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Biomedical subjects

J W Seeds

Publications and source records attributed to J W Seeds.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1989

Fetal and neonatal cardiovascular complications from beta-sympathomimetic therapy for tocolysis.

beta-Sympathomimetic drugs cross the placenta freely. Just as these agents cause serious cardiovascular changes in the mother, they may cause severe cardiovascular complications in the fetus. beta-Sympathomimetic agents for tocolysis have been associated with fetal heart rate and rhythm disturbances, hydrops, stillbirth, neonatal cardiac failure, myocardial ischemia and infarction, and neonatal death. Prospective studies have documented changes in interventricular septa of babies exposed to these drugs. Histologic changes have been reproduced in animal models and in vitro similar to those seen in infants with myocardial disease caused by beta-mimetic therapy. The mechanism of beta-mimetic toxicity appears to be increased myocardial intracellular calcium leading to overexcitation and cell necrosis. Since serious fetal cardiovascular effects may occur with beta-mimetic use, benefits should clearly outweigh risks before these drugs are administered.

Biomechanical Phenomena↗
PubMed1989

Temporary arrest of fetal movement with pancuronium bromide to enable antenatal magnetic resonance imaging of holoprosencephaly.

The well-known ability of real-time ultrasound to detect congenital abnormalities is often limited by acoustic artifact or fetal position or both. Magnetic resonance imaging can provide superior soft tissue resolution but is vulnerable to maternal and fetal motion artifact. Described and illustrated here is a case of fetal holoprosencephaly that was not of diagnostic clarity on ultrasound. The fetus was paralyzed with an intramuscular injection of pancuronium bromide before a resonance imaging study. Successful fetal paralysis with pancuronium bromide has been reported prior to a variety of fetal interventions for the temporary arrest of fetal movement. The resonance study illustrated here was of significantly superior clarity and improved the accuracy of prognosis and management counseling. It is concluded that in selected cases where ultrasound is not of diagnostic clarity due to acoustic artifact, fetal paralysis and magnetic resonance imaging may be considered.

Abnormalities, Multiple↗
PubMed1989

Echogenic venous turbulence is a critical feature of successful intravascular intrauterine transfusion.

Late during the fifth intravascular intrauterine transfusion of a fetus with severe Rh isoimmunization, the loss of visible echogenic turbulence within the umbilical vein during injection preceded the development of unresolving fetal bradycardia. An umbilical cord hematoma was found at the time of emergency cesarean delivery. Although seldom described, echogenic turbulence is an important feature of the successful intravascular intrauterine transfusion, and deserves close surveillance. Disappearance of this visible turbulence suggests loss of proper needle location. Possible sources of needle tip displacement are discussed and preventive measures described.

Adult↗
PubMed1989

Fetal death as a complication of intrauterine intravascular transfusion.

This report describes and illustrates a case of a fetal death 2 hours after an ultrasonically guided intravascular intrauterine transfusion. The apparent cause of fetal death was a cord hematoma at the site of puncture, with umbilical vein thrombosis. The hematoma appears to have been related to injection of pancuronium before confirmation of needle placement, resulting in creation of a dead space in the cord adjacent to the puncture site. A total of 68 such procedures performed on 23 fetuses with three fetal deaths (4%) have been reported. This case is the first documented procedure-related death in a consecutive experience of 35 transfusions in 15 fetuses at this institution.

Adult↗
PubMed1988

Immunoglobulin levels in fetal anatomic compartments.

Immunoglobulins G, M, and A were found in varying concentrations in four different human fetal anatomic compartments of 17 fetuses in the absence of apparent infection. The highest levels were noted in the thoracic cavity.

Ascites↗