Search PubMed⌕ Search

Biomedical subjects

L Lynch

Publications and source records attributed to L Lynch.

At least 73 records · Page 4Linked to original sources
PubMed1990

First-trimester transabdominal multifetal pregnancy reduction: a report of 85 cases.

Eighty-five cases of multifetal pregnancy reduction were performed transabdominally at 9.5-13 weeks' gestation. All pregnancies consisted of three or more fetuses (28 triplets, 47 quadruplets, four quintuplets, four sextuplets, one septuplet, and one nontuplet), and all except five were reduced to twins. Forty-five women have delivered viable infants and eight lost all of the fetuses; 32 pregnancies are ongoing. No temporal relationship was noted between the pregnancy losses and the procedures. The mean gestational age at delivery was 35.7 weeks; 16 women (35.5%) delivered at or after 37 weeks, 16 (35.5%) between 34.5-37 weeks, nine (20%) between 32-34.5 weeks, and four (9%) before 32 weeks. There were no perinatal deaths, and all infants are healthy except for one who developed sequelae of severe hyaline membrane disease.

Abortion, Induced↗
PubMed1990

Selective reduction: an unfortunate misnomer.

When the number of fetuses in multifetal pregnancies is reduced in the first trimester, the gender and karyotypic status of individual fetuses are rarely, if ever known. In these cases, the only basis for choosing to terminate a particular fetus is the physical location of its sac. The term "selective reduction" is therefore inaccurate, and may be psychologically damaging because it implies that specific fetuses have been targeted. We believe that this procedure should be referred to as multifetal pregnancy reduction.

Abortion, Eugenic↗
PubMed1989

First trimester growth delay in trisomy 18.

Neonates with trisomy 18 are usually growth retarded at birth, and delayed growth has been ultrasonigraphically detected antenatally during the second and third trimesters in fetuses with this aneuploidy. We examined the growth patterns of five fetuses with trisomy 18 during the first trimester and compared them with a group of 16 normal control subjects. The crown-rump length of all trisomy 18 fetuses was at least 5 days smaller than expected (mean, 8.2 days; range 5 to 11 days), whereas only two controls had a similar delay (p less than 0.005). We conclude that in patients in whom gestational age is certain by other parameters, significant growth delay detected during the first trimester may be a useful marker for trisomy 18.

Abnormalities, Multiple↗
PubMed1989

Ultrasound detection of Down syndrome: is it really possible?

Several ultrasonographic signs have been described in second-trimester fetuses at high risk for Down syndrome. We examined these parameters in twin pregnancies in which one fetus was affected with Down syndrome and the other was normal. Biparietal diameter to femur length ratio was concordant (either normal or abnormal) in eight of nine sets of twins. Actual femur length to expected femur length ratio was concordant in seven of nine sets of twins. Nuchal fold thickening (6 mm or more) correctly identified five out of nine affected fetuses and was not present in any of the normal fetuses. In conclusion, neither ratio was helpful in differentiating the fetus with Down syndrome from its normal cotwin. A thickened nuchal fold was the most informative parameter examined.

Diseases in Twins↗
PubMed1989

Selective second-trimester termination of the anomalous fetus in twin pregnancies.

Selective termination of the affected fetus was performed during the second trimester in 17 pregnancies in which one twin was diagnosed to be anomalous. The affected twin had a chromosomal aneuploidy in 14 cases, neural tube defect in two cases, and an inborn error of metabolism in one case. With increasing operator skill and improvement in technique, a striking improvement occurred in pregnancy outcome in the last 11 patients as compared with the first six. In four of the first six cases, the entire pregnancy was lost. Among the last 11 patients, on the other hand, no pregnancy was lost. All 11 women delivered healthy, viable infants; eight delivered at term and three delivered between 31-35 weeks. Of the various techniques used, we found intracardiac injection of potassium chloride to be the most effective, but it should not be used in monochorionic twin gestations.

Abortion, Induced↗
PubMed1988

Antenatal treatment of neonatal alloimmune thrombocytopenia.

Neonatal alloimmune thrombocytopenia results from the formation of a maternal antibody to a paternal antigen on fetal platelets. Intracranial hemorrhage, which may be antenatal, occurs in approximately 15 to 20 percent of infants with this form of thrombocytopenia. In families with an affected infant, 75 percent of subsequent infants are affected. We report the results of antenatal treatment with intravenous gamma globulin, with or without dexamethasone, in seven pregnant women who had previously had infants who had severe alloimmune thrombocytopenia. The platelet count increased by a mean (+/- SD) of 72.5 +/- 62 x 10(9) per liter in the six fetuses in whom periumbilical blood sampling was performed. All seven treated fetuses had platelet counts above 30 x 10(9) at birth, and none had an intracranial hemorrhage, in contrast to all seven of their respective untreated siblings, who had lower platelet counts and three of whom had intracranial hemorrhages (antenatal in two infants). Mild intrauterine growth retardation was observed in one treated infant; all seven infants have developed normally in the two months to four years since birth. We conclude that intravenous gamma globulin, with or without dexamethasone, is effective in elevating the fetal platelet count in severe cases of neonatal alloimmune thrombocytopenia and in helping to avoid intracranial hemorrhage.

Blood Group Incompatibility↗
PubMed1988

Intravascular monitoring and management of erythroblastosis fetalis.

Over a 27-month period 17 pregnancies in 16 patients with severe red blood cell isoimmunization were managed with intravascular transfusions performed in utero. Fourteen of these women were Rh negative and sensitized to D or to both D and C, and the remaining two patients were sensitized to the Kell antigen (K). In 12 of the 17 cases (71%) the first intravascular transfusion was performed at 26.5 weeks' gestation or earlier. Thirty-nine of 45 attempted transfusions (87%) were successfully performed. All were done percutaneously under ultrasonic guidance. Two procedures were partial exchanges, while the remainder were straight transfusions. Thirteen of the 17 fetuses (76%) were alive at birth and survived the neonatal period. Four fetuses died in utero at 25 to 26 weeks' gestation, all within 12 hours of an intravascular transfusion. When the 27 procedures attempted during the most recent 9 months of this series were compared with the 18 procedures attempted during the preceding 18 months, no appreciable differences in technical success or fetal outcome were evident. An analysis of this experience is presented, along with modifications in technique that have been implemented. Unresolved issues are discussed.

Bilirubin↗
PubMed1988

Efficacy and side effects of magnesium sulfate and ritodrine as tocolytic agents.

Ritodrine as the first-line drug in the treatment of established preterm labor has been supplanted in some centers by magnesium sulfate. To assess the relative efficacy and rates of side effects of these two agents, 120 patients were randomly assigned to receive one of these two drugs. Patients were included if they had intact membranes and met strict criteria for the definition of labor. In both groups excellent outcome was achieved, with 96.3% and 92.3% of patients receiving ritodrine and magnesium sulfate, respectively, obtaining a delay in delivery of greater than 48 hours. Side effects were comparable in both groups, although they tended to be more serious in the patients receiving ritodrine. In patients receiving both drugs together, the rate of side effects was 77% without a demonstrable benefit over a single agent. We conclude that ritodrine and magnesium sulfate are tocolytics of comparable efficacy and when used aggressively are highly successful in delaying delivery.

Adult↗
PubMed1988

The role of sonography in assessing severity of fetal anemia in Rh- and Kell-isoimmunized pregnancies.

Fetal hematocrit values of blood obtained by percutaneous umbilical blood sampling were correlated with ultrasound findings in 35 samples from 15 pregnancies undergoing evaluation for Rh or Kell sensitization. Intravascular fetal transfusion was performed after a low hematocrit was obtained on 29 of 35 occasions. All fetuses with sonographic evidence of hydrops had a hematocrit of 15% or less, although three fetuses with hematocrits below 15% showed no signs of hydrops. In patients followed with serial sonography, hydramnios was noted as the earliest sonographic abnormality in six of nine pregnancies. All six fetuses were anemic (hematocrit 14-26%) and required transfusion. However, in three pregnancies where the fetus was anemic (hematocrit 22%), there was no hydramnios or other sonographic abnormality. Increased placental thickness was observed in association with fetal hydrops and a hematocrit below 15% in four cases, as well as in three other cases with fetal hematocrit between 16-29% but no fetal hydrops. Measurements of umbilical vein diameter provided no useful information because no increase was observed in these measurements, even in pregnancies with advanced fetal disease evidenced by hydrops.

Anemia↗
PubMed1987

The nonpredictive value of fetal urinary electrolytes: preliminary report of outcomes and correlations with pathologic diagnosis.

Fetal urine was sampled 12 times in nine fetuses with sonographically diagnosed urinary tract obstruction to assess renal function. By previously proposed criteria, four fetuses were predicted to have poor renal function. Two of these fetuses were found to have renal dysplasia on autopsy after elective termination. The other two died in the neonatal period but only one of these had histologic evidence of renal dysplasia. Five fetuses were predicted to have good renal function. Three of these developed renal failure after birth, one was found to have renal dysplasia on autopsy after elective termination, and one is alive and well. We conclude that fetal urine electrolytes are not necessarily an accurate predictor of neonatal renal function.

Chlorides↗
PubMed1987

Technical aspects of intravascular intrauterine transfusions: lessons learned from thirty-three procedures.

Our technique for performing intravascular transfusions is described and four failed attempts are presented. The appropriate choice of needle, insertion site, and premedication are discussed. A rationale for intravenous fetal muscle blockade in selected cases is presented and a transfusion setup designed to minimize movement of the needle hub is described. Finally, the judicious use of intraperitoneal transfusions in some cases is suggested.

Blood Transfusion, Intrauterine↗
PubMed1987

Prenatal diagnosis of fetal brain tumors.

Two cases of congenital brain tumors were detected during routine antepartum sonography at the Mount Sinai Medical Center Perinatal Ultrasound Unit. In both cases, diagnosis was made during the third trimester at 31 and 33 weeks, respectively. In one of these patients, no intracranial abnormalities were noted on a sonogram performed in conjunction with genetic amniocentesis at 18 weeks gestation. The histologic diagnosis of both tumors was glioblastoma multiforme grade III. Previous reports describing the prenatal sonographic diagnosis of intracranial tumors have been in cases with fetal intracranial teratomas.

Adult↗
PubMed1986

Amiodarone: an effective alternative for recalcitrant supraventricular and ventricular tachycardias.

Amiodarone was used in the treatment of 21 patients with supraventricular or ventricular arrhythmias which were refractory to conventional antiarrhythmic drugs, individually or in combination. Six of seven patients with supraventricular arrhythmias and 12 of 14 with ventricular tachycardia were controlled with amiodarone. Although side effects were common, only one patient was removed from treatment due to pulmonary fibrosis. We conclude that amiodarone is an effective antiarrhythmic drug for refractory ventricular and supraventricular arrhythmias.

Amiodarone↗