Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality.
BACKGROUND: Transposition of the great arteries (TGA) is a life-threatening malformation in neonates, but it is amenable to complete repair. Prenatal detection, diagnosis, and early management may modify neonatal mortality and mortality. METHODS AND RESULTS: Preoperative and postoperative morbidity and mortality were compared in 68 neonates with prenatal diagnosis and in 250 neonates with a postnatal diagnosis of TGA over a period of 10 years. The delay between birth and admission was 2+/-2.8 hours in the prenatal group and 73+/-210 hours in the neonatal group (P<0.01). Clinical condition at arrival, including metabolic acidosis and multiorgan failure, was worse in the neonatal group (P<0.01). Once in the pediatric cardiology unit, the management was identical in the 2 groups (atrioseptostomy, PGE1 infusion, operation date). Preoperative mortality was 15 of 250 (6%; 95% CI, 3% to 9%) in the neonatal group and 0 of 68 in the prenatal group (P<0.05). Postoperative morbidity was not different (25 of 235 versus 6 of 68), but hospital stay was longer in the neonatal group (30+/-17 versus 24+/-11 days, P<0.01). In addition, postoperative mortality was significantly higher in the neonatal group (20 of 235 versus 0 of 68, P<0.01); however, the known risk factors for operative mortality were identical in the 2 groups. CONCLUSIONS: Prenatal diagnosis reduces mortality and morbidity in TGA. Prenatal detection of this cardiac defect must be increased to improve early neonatal management. In utero transfer of fetuses with prenatal diagnosis of TGA in an appropriate unit is mandatory. (+info)
Preterm labor is the leading cause of perinatal morbidity and mortality in the United States. It is characterized by cervical effacement and/or dilatation and increased uterine irritability before 37 weeks of gestation. Women with a history of preterm labor are at greatest risk. Strategies for reducing the incidence of preterm labor and delivery have focused on educating both physicians and patients about the risks for preterm labor and methods of detecting preterm cervical dilatation. Methods used to predict preterm labor include weekly cervical assessment, transvaginal ultrasonography, detection of fetal fibronectin and home uterine activity monitoring. As yet, it is unclear if any of these strategies should be routinely employed. At present, management of preterm labor may include the use of tocolytic agents, corticosteroids and antibiotics. (+info)
A new lethal syndrome of exomphalos, short limbs, and macrogonadism.
We report a new lethal multiple congenital abnormality (MCA) syndrome of exomphalos, short limbs, nuchal web, macrogonadism, and facial dysmorphism in seven fetuses (six males and one female) belonging to three unrelated families. X rays showed enlarged and irregular metaphyses with a heterogeneous pattern of mineralisation of the long bones. Pathological examination showed adrenal cytomegaly, hyperplasia of Leydig cells, ovarian stroma cells, and Langherans cells, and renal microcysts. We suggest that this condition is a new autosomal recessive MCA syndrome different from Beckwith-Wiedemann syndrome, especially as no infracytogenetic deletion or uniparental disomy of chromosome 11 was found. (+info)
Pregnancy detection and the effects of age, body weight, and previous reproductive performance on pregnancy status and weaning rates of farmed fallow deer (Dama dama).
Fallow does (n = 502) of different ages (mature, 2-yr-old, and yearling) were maintained with bucks for a 60-d breeding season to determine whether previous reproductive performance and changes in BW affect doe pregnancy rates and to compare the effectiveness of ultrasonography and serum pregnancy-specific protein B (PSPB) for the detection of pregnancy in fallow does. Ultrasonography was performed, blood samples collected, and BW recorded at buck removal (d 0) and at 30 and 90 d after buck removal. Lactational status (lactating = WET; nonlactating = DRY) were determined from farm records taken at weaning prior to each breeding season (autumn 1990 through autumn 1994). Ultrasonography and PSPB for determining pregnancy were in agreement 93% of the time. Overall pregnancy rates did not differ (P>.10) relative to age of the doe; the combined pregnancy rate was 92%. We also determined that 82.9% of does conceived early in the breeding season and that the incidence of embryonal-fetal mortality during the first 90 d after buck removal was 2.8%. In general, mature and 2-yr-old DRY does were heavier and had lower pregnancy rates than WET does. The overall weaning rate for all does was 77.9%. Loss in the number of fawns from pregnancy detection to weaning was equivalent to 14.8% for mature does, 24.7% for 2 yr old does, and 42.5% for yearling does. These data indicate that even though pregnancy rates were relatively high, further study is needed to determine the causes associated with subsequent fawn losses, particularly among yearling does. As a production tool, lactational WET/ DRY status testing was found to be an acceptable means for determining the reproductive potential of individual does within the herd. In addition, serum PSPB may be used in place of ultrasonography for pregnancy diagnosis in fallow deer as early as d 30 after buck removal. (+info)
Ventriculo-atrial time interval measured on M mode echocardiography: a determining element in diagnosis, treatment, and prognosis of fetal supraventricular tachycardia.
OBJECTIVE: To determine whether M mode echocardiography can differentiate fetal supraventricular tachycardia according to the ventriculo-atrial (VA) time interval, and if the resulting division into short and long VA intervals holds any relation with clinical presentation, management, and fetal outcome. DESIGN: Retrospective case series. SUBJECTS: 23 fetuses with supraventricular tachycardia. MAIN OUTCOME MEASURES: A systematic review of the M mode echocardiograms (for VA and atrioventricular (AV) interval measurements), clinical profile, and final outcome. RESULTS: 19 fetuses (82.6%) had supraventricular tachycardia of the short VA type (mean (SD) VA/AV ratio 0.34 (0.16); heart rate 231 (29) beats/min). Tachycardia was sustained in six and intermittent in 13. Hydrops was present in three (15.7%). Digoxin, the first drug given in 14, failed to control tachycardia in five. Three of these then received sotalol and converted to sinus rhythm. All fetuses of this group survived. Postnatally, supraventricular tachycardia recurred in three, two having Wolff-Parkinson-White syndrome. Four fetuses (17.4%) had long VA tachycardia (VA/AV ratio 3.89 (0.82); heart rate 226 (10) beats/min). Initial treatment with digoxin was ineffective in all, but sotalol was effective in two. Heart failure caused fetal death in one and premature delivery in one. All three surviving fetuses had recurrences of supraventricular tachycardia after birth: two had the permanent form of junctional reciprocating tachycardia and one had atrial ectopic tachycardia. CONCLUSIONS: Careful measurement of ventriculo-atrial intervals on fetal M mode echocardiography can be used to distinguish short from long VA supraventricular tachycardia and may be helpful in optimising management. Digoxin, when indicated, may remain the drug of choice in the short VA type but appears ineffective in the long VA type. (+info)
Individual growth patterns in the first trimester: evidence for difference in embryonic and fetal growth rates.
OBJECTIVE: To evaluate individual fetal growth during the first trimester in pregnancies resulting from spontaneous and in vitro fertilization (IVF). METHODS: The growth of 11 fetuses conceived by spontaneous fertilization (known dates of ovulation) in nine patients and 15 fetuses conceived by IVF in 12 patients were evaluated at weekly intervals from 6 weeks, menstrual age, to 14 weeks. Fetal length was determined at each examination. Measures of fetal length included the crown-rump length (CRL), maximum straight line length (MSLL) and maximum axial length (MAL). Comparisons of CRL and MSLL to MAL were carried out. The MSLL was used as the measure of length except when the MAL was available. Linear and quadratic functions were fitted to the complete data sets of individual fetuses in the two groups. Individual data sets from ten fetuses in each group were then divided into early and late growth phases, and linear functions were fitted to each data subset. Start points and pivotal points for each fetus were estimated from the coefficients of these two functions. Growth in these two groups of fetuses was compared, on the basis of slope values. RESULTS: Evaluation of length measures indicated that, before 8 weeks, only MSLL could be measured. After 8 weeks, all three measures could be obtained, with the MAL being the largest. Both the linear and quadratic models performed well with individual data sets (mean R2(+/- SD): linear 98.1 (1.0)%; quadratic 99.4 (0.4)%), with no differences found between spontaneous and IVF groups (maximum possible differences in mean slopes (95% probability): 5-8%). Similar findings were obtained for the early and late growth phase data subsets. Slope values in the early and late growth phases showed low variability (CV: early 13.5%; late 11.6%), but were significantly different (early 0.72 (+/- 0.10 SD) cm/week; late 1.21 (+/- 0.14 SD) cm/week). The mean start point was 5.9 (+/- 0.3 SD) weeks' menstrual age, while the mean pivotal point was 9.2 (+/- 0.7 SD) weeks, menstrual age. CONCLUSIONS: First-trimester growth studies in individual fetuses indicate that there is a change in length growth rate between 9 and 10 weeks, menstrual age. This is consistent with a shift in development from organogenesis to growth. These results can be used for more accurate assessment of first-trimester growth and may aid in the detection of fetal problems that manifest themselves as growth abnormalities. (+info)
Accuracy of sonographic estimates of fetal weight in very small infants.
OBJECTIVE: Fetal outcome is inversely related to gestational age and birth weight. Therefore, in very small fetuses, estimated weight may play an important role in clinical management. Our aim was to determine the accuracy of sonographic estimates of fetal weight in very small infants. DESIGN: Retrospective chart review. SUBJECTS: We retrospectively studied 100 consecutive infants with a birth weight of < 1000 g, at a gestational age between 24.0 and 34.0 weeks, in which biometric data < 2 weeks prior to delivery were available for analysis. METHODS: We estimated fetal weight with the use of two methods--by those of Hadlock and colleagues and Scott and colleagues--and compared the estimated values with measured birth weights. RESULTS: The infants had a mean birth weight of 742 +/- 173 (SD) g, at a gestational age of 28.1 +/- 2.0 (SD) weeks. With Hadlock's method, the mean estimated fetal weight (EFW) was 736 +/- 186 (SD) g, which was not significantly different from birth weight; the mean EFW error was 0.8 +/- 12.7 (SD) %. With Scott's method, the mean EFW was 780 +/- 185 (SD) g, which was significantly increased above birth weight; the mean EFW error was 5.7 +/- 12.5 (SD) %. The accuracy of the weight estimates was not significantly affected by the period between ultrasound examination and delivery if < 2 weeks, or by fetal growth restriction. CONCLUSION: In our population of small fetuses, Hadlock's estimates of fetal weight correlated well with measured birth weight, whereas Scott's method tended to overestimate. (+info)
Clinical interpretation of ultrasound biometry for dating and for assessment of fetal growth using a wheel and chart: is it sufficiently accurate?
OBJECTIVES: To investigate how accurately practicing obstetricians (experts) can apply dating rules and compare the interpretation of gestation-sensitive ultrasound data with those of a computer system. SUBJECTS: Seventeen practicing obstetricians. Members of the Royal College of Obstetricians and Gynaecologists, from 14 different units throughout the UK. DESIGN: Six cases with menstrual and ultrasound data together with identical ultrasound charts and obstetric wheels. MAIN OUTCOME MEASURES: Concordance between the calculated estimated date of delivery (EDD) and growth assessment provided by the experts and the computer system. RESULTS: The calculation of the EDD by the experts was imprecise (59% within 3 days overall). Concordance with the computer calculation was poorest when the ultrasound measurements lay close to the upper or lower centile lines (average 7% within 3 days of the computer). Interpretation of growth showed good concordance with the computer when gestation was not critical to the interpretation (94%), but very poor when gestation was critical (7%). CONCLUSIONS: Calculation of EDD by means of an obstetric wheel and charts is not precise. Compared with the computer system, these errors have a significant effect on the subsequent interpretation of growth scans when the data are borderline. A computer system provides the more accurate method for interpreting gestation-sensitive ultrasound biometry. (+info)