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Biomedical subjects

M Sermer

Publications and source records attributed to M Sermer.

30 records · Page 2Linked to original sources
PubMed1995

Pregnancy and functional deterioration in a woman with a univentricular heart. A case report.

A patient who had undergone Pott's procedure and a right Blalock-Taussig shunt in childhood for complex cyanotic congenital heart disease with a single ventricle presented with a planned pregnancy at age 22. Although asymptomatic prior to pregnancy, she experienced functional deterioration from the first trimester and had preterm labor with a footling breech presentation at 29 weeks following prelabor rupture of the membranes. A normal, 900-g female infant was delivered by cesarean section. Despite delivery the patient continued to experience progressive functional deterioration and returned to her prepregnancy cardiac status only after a Fontan operation, performed 14 months postpartum.

Adult↗
PubMed1995

Bladder pheochromocytoma in pregnancy without hypertension. A case report.

A 33-year-old nullipara presented at 20 weeks' gestation with episodes of nonsustained ventricular tachycardia, which were controlled with amiodarone. No hypertension was recorded except once after an attack of ventricular tachycardia. Pheochromocytoma was suspected when repeat 24-hour urine catecholamine levels were markedly elevated. Neither computed tomography nor postpartum metaiodobenzylguanidine scan could locate the tumor. Finally it was identified in the bladder by ultrasound after selective venous sampling localized it to the pelvis. It was excised four months postpartum.

Adult↗
PubMed1994

Impact of time since last meal on the gestational glucose challenge test. The Toronto Tri-Hospital Gestational Diabetes Project.

OBJECTIVE: The purpose of the study was to evaluate the impact of time since the last meal on the glucose challenge test and to find cut points that are most likely to predict the outcome of the oral glucose tolerance test in patients screened for gestational diabetes. STUDY DESIGN: This prospective analytic cohort study was carried out at the University of Toronto Perinatal Complex. A 50 gm glucose load was given at 26 weeks' gestation and the time since previous meal ingestion was recorded. At 28 weeks' gestation a 100 gm oral glucose tolerance test was administered. A total of 4274 eligible patients were screened. RESULTS: Time since the last meal had a marked effect on mean plasma glucose. Receiver-operator characteristic curve analysis with National Diabetes Data Group criteria to interpret the oral glucose tolerance allowed the selection of the most efficient cut points for the glucose challenge test on the basis of time since the last meal. These cut points were 8.2, 7.9, and 8.3 mmol/L for elapsed postprandial times of < 2, 2 to 3, and > 3 hours, respectively. With this change from the current threshold of 7.8 mmol/L the number of patients with a positive screening test dropped from 18.5% to 13.7%. There was an increase in positive predictive value from 14.4% to 18.7%. The rate of patient misclassification fell from 18.0% to 13.1%. CONCLUSION: We suggest that screening strategies for detection of gestational diabetes be reconsidered, to account for the impact of variable postprandial status on the test results.

Adult↗
PubMed1994

Pregnancy following surgical correction for transposition of the great arteries.

OBJECTIVE: To determine the maternal and fetal outcomes in pregnant patients with prior surgical correction of dextro-transposition of the great arteries. METHODS: A retrospective review was conducted of seven pregnancies managed from 1986-1992 in four women who had surgical correction for dextro-transposition of the great arteries. RESULTS: Three of the four patients had had the Mustard operation and the other had had the Rastelli operation. There were no maternal deaths. One patient who received the Mustard operation experienced functional deterioration in the last of three pregnancies, so it was terminated. Three of the remaining six pregnancies resulted in preterm deliveries, but there was no perinatal mortality and no infants had congenital heart disease. CONCLUSION: Maternal outcome can be satisfactory and the perinatal outcome good in patients with surgically corrected dextro-transposition of the great arteries.

Adult↗
PubMed1993

Congenital aortic stenosis and pregnancy--a reappraisal.

OBJECTIVE: This study was performed to determine the maternal and fetal outcome in pregnant patients with congenital aortic stenosis without previous valvular replacement. STUDY DESIGN: A retrospective review of 25 pregnancies in 13 patients delivered at our centers from September 1976 to September 1992 was undertaken. RESULTS: Five (38%) patients had associated congenital heart lesions, three (23%) had severe stenosis (echocardiographically estimated valve area < or = 0.7 cm2), two had prior open aortic valve commissurotomy, and one had balloon valvuloplasty during pregnancy. There were no maternal deaths. Of the 25 pregnancies, five (20%) resulted in therapeutic abortions. There was no perinatal mortality, preterm labor, or increased incidence of pregnancy complications or fetal growth retardation in the remaining 20 pregnancies. One infant (5%) had congenital heart disease. CONCLUSION: Pregnancy outcome is generally satisfactory in patients with congenital aortic stenosis.

Adolescent↗
PubMed1990

Ventriculoperitoneal shunt malfunction during pregnancy.

Many women with cerebrospinal fluid shunts are now reaching reproductive age. Shunt malfunction may occur during pregnancy, and management requires a well-planned, combined neurosurgical and obstetrical approach. We present a case of ventriculoperitoneal shunt obstruction manifesting during the third trimester managed successfully in a conservative fashion. The literature on ventriculoperitoneal shunt malfunction during pregnancy is reviewed.

Adult↗
PubMed1987

Prenatal diagnosis and management of congenital defects of the anterior abdominal wall.

Between the years 1980 and 1985, 25 cases of anterior abdominal wall defects were identified within the University of Toronto Perinatal Complex. There were 17 cases of omphalocele and eight cases of gastroschisis. Associated anomalies were found in 71% of infants with omphalocele and 50% with gastroschisis. They were the major cause of neonatal death. Prematurity was the second most common cause of death. The neonatal death rate was 59% in omphalocele and 38% in gastroschisis; the prematurity rates were 53% and 50%, respectively. In omphalocele, there was a 47% cesarean section rate, with a 50% neonatal death rate. Vaginal delivery was associated with a 67% death rate. In gastroschisis, there was a 50% cesarean section rate, with a 50% neonatal death rate. Vaginal delivery was associated with a 25% death rate. There is no evidence that cesarean section offers improved neonatal survival.

Abdominal Muscles↗
PubMed1987

Sacrococcygeal teratoma: prenatal diagnosis and management.

Although sacrococcygeal teratoma is a rare and potentially malignant tumor, 10 cases were documented during a 5-year period at the University of Toronto Perinatal Complex. Diagnosis was made in the six cases in which prenatal ultrasound examination was performed. One patient with twins elected to terminate the pregnancy at 19 weeks. In three of the cases diagnosed prenatally, serial ultrasound was performed. There was a 75% cesarean section rate. In all cases diagnosed prenatally, the large tumor size affected the mode of delivery. In the four cases without prenatal diagnosis, two infants were delivered vaginally, and two were delivered abdominally for obstetric reasons. There was one case of neonatal morbidity where tumor vascularity and rupture resulted in hypovolemic shock. All tumors were resected and found to be benign. A plan of management is recommended and, with appropriate obstetric and pediatric care, a good outcome can be anticipated in most cases.

Diseases in Twins↗
PubMedDate not supplied

Congenital heart disease in pregnancy.

Care of pregnant patients with congenital heart disease requires understanding of the specific congenital defect, the nature of previous surgical correction, and the residua and sequelae. General risks and principles can be adduced in management decisions. In addition, lesion- and patient-specific details are important. There are only a few conditions that place patients at a high enough risk to advise that pregnancy be avoided under all circumstances (pulmonary vascular obstructive disease, Marfan syndrome with dilated aortic root, severe aortic stenosis, and severe systemic ventricular dysfunction). Preconception counseling, optimization of status, and meticulous multidisciplinary management during pregnancy and the postpartum period will improve outcomes.

Counseling↗
PubMedDate not supplied

Management of pregnant women with cerebrospinal fluid shunts.

As more women with cerebrospinal fluid shunts reach child-bearing age, neurosurgeons, obstetricians and other health care providers will increasingly be called upon to care for them once they become pregnant. A review of the literature reveals that these patients may develop symptoms of shunt malfunction as uterine size increases. In most cases, symptoms can be managed conservatively during pregnancy and usually resolve following delivery. The presence of a CSF shunt per se, is not a contraindication to pregnancy and eventual fetal and maternal outcome has been excellent in the majority of cases. Labor and delivery should be allowed to progress naturally and interventions limited to those indicated for obstetrical reasons alone. Peripartum prophylactic antibiotics may be indicated and special care ought to be exercised if epidural analgesia or cesarian section is deemed necessary. Genetic investigations and counseling may be indicated in selected patients.

Adolescent↗