Biomedical subjects
Publications and source records attributed to J F Rodis.
Reported is a case of maternal hypothermia associated with magnesium sulfate therapy for treatment of preterm labor. Hypothermia was accompanied by fetal and maternal bradycardia. After discontinuation of magnesium sulfate infusion, maternal temperature, pulse, and fetal heart rate gradually returned to normal. No adverse effects were noted on either maternal or fetal outcome.
A protocol using daily fetal biophysical assessment was applied in 73 consecutive patients with premature rupture of the membranes and no clinical signs of infection or labor. A persistently low biophysical score (7 or less on two examinations 2 hours apart) in the presence of a nonreactive nonstress test and absence of fetal breathing was used as an indication for delivery. Measures of pregnancy outcome included the presence of amnionitis or neonatal infection. The outcome of pregnancy in this group of patients was compared with the outcomes of two historic groups: one managed conservatively (control group) and the other managed with amniocentesis on admission to the hospital (amniocentesis group). Infection outcome, maternal as well as neonatal, and low 5-minute Apgar scores were significantly less in the study than in the control group. The frequency of neonatal sepsis was significantly less in the study than in the amniocentesis group. These data suggest that management of premature rupture of the membranes with daily fetal biophysical profiles improves pregnancy outcome by reducing the incidence of maternal and neonatal infection.
Most current sonographic techniques for estimating fetal weight involve measurements of the head, abdomen, and femur length both alone and in combination. The value of the fetal thigh circumference measurement in addition to the head, abdominal, and femur length measurements has not been investigated previously. Eighty-nine patients were scanned within 72 hours of delivery, and the following ultrasonic fetal parameters were obtained in all fetuses: biparietal diameter, head circumference, abdominal circumference, femur length, and thigh circumference. With multiple stepwise regression analysis, the best-fit formulas were developed with one, two, three, four, and five parameters, respectively. The best results were obtained by combining measurements of all five parameters: biparietal diameter, head circumference, abdominal circumference, femur length, and thigh circumference. The mean error of this formula was 6%, the mean deviation 0.3%, and the SD 7.8%. These data suggest that the addition of thigh circumference to measurements of the head, abdomen, and femur length improves the accuracy of fetal weight estimates.
Double survival of monoamniotic twins is rare. Three consecutive cases in which double survival occurred are presented. Accurate antenatal diagnosis, intensive fetal surveillance, and operative delivery should improve neonatal outcome.
The objective of this study was to determine the degree of documented compliance of community-based ultrasound reports with suggested standards/guidelines for basic ultrasound examinations as published by the American College of Obstetricians and Gynecologists (ACOG) and the American Institute of Ultrasound in Medicine (AIUM). First trimester reports from obstetric offices (n = 20) had complete compliance with ACOG guidelines in 35% and AIUM standards in 15% of the cases (p = NS). Radiological reports (n = 26) had complete compliance with ACOG guidelines in 11.5% and AIUM standards in 3.9% of the cases (p = NS). None of the second/third trimester reports from either the obstetrical offices (n = 35) or from radiological facilities (n = 94) had complete compliance with either ACOG or AIUM standards/guidelines. Ultrasound reports generated by community-based obstetricians and radiologists from our referral sources demonstrate significant omissions in documentation of components suggested by AIUM and ACOG for minimum standards of basic ultrasound examinations.
We present a case of fetal hydrops associated with maternal parvovirus infection during the first trimester of pregnancy that sonographically mimicked findings associated with fetal aneuploidy. The transabdominal sonograms of this fetus at 12.9 weeks' gestational age were consistent with increased nuchal translucency thickness. Transvaginal sonographic evaluation of the fetus showed generalized subcutaneous sonolucency suggestive of early fetal hydrops. An etiologic evaluation identified serologic evidence of recent maternal parvovirus infection and a normal karyotype. The pregnancy ended in fetal demise. Our findings suggest that visualization of nuchal translucency thickening in the first trimester should prompt a complete sonographic evaluation for fetal hydrops, which, if identified, should lead to serologic evaluation for parvovirus infection.
This study was designed to determine whether umbilical artery levels of both interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM-1) correlate with levels in the umbilical vein. Paired umbilical artery-vein specimens were assayed for IL-6 and sICAM-1. The paired-sign test was used to compare umbilical artery vein levels of IL-6 and sICAM-1. Spearman rank correlation was used to determine relationships between paired umbilical artery-vein levels for a variety of clinical subgroups. For 23 paired samples overall, umbilical artery levels were greater than corresponding vein levels for both IL-6 (P = .039) and sICAM-1 (P = .035). Artery-vein correlations were significant for IL-6 (rho = 0.845, P = .001) and sICAM-1 (rho = 0.806, P = .0002). Correlations were not influenced by prematurity, route of delivery, labor, or neonatal sepsis. In conclusion, umbilical artery levels of IL-6 and sICAM-1 correlate significantly with umbilical vein levels.
This study was designed to evaluate the relationship of suspected early neonatal sepsis to umbilical artery and vein levels of interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM-1). Umbilical artery and vein samples from 17 preterm and 6 term pregnancies were assayed for IL-6 (pg/ml) and sICAM-1 (ng/ml). Neonates were categorized as having probable or suspected sepsis vs. no sepsis within 3 days of birth. Levels of IL-6 and sICAM-1 were evaluated based on sepsis status. Neonatal hematologic parameters were correlated with umbilical artery (ua) and vein (uv) levels of IL-6 and sICAM-1. Sensitivity, specificity, positive and negative predictive values for detecting neonates having probable or suspected early sepsis were calculated. There were significant differences of IL-6 levels between suspected sepsis and no infants in the umbilical artery (P < 0.002) and vein (P < 0.0001). The sensitivity, specificity, positive and negative predictive values for detection of suspected early neonatal sepsis using umbilical artery IL-6 levels > 7 pg/ml were 88.5%, 66.6%, 58.8%, 91%, and for umbilical vein levels > 7 pg/ml these values were 88.5%, 93.3%, 88.5%, and 93.3%. Umbilical artery and vein IL-6 levels correlated with both absolute band counts and immature/total neutrophil ratios. sICAM-1 levels were not affected by designated sepsis status. Umbilical cord blood IL-6 (but not sICAM-1) is potentially useful as a marker for suspected early neonatal sepsis.
OBJECTIVE: To determine whether a combination of elevated maternal serum alpha-fetoprotein (MSAFP) and low unconjugated estriol (E3) concentration identifies pregnancies at particularly high risk for fetal abnormality or poor outcome. METHODS: Pregnancy outcomes were reviewed for women with elevated MSAFP (> or =2.0 MoM) from our database of 50,315 women who had received triple marker testing from 1993-1998. Outcomes for those with low E3 (< or =0.7 MoM) were compared with those with normal E3 (>0.7 MoM). The incidences of fetal death, neural tube defects, chromosome abnormalities, congenital abnormalities, preterm birth, small-for-gestational age (SGA), twins, and inaccurate dates were compared in the two groups using Fisher's exact test with P < 0.05 considered significant. RESULTS: Of the 50,315 women screened, 1,435 (2.85%) had an elevated MSAFP. Pregnancy outcomes were obtained in 94% of those with elevated MSAFP and 70% of all patients screened. Neural tube defects were present in 57 fetuses/infants (21 anencephalic, 29 spina bifida, 7 encephalocele) of which 46 (81%) had an elevated MSAFP. Of the 1,435 women with an elevated MSAFP, 199 (14%) had a low E3. Compared to those women with elevated MSAFP but normal E3, women with elevated MSAFP and low E3 were at significantly increased risk for fetal death (20.6% vs. 2.8%, relative risk (RR) 8.9), anencephaly (9.0% vs. 0.1%, RR 122.8) and chromosome abnormality (2.5% vs. 0.6%, RR 4.0). CONCLUSIONS: Pregnancies complicated by elevated second trimester MSAFP and low E3 are at a particularly high risk (32%) for lethal perinatal outcomes. Twins, while a common cause of elevated MSAFP, are rarely found when an elevated MSAFP is associated with low E3.
The sonographic characteristics and the frequency of the presence or absence of fetal hair in the occipital region was determined from 16 weeks to 42 weeks of menstrual age. Our results suggest that the ultrasonic appearance of occipital hair is first noted at approximately 24 weeks of menstrual age and there is a progressive increase in frequency of hair presence as pregnancy approaches term. The normal ultrasonic characteristics of occipital fetal hair are described, and the differential diagnoses between normal fetal hair and malformations such as meningocele, encephaloceles, or cystic hygromas is discussed.
Fetal/neonate kidneys obtained at the time of autopsy were utilized to determine a suitable needle biopsy gauge to obtain renal parenchyma for histologic evaluation. Twenty-one fresh kidney specimens from 11 fetuses/neonates between 16-40 weeks gestation were used to obtain needle biopsies using 20-, 18-, 16-, and 14-gauge biopsy catheters. The specimens were graded according to the presence of normal histologic features of renal parenchyma. Seventy-five renal biopsies were obtained. The biopsy histology was interpreted using a grading system based on the presence of normal features of the renal parenchyma. Sixty-three (84%) of the samples were graded histologically as adequate (cortex or medulla present). Samples with both cortex and medullary structures present (completely adequate) were obtained in 39/63 (62%) of these adequate biopsies. The 14- and 16-gauge biopsy catheters gave the best results, respectively yielding 79 and 69% completely adequate biopsies. This is in contrast to the 20- and 18-gauge catheters that respectively yielded 35 and 25% completely adequate biopsies. Our initial results indicate that adequate kidney biopsies can be obtained. However, the current technique is associated with core sample disruption when the smaller gauge catheters are used. This could account for the low rate of completely adequate samples with the smaller gauge catheters. A different sampling technique is needed to overcome sample disruption, to determine the smallest catheter gauge that will yield a suitable tissue sample for histologic evaluation.
Abnormal fetal biometry is considered a marker for fetal trisomy. We prospectively evaluated the biparietal diameter/femur length ratio to identify Down syndrome fetuses. This ratio was calculated when women (< 35 years old) underwent an amniocentesis for an abnormal biochemical screen for Down syndrome. Using reported ratio cut-offs (> 1.5 SD above the mean), the ratio had a sensitivity of 50% (3/6), specificity of 92% (244/264), positive predictive value of 13% (3/23), negative predictive value of 99% (244/247), and a relative risk of 10.8. Using our own population ratio, a cut-off > 1.5 SD had a sensitivity of 50% (3/6), specificity of 94% (249/252), positive predictive value of 17% (3/18), negative predictive value of 99% (249/252) and a relative risk of 13.9. A lower cut-off decreased the efficacy to detect Down syndrome. A ratio > 1.5 SD above the mean is a useful adjunct to identify Down syndrome in pregnancies at risk by an abnormal biochemical screen.