Search PubMed⌕ Search

Biomedical subjects

J W Seeds

Publications and source records attributed to J W Seeds.

At least 19 recordsLinked to original sources
PubMed1995

The relation between pulmonary hypoplasia and amniotic fluid volume: lessons learned from discordant urinary tract anomalies in monoamniotic twins.

BACKGROUND: Adequate amniotic fluid (AF) volume is one of several factors felt to be essential for normal lung development. Renal agenesis and urinary tract obstruction usually result in oligohydramnios and pulmonary hypoplasia. CASE: Two sets of monoamiotic twins with discordant urinary tract anomalies were seen. One twin in each set had anomalies that in a singleton or diamiotic pregnancy would likely have resulted in fetal pulmonary hypoplasia and subsequent death. However, neither of these infants had pulmonary hypoplasia. One infant is unique in being the first case reported of normal pulmonary function and survival despite the anomaly. CONCLUSION: Adequate AF provided by a monoamniotic twin environment may prevent pulmonary hypoplasia, which usually results from oligohydramnios due to certain fetal urinary tract anomalies.

Abnormalities, Multiple↗
PubMed1993

Oligohydramnios: problems and treatment.

Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. Ultrasound detection of this complication should prompt the clinician to thoroughly evaluate the gravida for hypertension, diabetes, or other significant illness. In addition, a thorough fetal anatomic survey focusing on the genitourinary tract and an attempt at visualizing free amniotic bands should be performed with ultrasound. Karyotype should be considered. The role of amnioinfusion to assist in diagnosis should be considered. Once diagnosed, oligohydramnios with or without associated conditions should lead to intensive fetal biophysical surveillance including frequent ultrasound evaluation. Delivery in the term patients must be considered. The role of amnioinfusion as an adjunct to continuous fetal monitoring in labor to improve neonatal outcome appears beneficial in select series. The role of repetitive amnioinfusion in the preterm patient remote from term may offer marginal clinical benefit to neonatal outcome and is considered experimental at this time.

Congenital Abnormalities↗
PubMed1992

A practical approach to umbilical artery pH and blood gas determinations.

The use of the Apgar score as a means of identifying birth asphyxia has been challenged. Routine umbilical cord blood pH has been recommended as a more objective measure of the condition of the newborn. The purposes of this study were to evaluate a simplified and selective method of umbilical artery pH blood sampling and to determine the effect of delay in sampling upon umbilical artery pH, carbon dioxide pressure (PCO2), and oxygen pressure (PO2). Umbilical arterial blood of 25 patients was sampled from clamped umbilical cord segments every 15 minutes for 1 hour after delivery. The clamped umbilical cord segments were left at room temperature with no special care given. The blood samples were collected in non-heparinized and non-iced plastic syringes and processed promptly after sampling. During the 60 minutes after delivery, there were no statistically significant changes in pH, PCO2, or PO2 of umbilical arterial blood. Our results indicate that umbilical arterial blood may be obtained simply and reliably from clamped umbilical cord segments for pH and gas determinations for up to an hour after delivery.

Blood Gas Analysis↗
PubMed1991

Role of ultrasound and informed consent in the evaluation of elevated maternal serum alpha-fetoprotein.

Informed consent of medical procedures should include a discussion of both the risk of the procedure and the probability of the malady in question. Many centers in the United States currently recommend amniocentesis for all women with elevated levels of maternal serum alpha-fetoprotein (MSAFP) unexplained by targeted ultrasound examination. Prospective clinical data from our unit support the use of an algorithm that provides for a 90% reduction of the predicted risk of neural tube defect from MSAFP alone. The predicted risk is revised only if the ultrasound shows normal fetal cranial size and shape, normal ventricular size, normal posterior fossa anatomy, and normal spinal anatomy. Preliminary results supported this approach with no reduction in sensitivity, while substantially reducing the need for invasive testing. The additional experience reported here of 20,211 patients resulted in 451 ultrasound examinations for an elevated MSAFP, but only 54 amniocenteses. During this period, nine open neural tube defects were detected among patients with elevated MSAFP using ultrasound; none was missed. All fetuses with defects had ultrasound findings of cranial and intracranial changes first reported by Campbell. These data support the premise that, prior to amniocentesis, informed consent should include discussion of the ultrasound evaluation.

Amniocentesis↗
PubMed1991

Counseling and care for the pregnancy complicated by gastroschisis.

Twenty-one consecutive cases of fetal and neonatal gastroschisis were retrospectively reviewed. There was 100% survival if major nonintestinal malformations did not coexist; however, 28.6% of these patients had other major malformations and 66% of them died. There were significantly fewer small for gestational age infants if the defect was diagnosed prenatally (20% versus 75%, p less than 0.003). There was a 60% cesarean delivery rate in prenatally diagnosed infants and 0% if diagnosis occurred at delivery (p less than 0.01).

Abdominal Muscles↗
PubMed1991

Sonographic evaluation of growth discordance and chorionicity in twin gestation.

Ninety-four twin gestations had serial ultrasound examinations for evaluation of fetal growth, with special attention to prediction of weight discordance and chorionicity. Fetal weight estimations were made a mean of 3.2 days before birth and then compared to actual birthweights. The average error in intertwin discordance prediction was 1 +/- 9%. In 56 patients ultrasonic detection of membrane thickness was compared with placental pathologic conditions. If a membrane was seen between twins, it was confirmed by placental pathologic study in all cases. No membrane was seen in four twin pairs, but only one of these actually had monochorionic monoamniotic membranes. The three cases with false-positive diagnoses of monoamniotic twin gestation were initially seen late in pregnancy. If clinical decisions in twin gestations are based on ultrasound determination of discordance and chorionicity, the level of accuracy demonstrated by these data must be considered.

Birth Weight↗
PubMed1991

The role of ultrasound in evaluation of patients with elevated maternal serum alpha-fetoprotein: a review.

Accumulated experience with the sonographic detection of spina bifida and its associated fetal cranial changes indicates that nearly all these fetuses may be identified by ultrasound examination alone. A review of data from multiple centers shows that a complete and detailed, normal ultrasound is an appropriate basis for a reduction of at least 95% in the maternal serum alpha-fetoprotein (MSAFP)-based risk for neural tube defects. The use of this adjusted risk in patient counseling before amniocentesis may lower the rate of the procedure with no significant loss of diagnostic sensitivity. Among patients with elevated MSAFP, the rate of abnormal cytogenetic findings in fetuses with no abnormalities detected at ultrasound appears to be near 0.61%. Furthermore, the spectrum of abnormal cytogenetic results appears to differ from that associated with increased maternal age, in that the incidence of sex chromosome abnormalities is higher and that of Down syndrome is lower.

Amniocentesis↗
PubMed1991

Extremely high maternal serum alpha-fetoprotein levels at second-trimester screening.

Maternal serum alpha-fetoprotein (MSAFP) screening is widely used for the detection of open neural tube defects (NTDs) and a variety of other anomalies and complications. We examined the outcomes of 44 pregnancies with MSAFP elevations of 8 or more multiples of the median (MoM) from among 40,676 screened pregnancies. At the initial evaluation by ultrasound, 82% of the patients had at least one finding that may have accounted for the elevation. Approximately 45% of the fetuses had a major fetal anomaly, 25% died, 16% had an identifiable placental abnormality, and 5% had an underestimation of gestational age; 18% of the elevations remained unexplained after ultrasound. In follow-up of the pregnancies, all of those with an unexplained elevation after initial ultrasound had at least one obstetric complication or placental abnormality. The overall positive predictive value of an MSAFP value of 8 or more MoM for NTDs was 22.7%. The proportion of infants born alive in the overall group was low, with only 16 live births among 46 fetuses. The majority of the nonviable outcomes were associated with a fetus with a major anomaly that was terminated or died before 20 weeks. Of the live-born infants, 31% had a major anomaly, 19% had intrauterine growth retardation (IUGR) and an anomaly, 12.5% had IUGR without an anomaly, and 25% were preterm. Eighty-eight percent of those pregnancies with a live-born infant had at least one obstetric complication. Among pregnancies with MSAFP of 8 or more MoM, the majority are associated with large structural fetal anomalies or fetal death before 20 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Sonographic diagnosis of advanced ectopic pregnancy. A case report.

The diagnosis of advanced extrauterine pregnancy is made most often sonographically by identification of a uterus separate from the fetus. Leiomyomas or other pelvic masses can make the sonographic diagnosis more difficult. In a woman with an advanced ectopic pregnancy and uterine leiomyoma, the sonographic diagnosis was made by passing a sterile probe through the endocervix with simultaneous, real-time ultrasound observation.

Adult↗
PubMed1990

Familial cystic hygroma with normal karyotype.

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.

Adult↗
PubMed1990

Prenatal diagnosis of laryngeal atresia.

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.

Adult↗
PubMed1990

Ultrasound determination of fetal abdominal circumference: a comparison of measurement methods.

The measurement of fetal abdominal circumference by the direct perimeter method using a digitizer was compared with calculation of this measurement using the fetal mean abdominal diameter in 235 cases. The directly measured abdominal circumference was found to be greater than the calculated value (p = 0.00014). The magnitude of the difference, however was only 1.3 +/- 2.2%, which is smaller than the average interobserver measurement error. Although statistically significant, the difference between these two measurement methods is not clinically significant, and these data and discussion show that either method is acceptable to determine fetal abdominal circumference.

Abdomen↗
PubMed1990

Congenital nephrosis as a cause of elevated alpha-fetoprotein.

Two cases of congenital nephrosis were detected through routine maternal serum alpha-fetoprotein (MSAFP) screening of 95,135 patients. No other cases of congenital nephrosis from this group were reported, resulting in an incidence of approximately one in 47,500 in this low-risk population. In both of these cases, similar to other reported cases of congenital nephrosis having MSAFP screening, the protein concentrations were greater than or equal to 10 multiples of the median (MOM). Therefore, in the case of an MSAFP over 10 MOM and a normal ultrasound examination, congenital nephrosis should be included in counseling regarding the possibility of undetected malformations. Furthermore, in the case of a pregnancy with elevated amniotic fluid AFP with negative acetylcholinesterase and normal ultrasound, the possibility of congenital nephrosis should be mentioned, regardless of family history or ancestry. When a pregnancy is terminated because of these biochemical findings, special and immediate attention to the fetal kidneys using electron microscopy is necessary to evaluate properly the possibility of congenital nephrosis.

Female↗
PubMed1990

Accuracy of ultrasonic weight prediction in the fetus with preterm premature rupture of membranes.

The accuracy of ultrasonic fetal weight prediction in the low birth weight fetus was evaluated, comparing measurement errors in 86 fetuses with premature rupture of membranes with 112 fetuses with intact membranes. Using two ultrasonic formulas for estimation of fetal weight, we found no significant differences in the mean error of ultrasonic weight measurement between these groups. In both groups, the mean measurement error was approximately 9%, with a standard deviation of 7%. It appears that ultrasonic methods for estimation of fetal birth weight are equally applicable to preterm fetuses with or without ruptured membranes.

Birth Weight↗
PubMed1989

High-resolution computerized color transformation of real-time gray scale ultrasound images.

Contemporary real-time ultrasound images are constructed of graduated shades of gray. The practical range of echo contrast than can be depicted is therefore limited. The use of color as well as intensity would potentially increase the amount of information available and possibly augment tissue texture contrast. Previous efforts to color encode ultrasound images have not been of adequate visual resolution, and have not produced simultaneous or real-time results. Described and illustrated here is a microcomputer-based system that successfully produces high-resolution simultaneous real-time pseudocolor transformation of real-time ultrasound images. The system accepts the composite video output in any ultrasound machine, and the specific color scheme may be chosen to suit the operator. It is proposed that such color enhancement improves visual clarity of fine fetal anatomy by highlighting tissue-tissue contrast and tissue-fluid interfaces.

Color↗