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Biomedical subjects

W J Watson

Publications and source records attributed to W J Watson.

At least 19 recordsLinked to original sources
PubMed1992

Preterm premature rupture of membranes: results of expectant management in patients with cervical cultures positive for group B streptococcus or Neisseria gonorrhoeae.

OBJECTIVE: The antepartum course and short-term neonatal outcome for patients with premature rupture of membranes between 26 and 33 weeks' gestation with positive cervical cultures for group B streptococcus or Neisseria gonorrhoeae were reviewed. STUDY DESIGN: A retrospective analysis of 182 patients managed expectantly over a 3-year period was done. Thirty-four patients had cervical cultures positive for group B streptococcus, 11 had positive cultures for Neisseria gonorrhoeae, and 137 had negative cultures. Prophylactic antibiotics were routinely given, and antibiotic therapy was continued in patients with positive cultures. RESULTS: There was no difference between groups in latent phase or maternal morbidity. The incidence of neonatal pneumonia was increased in those with positive cervical cultures (p = 0.009, odds ratio 6.9, 90% confidence interval 2.1 to 22.8), but there was no difference in neonatal sepsis, respiratory distress, or neonatal mortality. CONCLUSION: These data support the conservative or expectant management of premature rupture of membranes between 26 and 33 weeks in patients with positive cervical cultures who are given prophylactic antibiotic therapy.

Case-Control Studies↗
PubMed1992

Treatment of persistent postpartum HELLP syndrome with plasmapheresis.

Thrombocytopenia, associated with microangiopathic disease, is one characteristic of severe preeclampsia. Thrombocytopenia and intravascular hemolysis usually resolve by postpartum days 4 to 5. When thrombocytopenia secondary to microangiopathic disease persists, plasmapheresis may be used to arrest and reverse the process. Three patients over a 24-month period were successfully treated with plasma exchange with fresh frozen plasma. Several investigators who have cared for patients with persistent thrombocytopenia associated with preeclampsia have concluded that early plasmapheresis may be useful therapy. Plasma exchange should also be considered as a therapeutic option when clinical deterioration occurs due to microangiopathic disease.

Adult↗
PubMed1992

Prenatal sonographic findings of massive lower extremity lymphangioma.

A massive lymphangioma was detected sonographically in the lower extremity of a fetus at 28 weeks' gestation. On ultrasound study, the mass had multiple cysts and extended from the left lower abdomen to the left knee. The differential diagnosis and obstetric management following prenatal diagnosis of a fetal lower extremity mass are presented.

Adult↗
PubMed1992

The cisterna magna in second-trimester fetuses with abnormal karyotypes.

Six hundred thirty-eight gravidas at 14-21 weeks' gestation, who were at increased risk for an abnormal fetal karyotype, had sonographic measurement of the fetal cisterna magna at the level of the posterior fossa before genetic amniocentesis. The size of the fetal cisterna magna increased significantly with advancing gestational age in the normal fetus (P less than .001). Twenty-eight fetuses had abnormal karyotypes: 12 with trisomy, eight with translocation or structural rearrangements, seven with sex chromosome abnormalities, and one with triploidy. In each of these fetuses with abnormal karyotypes, the cisterna magna measurement was normal. We conclude that measurement of the fetal cisterna magna at 14-21 weeks' gestation is not useful as a screening test for abnormal fetal karyotype.

Chromosome Aberrations↗
PubMed1992

Elemental mercury exposure in early pregnancy.

We present a case of first-trimester elemental mercury exposure and review the literature to demonstrate that the reproductive toxicity of mercury varies depending on the form of mercury to which one is exposed. It appears that elemental mercury exposure poses less of a reproductive threat than the well-known hazards of exposure to organic mercurials. It is critical to determine the form of exposure when counseling patients at risk.

Adult↗
PubMed1991

Steroid therapy for hydrops associated with antibody-mediated congenital heart block.

Evaluation of fetal bradycardia noted during a routine prenatal visit at 24 weeks' gestation in a mother without symptoms showed an antibody-mediated heart block with anti-La (SSB) antibody present. The fetus had a pericardial effusion and ascites. After maternal steroid therapy, the ascites resolved and the pericardial effusion was substantially diminished. Steroid therapy may be a helpful adjunct for treatment of a premature infant with hydrops as a result of antibody-mediated heart block.

Adrenal Cortex Hormones↗
PubMed1991

The clinical implications of subchorionic placental lucencies.

Forty-six patients were identified at a perinatal diagnostic referral center as having subchorionic placental lucencies. These lucencies varied from simple to multicystic and covered up to 50% of the subchorionic placental surface. Clinical follow-up of 40 patients demonstrated no increase in the incidence of adverse pregnancy outcome. We conclude that these pregnancies are not at higher risk when the subchorionic placental lucencies are not associated with other intraplacental or fetal anomalies.

Chorion↗
PubMed1991

Fetal death after normal biophysical profile.

Presented are three cases of fetal death, all of which occurred within 3 days of a normal biophysical profile. Despite the excellent record of this antepartum test in predicting fetal well-being, there is a low incidence of false-negative tests; increasing the frequency of testing will not prevent all false-negative tests.

Adult↗
PubMed1991

Counseling and care for the pregnancy complicated by gastroschisis.

Twenty-one consecutive cases of fetal and neonatal gastroschisis were retrospectively reviewed. There was 100% survival if major nonintestinal malformations did not coexist; however, 28.6% of these patients had other major malformations and 66% of them died. There were significantly fewer small for gestational age infants if the defect was diagnosed prenatally (20% versus 75%, p less than 0.003). There was a 60% cesarean delivery rate in prenatally diagnosed infants and 0% if diagnosis occurred at delivery (p less than 0.01).

Abdominal Muscles↗
PubMed1991

Sonographic evaluation of growth discordance and chorionicity in twin gestation.

Ninety-four twin gestations had serial ultrasound examinations for evaluation of fetal growth, with special attention to prediction of weight discordance and chorionicity. Fetal weight estimations were made a mean of 3.2 days before birth and then compared to actual birthweights. The average error in intertwin discordance prediction was 1 +/- 9%. In 56 patients ultrasonic detection of membrane thickness was compared with placental pathologic conditions. If a membrane was seen between twins, it was confirmed by placental pathologic study in all cases. No membrane was seen in four twin pairs, but only one of these actually had monochorionic monoamniotic membranes. The three cases with false-positive diagnoses of monoamniotic twin gestation were initially seen late in pregnancy. If clinical decisions in twin gestations are based on ultrasound determination of discordance and chorionicity, the level of accuracy demonstrated by these data must be considered.

Birth Weight↗
PubMed1991

The effect of lateral tilt on maternal and fetal hemodynamic variables.

We measured maternal blood pressure and heart rate, fetal heart rate, and umbilical artery velocity waveforms in 25 healthy women placed in the supine and in both right and left 5 degrees and 10 degrees lateral tilt positions. Although we found no significant difference among these variables in the various maternal positions, two of 25 women became hypotensive and symptomatic in the supine and 5 degrees tilt positions. Because we could not predict which women would become symptomatic, we recommend lateral tilt of all pregnant women during operative procedures beyond 20 weeks' gestation, including those in the lithotomy position for vaginal delivery.

Adolescent↗
PubMed1991

Pregnancy-induced changes in the maximal physiological responses during swimming.

The effect of pregnancy on peak O2 uptake (VO2 peak) during tethered swimming was evaluated in 10 women during their 25th and 35th wk of pregnancy, as well as 9-11 wk postpartum. The swim results were compared with cycle ergometry results obtained at similar times. The results indicated that exercise-induced maximal heart rates remained the same and were similar for the swim and cycle trials, approximately 184 +/- 4 beats/min. Cycling VO2 peak was not affected by pregnancy, averaging 1.94 +/- 0.11 l/min. Postpartum swim VO2 peak was similar to the cycle results; however, during pregnancy it was significantly lower than cycling VO2 peak (P less than 0.05; postpartum, 1.78 +/- 0.14 l/min; 25th wk, 1.64 +/- 0.12; 35th wk, 1.48 +/- 0.11). Hemoglobin concentrations and hematocrits were lower during pregnancy; however, changes in plasma volume (based on hematocrit and hemoglobin) were found to be significantly greater during cycling than during swimming and also greater during pregnancy for both modes of exercise. It was concluded that, unlike cycling, the VO2 peak of pregnant women during swimming is reduced. This reduction in VO2 peak was associated with a decreased peak ventilation (r = 0.864) but was not correlated to exercise-induced hemoconcentration (r = -0.29). Furthermore, pregnancy results in a greater-than-normal exercise-induced hemoconcentration, which may be related to pregnancy-induced changes in capillary dynamics.

Adult↗
PubMed1991

The role of ultrasound in evaluation of patients with elevated maternal serum alpha-fetoprotein: a review.

Accumulated experience with the sonographic detection of spina bifida and its associated fetal cranial changes indicates that nearly all these fetuses may be identified by ultrasound examination alone. A review of data from multiple centers shows that a complete and detailed, normal ultrasound is an appropriate basis for a reduction of at least 95% in the maternal serum alpha-fetoprotein (MSAFP)-based risk for neural tube defects. The use of this adjusted risk in patient counseling before amniocentesis may lower the rate of the procedure with no significant loss of diagnostic sensitivity. Among patients with elevated MSAFP, the rate of abnormal cytogenetic findings in fetuses with no abnormalities detected at ultrasound appears to be near 0.61%. Furthermore, the spectrum of abnormal cytogenetic results appears to differ from that associated with increased maternal age, in that the incidence of sex chromosome abnormalities is higher and that of Down syndrome is lower.

Amniocentesis↗
PubMed1991

Sonographic diagnosis of advanced ectopic pregnancy. A case report.

The diagnosis of advanced extrauterine pregnancy is made most often sonographically by identification of a uterus separate from the fetus. Leiomyomas or other pelvic masses can make the sonographic diagnosis more difficult. In a woman with an advanced ectopic pregnancy and uterine leiomyoma, the sonographic diagnosis was made by passing a sterile probe through the endocervix with simultaneous, real-time ultrasound observation.

Adult↗
PubMed1991

Spontaneous resolution of fetal nuchal cystic hygroma.

Complete resolution of the hygroma occurred in two fetuses with the mid-trimester ultrasound diagnosis of a nuchal cystic hygroma. Cytogenetic studies showed a normal 46,XX karyotype in one fetus, and a 47,XX, +18 in the other. Complete regression of cystic hygroma has been reported in fetuses with normal chromosomes, as well as in those with trisomy 21, and with Turner's syndrome. The incidence of spontaneous in utero resolution of fetal nuchal cystic hygroma is unknown. The natural history of cystic hygroma in utero cannot be correlated with the chromosome complement. An antenatal karyotype determination should be offered to any patient whose fetus has cystic hygroma, even to those with spontaneous resolution.

Adult↗
PubMed1991

Glycosylated hemoglobin and fructosamine. Indicators of glycemic control in pregnancies complicated by diabetes mellitus.

In 50 gravidas with insulin-dependent diabetes mellitus, mean preprandial whole blood glucose levels over a two-week period were compared with serum glycosylated hemoglobin (HbA1c) and fructosamine values. Although there was a statistically significant correlation between mean glucose levels and both HbA1c (r = .44, P less than .01) and fructosamine (r = .37, P less than .01), the wide range of HbA1c and fructosamine observed at all levels of mean blood glucose limited the usefulness of those assays in the management of pregnant diabetics.

Blood Glucose↗
PubMed1991

Effect of corpus luteum position on hyperemesis gravidarum. A case report.

It has been postulated that the position of the corpus luteum affects nausea and vomiting of pregnancy. Supposedly a corpus luteum arising from the right ovary results in a high concentration of sex steroids in the hepatic portal system, causing nausea and vomiting. A woman with severe hyperemesis underwent excision of a right-sided corpus luteum at 12 weeks. Removal of the corpus luteum failed to modify the course of the disease.

Adult↗