Trisomy 15 associated with nonimmune hydrops.
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Adult↗
Biomedical subjects
J A Kuller
Publications and source records attributed to J A Kuller.
Evolving fetal hydranencephaly mimicking intracranial neoplasm.
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Adolescent↗
Efficacy of hepatitis B screening in a private obstetrical population.
We sought to determine whether the recent Centers for Disease Control recommendation of universal prenatal screening for hepatitis B surface antigen (HBsAg) is necessary or cost-effective in a population of private patients. During the 21 months of our study there were 17,973 deliveries at Magee-Womens Hospital, the largest-volume private obstetrics service in the United States. We screened 12,377 of these patients for HBsAg. Only 11 patients, 0.09% of those screened (5 private and 6 clinic) tested positive. We administered questionnaires regarding historical risk factors for hepatitis B to all 11 patients testing positive for HBsAg and to 100 controls who tested negative for HBsAg. All private patients and 5 of 6 clinic patients testing positive for HBsAg had identifiable risk factors for hepatitis B. In addition, historical risk factors for hepatitis B were identified in 29% of the women testing negative for HBsAg. We found historical risk factors to be excellent predictors of the presence of HBsAg in our private patients. Our data indicate that universal screening for HBsAg is not necessary in private patients.
Cost-Benefit Analysis↗
Unusual presentations of fetal teratoma.
Teratomas are the most common congenital neoplasm. Fetal intracranial teratomas generally are large solid/cystic tumors that often completely replace normal brain tissue. Mediastinal teratomas are uncommon and rarely result in nonimmune hydrops fetalis. We describe two unusual presentations of fetal teratoma. The first is a fetus with massive hydrocephalus and marked facial deformities that were caused by a small intracranial teratoma. The second is a fetus with a mediastinal teratoma associated with non-immune hydrops fetalis. In both cases, compression by the mass resulted in lethal sequelae.
Adult↗
In utero intravascular transfusion for treating fetal hemolytic disease.
Technologic advances in ultrasound have led to the ability to access the fetal circulation in utero. Precise evaluation and accurate treatment of fetal hemolytic disease is now possible. This technique of in utero intravascular transfusion has several advantages. It uses a closed system that reduces the risk of infection and air embolus. The proximal extension tubing minimizes manipulation of the hub of the needle, which may lead to dislodgement of the needle, and permits a sampling port with minimal dead space between it and the fetal circulation. The HemoCue hemoglobinometer allows for rapid assessment of the concentration of fetal hemoglobin and, therefore, a shorter interval of time in which the needle is in the umbilical cord. This reduces the risks of trauma to the umbilical cord.
Blood Transfusion, Intrauterine↗
Vulvar leiomyosarcoma in pregnancy.
To our knowledge, this is the first case of vulvar leiomyosarcoma occurring during pregnancy to be reported. The neoplasm was resected immediately after a term vaginal delivery. A wide local excision of the vulva with bilateral superficial inguinal node sampling was performed 6 weeks post partum. Four previous cases of vulvar sarcoma occurring in pregnancy are reviewed. The need to perform biopsy of vulvar lesions during pregnancy is emphasized.
Adolescent↗
Hypokalemia associated with hyperparathyroidism in pregnancy.
A case of hyperparathyroidism complicating pregnancy is described. An uncommon associated finding of hypokalemia and its possible etiology is discussed. When hypokalemia occurs in the setting of hyperparathyroidism, oral phosphates should be used with caution, since they may worsen hypokalemia.
Adenoma↗
Rapid assessment of fetal hemoglobin concentration with the HemoCue system.
Successful treatment of severe fetal hemolytic disease depends on rapid and accurate measurement of fetal hemoglobin or hematocrit. The HemoCue is a portable hemoglobinometer that rapidly measures hemoglobin concentration. To evaluate the potential role of this instrument in fetal transfusion therapy, we measured hemoglobin concentration with the HemoCue and compared it with Coulter counter determination of hemoglobin in 39 fetuses. The HemoCue accurately measured fetal hemoglobin concentration (y = -0.3986 + 1.0276x; r = 0.97, P less than .001). This instrument is valuable for use with intravascular fetal transfusions.
Blood Transfusion, Intrauterine↗
Clinical use of oral contraceptives administered vaginally: a case report.
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Administration, Intravaginal↗
Prenatal diagnosis of Duchenne muscular dystrophy by fetal muscle biopsy.
Prenatal diagnosis and carrier detection for Duchenne muscular dystrophy (DMD) usually can be performed using DNA analysis. When recombination occurs within the DMD gene, or DNA analysis is uninformative, or in pedigrees where it is unclear whether or not the consultand is a carrier, direct examination of muscle by dystrophin analysis may provide the only means of prenatal diagnosis. We present three cases representing each of these molecular genetic diagnostic dilemmas. In each instance, we used sonographically guided fetal muscle biopsy for dystrophin protein analysis to resolve the dilemma. In the first and third cases, the presence of normal dystrophin was shown by immunofluorescence and this was followed by delivery of an unaffected male fetus. In the second case, dystrophin was not found in fetal muscle tissue implying that this fetus was affected. The absence of dystrophin and affected status was confirmed in skeletal and cardiac muscle obtained after pregnancy termination.
Abortion, Induced↗
Central hemodynamic effects of an oxytocin receptor antagonist (atosiban) in the isolated, perfused rat heart.
OBJECTIVE: Atosiban is a selective oxytocin receptor antagonist capable of inhibiting oxytocin-induced contractility of the uterus. Trials of this agent in intact animals and women as a tocolytic agent for preterm labor have shown atosiban to be devoid of cardiac effects. This is in contrast to other tocolytic agents, which have profound hemodynamic effects. We conducted this study to determine the cardiac effect of atosiban in the isolated, perfused rat heart model. METHODS: Hearts were excised from 60 female Sprague-Dawley rats and attached to a Langendorff apparatus. Left ventricular systolic pressure, heart rate, and contractility were measured. Hearts from half of the animals were exposed serially to 300 micrograms/min, 600 micrograms/min, and 1200 micrograms/min of atosiban. The remaining hearts formed the control group and were exposed to aerated Krebs solution. RESULTS: There were no significant differences between hearts exposed to atosiban and hearts within the control group for heart rate, left ventricular systolic pressure, and contractility. P values ranged from .12 to .73. CONCLUSIONS: Using a classic physiologic model to study cardiac performance and drug effects, we were unable to detect any central hemodynamic effects of atosiban. This is in contrast to oxytocin, which we previously studied and found negative chronotropic and positive ionotropic effects.
Animals↗
Fetal ovarian torsion appearing as a solid abdominal mass.
Fetal and neonatal ovarian cysts can be small asymptomatic lucencies or large symptomatic echocomplex masses that can cause intestinal obstruction and peritonitis. Solid masses are the most rare form of ovarian cysts. A fetus, anatomically unremarkable at 16 weeks' development, was found at 35 weeks to have a 5 x 5 cm solid mass. After delivery a laparotomy was performed, and a torsed ovary measuring 8 x 7 cm was removed. The infant did well after the procedure. Over 400 cases of perinatal ovarian cysts have been reported in the literature. Only 1% of these are purely echodense. When a fetal abdominal mass is present, separate from bowels and kidneys, a torsed ovary should be considered in the differential diagnosis. Management of the pregnancy and infant may be guided by the fetus or neonate's symptoms.
Adult↗
Perinatal outcomes in women with systemic lupus erythematosus.
OBJECTIVE: Pregnancies of women with systemic lupus erythematosus (SLE) were studied to assess the effects interaction of this disease and pregnancy. STUDY DESIGN: Charts of pregnant women with a discharge diagnosis of lupus were reviewed. Inclusion criterion was SLE diagnosed by the criteria of the American College of Rheumatology. All patients were cared for at the University of North Carolina Hospitals, a tertiary level university center. RESULTS: Between January 1988 and June 1995, we participated in the care of 21 women with the diagnosis of SLE. Their obstetric histories included a total of 56 pregnancies spanning 19 years. Obstetric histories were divided into pregnancies occurring before the patient was diagnosed with lupus and those pregnancies occurring after she had been given the diagnosis. The diagnosis of lupus was made during the course of five pregnancies; those five were categorized as occurring after diagnosis. Of the pregnancies that occurred before a woman's diagnosis of SLE, 46% resulted in live births, 36% ended in spontaneous abortion, and 18% ended in an intrauterine fetal demise. Among pregnancies occurring after the diagnosis of SLE, 85% resulted in live birth, 10% in spontaneous abortion, 3.3% in intrauterine fetal demise, and 3.3% in neonatal death. Of all live births, 53% were delivered before 37 weeks' gestation. The most common causes of maternal morbidity were joint involvement (n = 8) and dermatologic disorders (n = 6). Other clinical manifestations of SLE included nephritis (n = 5), hypertension (n = 4), pleuritis (n = 3), and thrombocytopenia (n = 3). One maternal death occurred as a result of pulmonary disease. Four pregnancies were complicated by preeclampsia. Seven patients were hospitalized during their pregnancies for lupus-related complications. CONCLUSIONS: Substantial fetal, neonatal, and maternal risks still exist for pregnant women with lupus.
Birth Rate↗