Biomedical subjects
Publications and source records attributed to M S Cardwell.
The authors discuss the long history of physician peer review and offer insight on the process, while presenting factors that have lead to increased physician non-peer review. The question at hand--have we gone far enough ... or too far?
Prenatal testing for Down Syndrome, the most common human malformation, is possible through three techniques: analysis of historical risk factors, ultrasonography, and evaluation of maternal serum alpha-fetoprotein levels. The authors describe these current screening techniques.
The authors illustrate the importance of early diagnosis, prompt delivery and intensive management of acute fatty liver of pregnancy (AFLP) in achieving the optimal maternal-fetal outcome.
Improving perinatal outcome in rural Missouri as reflected by a lowering of the perinatal mortality rate is a realistic and achievable goal for the state. The authors present information and data with suggestions for reaching this goal.
The possible relationship of oral contraception use to breast cancer is a concern to physicians and their patients. In this article, the authors present a review of the major studies conducted during the last 10 years, from an epidemiologic viewpoint.
A patient who received tocolysis with nifedipine developed neuromuscular blockade after 500 mg of magnesium sulfate was administered. This reaction demonstrates that nifedipine can seriously potentiate the toxicity of magnesium. Caution should be exercised when these two tocolytics are combined.
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As prenatal ultrasound and echocardiographic imaging become more common-place, prenatal diagnosis of serious cardiac conditions becomes possible. A case report points out the importance of establishing a firm diagnosis before undertaking definitive treatment after birth.
Nonimmune hydrops fetalis is a serious perinatal complication with diverse causes but few successful treatment modalities. The first reported case of hydrops fetalis caused by a massive fetomaternal hemorrhage treated successfully prenatally is presented. A modification of the standard intrauterine transfusion technique was used for therapy. Implications of future treatment are discussed.
This retrospective study of 129 pregnancies treated with cervical cerclage was done to analyze differences, if any, in reproductive outcome according to gestational age, race, history of previous successful pregnancy, gravidity, and procedure used (McDonald vs Shirodkar cerclage). Fetal salvage was significantly improved only when cerclage was done before 18 weeks of gestation. Cervical cerclage between 18 and 26 weeks' gestation significantly increased the prematurity rate. Cervical cerclage significantly improved fetal salvage in both the black and white populations but at the expense of increasing the prematurity rate in the former. There was no difference in fetal salvage whether the patient had had a previous successful pregnancy or not, or whether the patient was a primigravida or multigravida. Fetal salvage was significantly improved with both the McDonald and Shirodkar procedures, with no significant differences in the complication, prematurity, or cesarean section rates.
Bilateral renal agenesis is a common congenital defect, with an incidence of 1 per 3,000 births. Though prenatal diagnosis is possible with ultrasound examination, sonographic findings may be equivocal, making the management of such pregnancies difficult. I report three cases that represent the diversity of the condition, and discuss implications of management.
The twin-to-twin transfusion syndrome and severe cervical stenosis are two unusual complications of pregnancy. I have presented a case in which both complications were additive in their adverse effects on the pregnancy.
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Chorioangiomas of the placenta are found in approximately 1% of all pregnancies. In most cases the lesion is identified only on histologic examination of the placenta after delivery. Prenatal diagnosis of large lesions is possible with ultrasound. The occurrence of a large chorioangioma during pregnancy may lead to serious maternal and fetal complications. A case of a large chorioangioma was associated with polyhydramnios and diagnosed antenatally with ultrasound. Fetal compromise from pressure necrosis of the tumor on the normal placental tissue necessitated preterm delivery.
The acardiac twin is a rare consequence of monozygotic twinning and occurs in 1 per 35,000 deliveries. One percent of all monozygotic twins is affected. Prenatal diagnosis is possible with ultrasonography. Complications associated with the presence of an acardiac twin include sequelae from the twin-to-twin transfusion syndrome, polyhydramnios, dystocia, ruptured uterus and congestive heart failure in the normal twin. In utero fetal therapy is possible in some instances.
Obstetric complications of triplet pregnancies may make the delivery of extremely premature infants in these multiple gestations inevitable. To our knowledge, this case represents the first report of triplets delivered on three separate days, 16 days apart, using the technique of delayed interval delivery. One of the infants survived.
Spontaneous adrenal hemorrhage is rare during pregnancy. Most reported cases have been associated with preeclampsia-eclampsia, trauma or septicemia. A woman was treated for recurrent unilateral adrenal hemorrhage during pregnancy.
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