Biomedical subjects

S L Warsof

Publications and source records attributed to S L Warsof.

At least 19 recordsLinked to original sources

PubMed1994

Ultrasonographic growth and Doppler hemodynamic evaluation of fetuses of obese women.

All fetuses benefit from ultrasonographic estimation of gestational age and evaluation of growth patterns. Monitoring the pregnancies of obese women is perceived as more difficult than monitoring those of nonobese women. The aim of this study was to determine if maternal obesity affects the growth and Doppler resistance indices (RI) of the fetus. Twenty-eight women with a preconception weight > 90.7 kg underwent obstetric ultrasonographic evaluations from the 20th week of gestation. Their ultrasonographic data were compared with those of controls. Ten of the obese women developed gestational diabetes and had lower umbilical artery RIs for a given gestational age (P < .0001) than did those obese women without other medical complications, those with medically controlled pregnancy-induced hypertension or those from the control population. The relation between fetal unit weight and umbilical artery RIs was established. The pattern of RI changes was similar in all groups when estimated fetal weight instead of gestational age was used as the covariant. Fetal growth and Doppler velocimetry can be monitored adequately in obese women. Gestational diabetes significantly influences the pattern of fetal growth and the impedance to flow in the umbilical artery.

Adult↗

PubMed1992

Color Doppler imaging in the assessment of uteroplacental blood flow in abnormal first trimester intrauterine pregnancies. An attempt to define etiologic mechanisms.

The addition of color Doppler imaging (CDI) to the vaginal probe now enables sonographers to study more accurately the maternal-fetal circulation at the early stages of the gestation. Doppler studies of normal intrauterine first trimester gestations have been published, and our investigation was an attempt to study uteroplacental blood flow in abnormal intrauterine first trimester gestations. Although the calculated indices did not differ significantly from those found in normal gestations, we did find a higher rate of color detection in gestations defined as anembryonic as compared to those defined as missed abortions. Circulation abnormalities probably play a significant role in early pregnancy failures, and we believe CDI will help define the different etiologic mechanisms causing these early complications.

Abortion, Missed↗

PubMed1992

Twin pregnancy. Ultrasonographically observed changes in fetal presentation.

The changes in fetal presentation throughout pregnancy were observed ultrasonographically in 332 sets of twins. Seventy-eight percent of the leading twins were vertex at 26-30 weeks' gestational age, 75% at 31-34 weeks and 81% at 35-38 weeks. The incidence of nonvertex presentation for either twin was 73.0%, 64.5% and 59.5% at the same gestational ages. The results are not significantly different from those on concordant twins delivered at the same gestations. Thus, one can counsel parents of twins at all gestational ages in regard to the potential for malpresentation.

Breech Presentation↗

PubMed1992

Antenatal classification of hydrops fetalis.

Among 12,572 pregnant women referred for ultrasound examination from 1985-1990, 76 fetuses had ultrasonographic findings of hydrops fetalis, ten immune and 66 nonimmune. Fetuses with cystic hygroma (20), heart defects or arrhythmias (13), or other congenital anomalies (15) accounted for the majority of the nonimmune cases. Antenatal chromosomal studies were available in 42 fetuses with nonimmune hydrops, of which 14 (34%) were abnormal with seven monosomes and six trisomies. Seventeen cases of hydrops (22%) were classified as idiopathic because they had no recognizable etiology. It is concluded that: 1) The ultrasonographic incidence of fetal hydrops in referral centers can be as high as one in 165 pregnancies; 2) most cases of fetal hydrops are of the nonimmune type, which can occur in a low-risk population and can be detected with early second-trimester ultrasound screening; and 3) the complexity of this condition and the high rate of chromosomal abnormalities require referral to a high-risk center for evaluation and pregnancy management.

Chromosome Aberrations↗

PubMed1991

Transvaginal color Doppler imaging in the assessment of uteroplacental blood flow in the normal first-trimester pregnancy.

Characteristic changes of low resistance and high diastolic blood flow velocity were identified by Doppler studies starting in the early phase of the second trimester. These changes were attributed by some authors to trophoblastic invasion of the uterine vasculature converting the uterus into a low-resistance organ. Because of technical limitations previous studies were confined to the uterine artery and its main branches. With the development of color Doppler and transvaginal ultrasonography we can now identify blood flow in various small vessels in the placental bed. This study was performed to assess the ability of color Doppler ultrasonography to evaluate subtrophoblastic blood flow by color identification in the early phase of normal pregnancy from 5 to 9 weeks' gestation. Results show that the characteristic increase in diastolic blood flow is evident as early as 5 weeks' gestation.

Female↗

PubMed1991

Doppler evaluation of the fetoplacental circulation in the latent phase of preterm premature rupture of membranes.

Blood velocity waveform analysis by pulsed Doppler ultrasonography in preterm premature rupture of membranes is described. Reduced amounts of amniotic fluid did not impair determination of the resistance indices from the umbilical artery. Good results were obtained from the internal carotid artery in 82% of cases. Failure in measurements at the internal carotid artery occurred when fetal head engagement prevented good study planes. Ninety-three percent of umbilical artery determinations fell within the normal limits for our control population as did 89.2% of those at the internal carotid artery. No differences in the resistance indices could be attributed to the length of the latent period in prematurely ruptured membranes or subclinical chorioamnionitis. Therefore, if a mother or fetus has an underlying condition that affects fetoplacental circulation, the resulting abnormal blood velocity waveform should reflect this condition rather than the effect of ruptured membranes.

Blood Flow Velocity↗

PubMed1991

Value of a random single Doppler study of the umbilical artery for predicting perinatal outcome.

A prospective blinded study was performed on 191 high-risk patients with pregnancies ranging from 25 to 42 weeks gestation to investigate the value of a single Doppler analysis of the umbilical artery blood flow waveform (systolic-to-diastolic ratio, S/D) for predicting poor perinatal outcome. This was defined as the presence of heavy meconium, delivery of a growth-retarded infant, an umbilical cord arterial pH less than 7.2, or a 5-minute Apgar score less than 7. The interval between Doppler examination and delivery ranged from 12 hours to 15 weeks. No clinical data were available to the examiner performing the Doppler study. Moreover, the Doppler measurements were unknown to the attending physicians. The sensitivity, specificity, and positive and negative predictive values of the Doppler study in predicting outcome were 30.4%, 92.9%, 36.8%, and 92.6%, respectively, with an adverse outcome prevalence of 12%. These results indicate that a single random S/D ratio from the umbilical artery is not an adequate screening test for the risk of perinatal complications.

Female↗

PubMed1990

Placental histology in fetuses between 18 and 23 weeks' gestation with abnormal karyotype.

Placentas from karyotypically abnormal fetuses (18 to 23 weeks' gestation) were analyzed prospectively at the light microscopic level. Group I consisted of 14 control placentas. Group II consisted of 14 placentas from fetuses with an abnormal karyotype. Secondary and tertiary stem villi counts, small muscular artery counts, and total vessel counts were determined per 100 x field. There were no differences in secondary and tertiary stem villi counts between groups. A significant decrease in small muscular artery counts (p less than 0.01) and total vessel counts (p less than 0.01) was noted in group II. Placental and fetal weights were comparable between groups. This undervascularization may represent placental immaturity as a result of arrested or delayed angiopoiesis. It appears that this abnormality is established before the third trimester and may be enhanced by late vascular obliteration as reported by others. These data substantiate the concept that the structure and function of the placenta is determined to a great degree by fetal karyotype and may help explain the morbidity and mortality seen in these fetuses.

Chorionic Villi↗

PubMed1990

Death due to high-output cardiac failure in fetal sacrococcygeal teratoma.

Fetal sacrococcygeal teratoma (SCT) is being recognized with increasing frequency. Placentomegaly and hydrops fetalis are preterminal events, and it has been suggested that fetal death may be due to high-output cardiac failure from arteriovenous shunting through the tumor. We had a chance to examine this hypothesis when a 21-week fetus presented with a huge sacrococcygeal teratoma. There were marked placentomegaly, cardiomegaly, hyperdynamic ventricles, and a pericardial effusion. Doppler studies showed tremendous flow through the SCT with extreme enlargement of the inferior vena cava, consistent with congestive heart failure from increased flow through the tumor. Hydrops developed, and the fetus was delivered because of placental abruption. This case provides supportive evidence that the teratoma acts as a large arteriovenous shunt, causing high-output cardiac failure. We have now collected 18 more cases of sacrococcygeal teratoma diagnosed in utero. Of the total 45 cases of fetal SCT, 9 had placentomegaly and/or fetal hydrops and all 9 fetuses died in utero or shortly after birth. We conclude that the only hope for survival in these severely affected fetuses is to reduce blood flow to the tumor before birth.

Cardiac Output↗

PubMed1990

Combined intravascular-intraperitoneal transfusions in hydropic twins due to Rh (D) alloimmunization.

Fetal hydrops due to Rh (D) alloimmunization can be reversed by ultrasound-guided intravascular transfusions with improvement in perinatal morbidity and mortality. We report a case of in utero intravascular transfusion in hydropic twins which reversed all the hydropic findings within 3 days. A simple intraperitoneal transfusion was performed in each twin 2 weeks later, and only one neonatal exchange transfusion was required for the ultimate survival of both twins.

Adult↗

PubMed1989

Congenital cystic hygroma of the neck diagnosed prenatally: outcome with normal and abnormal karyotype.

Twenty-two cases of cystic hygromas were diagnosed prenatally at Eastern Virginia Medical School and followed through the neonatal period. Our series was combined with 131 cases which have been described in the literature. Karyotypes were obtained in 110 fetuses and 80 (72.7 per cent) were abnormal. Fifty-one were not terminated: 30 with abnormal and 21 with normal karyotypes. There were no neonatal survivors in the group with abnormal karyotypes. There were five survivors in the 21 with normal karyotypes but only 2/21 without severe medical complications. Combining our series with those previously reported in the literature would suggest only a 2-3 per cent rate of intact survivors when fetal cystic hygromas are diagnosed in utero. This information should be helpful when counselling patients whose pregnancies carry this diagnosis.

Amniotic Fluid↗

PubMed1989

Ultrasonographic measurement of fetal femur length in growth disturbances.

Ultrasonographic measurement of fetal femur length is a recognized technique for determination of gestational age and fetal growth. A total of 280 pregnant women were studied, each of whom had pathologies with the potential to either accelerate or delay fetal growth. There were 1000 measurements of the fetal femur length performed on these 280 fetuses. A total of 125 fetuses were found to have a growth disturbance-91 with asymmetrical intrauterine growth retardation and 34 with macrosomia. Comparison of fetuses with either intrauterine growth retardation or macrosomia with appropriate-for-gestational-age fetuses showed that the femur length is not statistically affected by intrauterine growth abnormalities.

Female↗

PubMed1989

Doppler study of umbilical artery blood flow waveform. Should we use an instrument-adapted nomogram?

Doppler studies of umbilical artery blood flow waveform are becoming an accepted tool of antenatal estimation of fetal well-being. The S/D ratio of the systolic peak (S) to the end-diastolic (D) frequency is the most commonly used parameter. Nomograms relating S/D ratio to gestational age have been published both for normal and pathologic pregnancies. Three hundred twelve analyses of umbilical artery blood flow were performed by continuous Doppler technology in normal, well-dated pregnancies using either one of the following instruments: GE 3600 (GE) or Multigon 500A (MG). Both instruments showed a decrease of S/D with GA, but, by use of a nonpaired t test, a statistically significant difference was found between the two machines. Data on the system used for a particular study should be provided; nomograms for this particular instrument should be consulted and the same machine should be employed for repeat testing in longitudinal studies.

Blood Flow Velocity↗

PubMed1989

Doppler analysis of the umbilical artery. The importance of choosing the placental end of the cord.

Thirty normal pregnancies were studied with continuous or pulsed Doppler ultrasound (50 measurements). The ratio of systolic (S) to end-diastolic (D) measurement, or S/D ratio, was obtained at both ends of the cord: the placental insertion and the fetal abdominal insertion. A statistically significant difference was demonstrated between the two sets of measurements. Normal values were obtained at the placental insertion, whereas, simultaneously, the fetal abdominal insertion generated highly abnormal values. When performing Doppler waveform analysis of the umbilical artery, if abnormal values are obtained, one should be cautious to be certain that they originated from the placental insertion.

Blood Flow Velocity↗

PubMed1988

Lower limb movements and urologic function in fetuses with neural tube and other central nervous system defects.

Lower limb movements and urologic systems were evaluated by prenatal ultrasound in 120 fetuses with either neural tube defects or intracranial anomalies. Despite anticipated major lower extremity and bladder dysfunction, lower limb movements were seen in 100% of the fetuses with anencephaly and encephaloceles, 93% with isolated spina bifida, 60% with complex spina bifida and 90% with abnormal intracranial findings. In all the cases except those with cloacal exstrophy, fetal bladder and collecting systems appeared normal. Therefore, fetal lower limb movements and urinary tract integrity appear to have no diagnostic or prognostic value in fetuses with neural tube defects or other central nervous system anomalies. These diagnoses can only be made by direct ultrasound observation of the lesion itself.

Anencephaly↗

PubMed1987

Ultrasound diagnosis of intrauterine growth retardation.

Intrauterine growth retardation is associated with increased perinatal morbidity and mortality. Assuming an accurately dated pregnancy, ultrasonic estimations of fetal weight can be used to predict intrauterine growth retardation. Antenatal detection of this condition will have an impact on management and ideally may improve outcome.

Female↗

PubMed1987

Fetal sacrococcygeal teratoma.

Early prenatal diagnosis of fetal sacrococcygeal teratoma (SCT) has enabled the perinatal team to institute management of this condition during the perinatal period. We report 2 additional cases to our previous 27 cases including 1 which represents the earliest diagnosis of SCT. Fetal SCT behaves in a different manner than neonatal SCT. In utero manipulation of fetal SCT may be possible if diagnosis is made during the second trimester.

Adult↗

PubMed1986

Midtrimester amniotic fluid delta optical density at 450 nm in normal pregnancies.

Spectrophotometric analysis of amniotic fluid has become the standard for assessing the fetal condition in Rh-immunized pregnancies. Serial amniocentesis is usually started at 28 to 29 weeks of gestation unless the antibody titer or history indicates it should be done earlier. This study presents the values from 14 to 20 weeks in normal pregnancies, which will also assist in evaluating pathologically elevated values.

Adult↗