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Biomedical subjects

W J Watson

Publications and source records attributed to W J Watson.

At least 73 records · Page 4Linked to original sources
PubMed1991

Prolonged postpartum urinary retention.

Urinary retention after vaginal delivery is a relatively common problem, usually resolved by the temporary use of an indwelling catheter. Presented are two patients with persistent bladder atony after vaginal delivery, despite the use of an indwelling catheter for 10 days. Both patients had low forceps deliveries without severe perineal trauma. Both were treated by self-intermittent catheterization, with resolution of urinary retention at 24 and 37 days postpartum, respectively. These patients were able to learn this technique with minimal instruction. Advantages of intermittent catheterization over prolonged use of an indwelling catheter include greater patient acceptance and possible reduction in the incidence of urinary tract infection.

Adult↗
PubMed1991

Fetal responses to maximal swimming and cycling exercise during pregnancy.

Fetal responses to maximal maternal exercise were studied during cycle ergometry and tethered swimming in 13 untrained subjects at 25 and 35 weeks' gestation. The fetal heart rate (FHR) and uterine and umbilical artery waveforms were measured before exercise, immediately after exercise, and at 5-minute intervals during 20 minutes of recovery. The mean maternal maximal heart rate was 179 +/- 12 beats per minute and did not differ between swimming and cycling exercise trials. Six episodes of transient bradycardia occurred after a total of 45 maximal exercise trials. The mean FHR decreased slightly immediately after exercise, then increased approximately ten beats above baseline levels at 10-20 minutes after exercise (P less than .02). The changes from baseline in FHR were greater after cycling than after swimming. Changes observed in the systolic-diastolic ratio (S/D) of the umbilical artery could be accounted for by the FHR variations. The S/D of the uterine artery was significantly higher after cycling than after swimming (P = .05). We conclude that maximal maternal exercise during pregnancy causes transient fetal bradycardia in approximately 15% of cases, in cycling more often than in swimming.

Adult↗
PubMed1991

Vaginal birth after cesarean section in a small hospital.

Most studies on vaginal birth after cesarean section come from medical centers or university hospitals. However, the minority of births in the United States occur in these hospitals. When compared with larger institutions, many small hospitals have longer operating start-up times, less adequate blood banking facilities, and decreased obstetrical anesthesia support. Over a 30-month period in a small hospital, a trial of labor was successful in 76% of patients with prior cesarean section. Despite the limitations of support in a small hospital, vaginal birth can be offered to selected patients with prior cesarean section delivery. In our experience, vaginal birth after cesarean delivery requires significantly more physician hours in the hospital than does repeat cesarean section. The problem of a pregnancy with a prior cesarean section is an ever-increasing one and, in our practice, approximately 25% of multiparous patients have had a prior cesarean delivery.

Female↗
PubMed1990

Familial cystic hygroma with normal karyotype.

A patient is described who had three consecutive fetuses with cystic hygroma and hydrops, two of which had documentation of normal karyotype. Some twenty percent of fetuses with cystic hygroma have a normal karyotype, and many of these have other major malformations. An autosomal recessive pattern of inheritance has been postulated, but cystic hygroma may also occur in association with a variety of syndromes, some of which have other patterns of inheritance.

Adult↗
PubMed1990

Prenatal diagnosis of laryngeal atresia.

In a patient in whom preeclampsia developed at 23 weeks' gestation, ultrasonographic examination of the fetus showed enlarged edematous lungs, a compressed fetal heart, severe ascites, fetal hydrops, and placental edema. Autopsy of the hydropic stillborn infant showed laryngeal atresia. The ultrasonographic appearance of this rare malformation is presented.

Adult↗
PubMed1990

Ultrasound determination of fetal abdominal circumference: a comparison of measurement methods.

The measurement of fetal abdominal circumference by the direct perimeter method using a digitizer was compared with calculation of this measurement using the fetal mean abdominal diameter in 235 cases. The directly measured abdominal circumference was found to be greater than the calculated value (p = 0.00014). The magnitude of the difference, however was only 1.3 +/- 2.2%, which is smaller than the average interobserver measurement error. Although statistically significant, the difference between these two measurement methods is not clinically significant, and these data and discussion show that either method is acceptable to determine fetal abdominal circumference.

Abdomen↗
PubMed1990

Magnesium sulfate tocolysis in selected patients with symptomatic placenta previa.

Tocolysis can be used to arrest contractions in selected patients with placenta previa if the maternal condition is stable. Over a 5-year period, 41 patients with symptomatic placenta previa were treated, of whom 18 were given magnesium sulfate therapy for tocolysis. The mean prolongation of gestation was 18.5 days, and tocolysis was successful in 17 of 18 cases. Since betamimetic drugs used for tocolysis may mask or blunt maternal cardiovascular responses to volume depletion, magnesium sulfate is a better choice to inhibit contractions in patients with symptomatic placenta previa whose bleeding is mild or moderate.

Adult↗
PubMed1990

Screening for glycosuria during pregnancy.

It is currently recommended that every pregnant woman have a blood glucose screening test for gestational diabetes at 24 to 28 weeks' gestation. Random urine samples are also tested for glucose at each prenatal visit. In 500 consecutive pregnant women, random urine glucose screening values from each prenatal visit were compared with a serum glucose test done at 28 weeks' gestation after ingestion of a 50 gm glucose-containing beverage. Twenty-two patients (4.4%) subsequently were identified as having gestational diabetes. Eighty-five (17%) had some degree of glycosuria, and 19 (3.8%) had severe glycosuria. Only six (27%) of the 22 women with gestational diabetes had any glycosuria. As a screening test for gestational diabetes, glycosuria had a 27% sensitivity and a positive predictive value of only 7.1%. Severe glycosuria, although increased in women with gestational diabetes (P = .0071), occurred in only 18% of cases. Detection of severe glycosuria before 24 weeks' gestation is an indication to do earlier blood glucose screening. After blood glucose screening is done, routinely screening the urine for glycosuria at each prenatal visit does not appear to be clinically useful.

Blood Glucose↗
PubMed1990

Plasmapheresis during pregnancy.

Plasmapheresis, a process in which blood is withdrawn, the plasma removed, and the red cells reinfused after resuspension in a replacement solution, has been used for a variety of conditions during pregnancy, but is most useful in the treatment of pregnancy complicated by thrombotic thrombocytopenic purpura or persistent postpartum microangiopathic hemolytic disorders. A low risk of morbidity and fatalities associated with plasmapheresis has been reported, but the incidence of these complications does not seem to be affected by pregnancy.

Female↗
PubMed1990

Human immunoglobulin therapy for preeclampsia associated with lupus anticoagulant and anticardiolipin antibody.

A patient with lupus anticoagulant and anticardiolipin antibody developed preeclampsia at 24 weeks' gestation. Therapy with human immunoglobulin (Ig) resulted in stabilization of preeclampsia and suppression of the lupus anticoagulant. Anticardiolipin antibody titers were partially suppressed. Preeclampsia worsened at 32 weeks' gestation, and a healthy infant was delivered. For patients with preeclampsia secondary to lupus anticoagulant before the fetus is viable, human Ig is a potential therapeutic option.

Adult↗
PubMed1990

Early-second-trimester fetal sex determination with ultrasound.

A prospective investigation was performed to determine the accuracy of fetal gender determination with ultrasound at 13-19 weeks' gestation. A determination could be made in 91 of 100 women. Factors associated with nonvisualization were maternal obesity and breech presentation. The findings on ultrasound were compared with phenotypic sex after birth. The overall accuracy of sex prediction was 92.3%; for males it was 89.5% and for females, 97.1%. Significantly fewer errors were noted as experience with gender identification increased.

Female↗
PubMed1990

Monozygotic twins discordant for partial trisomy 1.

A 25-year-old primigravida delivered monozygotic twins discordant for multiple anomalies and partial trisomy 1 mosaicism. The phenotype of partial trisomy 1 includes craniofacial, central nervous system, and ocular anomalies. The most likely explanation for these findings is that the translocation occurred after twinning occurred. This observation emphasizes that monozygotic twins are not necessarily genetically identical. They are identical at conception, but subsequent mutation and rearrangement of the genome may cause substantial phenotypic differences.

Abnormalities, Multiple↗
PubMed1990

Accuracy of ultrasonic weight prediction in the fetus with preterm premature rupture of membranes.

The accuracy of ultrasonic fetal weight prediction in the low birth weight fetus was evaluated, comparing measurement errors in 86 fetuses with premature rupture of membranes with 112 fetuses with intact membranes. Using two ultrasonic formulas for estimation of fetal weight, we found no significant differences in the mean error of ultrasonic weight measurement between these groups. In both groups, the mean measurement error was approximately 9%, with a standard deviation of 7%. It appears that ultrasonic methods for estimation of fetal birth weight are equally applicable to preterm fetuses with or without ruptured membranes.

Birth Weight↗
PubMed1989

Serial changes in the 50-g oral glucose test in pregnancy: implications for screening.

To quantitate the effect of advancing pregnancy on the screening test for gestational diabetes, 550 patients were given a 50-g oral glucose screening test at 20, 28, and 34 weeks' gestation. A significant increase in the plasma glucose value was found, with a mean increase of 1.1 +/- 1.9 mg/dL per week from 20-34 weeks' gestation (r = 0.39, P less than .01). Only 34 patients (6.2%) had a positive screening test at 20 weeks' gestation, and it appears that routine screening in a low-risk population at 20 weeks is not warranted. Sixty patients (10.9%) with a negative screening test at 20 weeks had a positive test at 28 weeks. Forty-four patients (8.0%) with a negative test at 28 weeks had a subsequent positive test at 34 weeks. The overall incidence of gestational diabetes in this population was 4.9%. Currently, screening is recommended at 24-28 weeks for all pregnancies that have not been previously identified as having glucose intolerance. Eleven percent of the gestational diabetics in our population would have been undetected had we screened only at 24-28 weeks. This quantitative information may be helpful in deciding whether rescreening later in pregnancy is indicated.

Female↗