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Biomedical subjects

J F Rodis

Publications and source records attributed to J F Rodis.

At least 55 records · Page 3Linked to original sources
PubMed1994

Effect of intravenous magnesium sulfate on the biophysical profile of the healthy preterm fetus.

OBJECTIVE: The null hypothesis is that intravenous magnesium sulfate does not affect the biophysical profile of the healthy preterm fetus. STUDY DESIGN: Thirty-one fetuses of 25 patients between the gestational ages of 24 and 35 weeks, median 31.4 and mean (+/- SD) 30.4 (+/- 2.9), who required tocolysis for uterine contractions were prospectively studied. After normal fetal biophysical assessment was documented, intravenous magnesium sulfate was started as a 4 or 6 gm loading dose and then infused at 2 to 3.5 gm/hr to achieve tocolysis. Blood was drawn for measurement of maternal serum magnesium levels immediately before intravenous magnesium sulfate was administered and at 2 and 12 hours after the loading dose. Biophysical profiles, consisting of a possible 12 points, were performed at the same time as blood was drawn. Serum magnesium levels were compared with one-way analysis of variance for repeated measures and biophysical profile scores with Friedman's test. Statistical significance was considered p < 0.05. RESULTS: Mean (+/- SD) serum magnesium levels were 1.7 (+/- 0.1) mg/dl before infusion, 4.3 (+/- 0.6) mg/dl at 2 hours, and 5.2 (+/- 0.7) mg/dl at 12 hours (p < 0.001). Six fetuses did not have a 12-hour biophysical profile; three were delivered for severe variable decelerations, two progressed in labor, and in one tocolysis was discontinued. The median biophysical profile score was 11 before intravenous magnesium sulfate, at 2 hours, and at 12 hours after the loading dose. The biophysical parameters present and the percentage of fetuses with each parameter were as follows: breathing (> 30 seconds), 88% (22/25) before magnesium sulfate, 84% (21/25) at 2 hours, and 92% (23/25) at 12 hours; nonstress test (reactive), 84% (21/25) before magnesium sulfate, 68% (17/25) at 2 hours, and 80% (20/25) at 12 hours; movement (normal), 100% (25/25) before magnesium sulfate, 100% (25/25) at 2 hours, and 96% (24/25) at 12 hours. CONCLUSION: Intravenous magnesium sulfate did not significantly alter the biophysical profile in the 25 fetuses evaluated by three biophysical profiles in spite of the significant increase in maternal serum magnesium levels.

Adult↗
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↗
PubMed1993

Do survival and morbidity of very-low-birth-weight infants vary according to the primary pregnancy complication that results in preterm delivery?

OBJECTIVE: This retrospective study was conducted to determine whether predischarge survival and morbidity of very-low-birth weight infants varied according to the principal pregnancy complication that led to preterm delivery. STUDY DESIGN: The hospital records of 535 consecutive live-born singleton infants who weighed between 500 and 1499 gm were reviewed, and five primary complications that resulted in preterm delivery were identified: (1) premature rupture of membranes (n = 244, 46%), (2) idiopathic preterm labor (n = 97, 18%), (3) antepartum hemorrhage (n = 58, 11%), (4) pregnancy-induced hypertension (n = 98, 18%), and (5) "other" complications (n = 38, 7%). Neonatal records were studied to identify the presence of respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary interstitial emphysema, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and infant death before hospital discharge. Logistic regression analysis was used to analyze the association of each pregnancy complication with the various forms of neonatal morbidity. RESULTS: There were no statistically significant differences in discharge survival rates (range 71% to 88%) among infants born to women who experienced one of the five types of primary complications. Independent of all confounders, premature rupture of membranes was associated with a decreased risk of respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary interstitial emphysema, patent ductus arteriosus, and intraventricular hemorrhage. Preterm labor was associated with an increased risk of pulmonary interstitial emphysema, patent ductus arteriosus, and intraventricular hemorrhage. Pregnancy-induced hypertension was associated with an increased risk of respiratory distress syndrome, pulmonary interstitial emphysema, and patent ductus arteriosus. Antepartum hemorrhage was associated with an increased risk of patent ductus arteriosus. CONCLUSION: The principal pregnancy complication that led to preterm delivery significantly influenced predischarge morbidity but not the predischarge survival of live-born infants.

Female↗
PubMed1993

Does "idiopathic" preterm labor resulting in preterm birth exist?

OBJECTIVE: In an effort to elucidate possible causes of preterm labor, we undertook a prospective study of 50 patients consecutively admitted with intact membranes and preterm labor who eventually had a preterm delivery despite the use of tocolysis. STUDY DESIGN: A comprehensive evaluation plan was instituted. This included a detailed history and physical examination, targeted ultrasonography, amniocentesis for Gram stain, culture, and glucose determination, laboratory analysis for infection (complete blood cell count, urinalysis, and cervical and urine cultures) and for antiphospholipid antibody syndrome (antinuclear antibody, lupus anticoagulant, anticardiolipin antibody), pathologic examination of the placenta, and a urine toxicology screen. RESULTS: The following groups of possible causes of preterm labor were identified: (1) faulty placentation, 50% (25/50); (2) intrauterine infection 38% (19/50); (3) immunologic factors, 30% (15/50); (4) cervical incompetence, 16% (8/50); (5) uterine factors, 14% (7/50); (6) maternal factors 10% (5/50); (7) trauma and surgery, 8% (4/50); (8) fetal anomalies, 6% (3/50); and (9) idiopathic conditions, 4% (2/50). Among the 50 patients two or more possible causes were identified in 58% (29/50). CONCLUSION: We suggest that an exhaustive evaluation plan can identify possible causes in the majority (96%) of cases of "idiopathic" preterm labor that result in preterm delivery.

Female↗
PubMed1993

Combined pentalogy of Cantrell and sirenomelia: a case report with speculation about a common etiology.

A case of combined pentalogy of Cantrell with sirenomelia in a monozygotic twin is described. Similar cases from the world literature are reviewed. Current concepts on the etiology of anterior midline ventral wall defects and sirenomelia are detailed. It has been proposed that anterior midline ventral wall defects may be caused by either monozygotic twinning or vascular dysplasia. Likewise, a vascular steal phenomenon causes sirenomelia. A common etiology for these defects, an alteration in vascular development, is proposed.

Abnormalities, Multiple↗
PubMed1993

Ear length in second-trimester aneuploid fetuses.

OBJECTIVE: To test the hypothesis that small ears have diagnostic value in detecting second-trimester aneuploid fetuses by ultrasound. METHODS: We prospectively studied 452 patients with singleton pregnancies undergoing ultrasound examination for genetic amniocentesis at 14-25 weeks and an additional 30 singleton pregnancies at 20-25 weeks with a negative anomaly screen. Standard fetal biometry measurements were obtained, including ear length (from helix to end of lobe). RESULTS: Of these patients, 424 (88%) had ear measurements obtained, and a nomogram for ear length by gestational age was compiled. The relationship between ear length and gestational age was linear across the second trimester (r = 0.84, P < .001). Fourteen fetuses had aneuploidy by amniocentesis, of whom ten had ear lengths at or below the tenth percentile. The sensitivity was 71% and the specificity 92% (377 of 410). Positive and negative predictive values were 23% (ten of 43) and 99% (377 of 381), respectively. CONCLUSION: Fetal ear length may be useful in identifying aneuploid fetuses sonographically during the second trimester.

Aneuploidy↗
PubMed1992

Transverse cerebellar diameter measurements in twin pregnancies and the effect of intrauterine growth retardation.

OBJECTIVES: Transverse cerebellar diameter measurements have been established for singleton but not twin pregnancies. In singleton pregnancies controversy exists on whether cerebellar growth is affected by intrauterine growth retardation. We undertook this retrospective study in twin pregnancies to establish a nomogram for the transverse cerebellar diameter in twins and to assess the effect of growth retardation on this measurement. STUDY DESIGN: A retrospective review was performed on 171 patients with twin pregnancies with reliable dating from 15 to 36 weeks' gestation who had been referred to our antenatal evaluation unit for routine ultrasonographic examination. Of the 342 fetuses, 322 were available for analysis and establishment of a nomogram for the transverse cerebellar diameter. Twenty-four twin, growth-retarded fetuses were analyzed separately. RESULTS: The transverse cerebellar diameter increased linearly with gestational age (r = 0.94, p < 0.001). Fifteen (63%) of the growth-retarded fetuses had a transverse cerebellar diameter of < or = 5th percentile for gestational age. CONCLUSION: We suggest that intrauterine growth retardation may affect cerebellar growth in twins.

Cerebellum↗
PubMed1992

A comparison of pre-discharge survival and morbidity in singleton and twin very low birth weight infants.

The perinatal mortality rate of twins is four to 11 times higher than that of singletons, and twins are widely reported to have more morbidity than singletons, mainly because of a higher preterm birth rate. However, it is not clear that live-born preterm birth rate. However, it is not clear that live-born preterm twins suffer greater morbidity than comparable singletons. In fact, twins have been reported to develop pulmonary maturity earlier than singletons, which might result in decreased morbidity relative to comparable preterm singletons. We conducted this retrospective review of 496 consecutive singleton and 104 twin infants weighing 500-1499 g and born alive at 24-31 weeks' gestation to determine whether pre-discharge survival and morbidity in very low birth weight (VLBW) twin infants were greater than those of comparable singletons. The mean (+/- standard deviation) gestational age of the singletons was 27.5 +/- 2.0 weeks and of the twins 27.6 +/- 2.0 weeks. There were no differences in mean gestational age, gestational age distribution, mean birth weight, birth weight distribution, gender, or maternal race between the two groups. The pre-discharge survival rate for twins (77%) was not significantly different than that of singletons (82%). There were no differences between twins and singletons in the incidences of neonatal respiratory distress syndrome (63 versus 71%), pulmonary interstitial emphysema (14 versus 16%), patent ductus arteriosus (28 versus 29%), necrotizing enterocolitis (3 versus 5%), intraventricular hemorrhage (11 versus 16%), and retinopathy of prematurity (11 versus 18%). The incidence of bronchopulmonary dysplasia was significantly less in twins (27 versus 46%; P = .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
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↗
PubMed1992

Pregnancy outcome following first-trimester varicella infection.

Varicella infection in the first trimester has been associated with a constellation of congenital abnormalities. The incidence of the congenital varicella syndrome is unknown, although it has been reported to be as high as 9%. In a prospective study performed between 1986-1990, 40 patients were identified who had first-trimester varicella infection. Pregnant patients were referred from physicians in the perinatal regional network after developing the classical picture of varicella infection. Targeted fetal ultrasound examinations were performed between 16-20 weeks' gestation in all cases and neonatal outcome was determined. Of the 40 patients, three had first-trimester losses and another underwent an elective termination of pregnancy after counseling. Of the remaining 36 women, one had fetal omphalocele. Thirty-five pregnancies continued until term, and no infant had features of the congenital varicella syndrome at birth. Other than the case of omphalocele, no major congenital anomalies were identified. This study, the largest series of patients with first-trimester varicella infection, showed an incidence of congenital varicella syndrome of 0% and an incidence of congenital anomalies of 3% (range 0-8% at 95% confidence level).

Chickenpox↗
PubMed1991

Relationship between fetal biophysical activities and umbilical cord blood gas values.

In a prospective study of 62 patients undergoing cesarean section before the onset of labor a fetal biophysical profile assessment was performed within 3 hours before the cesarean section. The presence or absence of the individual fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetuses with nonreactive nonstress test results or the absence of breathing had significantly lower cord artery pH, PO2 bicarbonate, and base excess measurements but not a significantly different PCO2 level as compared with fetuses that had these activities present. Fetuses with the absence of movements or tone had lower pH, PO2 bicarbonate, and base excess levels and higher PCO2 levels as compared with fetuses with the presence of movements or tone, respectively. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. Subsequent analysis of the blood gas and acid-base measurements of the fetuses with compromised biophysical activities revealed that there are different levels of acidemia, hypoxemia, and hypercapnia at which the individual biophysical activities are compromised. These data suggest that the first manifestations of fetal hypoxemia and acidemia are nonreactive nonstress test results and loss of fetal breathing; in advanced acidemia, hypoxemia, and hypercapnia fetal movements and fetal tone are compromised.

Carbon Dioxide↗
PubMed1991

The relationship between umbilical artery Doppler velocimetry and fetal biometry.

The relationship between peak-systolic/end-diastolic ratio of the umbilical artery waveform and fetal biometry was studied in 127 uncomplicated pregnancies with established dates between 20 and 40 weeks' gestation. At each ultrasonographic examination fetal biometry included measurement of the biparietal diameter, head circumference, abdominal circumference, and femur length. The peak-systolic/end-diastolic ratio was measured by either a continuous or a pulsed-wave method. There were significant linear negative correlations between all the biometric parameters, as well as between the ultrasonographically estimated fetal weight and peak-systolic/end-diastolic ratio. Of the individual ultrasonographic parameters the femur length (for gestations less than 30 weeks) and the abdominal circumference (for gestations greater than or equal to 30 weeks) were found to be best correlated with the peak-systolic/end-diastolic ratio. Regression curves, including the 10th and the 90th percentile, were developed between each biometric parameter (biparietal diameter, head circumference, abdominal circumference, and femur length), as well as between estimated fetal weight and peak-systolic/end-diastolic ratio. The estimated fetal weight nomogram had the best sensitivity (48%) in predicting intrauterine growth retardation. These nomograms should prove most useful in assessing downstream placental vascular resistance in high-risk patients with unknown dates.

Adolescent↗
PubMed1991

Comparison of humerus length with femur length in fetuses with Down syndrome.

A recent report by FitzSimmons et al. demonstrated a greater frequency of upper- versus lower-extremity shortening in autopsies of second-trimester fetuses with trisomy 21. We undertook this study to determine whether this upper-limb shortening could be detected by prenatal ultrasonography in the second trimester and therefore identify fetuses at risk for trisomy 21. A retrospective review of all prenatal sonograms preceding genetic amniocentesis was conducted. Between 1987 and 1990 11 consecutive fetuses between 15 and 22 weeks' gestation with trisomy 21 were identified by genetic amniocentesis. Femur and humerus lengths were plotted on growth curves created from 1470 normal patients between 12 and 26 weeks. Gestational age was confirmed by last menstrual period and biparietal diameter. In fetuses with trisomy 21, seven of 11 humeri were less than 5th percentile, for a sensitivity of 64%, whereas only two of 11 femurs were less than 5th percentile, for a sensitivity of 18%. Biparietal diameter/femur length and biparietal diameter/humerus length ratios were also tested to predict Down syndrome. In only 2 of 11 cases was the biparietal diameter/femur length ratio greater than 95th percentile, whereas the biparietal diameter/humerus length ratio was greater than 95th percentile in 7 of 11. Since all seven were identified by shortened humerus alone, we conclude that humerus length versus gestational age is the simplest and most effective screen. The positive predictive value of an abnormally short humerus length in detecting Down syndrome was 6.8% in our population where the prevalence of Down syndrome was 1 of 173. The present study supports the observations of FitzSimmons et al. that shortened humerus length has a greater sensitivity than femur length in cases of trisomy 21. We conclude that in fetuses at risk for trisomy 21 humerus length should be determined, because it may, if shortened, aid in the prenatal diagnosis.

Anthropometry↗
PubMed1991

The relationships among umbilical artery velocimetry, fetal biophysical profile, and placental inflammation in preterm premature rupture of the membranes.

The relationships among umbilical artery velocimetry, fetal biophysical profile, and placental inflammation in 44 consecutive patients with preterm premature rupture of the membranes were determined. All patients were followed up with daily fetal biophysical profiles and systolic/diastolic ratios. After delivery, placental pathologic examination for histologic evidence of infection (umbilical vasculitis) was performed in all cases according to a standard protocol. The longitudinal trends of fetal biophysical profile scores and systolic/diastolic ratios were analyzed for patients with and without umbilical vasculitis. Analysis of the longitudinal trend during the period of 2 to 7 days before delivery showed that there were no differences of biophysical scores of systolic/diastolic ratios in either group. However, in the last examination, within 24 hours of delivery, patients with umbilical vasculitis had higher systolic/diastolic ratios and lower biophysical profile scores as compared with previous examinations. In addition, the biophysical profile score of the last examination 24 hours before delivery in patients with umbilical vasculitis was found to be significantly lower as compared with patients without umbilical vasculitis (mean +/- SD, 6.6 +/- 2.3 versus 8.2 +/- 2.4, respectively). These data suggest that subclinical stages of infection are associated with biophysical alterations of the fetoplacental unit (i.e., simultaneous decrease in fetal biophysical activities and increase in systolic/diastolic ratios). Daily umbilical artery systolic/diastolic ratios, in conjunction with biophysical profiles, may be useful to follow up patients with preterm premature rupture of the membranes.

Blood Flow Velocity↗
PubMed1991

Cord blood gases and abnormal fetal biophysical assessment in preterm premature rupture of the membranes.

The relationship between cord blood gases and infection outcome was determined in 53 consecutive patients with preterm premature rupture of the membranes who were delivered because of abnormal fetal biophysical assessment. Measures of infection outcome included the presence of clinical amnionitis, possible neonatal sepsis, and neonatal sepsis. Fetal acidosis at birth, as defined by cord arterial pH less than 7.20, was found in six fetuses; five of these developed neonatal sepsis and the other was born to a mother who had intrapartum clinical amnionitis. The mean cord blood pH (artery and vein) of fetuses with neonatal sepsis was significantly less than in fetuses with possible neonatal sepsis or no sepsis; however, two thirds (10 of 15) of the neonates with sepsis had normal acid-base status at birth. These data suggest that the fetal biophysical assessment becomes abnormal before the development of fetal acidosis. The possible mechanisms by which fetal infection diminishes fetal biophysical activities prior to the development of acidosis are discussed.

Bicarbonates↗