their ventral portion, and a face-to-face fetal position. The pregnancies were allowed to continue until term with no significant prenatal complications, and an elective cesarean section was performed to avoid a traumatic delivery. In both cases the infants died during the first week of life because of cardiorespiratory insufficiency. The ultrasound criteria for the antenatal diagnosis of conjoined twins are reviewed, concluding that the careful ultrasound examination of all identified sets of twins, specially in those cases in which no separating membrane is demonstrated, is the cornerstone in making the prenatal diagnosis. In addition, ultrasound plays a crucial role not only in the diagnosis, but also in establishing the degree of conjoining, which is essential for planning an appropriate obstetrical and perinatal management.

Adult↗
PubMed1989

Sonographic detection of echogenic amniotic fluid and its clinical significance.

It has been suggested that meconium-stained amniotic fluid can be detected in the antepartum period by means of ultrasound, based on the following findings: (1) a diffuse echogenic pattern throughout the amniotic cavity, (2) a clear contrast between the amniotic fluid and the umbilical cord, and (3) layering in the more dependent areas. Reported is a case in which a similar picture was obtained in a third trimester, high-risk pregnancy, but representing vernix instead of meconium. We are aware of six cases, including ours, of sonographic detection of echogenic amniotic fluid. The review of these cases indicates that the findings refer more often to a considerable amount of vernix rather than meconium, and it is not necessarily associated with postmaturity. If echogenic amniotic fluid is identified in an obstetrical ultrasound, we recommend: (1) rule-out meconium by amniocentesis or amnioscopy, or (2) study fetal well-being by means of nonstress test and/or biophysical profile. Thus, a false positive diagnosis of fetal distress in these cases could be easily avoided.

Amniotic Fluid↗
PubMedDate not supplied

Perforation of the rectum by a Copper-T intra-uterine contraceptive device; a case report.

A case of a rare complication of a Copper-T intra-uterine contraceptive device (IUCD) producing uterine and rectal perforation is reported. The patient presented with the threads of the IUCD protruding through the anus and the device was removed from the rectum using a proctoscope. A review of the literature revealed only seven cases of perforation of the rectosigmoid by an IUCD in which the device was removed per rectum, and this report documents the first of such cases involving a Copper-T. Proctosigmoidoscopic evaluation is recommended whenever perforation of the rectosigmoid by an IUCD is suspected, since it may select those patients for whom rectal recovery of the IUCD is feasible, thus avoiding unnecessary surgical intervention.

Adult↗
PubMedDate not supplied

[Optic density of gastric content in the rapid assessment of pulmonary maturity of the newborn].

The authors studied the correlation between optical density at 650 nm (OD650) in paired samples of amniotic fluid and newborn gastric aspirate obtained from 50 pregnant women who underwent cesarean delivery and from their respective newborns. There was a good correlation between both samples (r = 0.92), which demonstrates that OD650 is a reliable method for studying neonatal pulmonary maturity, especially in those high-risk cases in which no prenatal study is available. None of the infants with mature readings (OD650 > or = 0.10) and 6 out of 13 infants with immature readings (OD650 < 0.10) developed RDS.

Amniotic Fluid↗