Biomedical subjects
Publications and source records attributed to J M Thorp.
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.
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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.
Preterm delivery (less than 37 weeks completed gestation) is known to result from diverse etiologic pathways, which can be grouped into idiopathic preterm labor, preterm premature rupture of the membranes, and medical complications. Data from publications providing sufficient detail to subdivide preterm delivery cases into these groups were tabulated. In spite of inconsistent terminology and incomplete reporting, patterns were identified. Black women have a markedly higher risk of preterm delivery, which is especially pronounced for preterm premature rupture of the membranes. Idiopathic preterm labor is predominant in lower-risk, white populations. These observations encourage consideration of subcategories of preterm delivery in studies of etiology and prevention.
Malpresentation is a common complication of pregnancy. Using ultrasound as the gold standard, we prospectively tested Leopold maneuvers as a screen for nonvertex presentation in the third trimester. In our hands this technique performed poorly. Values for sensitivity, specificity, positive predictive value, and negative predictive value were 28, 94, 24, and 95%, respectively, in a population with a 7% prevalence of noncephalic presentation. Much of the correlation between the screening and diagnostic tests seemed to arise from chance (kappa = 0.13).
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.
Gonadotropin releasing hormone agonists are often used in the management of myomas in an attempt to decrease both the myoma and uterine volume. This therapy in a woman with submucous myomas resulted in profuse vaginal bleeding requiring a transfusion and myomectomy.
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.
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We reviewed twin deliveries during a five year period at North Carolina Memorial Hospital and Wake County Medical Center in which Twin B presented as nonvertex. We compared three delivery routes: primary abdominal delivery, breech extraction of the second twin and external version of the second twin. There was no difference in neonatal outcome between the delivery routes. Mothers in the external version group were more likely than those in the breech extraction group to undergo abdominal delivery of the second twin. These women also required more emergency anesthesia, had a higher blood loss and stayed in the hospital longer after delivery.
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A new technique using acrylic plug surface electrodes was employed to record electromyographic activity in the musculature surrounding the rectum and vagina. Forty-one asymptomatic nulliparous women were tested. The group had a wide range of normal values. When eight women were chosen at random for a second testing session, intra-class correlation coefficients to compare readings between the two sessions ranged from 0.76-0.97, indicating adequate reliability. No demographic factor correlated with the voltage generated in these women.
A patient is described who had three consecutive fetuses with cystic hygroma and hydrops, two of which had documentation of normal karyotype. Some twenty percent of fetuses with cystic hygroma have a normal karyotype, and many of these have other major malformations. An autosomal recessive pattern of inheritance has been postulated, but cystic hygroma may also occur in association with a variety of syndromes, some of which have other patterns of inheritance.
Triamcinolone acetonide, a fluorinated glucocorticoid, when given in large parenteral doses has produced structural anomalies and severe growth retardation in nonhuman primates. We present a case report of a gravid patient who applied 40 mg/day of triamcinolone cream because of atopic dermatitis from 12 to 29 weeks' gestation. The infant was symmetrically growth retarded, possibly from exposure to triamcinolone acetonide. There was no evidence of hypoxic, chromosomal, or infectious cause of the growth delay.
Autonomic hyperreflexia is a serious complication for paraplegic patients. A paraplegic woman in early labor presented with autonomic hyperreflexia. After epidural analgesia was established, hyperreflexia resolved. When the analgesic wore off, hyperreflexia returned. Continuous epidural analgesia may be helpful for pregnant women who are susceptible to autonomic hyperreflexia.
In a patient in whom preeclampsia developed at 23 weeks' gestation, ultrasonographic examination of the fetus showed enlarged edematous lungs, a compressed fetal heart, severe ascites, fetal hydrops, and placental edema. Autopsy of the hydropic stillborn infant showed laryngeal atresia. The ultrasonographic appearance of this rare malformation is presented.
Sixty-one of 375 women with hypertension and preeclampsia in a 48-month period had thrombocytopenia. By postpartum day 3, 90% of these women had rising platelet counts, and by day 4, 59 of 61 women had counts greater than 100,000/mm3. The two exceptions had other pathologic conditions in addition to preeclampsia. Thrombocytopenia associated with preeclampsia should resolve by postpartum day 4.
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