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ABSTRACT: First-trimester septated cystic hygroma, frequently noted during general obstetric first-trimester screening, is strongly associated with fetal aneuploidy and structural anomalies and is considered an ominous finding. We present the case of a fetus with a first-trimester septated cystic hygroma and cavum velum interpositum cyst.
Journal of Clinical Ultrasound 07/2011; 39(6):356-8. · 0.81 Impact Factor
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Ultrasound in Obstetrics and Gynecology 01/2011; 37(6):739-40. · 3.01 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2010; 29(6):989-92. · 1.25 Impact Factor
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Prenatal Diagnosis 06/2010; 30(6):591-3. · 2.11 Impact Factor
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ABSTRACT: Multiple endocrine neoplasia (MEN) type 2a is an autosomal dominant syndrome caused by specific proto-oncogene mutations characterized by medullary carcinoma of the thyroid, pheochromocytoma, and, occasionally, multiglandular parathyroid hyperplasia, which rarely complicates pregnancy. Secondary diabetes rarely has been reported in association with principal endocrinopathies complicating pregnancy.
A 34-year-old primiparous woman with recently diagnosed gestational diabetes had repeated episodes of dizziness at 30 weeks of gestation, initially attributed to glyburide. Continued episodes of dizziness and later-appearing bouts of severe headache, palpitations, diaphoresis, severe hypertension, and marked tachycardia led to diagnosis and management of MEN type 2a complicating pregnancy.
Patients with MEN type 2a complicating pregnancy may present with gestational diabetes.
Obstetrics and Gynecology 02/2010; 115(2 Pt 2):455-7. · 4.73 Impact Factor
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ABSTRACT: Short umbilical cords are associated with fetal anomalies, often including those with decreased or absent fetal movement, fetal akinesia/hypokinesia sequence, and restrictive dermopathies and aneuploidy. In normal fetuses, abnormally short umbilical cords have been associated with an increased risk of umbilical vessel hematomas, thrombosis, rupture, thrombocytopenia, cord compression, variable fetal heart rate decelerations, instrumental and operative deliveries, and fetal demise. We report a 24-year-old gravida 2, para 0 with a concordant dichorionic twin gestation, at 26 weeks' gestation, in whom sonography depicted fetuses with normal-appearing anatomy as well as short umbilical cord of the 1st twin. Increased fetal surveillance was conducted. Following delivery at 36 weeks' gestation, the presence of a short umbilical cord of the 1st twin measuring 19 cm was confirmed. Systematic review of the literature confirms that this is the first report of prenatal diagnosis of a short umbilical cord in an otherwise normal fetus.
Journal of Clinical Ultrasound 10/2009; 38(2):91-3. · 0.81 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2009; 28(10):1401-3. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2009; 28(10):1405-8. · 1.25 Impact Factor
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ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is an extremely rare etiology of chorioamnionitis.
A young primigravida, with sickle cell (Hb SS) disease and beta thalassemia presented at 37 weeks of gestation with fever, chills, and lower abdominal pain in the presence of intact fetal membranes, 10 days after recurrent marsupialization of a Bartholin abscess. Overt clinical chorioamnionitis was diagnosed. The patient received intravenous triple antibiotics and delivered by immediate cesarean. Maternal blood, uterine, placental and neonatal nares, external auditory canal, and umbilical cord stump cultures all yielded MRSA. Both the mother and infant received intravenous vancomycin and did well.
Our case and the literature suggest that it may be prudent to consider MRSA when contemplating the possibility of chorioamnionitis in the presence of intact fetal membranes, especially in gravidas with recurrent admissions or minor surgical procedures or who are hospital staff.
Obstetrics and Gynecology 09/2009; 114(2 Pt 2):471-2. · 4.73 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2009; 28(5):699-701. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2009; 28(3):405-7. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to create reference range nomograms of the axial transverse diameter of the fetal foramen magnum (TDFM) between 14 and 40 weeks' gestation.
This cross-sectional study included pregnant patients between 14 and 41 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early sonography) and nonanomalous singleton fetuses with intact amniotic membranes. Sonographic measurements included biparietal diameter, head circumference, abdominal circumference, femur length, humerus length, transcerebellar diameter, and sonographically estimated fetal weight. Values of the TDFM were each calculated as the mean of 3 separate measurements. The 5th, 50th, and 95th percentiles were estimated at each week of gestational age (GA) by least squares regression for the mean and SD of the TDFM as functions of GA. R(2) and associated P values for the relationships between the TDFM and other biometric measurements were calculated.
The study included 602 consecutive patients meeting the inclusion criteria. The mean maternal age +/- SD was 27.5 +/- 6.4 years; median gravidity, 3 (range, 1-12); and median parity, 1 (range, 0-7). The mean TDFM was 13.5 +/- 3.7 mm. The reference curve formulas for the mean and SD of the TDFM (mm) were TDFM = -12.58 + GA/0.5616 - GA(2)/24.9 + GA(3)/2430.7, and SD(TDFM) = 1.05 - GA/19.4 + GA(2)/588.8. The TDFM correlated significantly and strongly with biparietal diameter, head circumference, abdominal circumference, humerus length, femur length, transcerebellar diameter, and estimated fetal weight (all R(2) >or= 0.90; all P < .0001).
We present reference range nomograms of the TDFM between 14 and 40 weeks' gestation.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2008; 27(9):1297-303. · 1.25 Impact Factor
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ABSTRACT: The differential diagnosis of prenatally diagnosed adrenal masses includes neuroblastoma, adrenal hemorrhage, adrenal and cortical renal cysts, adrenal adenoma and carcinoma, subdiaphragmatic pulmonary sequestration, Beckwith-Wiedemann syndrome, duplication of the renal system, Wilms tumors, congenital mesoblastic nephroma, and mesenteric and enteric duplication cysts. The worldwide annual incidence of childhood adrenal cortical neoplasms ranges between 0.3 and 0.38 per 1 million children younger than 15 years. These neoplasms are even more unusual among infants, with only 23 cases reported in the literature.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2008; 27(7):1091-3. · 1.25 Impact Factor
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ABSTRACT: First-trimester screening for fetal aneuploidy using nuchal translucency (NT), pregnancy-associated plasma protein A, free or total beta-hCG, and maternal age constitutes a very effective screening test for fetal Down syndrome. We describe a case in which a patient presented at 14 weeks' gestation with an acute abdomen 1 week after first-trimester screening (including NT measurement) performed elsewhere, which was negative for trisomies 21 and 18. Sonographic examination revealed an interstitial pregnancy with a singleton fetus with present cardiac activity, which had not been noted 1 week earlier at the time of earlier transabdominal NT measurement. This case indicates that successful acquisition of a NT measurement during first-trimester screening for fetal aneuploidy does not negate the rare possibility of an unusual ectopic pregnancy.
Journal of Clinical Ultrasound 06/2008; 37(3):168-70. · 0.81 Impact Factor
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ABSTRACT: A cervical pregnancy is an uncommon ectopic pregnancy that accounts for less than 1% of such gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. The current diagnostic modality of this potentially life-threatening condition is transvaginal sonography, supported at times by magnetic resonance imaging. The definitive diagnostic imaging feature of a cervical pregnancy is the location of a gestational sac in the cervix in the presence of a closed internal uterine cervical os. We report the 3-dimensional transvaginal sonographic findings of a cervical pregnancy at 6 weeks' gestation.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2008; 27(1):155-8. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to create reference range nomograms of the axial fetal neck circumference (FNC) and fetal neck area (FNA) throughout gestation.
This prospective cross-sectional study involved pregnant patients between 14 and 40 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early sonography) and nonanomalous singleton fetuses with intact fetal membranes. Sonographic measurements included biparietal diameter, head circumference, abdominal circumference, femur length, humerus length, transcerebellar diameter, and sonographically estimated fetal weight. Axial FNC and FNA values were calculated as means of 3 separate measurements. The 5th, 50th, and 95th percentiles were estimated at each week of gestational age (GA) by least squares regression for the mean and SD of the FNC and FNA as functions of GA. R(2) and associated P values for the relationships between the FNC, FNA, and other sonographic biometric measurements were calculated.
The study included 720 consecutive patients. The mean maternal age +/- SD was 27.3 +/- 6.6 years; median gravidity, 3 (range, 1-13); and median parity, 1 (range, 0-10). The following equations were devised: mean FNC (centimeters) = -11.85 + 1.687 x GA (weeks) -0.043 x GA(2) + 0.0004951 x GA(3); SD(FNC) = 3.15 - 0.3823 x GA + 0.01733 x GA(2) - 0.0002179 x GA(3); mean FNA (square centimeters) = 37.29 - 7.0 x GA + 0.4717 x GA(2) - 0.01245 x GA(3) + 0.0001222 x GA(4); and SD(FNA) = 7.08 - 0.9413 x GA + 0.04135 x GA(2) - 0.0004829 x GA(3). Both the FNC and FNA correlated significantly and strongly with biparietal diameter, head circumference, abdominal circumference, humerus length, femur length, transcerebellar diameter, and sonographically estimated fetal weight.
Current nomograms of the axial FNC and FNA throughout gestation have been provided.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2007; 26(11):1529-37. · 1.25 Impact Factor
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ABSTRACT: Abdominal pregnancy is a rare condition in which the fetus and placenta are located within the peritoneal cavity. Sonographic findings include visualization of the fetus separate from the uterus, failure to visualize the uterine wall between the fetus and urinary bladder, close approximation of fetal parts to the maternal abdominal wall, eccentric position or abnormal fetal attitude, and visualization of extrauterine placental tissue. We present an unusual case in which mid-trimester transabdominal color Doppler sonographic findings depicted unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy. Postpartum maternal angiography confirmed these vessels as abnormal maternal arterial perfusion of the extrauterine placenta emanating from the uterine arteries and inferior epigastric arteries. Systematic review of the literature confirms that this is the first report of such sonographic manifestations of an abdominal pregnancy.
Journal of Clinical Ultrasound 07/2007; 35(5):268-73. · 0.81 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2007; 25(12):1599-602. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2006; 25(11):1485-7. · 1.25 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2006; 25(11):1469-73. · 1.25 Impact Factor
