Biomedical subjects

Joan M Mastrobattista

Publications and source records attributed to Joan M Mastrobattista.

11 recordsLinked to original sources

PubMed2005

Diagnosis and management of human parvovirus B19 infection.

Parvovirus B19 is a common infection in children occurring in winter and spring months that can affect pregnant women and their unborn fetuses. Adverse fetal sequelae may include red blood cell aplasia due to bone marrow suppression, anemia, myocarditis, nonimmune hydrops, and fetal death. Fortunately, several noninvasive testing schemes are available to assess the fetus, and invasive testing is reserved for fetuses with marked anemia.

Antibodies, Viral↗

PubMed2005

Ultrasound diagnosis of coexisting molar pregnancy following referral for abnormal serum screen.

Complete hydatidiform mole and coexistent fetus is a rare occurrence. We report a case of a patient referred for abnormal serum screen and vaginal bleeding in the second trimester of pregnancy. Ultrasound revealed a cystic and solid mass along the posterior uterine wall with multiple hypoechoic (honeycomb) areas noted, consistent with molar degeneration of the placenta. Separate from this mass was a coexisting viable fetus with normal fetal anatomy and distinct anterior placenta. At delivery, a large cystic mass of placental tissue appeared to be implanted separately from a normal-appearing fetus and placenta. The mass weighed 184 g and contained multiple 1- to 1.5-cm cysts throughout. Microscopic sections revealed hydropic chorionic villi with central cistern formation and nonpolar trophoblastic hyperplasia with atypia, compatible with complete hydatidiform mole. This case illustrates that the diagnosis of coexisting molar pregnancy after referral for abnormal serum screen should be considered, especially if maternal serum beta-human chorionic gonadotropin is high and the patient has vaginal bleeding.

Adult↗

PubMed2005

Effects of nuchal cord on birthweight and immediate neonatal outcomes.

Our objective was to ascertain if nuchal cord is associated with adverse neonatal outcomes. Using a retrospective database of term neonates, outcomes were compared among infants with 0, 1, and 2 or more loops of cord encircling the neck. Of 4426 neonates, 3651 served as controls, 691 had one loop, and 84 had two or more loops. There were no significant differences in the mean birthweight, the frequency of nonreassuring fetal heart rate patterns, operative vaginal deliveries, or 5-minute Apgar scores of < 7. The cesarean delivery rate was significantly different among the three groups and was the highest among the group of women whose fetus had no nuchal cord ( p < 0.01). A nuchal cord at term is not associated with untoward pregnancy outcomes.

Apgar Score↗

PubMed2005

Perinatal pseudocoarctation: echocardiographic findings in vein of Galen malformation.

OBJECTIVE: Vein of Galen aneurysmal malformations (VGAMs) are rare congenital malformations thought to develop during weeks 6 to 11 of fetal life. Although they represent less than 1% of all cerebral vascular malformations, they constitute up to 30% of all pediatric vascular malformations. Vein of Galen aneurysmal malformations cause high-output heart failure in the fetus and neonate secondary to the decreased resistance and high blood flow in the lesion. We describe 2 cases, 1 prenatal and 1 postnatal, in which unusual aortic Doppler flow patterns and substantial brachiocephalic vessel dilation contributed to the discovery of a VGAM. METHODS: Echocardiographic findings associated with VGAM malformations in 2 cases are described. RESULTS: Unusual Doppler flow patterns and substantial brachiocephalic vessel dilation were seen in both cases. Pseudocoarctation of the aorta was also noted in both cases. CONCLUSIONS: The echocardiographic findings in fetal and neonatal VGAM may include pseudocoarctation of the aorta. Abnormal fetal cardiac findings should raise the practitioner's suspicion for cerebral malformations and vice versa.

Adult↗

PubMed2004

Diagnosis of pulmonary embolism: a cost-effectiveness analysis.

OBJECTIVE: Pulmonary embolism is a major cause of maternal death. The work up for suspected pulmonary embolism is complex, with many potential diagnostic options. We performed a cost analysis to evaluate which of several diagnostic strategies was the most cost-effective with the least number of deaths from pulmonary embolism. STUDY DESIGN: We created a decision tree to evaluate the following strategies: (1) Compression ultrasonography followed by anticoagulation (if there is a positive result) or secondary tests, ventilation perfusion scans or spiral computed tomography (if there is a negative result); high probability ventilation perfusion scans (a positive test result) resulted in anticoagulation; low probability ventilation perfusion scans (a negative test) resulted in no treatment; intermediate tests that resulted in a second test (computed tomography or pulmonary angiography). (2) Ventilation perfusion scans as a primary test followed by anticoagulation. (3) Computed tomography followed by anticoagulation (if there is a positive result). The following assumptions were made: The incidence of pulmonary embolism in pregnant women with suspected pulmonary embolism is 5%; 40% of documented pulmonary embolisms have a positive compression ultrasound result; 10% of ventilation perfusion scans for suspected pulmonary embolism are high probability, 60% are indeterminate, and 30% are low probability for pulmonary embolism; the sensitivity of computed tomography is 95%; the sensitivity of angiography is 98%. The assumed mortality rate of treated pulmonary embolism is 0.7% and of untreated pulmonary embolism in pregnancy is 15% (range, 10%-50%). The angiography-associated mortality rate is 0.5%, and the anticoagulation associated mortality rate is 0.2%. The following costs were used for the model: compression ultrasonography, 200.00 dollars; ventilation perfusion scans, 400.00 dollars; angiography, 1000.00 dollars; computed tomography, 500.00 dollars; and anticoagulation, 5982.00 dollars. With baseline assumptions, spiral computed tomography as the initial diagnostic regimen was found to be the most cost-effective at 17,208 dollars per life saved. Sensitivity analyses were performed over a wide range of assumptions that included alteration of the probability of pulmonary embolism, the sensitivity of computed tomography, ventilation perfusion scans, and compression ultrasonography, the cost of computed tomography, and the mortality rate of untreated pulmonary embolism. Our findings remained robust over a wide range of assumptions. CONCLUSION: Suspected pulmonary embolism remains a diagnostic quandary. Our analysis indicated that spiral computed tomography offers the most cost-effective method for diagnosing this potentially fatal condition.

Cost-Benefit Analysis↗

PubMed2004

Pregnancy after organ transplant.

The frequency and variety of solid organ transplantation in reproductive-age women increases each year. Pregnancy is no longer contraindicated in transplant recipients provided that their graft is functioning well and they are in good general health. Physicians who care for pregnant transplant recipients should be aware of the surmounting data that are available in the literature and through registries of maternal, fetal, and neonatal risks and complications as well as outcome data. Newer immunosuppressive agents preserve graft function and registry data attest to their safety in pregnancy. For optimal maternal and neonatal outcomes, a multispecialty care approach that includes the obstetrician/maternal-fetal specialist,transplant team, anesthesiologist, and neonatal team is prudent when caring for pregnancies after organ transplantation.

Female↗

PubMed2004

Milk-alkali syndrome in pregnancy.

BACKGROUND: Severe hypercalcemia, a potentially life-threatening medical emergency, is rare in pregnancy. CASE: We report a 32-year-old woman presenting early in the second trimester with severe hypercalcemia (total calcium 22 mg/dL), alkalosis, and acute renal insufficiency resulting from excessive ingestion of calcium carbonate-containing antacid for gastroesophageal reflux. The patient was treated with aggressive hydration and furosemide, and received 1 dose of intravenous etidronate, leading to short-term symptomatic hypocalcemia. To our knowledge, this is the third reported case of milk-alkali syndrome in pregnancy. CONCLUSION: Milk-alkali syndrome is an uncommon cause of hypercalcemia in pregnancy. Intravenous hydration with saline should be the cornerstone of treatment, reserving bisphosphonates for selected cases.

Acute Kidney Injury↗

PubMed2004

Humerus length evaluation in different ethnic groups.

OBJECTIVE: Femoral length has gained much attention for its use as a marker for Down syndrome, and racial variation has been evaluated. We hypothesized that no racial differences in humerus length will be shown from 14 to 22 weeks' gestation. METHODS: Our sonography database was queried from January 1, 1994, to September 30, 2001, for obstetric sonographic examinations of singleton fetuses. Cases with incomplete data, fetal anomalies, and cases without documented ethnicity were excluded. Only 1 examination per fetus was used. Individual parameters were evaluated from 14 to 22 weeks' gestation in white non-Hispanic, Hispanic, African American, Asian, and Eastern Indian women. Linear regression was used to model the relation of humerus length to menstrual age and to compare the humerus length for gestational age among ethnic groups. We compared the sensitivity for Down syndrome detection from a standard expected humerus length formula and ethnic-specific formulas. RESULTS: We identified 1164 fetuses: 380 white, 224 Hispanic, 432 African American, 116 Asian, and 12 Eastern Indian. Comparing with white fetuses, we found differences in humerus length among African American (P < .001) and Asian (P < .001) fetuses but not among Hispanic fetuses (P = .98). The sensitivity for Down syndrome detection from standard and ethnic-specific formulas was identical. CONCLUSIONS: In this cohort, small differences in humerus length exist among ethnic groups. These differences did not affect the sensitivity of expected humerus length as a marker of Down syndrome in our diverse population.

Adult↗

PubMed2003

In utero cocaine exposure: a thorny mix of science and mythology.

Fetal cocaine exposure has proven to be an area of medicine that has generated more heat than light. Although many reports associate cocaine with a variety of isolated structural anomalies, there is no detectable syndromic clustering, raising doubts about a real causal association or a specific teratogenic action. Potential confounding variables, including the abuse of other drugs, pregnancy deprivations, and socially patterned maternal behaviors, have limited the reliability of observational studies, making it difficult to demonstrate effects solely attributable to cocaine. The clinical expression of in utero cocaine exposure is contextual, critically dependent on the biology/environment interplay. The present work summarizes the fetal structural anomalies that have been associated in the literature with cocaine use during pregnancy, and reviews the putative mechanisms of fetal impairment secondary to cocaine exposure. The final discussion of methodologic issues in cocaine epidemiology highlights the need for innovative approaches to assure that the myths conjured up about "crack babies" are replaced with reliable, high-quality scientific data.

Abnormalities, Drug-Induced↗

PubMed2002

Effect of parental education on decision-making about neonatal circumcision.

BACKGROUND: We investigated the impact of unbiased, published, easily accessible brochures on the parental decision about circumcision. METHODS: A total of 190 women who were delivered of healthy male infants at Memorial-Hermann Hospital and Woman's Hospital of Texas from December 1, 1999, to April 30, 2000, were asked to complete a brief demographic self-description and questionnaire regarding their attitudes and beliefs about circumcision. The most recent American Academy of Pediatrics (AAP) brochure about circumcision was then distributed, and subjects completed the questionnaire a second time after reading the brochure. RESULTS: Eighty-five percent of participants opted for circumcision. No woman altered her decision on the basis of information in the AAP brochure. Regardless of parental desire for circumcision, responses to all questions before and after distribution of the AAP brochure were highly correlated. Circumcision status of the father and the parents' education and age were significantly associated with the decision to circumcise. There was no significant association between this decision and marital status, race, or religion. CONCLUSIONS: Parental education about the medical indications and possible risks of circumcision has no impact on the decision-making process about neonatal circumcision.

Adolescent↗

PubMed2002

Mirror syndrome. A case report.

BACKGROUND: Water retention in a pregnant woman can mirror fetal hydropic changes. This clinical presentation has been named "mirror syndrome." Awareness of the syndrome is important due to the associated fetal and maternal risks. CASE: A 26-year-old woman, gravida 3, para 1011, presented at 31 weeks' gestation with significant edema and a 7-km weight gain in one week. Sonographic evaluation revealed hydramnios and fetal ascites. Maternal workup was negative for preeclampsia, diabetes, or cardiac or renal dysfunction. A workup for nonimmune hydrops was also negative. Over the next three days there was progression of maternal edema. With diagnosis of mirror syndrome, the decision for delivery was made. Both neonate and mother subsequently did well, with normalization of ascites and edema, respectively. CONCLUSION: Our case, along with 19 reviewed in the literature, reiterate the features of mirror syndrome and provide an opportunity to dispel some of the misconceptions in the literature. The condition is frequently mistaken for preeclampsia, although distinguishing characteristics can be identified. Mirror syndrome is a manifestation of extremely severe fetal hydrops. When the specific cause of fetal hydrops cannot be identified and corrected, immediate delivery is necessary in order to avoid fetal death and maternal complications.

Adult↗