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Biomedical subjects

S L Warsof

Publications and source records attributed to S L Warsof.

36 records · Page 2Linked to original sources
PubMed1986

Fetal sacrococcygeal teratoma.

Sacrococcygeal teratoma (SCT) is being diagnosed before birth with increasing frequency. We were recently consulted about management of a 22-week fetus with SCT and reviewed our experience (6 cases) and the literature. We found that most fetal SCT present from 22 to 34 weeks gestation with a uterus enlarged by the tumor and/or associated polyhydramnios; although the American Academy of Pediatrics Surgical Section clinical classification is an important prognostic indicator in neonatal SCT, it does not appear to predict outcome in fetal SCT; associated chromosomal abnormalities or life threatening anomalies are rare; presentation after 30-weeks gestation is a relatively good prognostic sign with fetal survival, after planned cesarean delivery, in 6 of 8 cases; and hydrops and/or placentomegaly in association with fetal SCT predicts fetal demise soon after diagnosis with 7 of 7 cases dying in utero.

Female↗
PubMed1986

Routine ultrasound screening for antenatal detection of intrauterine growth retardation.

This prospective screening program of a large obstetric population was designed to determine the effectiveness of ultrasonic biometry to diagnose intrauterine growth retardation. The results of 3616 pregnancies were analyzed. All pregnancies were dated before the 24th week by ultrasonic measurements. The study compared the effectiveness of three ultrasonic growth parameters: biparietal diameter (BPD), head circumference, and abdominal circumference, to detect intrauterine growth retardation and to determine the optimal gestational age to perform the scan for this purpose. To maintain a high sensitivity required in a screening program, all ultrasonic measurements below the 25th percentile for gestational age were considered abnormal. The predictive value of a positive test in this situation ranged from 0.25 to 0.55, depending on the week of gestation in which the scan was performed. Accuracy of predictions improved greatly when the scans were performed within two weeks of delivery. Abdominal circumference measurements were more predictive of intrauterine growth retardation than either head circumference or BPD measurements or the combination of these parameters. In view of the sensitivity of the test and the prevalence of the disorder, it is concluded that 34 +/- 1 weeks of gestation is the optimal time to screen patients ultrasonically for intrauterine growth retardation.

Abdomen↗
PubMed1986

Comparison of fetal weight estimation formulas with and without head measurements.

Most published sonographic techniques for estimating fetal weight use measurements of the biparietal diameter (BPD) and abdominal circumference. In many clinical situations, however, accurate head measurements cannot be obtained. One hundred one patients were scanned within 72 hours of delivery. Using multiple stepwise regression analysis, a best-fit formula was developed using abdominal circumference and femur length, or femur length alone. The mean error was 109 g/kg fetal weight for abdominal circumference and femur length that was comparable with BPD and abdominal circumference formulas for estimated fetal weight. The mean error when femur length was used alone was 129 g/kg fetal weight. When these models were tested prospectively on 67 patients and compared with published formulas, they yielded results that were similar in accuracy. Among these additional patients, the model using one parameter (femur length) had an average error of 114 g/kg, whereas the femur length and abdominal circumference showed a mean error of 125 g/kg.

Anthropometry↗
PubMed1985

Routine ultrasound screening for the prediction of gestational age.

In a technician-oriented routine ultrasound program, the value of screening an entire obstetric population for predicting gestational age based on a single measurement was evaluated over selective scans performed on the basis of uncertain menstrual history. Consecutive pregnancies of 4527 women were scanned, and the results were analyzed. Gestational ages were determined by both menstrual history and ultrasonic crown-rump length or biparietal diameter (BPD) measurements. The estimated date of confinement based on ultrasound measurements was compared with menstrual history in its ability to predict the actual onset of spontaneous labor. Of patients with optimal menstrual history, 84.7% delivered within +/- two weeks of the date predicted. Only 69.7% delivered within +/- two weeks of the estimate date of confinement based on suspect menstrual history. Crown-rump length measurements were as predictive (84.6%) as optimal menstrual history. Biparietal diameter measurements done between 12 and 18 weeks' gestation were significantly more accurate in gestational predictions (89.4%) than those based on menstrual history (P less than .001). It is concluded that ultrasound cephalometry before 18 weeks is the single best dating parameter.

Cephalometry↗
PubMed1985

Oral ritodrine and preterm premature rupture of membranes.

A prospective randomized study was performed to determine whether or not oral ritodrine therapy significantly prolonged the latent period in patients with prematurely ruptured membranes. Compared with a control group of similar patients, those treated had a significantly prolonged mean latent period. In addition, 47.6% of the treatment group versus 14.2% of the control group had a latent period of more than one week.

Birth Weight↗
PubMed1985

Endocervical curettage as a routine part of colposcopic examinations for abnormal cervical cytology.

Two hundred seven consecutive patients with adequate colposcopy and routine endocervical curettage (ECC) were evaluated for abnormal cervical cytology. A positive ECC was found in 31 patients (15.0%). In patients with grade III cervical intraepithelial neoplasia (CIN), ECC was positive 260% more often than in patients with CIN 1 and 2 (P less than .005). The ECC was the only evidence of dysplasia in three instances. The data suggest that routine ECC should be an integral part of the colposcopic examination of patients with abnormal cytology.

Biopsy↗
PubMed1984

The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions.

Twenty-five severely rhesus-isoimmunized fetuses, including 15 with hydrops fetalis, underwent a total of 77 intrauterine transfusions between 19 and 32 weeks' gestation. Fifty-eight of the procedures were fetoscopically directed intravascular transfusions, nine were ultrasound-guided intraperitoneal transfusions, and 10 were a combination of intravascular transfusion, fetal paracentesis, and intraperitoneal transfusion. The average number of antenatal procedures per patient was three (range, one to five). The survival rate for the 19 fetuses that received their initial intrauterine transfusion at or before 25 weeks' gestation was 84%; 11 of the 13 hydropic fetuses and five of the six fetuses without antenatal evidence of hydrops survived. In six cases hydrops fetalis was reversed in utero. The outcome in patients referred after 25 weeks' gestation was poor; neither of the two hydropic fetuses and only two of the four nonhydropic ones survived, which suggests the importance of early referral to a team experienced in the management of this problem. However, most of these fetal losses occurred early in the series. Seven of the 20 neonates were hydropic, and nine had severe thrombocytopenia (platelet count, less than 50,000 X 10(6)/L). The mean cord blood hematocrit and bilirubin of the neonates were 25.1% and 82 mumol/L, respectively. The babies required a total of 69 exchange transfusions (range, 0 to 9) and 68 simple transfusions (range, 0 to 25). One newborn infant who had had ultrasound evidence of hydrops fetalis at 22 weeks' gestation did not require any exchange transfusions. Nine patients required intermittent positive pressure ventilation (eight had respiratory distress syndrome and one had apnea) for a range of 1 to 86 days. The neonatal survival rate was 90% (18/20).

Blood Transfusion, Intrauterine↗
PubMed1983

Medical and surgical treatment of inflammatory bowel disease in pregnancy.

Inflammatory bowel disease is a relatively common spectrum of disorders of the gastrointestinal tract in women of the reproductive age group. Although Crohn's disease may decrease fertility, female reproductive ability is normal in UC. In general, IBD is not a contraindication to pregnancy or vaginal delivery and is not an indication for therapeutic abortion. Pregnancy will have a variable effect on IBD, and the patient's experience in previous pregnancies is not prognostic of future pregnancies. Whenever possible, pregnancies should be planned when IBD is quiescent and the patient is on a minimal drug regimen. The treatment of IBD is essentially the same regardless of pregnancy. Aggressive medical management with supportive therapy, corticosteroids, and sulfasalazine is effective in the treatment for this disorder. Sulfasalazine is effective in preventing recurrence of UC. Surgical treatment may be necessary in pregnancy. An enlarged uterus may make recognition of acute complications difficult, and fear of radiation may decrease the number of diagnostic x-ray studies performed. A proctocolectomy and ileostomy is curative for UC, but no procedure will cure Crohn's disease. In pregnancy, a limited surgical procedure may be necessary. There is a high incidence of fetal loss if surgery is required in IBD. This fetal loss is probably caused by the fulminant nature of the disease rather than surgery itself. If surgery is indicated, however, it should be performed for maternal indications despite the risk to the fetus. As can be seen, management of IBD in pregnancy is not to be taken lightly and requires extensive collaboration between obstetrician, gastroenterologist, surgeon, and other support personnel.

Adrenocorticotropic Hormone↗
PubMed1983

Fetoscopy.

Explore the source record for details and available documents.

Blood Transfusion, Intrauterine↗
PubMed1983

The present place of routine ultrasound screening.

The value of routine ultrasound examinations is illustrated in Table 3. Ultrasound examination may of course be indicated in early pregnancy on clinical grounds. If it is not, we recommend that all patients should have measurement of the BPD between 16 to 18 weeks' gestation even if they have optimal menstrual histories. It is preferable to have a routine ultrasound service if a MSAFP programme is offered because, although it is possible to scan only patients with a raised MSAFP, prior knowledge of gestational age helps in the timing of the sample and prevents concern in patients with inaccurate dates. At 16 to 18 weeks' gestation multiple pregnancies can be diagnosed reliably and many structural abnormalities can be detected even when the routine examination is performed by non-medically trained personnel. A fundal placenta at 16 to 18 weeks' gestation excludes the possibility of placenta praevia. Seeing the fetus on the ultrasound screen and watching fetal movements strengthens parental feelings towards pregnancy. A repeat ultrasound examination in the third trimester to measure AC is superior to clinical means of detecting growth retardation. Placental localization at this gestation is accurate and has removed the need for the hazardous 'examination under anaesthetic'. If facilities are available we recommend that every patient has a repeat scan in the third trimester. If facilities are insufficient then we recommend that high risk patients have serial scans and that other patients have SFH measurement at each antenatal visit, and that only those that have a low SFH should have repeat ultrasound examinations. Until the day arrives when there is sufficiently trained personnel, adequate equipment and time to perform detailed examinations of all fetuses at 16 to 18 weeks' gestation, together with serial examination and measurement of all growth parameters, we feel the above schema makes the best use of available facilities.

Female↗
PubMed1982

An evaluation of two equations for predicting fetal weight by ultrasound.

In an earlier study we presented a method of determining fetal weight from ultrasound measurements of abdominal circumference (AC) and biparietal diameter (BPD). From an equation with these two measurements as independent variables we generated tables of estimated fetal weights (E1). Although these tables have been very useful, we had the impression we were underestimating fetal weight. Therefore, we reconsidered an earlier unpublished table generated from a different equation (E2). While most estimates from E1 and E2 were likely to be within 10% of actual weight, there was significant underestimation with E1. E2 provides a better balance between the distribution of overestimations and underestimations.

Birth Weight↗
PubMed1980

Prenatal diagnosis of congenital adrenal hyperplasia.

In patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, the concentrations of the cortisol precursor 17-alpha hydroxyprogesterone (17-OHP) and its metabolite delta 4-androstenedione (delta 4 A) are increased. CAH was diagnosed in twins by measurement of 17-OHP and delta 4 A concentrations in amniotic fluid obtained by amniocentesis from both amniotic cavities at 17 weeks' gestation. Both prenatal karyotypes were 46,XX. Spontaneous labor and delivery of 2 nonviable fetuses with genital masculinization occurred at 26 weeks' gestation. It is concluded that delta 4 A measurement, like 17-OHP quantitation, is valuable in the prenatal diagnosis of CAH; that both methods appear useful in prediction of CAH in twin fetuses; and that abnormal adrenal-mediated masculinization in female CAH is well established before the end of the second trimester.

Adrenal Hyperplasia, Congenital↗
PubMed1977

The estimation of fetal weight by computer-assisted analysis.

The need for a quick and easy method for estimating fetal weight in utero has been clearly established. Estimates by abdominal palpation and fetal hormone production have proved to be of limited value. Eight-five patients, ranging from 17 to 41 weeks' gestation, were ultrasonically scanned within 48 hours of delivery. Statistical analysis and multiple multivariant linear regressions were performed employing the BMD statistical packages. Our results show that birth weight is a logarithmic function of fetal body parameters and that the abdominal circumference has the single best correlation with the log10 birth weight. Our best linear regression with the use of two fetal dimensions (abdominal circumference and biparietal diameter) had a standard deviation of 106 grams per kilogram fetal weight. Since this derived formula is very cumbersome to manipulate, tables have been prepared with computer assistance to read the estimated fetal weight directly. Prospective estimates in 32 cases of both normal and pathologic gestations have proved to be within our expected accuracy.

Abdomen↗
PubMedDate not supplied

Fetoplacental and uteroplacental Doppler blood flow velocity analysis in premature rupture of membranes.

The value of Doppler velocimetry in predicting fetal distress or perinatal infection was investigated in 60 patients with premature rupture of the membranes (PROM) between 25 and 38 weeks of gestation. Studies were performed in the umbilical and uterine arteries after admission to the hospital and repeated every 24 to 76 hours until delivery. Results of the last study, performed less than 24 hours before delivery and comparison between longitudinal studies in the same patient, failed to disclose statistical differences between patients who did or did not develop the perinatal complications under study. We conclude that Doppler velocimetry is not a sensitive enough means of predicting fetal distress or infection in PROM.

Arteries↗
PubMedDate not supplied

Ultrasonic prediction of discordant growth in twin pregnancies.

In this prospective study conducted from 1984 through 1987, the ability to correctly predict growth discordancy in twin gestations by ultrasonic estimated fetal weights is examined. Discordancy was defined as an intertwin birth weight difference of 25% or greater. This method resulted in a sensitivity rate of 77% and a specificity rate of 92%. The positive predictive value of an abnormal test (i.e. discordant growth) was 67% and the negative predictive value of a normal test (i.e. concordant growth) was 95%. The perinatal mortality rate of 217/1,000 in discordant twin fetuses was significantly higher than 29/1,000 in the concordant twins in this study population (p < 0.01) and even more of a contrast to the rate of 10/1,000 in our singleton population. Accurate prediction of discordant twin pregnancies which are at high risk for poor outcome opens the opportunity for potential in utero treatment modalities.

Birth Weight↗
PubMedDate not supplied

A non-human primate model for the in utero chronic catheterization of the umbilical vein. A preliminary report.

Short-term ultrasound-guided fetal umbilical cord catheterization in humans has been reported. However, before chronic umbilical vein catheterization is attempted in humans the technique must be tested in the non-human primate model. If the fetus was to tolerate this procedure, chronic fetal umbilical vein catheterization could be used for drug administration, parenteral fetal nutrition or to monitor the changes of hematologic parameters during and after open or endoscopic fetal surgery. In this study, 4 pregnant baboons were used to test the feasibility of ultrasound-guided umbilical vein catheterization. Although the umbilical vein was successfully catheterized in all the animals, only 1 fetus survived the postoperative period. The 3 immediate fetal deaths were due to a fetal intra-amniotic hemorrhage, while the most likely cause of death of the 4th animal was infection. In the surviving fetus and mother, blood was sampled once a day. Neither fetomaternal hemorrhage nor thrombosis could be documented. We conclude that ultrasound-guided transplacental umbilical vein chronic catheterization is technically difficult but feasible in the baboon model. Further studies in this model are needed to improve the catheterization technique and to monitor the extent of time that the catheter may be tolerated within the umbilical vein.

Animals↗