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Biomedical subjects

J R Wax

Publications and source records attributed to J R Wax.

At least 37 records · Page 2Linked to original sources
PubMed1998

Adjunctive color Doppler ultrasonography in second-trimester transabdominal amnioinfusion.

Transabdominal amnioinfusion improves the diagnostic accuracy of ultrasonography in pregnancies complicated by second-trimester oligohydramnios. Needle localization may be difficult because of patient obesity or the absence of an acoustic window. The two cases presented demonstrate that color Doppler imaging facilitates amnioinfusion by visualizing the injection jet of free-flowing infusate, confirming intraamniotic needle placement.

Adult↗
PubMed1998

Differential transmission of adenovirus in a twin pregnancy.

BACKGROUND: Intrauterine adenovirus infection has been associated with nonimmune hydrops. We describe a twin pregnancy in which adenovirus was demonstrated by polymerase chain reaction in the amniotic fluid of one twin afflicted by hydrops. Adenovirus was absent in the amniotic fluid of the other twin. CASE: A 25-year-old, gravida 3, para 1, with twin gestation at 20 weeks' gestation was noted on ultrasound anomaly screen to have hydrops associated with twin B. Polymerase chain reaction analysis of amniotic fluid revealed adenovirus in twin B with none noted in twin A. At 26 weeks' gestation both infants died. CONCLUSION: This case demonstrates differential transmission of adenovirus in a twin pregnancy. One twin developed hydrops fetalis possibly secondary to adenovirus infection.

Adenovirus Infections, Human↗
PubMed1998

Acute intentional iron overdose in pregnancy.

BACKGROUND: Although iron is the second most common overdose agent in pregnancy, the obstetric literature does not reflect current management of this emergency. CASE: A 27-year-old woman, para 0-3-4-3, at 27 weeks' gestation ingested 24 mg/kg of elemental iron in a suicide attempt. Therapy with crystalloid hydration, gastric lavage, and intravenous deferoxamine chelation treated the overdose without maternal or fetal complications. CONCLUSION: Pregnancy should not alter therapy for acute iron overdose. Deferoxamine administered in the third trimester is not associated with perinatal complications and is potentially life saving.

Acute Disease↗
PubMed1998

Fetal intracardiac echogenic foci: does it matter which ventricle?

We sought to determine whether an association exists between the location of intracardiac echogenic foci and fetal aneuploidy or structural cardiac lesions. A search of the English language literature since 1980 revealed nine studies reporting location of intracardiac echogenic foci, fetal chromosomal abnormalities, and cardiac anomalies. Aneuploidy was noted in 10 of 217 fetuses with left ventricular and in one of 18 with right ventricular intracardiac echogenic foci. Three of 11 fetuses with biventricular intracardiac echogenic foci were aneuploid, which is significantly more frequently than when intracardiac echogenic foci were present in either ventricle alone (P = 0.02). There were nine cases of trisomy 21, four of trisomy 13, and one of trisomy 18. Structural cardiac lesions were recognized in eight of 217 fetuses with left ventricular foci, two of 18 with right ventricular foci, and one of 11 with biventricular intracardiac echogenic foci (P = 0.16). Biventricular intracardiac echogenic foci are more frequently associated with fetal aneuploidy but not structural lesions, as compared to isolated left or right ventricular intracardiac echogenic foci.

Aneuploidy↗
PubMed1997

Effect of fetal movement on the amniotic fluid index in diamniotic twin gestations.

Fetal movement changes the size and location of amniotic fluid pockets during measurement of the amniotic fluid index. In singleton gestations, the effect of redistributing the fixed intrauterine fluid volume on the amniotic fluid index is clinically insignificant. In this study, we tested the hypothesis that the index in twin pregnancies is unaffected by fetal movement. A single examiner prospectively determined the amniotic fluid index before and after three discrete episodes of movement by both fetuses of 82 diamniotic twin pregnancies referred for obstetric sonograms between 20 and 38 weeks' menstrual age. A reliable blinded examiner provided a second post-movement measurement as a control. Data were analyzed by the paired t-test. The mean change in the amniotic fluid index after fetal movement was 2.1 +/- 0.2 cm and 3.7 +/- 0.3 cm for post-movement determinations by the same and blinded examiners, respectively (p < .001). Interobserver variation was 3.5 cm. Intraobserver variation was 1.8 cm for the first examiner and 2.2 cm for the second examiner. Therefore, interobserver and intraobserver variation can account for the observed change in the amniotic fluid index following movement of both diamniotic twins.

Amniotic Fluid↗
PubMed1997

Pregnancy complicated by multiple endocrine neoplasia type IIA (Sipple's syndrome).

A patient with preexisting multiple endocrine neoplasia type IIA had normal 24-hour urinary metanephrine and vanillylmandelic acid excretions before and during pregnancy. After a benign prenatal course, the patient had a term spontaneous vaginal delivery. Multiple endocrine neoplasia type IIA antedating pregnancy may be associated with a normal obstetric outcome in the absence of a phenochromocytoma.

Adult↗
PubMed1997

Fetal laceration injury at cesarean delivery.

OBJECTIVE: To investigate the incidence of fetal laceration injury in cesarean delivery. METHODS: A retrospective review was conducted using a computer-based data coding system. All neonatal records were reviewed for infants delivered by cesarean during a 2-year period. Maternal records were reviewed in those cases of documented fetal laceration injury. The Fisher exact test was used when indicated. RESULTS: There were 904 cesarean deliveries performed during the study period; of these, 896 neonatal records (98.4%) were available for review. Seventeen laceration injuries were recorded (1.9%). The incidence of laceration appeared higher when the indication for cesarean was nonvertex (6.0% versus 1.4%, P = .02). One of 17 (5.9%) maternal records indicated the presence of the laceration of the fetus. CONCLUSION: Fetal laceration injury at cesarean delivery is not rare, especially when it is performed for nonvertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.

Cesarean Section↗
PubMed1996

Intrapartum fetal atrial bigeminy--diagnostic and therapeutic role of the fetal scalp stimulation test.

Concern for fetal hypoxia often leads to cesarean delivery when persistent fetal bradycardia is identified. A fetus with premature atrial contractions had a prolonged second-stage heart rate of 80 beats/min. Intrapartum echocardiography and electronic fetal heart rate monitoring distinguished bradycardia caused by blocked atrial bigeminy from hypoxic bradycardia. The fetal scalp stimulation test documented normal acid-base balance and normalized the ventricular rate, avoiding cesarean delivery.

Adult↗
PubMed1995

Second trimester uterine atony imitating ectopic pregnancy: magnetic resonance diagnosis.

When an obstetrical patient was referred for inability to auscultate fetal heart tones at 18 weeks' gestation, ultrasound identified a single living fetus in the maternal right upper quadrant. Magnetic resonance imaging (MRI) ruled out a suspected uterine ectopic pregnancy and avoided laparotomy. The patient experienced an uncomplicated term delivery. MRI is a useful adjunct to ultrasound for mid-trimester pregnancy localization when the differential diagnosis includes uterine eccyesis.

Adult↗
PubMed1994

Unilateral renal hypoplasia and contralateral renal agenesis: a new association with 45,X/46,XY mosaicism.

The association of urinary anomalies with Turner's syndrome is well established. This report describes an unusual antenatal presentation of this cytogenetic disorder and the first reported case of unilateral renal hypoplasia and contralateral renal agenesis in a 45,X/46,XY fetus. The fetus presented with severe third trimester oligohydramnios and symmetrical intrauterine growth retardation at 29 weeks and 2 days' gestation. Chorionic villus cultures revealed a 45,X karyotype. A phenotypically male infant weighing 1833 g was delivered at 35 weeks and 2 days. Chromosomal analysis of the newborn showed a 45,X/46,XY mosaicism, and surgical exploration revealed absence of the left kidney and a hypoplastic right kidney. The infant died at 11 months of age from renal failure and peritonitis. This case demonstrates that monosomy X may be encountered in fetuses with marked growth delay and oligohydramnios. The etiology of the oligohydramnios in this case was a fetal renal malformation not previously described in Turner's syndrome. Antenatal cytogenetic findings should be confirmed postnatally, with a search for mosaicism, when monosomy X is encountered.

Female↗
PubMed1993

Effect of fetal movement on the amniotic fluid index.

OBJECTIVES: Fetal movement has been shown to change the size and location of amniotic fluid pockets during measurement of the amniotic fluid index. The effect of redistributing the fixed intrauterine fluid volume on the amniotic fluid index is unknown. Therefore we tested the hypothesis that the amniotic fluid index was unaffected by fetal movement. STUDY DESIGN: A single examiner prospectively determined the amniotic fluid index before and after three discrete episodes of fetal movement during 96 biophysical profiles. A reliable blinded examiner provided a second postmovement measurement as a control. Data were analyzed by the paired t test. RESULTS: The mean change in the amniotic fluid index after fetal movement was 1.5 +/- 0.1 cm and 2.5 +/- 0.2 cm for postmovement determinations by the same examiner and blinded observer, respectively (p < 0.001). CONCLUSION: Interobserver and intraobserver variation can account for the change in the amniotic fluid index after fetal movement.

Amniotic Fluid↗