A sound way to diagnose congenital anomalies.
Explore the source record for details and available documents.
Congenital Abnormalities↗
Biomedical subjects
J F Rodis
Publications and source records attributed to J F Rodis.
Congenital heart defects--and other prenatal findings.
Explore the source record for details and available documents.
Bone and Bones↗
Elevated maternal serum alpha-fetoprotein and mild fetal uropathy.
Sixty-one consecutive patients referred because of elevated maternal serum alpha-fetoprotein (MSAFP) levels and 80 referred for second-trimester ultrasound for other reasons were examined. Ultrasound examination of the genitourinary tract and assignment of phenotypic sex was done by ultrasonographers blinded to the MSAFP results. Among male fetuses with elevated MSAFP, 33% had pyelectasis compared with only 5% of controls. Among female fetuses, pyelectasis was seen in 16% of cases and no controls. Increased MSAFP not caused by an open neural tube defect may be seen in conjunction with mild benign uropathy in the second trimester.
Dilatation, Pathologic↗
The relationship between fetal biophysical assessment, umbilical artery velocimetry, and fetal acidosis.
In a prospective study of 62 patients undergoing cesarean delivery before the onset of labor, fetal biophysical assessment and umbilical artery systolic-diastolic ratios (S/Ds) were performed within 3 hours of delivery. There was a significant relationship between the fetal biophysical profile score and cord arterial as well as cord venous pH. However, there was no identifiable relationship between S/D and cord arterial or venous pH. The efficacies of the biophysical components alone (nonstress test [NST] and fetal biophysical profile) and in combination with S/D to predict fetal acidosis were determined. The NST had the best sensitivity (100%) and negative predictive value (100%). The fetal biophysical profile had the best specificity (91%), positive predictive value (62%), and overall efficiency (90%). The S/D had the lowest sensitivity (66%), specificity (42%), positive predictive value (16%), negative predictive value (88%), and overall efficiency (45%). The addition of S/D to the NST or fetal biophysical profile did not improve diagnostic accuracy. These data suggest that the NST should be used as a primary test for the antepartum detection of fetal acidosis, whereas the fetal biophysical profile is a reasonable adjunct test. The umbilical artery S/D, as determined by continuous-wave Doppler velocimetry, has no value as a primary method or an adjunct in the antepartum detection of fetal acidosis.
Acidosis↗
Placenta previa is not an independent risk factor for a small for gestational age infant.
Previous studies have presented conflicting evidence on the association between intrauterine growth retardation (IUGR) and placenta previa, with some groups reporting rates of IUGR as high as 16-19%. However, most of these studies failed to include a control population, included patients with other factors known to be associated with IUGR (eg, chronic hypertension, fetal anomalies, pregnancy-induced hypertension, insulin-dependent diabetes mellitus, etc), and/or did not confirm the patient's estimated gestational age. During the study period of January 1, 1980 through June 30, 1990, 54,969 deliveries occurred at the three affiliated hospitals of the Maternal-Fetal Medicine Division of the University of Connecticut Health Center. Review of the delivery records revealed 179 singleton pregnancies with documented placenta previa and without the above exclusion factors. One hundred seventy-one of these 179 study patients were compared with 171 women without placenta previa matched for confirmed gestational age, race, parity, and fetal sex. The incidence of small for gestational age (SGA) infants was 4.1% (seven of 171) in the study group and 5.8% (ten of 171) in the control group. Mean birth weights were 2559 and 2476 g, respectively. Neither difference was statistically significant. These results suggest that the prenatal diagnosis of an SGA fetus in a pregnancy complicated by placenta previa should not simply be attributed to abnormal placental implantation. Furthermore, routine ultrasonic examinations for growth in pregnancies complicated by placenta previa are not indicated.
Birth Weight↗
Transverse cerebellar diameter/abdominal circumference ratio throughout pregnancy: a gestational age-independent method to assess fetal growth.
In a prospective study of 162 patients, measurements of the transverse cerebellar diameter (TCD) and abdominal circumference (AC) were obtained between 15-38 weeks' gestation. A ratio between the TCD and AC was calculated after each examination. This ratio remained constant during gestation. The mean ratio was 13.7% (fifth and 95th percentiles of 11.9 and 15.9%, respectively); the median ratio was 13.6%. Forty-two patients had repeat measurements and the ratio did not change. This ratio is gestational age-independent; however, further investigation is needed to determine its application in the assessment of fetal growth abnormalities.
Abdomen↗
Management and outcomes of pregnancies complicated by human B19 parvovirus infection: a prospective study.
During a large statewide outbreak of fifth disease in Connecticut in 1988, 39 pregnant women were identified who had serologic evidence of recent human B19 parvovirus infection. The patients were followed up prospectively with targeted fetal ultrasonographic examinations to detect signs of fetal hydrops. Of these 39 pregnant women, 37 had healthy infants and two patients had miscarriages. None of the fetuses developed hydrops. We propose that pregnant women exposed to B19 parvovirus be tested for evidence of IgG and IgM B19-specific antibodies and that targeted fetal ultrasonography be considered when IgM antibodies are found. Percutaneous umbilical blood sampling and intrauterine transfusion can be considered in cases of B19 parvovirus-associated hydrops and anemia. The overall fetal loss rate in this prospective follow-up group was 5%.
Abortion, Spontaneous↗
Intrauterine fetal growth in concordant twin gestations.
We longitudinally assessed intrauterine ultrasonic growth parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) in 60 pairs of concordant twins. Head circumference to abdominal circumference and femur length to abdominal circumference ratios were calculated. Estimated fetal weight curves were created with the formula of Shepard et al., incorporating biparietal diameter and abdominal circumference, as well as that of Hadlock et al., incorporating femur length and abdominal circumference. Biparietal diameter was obtained in only 79% of fetuses, whereas femur length and abdominal circumference were obtained in 96% and 99% of fetuses, respectively. The intrauterine growth of abdominal circumference appears to be linear between 18 and 40 weeks, fitting the simple equation abdominal circumference = -4.5 + 0.97 gestational age (gestational age in weeks). The mean femur length to abdominal circumference ratio is 22.4 +/- 1.5 and appears to be gestational age independent between 20 and 40 weeks. The head circumference to abdominal circumference ratio decreases as gestational age advances in a linear fashion. Estimated fetal weight curves by the formulas of both Shepard et al. and Hadlock et al. fit second-order polynomial equations. Neither formula appears to be superior in estimating fetal weight in twin gestations, although that of Hadlock et al. can be used more frequently since biparietal diameter cannot always be obtained in both twins.
Embryonic and Fetal Development↗
Intrauterine fetal growth in discordant twin gestations.
Twenty-five discordant twin pairs were assessed ultrasonically in a longitudinal fashion and were compared with a group of 60 concordant twin pairs. The growth parameters of the larger fetus of the discordant pair did not differ significantly from the concordant twins, while the smaller of the discordant pair exhibited a slower rate of intrauterine growth as early as 23 to 24 weeks. We conclude that (1) twins who ultimately become discordant exhibit demonstrable differences as early as 23 to 24 weeks; (2) the smaller twin in a discordant pair has a much slower rate of growth between 33 to 37 weeks; and (3) using estimated fetal weight to predict concordancy and discordancy by Shepard's and Hadlock's tables are equally efficacious, although Hadlock's table can be used more often because biparietal diameter cannot be obtained as often as femur length.
Diseases in Twins↗
Calculated risk of chromosomal abnormalities in twin gestations.
Genetic counseling concerning the risks of chromosomal abnormalities in twin gestations can be difficult; the risk of amniocentesis is weighed against that of chromosomal abnormalities in either one or both of the twins. Because most twins are dizygotic (each with a risk a priori of aneuploidy), the chance that one of the fetuses is affected is greater than would be expected for a singleton. Only three possibilities would result in either one or both twin's being affected: 1) dizygotic twins with one fetus affected, 2) dizygotic twins with both fetuses affected, and 3) monozygotic twins with both fetuses affected. Using existing tables of estimated risks of chromosomal abnormalities in singleton gestations and mathematically derived formulas, we created tables defining the age-related risks of chromosomal abnormalities in twin gestations. According to these tables, a patient at 33 years of age with a twin gestation has a risk of Down syndrome in at least one of her twins equivalent to that of a 35-year-old with a singleton. Prenatal genetic testing should be considered for women with twins at a younger age than the traditional 35.
Adult↗
Comparison of six different ultrasonographic methods for predicting lethal fetal pulmonary hypoplasia.
Nomograms of six different ultrasonographic fetal parameters were established by studying uncomplicated, singleton pregnancies, with well-established dates, between 16 and 40 weeks of gestation. The studied parameters could reflect fetal lung mass and included the following: chest circumference (CC), chest area (CA), chest area minus heart area (CA - HA), chest circumference/abdominal circumference ratio (CC X 100/AC), chest area/heart area ratio (CA/HA), and chest area minus heart area divided by chest area ratio [(CA - HA) X 100/CA]. The effect of ruptured membranes on these six ultrasonographic parameters was assessed by studying patients who had premature rupture of the membranes of less than 1 week's duration. It was found that premature rupture of the membranes is associated with increased frequency of CC, CA, and CA - HA measurements at or below the 5th percentile. However, in patients with premature rupture of the membranes all measurements were within the normal range for the three ratios. The efficacy of each of the six parameters was determined by studying 13 fetuses at high risk for development of lethal pulmonary hypoplasia. The (CA - HA) X 100/CA parameter had the best diagnostic accuracy (sensitivity 85%, specificity 85%, positive predictive value 83%, and negative predictive value 85%).
Female↗
Relationship between cyclic variation of fetal heart rate patterns and cord pH in preterm gestations.
The presence or absence of cyclic variation (cyclicity) of fetal heart rate patterns was prospectively investigated in fetuses between 25 and 32 weeks' gestation. All fetuses were delivered by cesarean section before the onset of labor. The relationship between the presence or absence of fetal heart rate cyclicity and fetal acidosis, as determined by cord pH measurements, was investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of this method in predicting fetal acidosis were: 100, 90, 50, and 100%, respectively. All fetuses with reactive nonstress tests also had fetal heart rate cyclicity present and none were acidotic at birth. The majority of fetuses (68.8%) with nonreactive nonstress tests had fetal heart rate cyclicity present and none were acidotic; fetuses with nonreactive nonstress tests and absence of fetal heart rate cyclicity were acidotic in 50% of the cases. These preliminary data suggest that the presence or absence of fetal heart rate cyclicity may help to select the healthy preterm fetuses with nonreactive nonstress testing who are in good condition and therefore in no need for further testing.
Acidosis↗
Neonatal survival rates based on estimated fetal weights in extremely premature infants.
With the increasing survival rates of the extremely premature infants, counseling patients as to the potential outcome of the pregnancy is difficult. Traditional methods of basing survival rates on gestational age and actual birthweights have limitations. This study compares survival rates based on ultrasonically estimated fetal weights to those of actual birthweights and demonstrates an excellent correlation at this institution. It is suggested that individual institutions should construct their own neonatal survival rates based on estimated fetal weights for the extremely premature fetus to counsel better patients at risk for early delivery.
Birth Weight↗
Maternal smoking and accelerated placental maturation.
In a prospective study of 367 patients referred for obstetric ultrasound evaluation, maternal cigarette smoking was found to have an important effect on the rate of placental maturation. The frequencies of grades 0, I, II, and III placentas throughout gestation were determined for both smoking and nonsmoking groups. Overall, the smoking mothers had more mature placentas than the nonsmoking mothers. This was reflected by the earlier mean gestational age at appearance of each of the placental grades in the smoking group as compared with the nonsmoking group. The mean gestational ages at appearance of grades 0, I, II, and III placentas for smoking mothers were 23.5, 27.9, 32, and 34.4 weeks, respectively, as compared with 26, 31.6, 35.7, and 38.3 weeks in the nonsmoking group. Smokers had a greater frequency of grade II placentas from 22-35 weeks than nonsmokers, and a greater frequency of grade III placentas beyond 25 weeks.
Female↗
Fetal biophysical profile scoring: current status.
The fetal biophysical profile may assist the clinician to ascertain the fetal condition at the time of testing (acute markers), the degree of fetal compromise (gradual hypoxia concept), the presence of chronic fetal stress or possibility of in utero death due to cord accident (oligohydramnios), intrapartum complications such as abnormal heart rate patterns and abruptio (grade III) placenta, and impending fetal infection in patients with PROM (if performed daily). In addition it may identify major congenital anomalies which may drastically alter obstetric management. It remains to be seen if the use of computer-assisted systems for concurrent observation of the biophysical activities, or the addition of more biophysical variables, will further improve the accuracy of this testing method.
Female↗
Use of the fetal biophysical profile in severe oligohydramnios after preterm premature rupture of the membranes.
A protocol of expectant management using daily fetal biophysical assessment was applied to 23 consecutive women with severe oligohydramnios after preterm premature rupture of the membranes. A persistently low biophysical score (less than or equal to 6 on two examinations two hours apart) in the presence of a nonreactive nonstress test and absence of fetal breathing was used as an indication for delivery. The pregnancy outcome in this group was compared to that in a historic control group managed similarly except that an abnormal biophysical assessment was not an indication for delivery. The results suggest that the management of women with severe oligohydramnios after preterm premature rupture of the membranes with daily fetal biophysical profiles decreases the incidence of low five-minute Apgar scores as well as that of maternal and neonatal infection.
Amniotic Fluid↗
Human parvovirus infection in pregnancy.
During an outbreak of fifth disease in the Hartford, Connecticut area in the winter of 1986, nine pregnant women were exposed to the parvovirus. Five of these nine had serologic evidence of previous exposure and immunity; all five had uneventful pregnancies. Three of the four women who exhibited serologic evidence of recent exposure to the parvovirus had hydropic fetuses who died, one of whom was anencephalic. Histologic and DNA hybridization studies suggest parvovirus infection as a cause for nonimmune hydrops and fetal death. A review of the literature suggests that of 37 women who were exposed and infected by human B19 parvovirus during pregnancy, 14 (38%) had adverse outcomes, including spontaneous abortions, intrauterine fetal death, and congenital anomalies. Women at high risk for exposure (school teachers) should have screening for immunoglobulin G parvovirus-specific antibodies; if these are absent, they should avoid close contact with schoolchildren. Pregnant women with evidence of recent infection should have a level II ultrasound. Because no vaccine is currently available, routine screening cannot be recommended.
Adolescent↗
Spontaneous resolution of fetal cystic hygroma in Down's syndrome.
We describe a case of spontaneous resolution of a cystic hygroma between 14-16 weeks' gestation in a fetus with trisomy 21 who, at termination at 19 weeks, revealed only mild webbing of the neck. Redundant nuchal skin folds are among the most common features of trisomy 21. Our case supports the hypothesis that this redundant skin of the fetal neck represents early cystic hygromas, which resolve in utero before 16 weeks' gestation.
Adult↗