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Biomedical subjects

R Santos-Ramos

Publications and source records attributed to R Santos-Ramos.

36 records · Page 2Linked to original sources

Sonar cephalometry in twins: a table of biparietal diameters for normal twin fetuses and a comparison with singletons.

In 123 normal twin pregnancies, 589 biparietal diameter (BPD) measurements were obtained between 16 and 40 weeks' gestation and mean values for each week were computed. A table of BPDs for normal twin pregnancies based on these data is proposed. Mean twin BPDs were consistently smaller than those of singletons, the difference averaging 3.5 mm between 16 and 40 weeks' gestation. The development of a twin BPD table now permits a more accurate assessment of twin gestational age and fetal growth.

Cephalometry↗

The value of sonography in suspected ectopic pregnancy.

Of 356 women undergoing sonography to diagnose or rule out an ectopic gestation, data sufficient to assign a final diagnosis were available on 260 of them. Ectopic gestation was diagnosed in 25 cases in this group and intrauterine pregnancy in 99, while the remaining 136 patients were found not to be pregnant. During sonography, ectopic gestations were suspected or diagnosed in 27 instances: In 17 cases this was in agreement with the final diagnosis, but neither an intrauterine nor an extrauterine gestation existed in 10 cases, although neoplastic or inflammatory masses were present. Of the 25 patients with the final diagnosis "ectopic pregnancy," this was not detected with sonography in 8 instances. Intrauterine pregnancies were diagnosed by sonar in 94 of the 99 cases. Although reliable sonar identification of ectopic gestation is not always possible, sonography is helpful in diagnosing intrauterine pregnancy so that surgical intervention can be avoided.

Adolescent↗

A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus.

In a paired, controlled, retrospective study, 44 low birth weight breech fetuses delivered vaginally were compared with 44 breech fetuses delivered by cesarean section. Seven deaths occurred in the vaginal delivery group, compared with only 1 in the abdominal delivery group. Asphyxia, trauma, and intracranial hemorrhage were also found more frequently among vaginally delivered fetuses. The authors conclude that for the low birth weight breech fetus, delivery by cesarean section is preferable.

Asphyxia Neonatorum↗

Prenatal diagnosis of gastrointestinal tract obstruction.

The diagnosis of possible duodenal atresia was made in a near-term fetus. The mother had developed polyhydramnios, and the fetus was found on sonography to have two communicating upper abdominal masses. It also failed to ingest contrast media after injection of radiopaque material into the amniotic sac. An esophageal atresia was found after delivery, in addition to the prenatally diagnosed duodenal atresia. The infant had a surgical repair 16 hours after delivery and survived.

Amnion↗

First experiences with a (15S)-15-methyl prostaglandin F2alpha vaginal device for termination of early first trimester pregnancy with serial sonographic observations.

A silastic device containing 10 mg (15S)-15-Methyl Prostaglandin F2alpha was administered vaginally in three parous patients under 50 days gestation who requested therapeutic abortion. Painful contractions appeared within one hour and vaginal bleeding within three hours of application. All patients aborted, although in one tissue had to be removed from the uterus. Plasma progesterone concentrations were measured in two patients: they decreased within four hours, then increased slightly and finally decreased 24 hours after administration of the device. Nausea, vomiting, and diarrhea were observed in all three patients. The estimated blood loss was less than 100 ml and no significant hematocrit changes were observed in all patients. In serial sonographic examinations of one patient, the fragmentation and dislodgment of the gestational sac could be observed within six hours after administration of the device. After these albeit limited experiences, it is concluded that the (15S)-15-Methyl PGF2alpha vaginal device is of great potential value for induction of early first trimester abortion.

Abortion, Induced↗

Diagnosis of congenital fetal abnormalities by sonography.

Sonographic examinations were performed on 13 patients whose fetuses had the following congenital malformations: anencephaly (4 cases), hydrocephaly (4), obstruction of the renal excretory system (3), iniencephaly (1), and sacrococcygeal teratome (1). In 7 cases the initial diagnosis was made by sonography, in 6 cases by radiography. Sonography was valuable a) in the detection of discrepant growth between fetal chest and head and b) in the recognition of fetal soft tissue abnormalities. It is concluded that sonography is a valuable aid in the diagnosis of congenital fetal anomalies.

Adolescent↗

Color flow mapping for myometrial invasion in women with a prior cesarean delivery.

OBJECTIVES: Our aim was to evaluate the utility of color flow mapping in the prediction of placental myometrial invasion in women with Cesarean delivery. METHODS: Ultrasound color flow mapping was performed on placental implantations in potential proximity to the hysterotomy scar. The smallest myometrial thickness was measured under the placenta to evaluate the degree of myometrial attenuation in this area and note was made of unusual vascular lakes. RESULTS: Two hundred fifteen women with placentas in proximity to the prior hysterotomy scar underwent color Doppler mapping. Of 20 women with placenta previa and Cesarean delivery, 15 had Cesarean hysterectomy for bleeding complications and nine had the pathological diagnosis of placental invasion. The measurement of <1 mm for the smallest myometrial thickness or presence of large intraplacental lakes was predictive of myometrial invasion (sensitivity 100%, specificity 72%, PPPV 72%, and NPV 100%). CONCLUSIONS: Color flow mapping predicted myometrial invasion when the smallest myometrial thickness was <1 mm and large intraplacental lakes were demonstrated.

Cesarean Section↗

Ultrasound anthropometric reliability.

Method errors and reliabilities were estimated for seven sonographic measurements in pregnancies of 106 women examined between January and July 1989. Teams of two experienced sonographers replicated the following measurements: biparietal diameter (BPD), occipital-frontal diameter (OFD), anterior-posterior diameter (APD), transabdominal distance (TAD), and femur diaphysis length (FDL). Multilevel modeling procedures were used to estimate the variance components. Significant (p < 0.01) covariates in the fixed part of the model included an increase in error with greater parity, estimated menstrual age (EMA), and maternal abdominal wall thickness (taken at the umbilicus). Intraobserver reliability ranged from 85.2% (AC) to 99.3% (FDL); interobserver reliability ranged from 80.8% (TAD) to 92.4% (FDL). Method errors, describing the expected error for 68% of the measurements taken, ranged from 0.8 mm to 7.7 mm (intraobserver) and from 1.2 mm to 7.8 mm (interobserver). These results suggest that large error components should be considered in the interpretation of the reliability of ultrasonographically obtained measurements.

Adolescent↗

Anatomic correlates of ultrasonographic prenatal diagnosis.

In utero sonographic diagnoses from forty-five malformed infants were correlated with their autopsy findings. Fifty-two malformations were diagnosed prenatally in 42 of the patients but 90 additional malformations were not. Nine sonographically diagnosed abnormalities were not confirmed at autopsy. Factors compromising sonographic diagnosis included: limited examinations, small fetal size, timing of examination, oligohydramnios, fetal position, nature of the malformation and unfamiliarity of the ultrasonographer with specific malformation syndromes. In utero ultrasonography is an invaluable tool of diagnosing congenital malformations but has limitations.

Abnormalities, Multiple↗