Faculty Bibliography

In this study, we attempted to develop a surveillance protocol for elective first-trimester termination to see whether unsuspected ectopic pregnancy could be detected earlier, and to identify those patients with unsuspected second-trimester pregnancies that could be terminated more safely in the hospital. Two hundred fifty consecutive patients requesting elective termination were studied prospectively. All were 12 weeks or less by last menstrual period, had positive urinary pregnancy tests, and had no history of vaginal bleeding. All patients had ultrasound screening before curettage. Immediately after curettage, a 'modified' gross pathologic examination (3X magnification) was also performed on unstained curettage material. The sonographic, operative, and pathologic findings were all correlated. Such screening identified four patients with unruptured ectopic pregnancies, who were operated on the same day as the curettage. In addition, four patients, who were actually in the second trimester but had inaccurate dates, were identified and referred to hospital for appropriate methods of termination. We conclude that such surveillance may reduce morbidity in elective terminations and more rapidly identify unsuspected ectopic pregnancies

The sine qua non of fetal well-being in the first trimester is considered to be the presence of fetal cardiac activity. Despite fetal viability, some pregnancies might have a sac that is too large or small for the gestational age, even in the first trimester. As a first step in evaluating this hypothesis, a nomogram was constructed for the ratio of normal sac volume to crown-rump length

Five pregnant Southeast Asian women presenting during a 14-month period with microcytic anemia, preeclampsia, and size-date discrepancies were all ultimately diagnosed as carrying fetuses with homozygous alpha-thalassemia hydrops fetalis. The perinatal complications of this hemoglobin disorder are unique to persons of this ethnic background and include uniform fatality for the affected infant, maternal preeclamptic morbidity, and retained placenta. In this report the obstetric ultrasound findings are presented and the clinical manifestations are discussed, with recommendations made to reduce this emerging public health problem in the United States

The prenatal diagnosis and postpartum confirmation of hydranencephaly is discussed. The need for an adequate knowledge of fetal cranial anatomy when performing obstetric sonography is stressed

Doppler blood velocity waveforms were analyzed from the umbilical artery as an indication of fetal well-being. Since the ratio of systolic to diastolic peak flows (A/B) reflects placental vascular resistance, an abnormality of this value may accurately predict compromised fetuses. Twenty-one studies were performed on 13 patients, using a new duplex system for real-time imaging and range-gated pulsed Doppler analysis, and compared to normal standards. Thirteen studies done in nine uneventful pregnancies were consistently normal. However, abnormal studies were found in the four patients reported as case histories, including women with sickle cell anemia, systemic lupus, diabetes, and growth retardation. The A/B ratio was felt to have predicted potential fetal compromise, including the two fetal deaths. Therefore, with certain cautions, we feel that this rapid, non-invasive technique is useful as a serially applicable reflector of the status of fetoplacental circulation

Real time ultrasound was used to evaluate the anatomy of the fetal brain at different gestational ages. Anatomical correlation with the gross brain was utilized for more accurate identification of the neuroanatomical structures. The normal growth of the ventricular system was studied. Transaxial measurements of the anterior horn (AH) and maximum ventricular length (MVL) and width (MVW) were made, and enlarged as pregnancy progressed. The ratios of MVW/MVL, MVL/BPD, and MVW/BPD provide guides to the early diagnosis of hydrocephalus and intracranial abnormalities. Specific measurements of the cerebral ventricles at various gestational ages may be made accurately by utilizing the anatomical landmarks. The anterior horn and midbrain measurements are of little value in the early diagnosis of hydrocephaly. Maximum ventricular length and width are the most useful determinants of hydrocephaly, even as early as 20 weeks. A set of discordant twins in which twin B was found to be hydrocephalic by these studies in the twentieth week is presented with serial measurements for both twins. Multiple measurements of the cerebral ventricular system in utero permit early and precise diagnosis of fetal hydrocephaly