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Biomedical subjects

L R Saldana

Publications and source records attributed to L R Saldana.

At least 19 recordsLinked to original sources
PubMed2000

Premature closure of foramen ovale and renal vein thrombosis in a stillborn twin homozygous for methylene tetrahydrofolate reductase gene polymorphism: a clinicopathologic case study.

Premature closure of the foramen ovale, 4-chamber cardiac hypertrophy, and renal vein/vena cava thrombosis were found at autopsy of a stillborn dizygotic twin at 36 weeks gestational age. Review of the original prenatal sonograms showed features suggestive of early closure of the foramen ovale. Homozygosity for the 5, 10 methylene tetrahydrofolate reductase mutation was shown only in the affected twin after the parents were found to be heterozygous for the mutation. The difference in outcome of the twins following prenatal treatment with beta mimetics and corticosteroids for preterm labor may be related to the added susceptibility factor for thromboembolism associated with presumed hyperhomocysteinemia in the proband which was not shared by the surviving healthy twin. The role of premature closure of the foramen ovale and prenatal treatment are discussed but remain uncertain.

Cardiomegaly↗
PubMed1999

45,X/46,X,r(Y) karyotype transmitted by father to son after intracytoplasmic sperm injection for oligospermia. A case report.

BACKGROUND: The advent of assisted reproductive techniques, such as intracytoplasmic sperm injection (ICSI), has permitted conception and successful pregnancy for an increasing population of infertile men. Approximately 13.7% of infertile men with aspermia and 4.6% with oligospermia have a coexistent chromosome abnormality. Although the ICSI procedure appears safe thus far, early studies are in progress to evaluate outcomes of such pregnancies. For men whose infertility is linked to genetic conditions, it is an unprecedented challenge to predict the potential effects on their offspring. CASE: At 18 weeks' gestation, a 45,X/46,X,r(Y) karyotype was found on genetic amniocentesis performed for advanced maternal age. The pregnancy was achieved by ICSI using sperm from the husband, who was infertile due to severe oligospermia. Subsequently the same karyotype was found in the father. To our knowledge, this is the first reported case of familial transmission of ring Y chromosome. CONCLUSION: It is strongly recommended that ICSI and other new assisted reproductive techniques be preceded by genetic screening for male infertility as well as other indications warranted by the family history since traditional risk assessment may require revision and outcomes may be uncertain in some cases.

Adult↗
PubMed1991

Ultrasound and genetic features of a term triploid pregnancy.

A 69,XXY triploid term infant is reported to demonstrate the prenatal sonographic findings of first trimester intrauterine growth retardation as an important early indicator of this diagnosis. Progressive lag in early sonographic dating for gestational age should raise suspicion of triploidy, which can lead to an early diagnosis, genetic counseling, and a realistic management plan.

Female↗
PubMed1987

Umbilical blood waveforms in fetal surveillance of twins.

Umbilical arterial velocity waveforms were recorded in 69 pairs of twins by means of continuous-wave Doppler analysis and an Angioscan spectrum analyzer. A systolic/diastolic ratio was measured for each twin. The sum of the systolic/diastolic ratio was calculated and the difference between each twin was expressed as the delta systolic/diastolic ratio. Significant differences in delta systolic/diastolic and neonatal weight were previously set at 0.4 and 350 gm, respectively. Sonography was used for fetal age confirmation and diagnosis of fetal growth retardation. All neonates were weighed; at birth gestational age was assigned by Dubowitz criteria and categorized as adequate-, small-, or large-for-gestational age. The sensitivity, specificity, and predictive value of the delta systolic/diastolic ratio were determined. The perinatal implications of this test in the management of twin pregnancy are discussed.

Blood Flow Velocity↗
PubMed1985

Surveillance of twin pregnancy with umbilical arterial velocimetry.

A continuous-wave Doppler system and a spectrum analyzer provide the tools for the measurement of systolic-diastolic velocity wave ratios in the umbilical arteries. In twins, each umbilical cord can be studied without imaging the fetuses. Results were tabulated by taking the average difference in the ratios between each fetus and plotting these values against the neonatal weight differences. In 43 twin pregnancies, the data revealed that ratio differences between fetuses that averaged 0.4 or more was predictive of a weight difference of greater than 349 gm. The sensitivity was 73% and specificity 82%. Two cases of twin transfusion syndrome were recognized by the simultaneous presence of high- and low-resistance values.

Adult↗
PubMed1984

Potassium and glucose concentrations in patients treated with oral tocolytic agents: a preliminary report.

Fifteen patients referred to the Division of Maternal-Fetal Medicine with the diagnosis of cervical incompetence were placed in a study protocol where prophylactic oral beta mimetic agents were used in an attempt to prevent cervical dilatation between 20 and 36 weeks of gestation. Our study suggest that after the first week of therapy prolonged maternal oral tocolytic therapy has no significant effect on glucose or serum potassium levels and no deleterious effects on the immediate neonatal course.

Administration, Oral↗
PubMed1984

Fetal growth sustained by parenteral nutrition in pregnancy.

Severe maternal nutritional deprivation has been associated with intrauterine growth retardation, premature labor, and increased perinatal mortality and morbidity. The authors present four cases in which total parenteral nutrition was used successfully to support fetal growth in such diverse complications as twin pregnancy with maternal jejunoileal bypass, regional enteritis, and acute pancreatitis. Maintenance of fetal growth as evidenced by serial sonographic examination allows achievement of fetal lung maturation before delivery. In all the cases presented there was no perinatal mortality or morbidity. The main clinical implication of the report is the possible application of total parenteral nutrition to maintain adequate growth in fetuses small for gestational age because of maternal nutritional deprivation.

Adolescent↗
PubMed1983

The use of ultrasound in the expectant management of abruptio placentae.

The use of real-time ultrasound and antepartum nonstress testing in the management of abruptio placentae is discussed. In one patient, fetal distress developed when the retroplacental clot volume reached 480 ml. Two cases in which retroplacental clot was less than 480 ml were managed expectantly with the use of ultrasound and antepartum fetal testing, with excellent results.

Abruptio Placentae↗
PubMed1983

Home birth: negative implications derived from a hospital-based birthing suite.

Our study of 390 patients enrolled in a birthing suite program revealed that antepartum or intrapartum problems allowed only 160 (41%) to actually give birth in the birthing suite. Antepartum complications included premature labor in ten (2.5%), premature ruptured membranes in 31 (8%), postdatism in 50 (13%), preeclampsia in 27 (7%), and diabetes mellitus in five (1.3%). Intrapartum complications included meconium in 62 (16%), arrest of labor in 64 (16%), oxytocin use in 85 (22%), and fetal heart rate decelerations in 28 (7%). Two hundred ninety-seven births (76%) were spontaneous. Forty-two low-forceps deliveries (10%), 12 mid-forceps deliveries (3%), and 39 cesarean sections (10%) were done in the traditional labor and delivery suite. Puerperal complications included one uterine inversion, two cases of placenta accreta, one rectovaginal fistula, and two requirements of blood transfusion. Neonatal morbidity included 22 low Apgar scores (7%), two shoulder dystocia, three cytomegalovirus infestations, and one lethal anomaly. Six infants had meconium aspiration, two with severe hypoxia. Any of these complications would overwhelm the patient in home birth. Intense prenatal screening may decrease some risk factors, but the intrapartum period was found to pose unacceptable risks for home birth in this population.

Adolescent↗
PubMed1983

Anagen ratios in high-risk pregnancies.

Forty pregnant women attending the high-risk and normal obstetric clinics were evaluated for parietal scalp hair stage ratios during the second and/or third trimesters. In seven of the ten high risk patients from whom hair samples were obtained on two occasions, there was an observed fall in anagen hair percentages. Two of these had unfavorable outcomes, including severe anomalies and fetal death. These results are preliminary, but indicate the need for further evaluation of the anagen percentage as an indicator of pregnancy outcome.

Estrogens↗
PubMed1982

Fetal heart rate acceleration: fetal movement ratio in the management of high-risk pregnancy.

The nonstress test (NST) was used as the primary tool in the management of 318 high-risk pregnancies. A simple and reliable method for interpreting the NST is obtained by dividing the total number of fetal heart rate accelerations associated with fetal movements by the total number of fetal movements. This is expressed as a percentage called the acceleration:fetal movement ratio. Fetuses at risk who were delivered within 7 days of the last NST from the basis of this report. The incidence of fetal distress and small-for-gestational-age infants was significantly higher (P less than .05) in 47 fetuses with an acceleration:fetal movement ratio below 10% than in the group with a ratio over 10%. Also, perinatal mortality was more common in this group. The advantages and limitations of applying this quantitative method of interpreting the NST to the management of high-risk pregnancies are discussed.

Female↗
PubMed1981

Pitfalls in sonographic diagnosis of abdominal pregnancy.

Abdominal pregnancy is relatively rare, with an estimated frequency of 1/3,000 pregnancies in this country. We have described serial sonographic findings in an abdominal pregnancy from 28 weeks to term. Particular emphasis is placed on the pitfalls facing the sonographer in the diagnosis of advanced abdominal pregnancy.

Adult↗
PubMed1980

Gastrointestinal sediment layering. A useful sign for the prenatal sonographic diagnosis of fetal intestinal obstruction.

An instance of fetal intestinal obstruction uncovered during serial sonography in a pregnancy complicated by previous jejunoileal bypass is discussed. The presence of abnormal cystic structures with a gravity-dependent sediment layering effect within the fetal abdomen provided a useful, and possibly specific, sign in the diagnosis of fetal gastrointestinal obstruction.

Adult↗