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Biomedical subjects

L M Hill

Publications and source records attributed to L M Hill.

At least 19 recordsLinked to original sources
PubMed1995

The natural history of fetal cytomegalovirus infection as assessed by serial ultrasound and fetal blood sampling: a case report.

A patient in whom intrauterine fetal cytomegalovirus (CMV) infection was diagnosed at approximately 25 weeks' gestation is presented. The fetus was evaluated by serial fetal blood samplings and ultrasound examinations. The fetus manifested evidence of severe thrombocytopenia and hepatic inflammation, with recovery over a period of approximately 8 weeks. The initial sonographic findings of marked fetal ascites and cardiomegaly gradually resolved; ventriculomegaly developed during the third trimester. At delivery, the baby was morphologically normal with the exception of mild ventriculomegaly. Cord blood was negative for CMV IgM but urine was culture-positive for CMV. At age 3, the child has a severe but stable unilateral hearing deficit and is otherwise developmentally normal. This case demonstrates the utility of serial ultrasound and fetal blood sampling in the prenatal diagnosis and management of fetal CMV infection.

Adult↗
PubMed1995

The association between polyhydramnios and preterm delivery.

OBJECTIVE: To determine whether an association exists between the severity of polyhydramnios and the frequency of preterm delivery. METHODS: The study group consisted of 275 singleton pregnancies with polyhydramnios as defined by an amniotic fluid index (AFI) of at least 25 cm. Polyhydramnios was arbitrarily categorized into three groups by severity: mild (AFI 25-30 cm), moderate (AFI 30.1-35 cm), and severe (AFI greater than 35.1 cm). A delivery was considered preterm if it occurred before 37 weeks' gestation. RESULTS: Fifty-two of 275 (18.9%) women delivered before 37 weeks' gestation. Preterm delivery occurred in 37 of 199 (18.5%) cases with mild polyhydramnios, 12 of 55 (21.8%) with moderate polyhydramnios, and three of 21 (14.3%) with severe polyhydramnios (no statistically significant difference). Fetuses with congenital malformations (16 of 41, 39%) and those of diabetic mothers (ten of 45, 22.2%) had a significantly higher incidence of preterm delivery than did cases with unexplained polyhydramnios (24 of 190, 12.6%; P < .001). The prematurity rate in cases with idiopathic polyhydramnios was no higher than the overall rate for our hospital. CONCLUSION: The underlying cause of polyhydramnios, rather than the relative excess of amniotic fluid as defined by this study, appears to determine when preterm labor will occur.

Adolescent↗
PubMed1995

Transvaginal sonographic evaluation of first-trimester placenta previa.

Our objective was to determine the relationship between the placenta and the internal cervical os in the first trimester. This study included ultrasound examinations performed between 9 and 13 weeks' gestation over a 28-month period. The position of the lower edge of the placenta with respect to the internal cervical os was recorded for each transvaginal ultrasound examination. A total of 77 out of 1252 (6.2%) patients had a first-trimester placenta previa; four cases persisted until term. There were no false-negative diagnoses. Our conclusion is that approximately 6.2% of patients will have a placenta previa in the first trimester. Transvaginal sonography can exclude a diagnosis of placenta previa after 9 weeks' gestation. The likelihood that a placenta previa will persist until term increases if the placenta covers the internal cervical os by > or = 1.6 cm.

Female↗
PubMed1994

Sonographic determination of first trimester umbilical cord length.

Umbilical cord length was measured sonographically in 53 normal fetuses and 15 fetuses with an intrauterine demise. The age of the fetuses ranged from 6.1 weeks to 11 weeks, menstrual age. Intra- and interobserver differences in measurements were not significantly different from zero. A close linear relationship (r2 = 0.89) was found between umbilical cord length and menstrual age in the normal group. The cord lengths of 9 of 15 fetuses (60%) with an intrauterine fetal demise were more than 2 SD below the expected value for menstrual age in normal fetuses.

Female↗
PubMed1994

Second-trimester echogenic small bowel: an increased risk for adverse perinatal outcome.

2267 singleton fetuses who had one ultrasound examination between 15 and 21 weeks' gestation were prospectively evaluated for echogenic small bowel. Thirty-two cases of echogenic small bowel were detected--a prevalence of 1.4 per cent. Echogenic fetal small bowel was divided into two grades: grade 1, where the small bowel was more echogenic than the liver; and grade 2, where the small bowel had the echogenicity of bone. In contrast to 19/23 fetuses with grade 1 small bowel echogenicity, only 2/9 fetuses with grade 2 echogenic bowel had a normal pregnancy outcome (Fisher's exact test; P < or = 0.01). Complications associated with second-trimester echogenic small bowel included in utero cytomegalovirus infection, second-trimester growth restriction, intrauterine fetal demise, and chromosomal abnormalities. Second-trimester fetal echogenic small bowel is associated with an increased risk of an adverse outcome. The prevalence of perinatal and neonatal complications is significantly greater when small bowel echogenicity approaches that of bone.

Adult↗
PubMed1994

Persistent right umbilical vein: sonographic detection and subsequent neonatal outcome.

OBJECTIVE: To review our experience with antenatal detection and subsequent neonatal outcome of fetuses with a persistent right umbilical vein. METHODS: In a prospective observational study, 33 cases of persistent right umbilical vein were detected during 15,237 obstetric ultrasound examinations performed after 15 weeks' gestation. RESULTS: Persistent right umbilical vein was detected at a rate of one per 476 obstetric ultrasound examinations. Six of 33 (18.2%) fetuses with a persistent right umbilical vein had additional important congenital malformations. CONCLUSIONS: Careful second- and third-trimester ultrasound examinations can detect a persistent right umbilical vein. When this particular anomaly is detected, a thorough fetal anatomic survey, including echocardiography, should be performed to rule out more serious congenital malformations.

Abortion, Eugenic↗
PubMed1992

Composite assessment of gestational age: a comparison of institutionally derived and published regression equations.

OBJECTIVES: This study was undertaken to evaluate (1) the applicability of previously reported regression equations for gestational age assessment to our patient population in Pittsburgh and (2) whether the addition of radius length or its substitution for one of the other fetal measurements could improve the prediction of gestational age. STUDY DESIGN: Five fetal parameters--biparietal diameter, head circumference, abdominal circumference, femur length, and radius length--were measured in a prospective cross-sectional study of gestational age assessment in 265 pregnant women between 13 and 43 weeks' gestation. RESULTS: The regression equation derived for each fetal parameter was found to be quite similar to previously published reports. Although the coefficient of determination was only minimally affected, the variability improved with the institutionally derived regression equation. CONCLUSION: The incorporation of several fetal measurements into a composite assessment of gestational age generally enhances the accuracy of the prediction. The addition of a second long bone to a gestational age assessment does not significantly improve results.

Biometry↗
PubMed1992

New ultrasound observations of fetal anomalies in the second trimester.

Accurate prenatal diagnosis of fetal anomalies is essential for making decisions on pregnancy management options and for the determination of recurrence risk. However, the types of congenital anomalies that should be diagnosed using routine sonography are difficult to define. Factors that can affect the ultrasonographic detection of a particular congenital abnormality include equipment resolution, the time in gestation when the anomaly becomes apparent, and sonographer or sonolist experience. This review outlines the work that has been done over the past year to improve the detection rate of specific second trimester congenital malformations.

Congenital Abnormalities↗
PubMed1992

Subcutaneous tissue thickness cannot be used to distinguish abnormalities of fetal growth.

Two hundred forty-four women with normal pregnancies between 15-42 weeks' gestation served as a control group to determine subcutaneous tissue thickness at three different fetal locations: mid-calf, mid-thigh, and abdomen at the level of the abdominal circumference. The values at the three locations were comparable, varying between 1 mm at 15 weeks' gestation and approximately 5.5 mm at term. Similar measurements were obtained in two study groups consisting of 13 growth-retarded and 38 large for gestational age fetuses. The degree of overlap in subcutaneous tissue thicknesses between the normal group and the two groups with disturbances in fetal growth was such that neither growth retardation nor macrosomia could be reliably predicted with these sonographic measurements.

Adipose Tissue↗
PubMed1991

Fetal loss rate after ultrasonically documented cardiac activity between 6 and 14 weeks, menstrual age.

The pregnancy outcome of 347 patients with a confirmed, viable intrauterine pregnancy between 6.0 and 14.0 weeks, menstrual age, was determined. The miscarriage rate was 4.2% in a subgroup of patients without vaginal bleeding, as compared with 12.7% in a subgroup with bleeding (chi 2 = 7.4, p less than 0.006). First trimester vaginal bleeding was a significant covariate in the determination of the spontaneous miscarriage rate after fetal cardiac activity has been confirmed.

Abortion, Spontaneous↗
PubMed1991

The effect of trisomy 18 on transverse cerebellar diameter.

The transverse cerebellar diameter was measured in 19 fetuses with trisomy 18. Eleven of the cerebellar measurements (57.9%) were greater than 2 SD below the mean for the patient's gestational age. If fetal biometry rather than last menstrual period were used to determine gestational age, four of the 19 (21.0%) cerebellar measurements were greater than 2 SD below the mean. Both intrauterine growth retardation and intrinsic central nervous system abnormalities associated with trisomy 18 appeared to affect cerebellar size.

Cerebellum↗