Peter A. Grannum's research while affiliated with University of California, Berkeley and other places

Publications (46)

Article
Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection of fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and mon...
Article
To determine whether plasma erythropoietin is increased in fetuses with anemia due to Rh isoimmunization. Hemoglobin and erythropoietin were measured in samples obtained by funipuncture from 15 fetuses with Rh isoimmunization (gestational age 26.2 +/- 5.0 weeks, mean +/- standard deviation) and from 13 control fetuses (23.1 +/- 6.7 weeks). Hemoglob...
Article
The in utero ultrasonographic diagnosis of a fetal subdural hematoma is presented. The value of percutaneous umbilical blood sampling, transvaginal ultrasonography, and magnetic resonance imaging for diagnosis and management is discussed.
Article
The perinatal outcomes of four patients with isolated fetal ascites were evaluated. The ascites disappeared prior to delivery in 50% of the cases and was resolved shortly after delivery in the remainder. Excellent neonatal outcomes were observed. Thus, isolated fetal ascites may represent a separate condition that significantly differs from the gen...
Article
Full-text available
Plasma concentrations of atrial natriuretic factor were determined by radioimmunoassay in 16 human fetuses of between 19 and 38 weeks' gestation. Fifteen fetuses had varying degrees of anaemia as a result of Rh isoimmunisation, and one fetus was normal. Eight fetuses had ultrasonographic evidence of severe hydrops fetalis and an additional three fe...
Article
The major applications of invasive techniques in fetal medicine have been in the establishment of diagnoses and the treatment of known conditions. The diagnoses that we will consider are derived from multiple organ systems, but can also be classified based on the method of diagnosis. The simplest approach, which has rapidly gained widespread accept...
Article
The development of the subspecialty of maternal-fetal medicine has been hampered by the inability to gain direct access to the fetus. With the development and improvement of high-resolution real-time ultrasound, access to the fetus and its intravascular compartment has become a reality. This article presents a description of the invasive procedures...
Chapter
The development of the discipline of maternal-fetal medicine has been hampered by the lack of direct access to the fetus. With the development of high-resolution, real-time ultrasound, we have acquired a way to perform a “physical exam” of our fetal patients, but the idea of a modern internist or pediatrician making diagnoses or administering treat...
Article
We previously reported a significant relationship between the hematocrit levels of anemic fetuses and information derived from ultrasonographic and Doppler flow-velocity waveforms. In this study we prospectively tested two formulas for the prediction of hematocrit values, by use of gestational age, presence or absence of hydrops, and Doppler indice...
Article
The mechanism of development of hydrops fetalis in severe isoimmunization has been subject to speculation. We performed pulsed Doppler assessment of cardiac output in 13 severely isoimmunized fetuses before and after intravascular transfusion and compared the results with 37 control fetuses between 20 and 34 weeks' gestation. The cardiac index of t...
Article
A new technique is presented for funipuncture under ultrasound guidance using a biopsy guide and a 20/25-gauge needle combination. The 20-gauge needle was used for uterine entry and the 25-gauge needle for the actual cord puncture. The method was used for sampling fetal blood in 262 pregnancies with 264 fetuses (two sets of twins) between 17-39 wee...
Article
The pathogenesis of the prune belly syndrome is unclear. The proposed etiologies include a distal obstructive uropathy or a mesodermal defect of the anterior abdominal wall and urinary tract. Detection of increased intravesicular pressure might identify those fetuses with an obstructive etiology who, therefore, would benefit from shunting.
Article
Current management of isoimmunization in pregnancy is predicted on the assumption that all sensitized women carry antigen-positive fetuses. In addition, management is based on indirect predictors of the magnitude of the fetal hemolytic disease. We present a preliminary report using a new approach of direct fetal blood sampling for the diagnosis and...
Article
Maternal immune thrombocytopenic purpura has been associated with profound fetal and neonatal thrombocytopenia. Percutaneous umbilical blood sampling offers a reliable method of determining the fetal platelet count antenatally and optimizing obstetric management. We present our experience with this technique in 19 gestations.
Article
Intrauterine intravascular transfusion for the treatment of severe erythroblastosis fetalis has resulted in a number of benefits: (a) Direct access to the fetal vasculature allows an accurate assessment and prompt correction of anemia, albeit temporary. In contrast, intraperitoneally transfused blood may be absorbed erratically, especially in the f...
Article
Seventy-two intrauterine intravascular transfusions were performed on 26 patients with severe erythroblastosis fetalis. Twenty of the 26 fetuses were hydropic at the time of referral. Of the 20 hydropic fetuses, 16 (80%) survived. Hydrops was completely reversed in 13 of the 16 fetuses (81%). Total protein of less than 3 gm/dl, albumin less than 2...
Article
Pulsed Doppler studies of the fetal and maternal circulations were carried out before and after 64 intrauterine transfusions performed on 24 fetuses. A model was derived for the prediction of hematocrit before the first transfusion: Hematocrit = 7.778 - (0.088 x peak velocity in descending aorta) + (0.968 x gestational age [weeks]) - (10.911 if hyd...
Article
Intravascular fetal transfusion can be complicated by difficulty in maintaining vascular access because of fetal movements. Treatment by intramuscular pancuronium bromide has been proposed as a means of arresting fetal movements, although this treatment requires a separate puncture for injection. We report in this article our experience with intrav...
Article
TRADITIONALLY, attempts to give transfusions to severely affected isoimmunized fetuses have involved the intraperitoneal injection of packed red cells.1 2 3 The success of this procedure depends on absorption of the blood through the subdiaphragmatic lymphatic vessels of the fetus. Since there may be erratic and inconsistent absorption in severely...
Article
Bilateral multicystic kidney disease is a congenital disorder that is fatal in the newborn period. A series of nine cases of bilateral multicystic kidney disease diagnosed prenatally by ultrasound is presented. Ultrasound criteria necessary for the diagnosis are bilateral multicystic kidneys, loss of renal architecture, nonvisualization of the feta...
Article
Bilateral multicystic kidney disease is a congenital disorder that is fatal in the newborn period. A series of nine cases of bilateral multicystic kidney disease diagnosed prenatally by ultrasound is presented. Ultrasound criteria necessary for the diagnosis are (1) bilateral multicystic kidneys, (2) loss of renal architecture, (3) nonvisualization...
Article
As the use of Rhesus immune globulin has decreased the incidence of Rh sensitization, other red blood cell antigen systems have become relatively more common. The most common of these is the Kell antigen, which often produces unexpectedly severe fetal disease. High-resolution ultrasound was used to guide in the sampling of fetal blood directly from...
Article
The sites of obstruction found during development are reviewed: high (uretero-pelvic junction), mid (ureterovesical junction) and low (posterior urethral valves). Diagnostic evaluation of the fetal urinary tract is reviewed. The management of obstructive uropathies is briefly outlined and centres around the level of the lesion and whether the obstr...
Article
Normal values for fetal spleen dimensions are proposed, including longitudinal, coronal, and transverse diameters, the perimeter, and the estimated volume. Similar values were then obtained in cases of Rh-immunization and prolonged premature rupture of the membranes. A good correlation between amniotic fluid optical density and fetal spleen size wa...
Article
This report describes a technique for the performance of a sonographically guided percutaneous umbilical blood sampling and its potential uses in the management of diagnostic problems in the second and third trimester of pregnancy. The method has been employed in the prenatal assessment of 13 fetuses at risk for hemostatic failure (hemophilia and i...
Article
The use of ultrasound to identify the fetus at risk for postmaturity among postterm pregnancies was evaluated. The ultrasound findings in 85 postterm pregnancies were reviewed. No grade 0 or grade 1 placentas were observed and grade 2 and 3 placentas were found with similar frequency. The incidence of advanced postmaturity was 12.9%. Advanced postm...
Article
The rates of intraoperative complications (dry and bloody taps) of two amniocentesis techniques were compared in 1300 patients undergoing second trimester procedures for genetic indications. The sonographically guided technique consisted of the selection of a site for needle insertion with ultrasound, removal of the transducer, and immediate amnioc...
Article
Bilateral renal agenesis is a lethal congenital anomaly. A reliable prenatal diagnosis is extremely important, since it may offer options for pregnancy termination or may change obstetric management in the third trimester. This study examined the accuracy of ultrasound in making an antenatal diagnosis of bilateral renal agenesis in three different...
Article
Infantile polycystic kidney disease in an autosomal recessive disorder which in its severe form is characterized by bilateral renal enlargement and renal failure. The present study was undertaken to assess the diagnostic accuracy of antenatal sonography in a population at risk. Nineteen patients with fetuses at risk for infantile polycystic kidney...
Article
Infantile polycystic kidney disease is an autosomal recessive disorder which in its severe form is characterized by bilateral renal enlargement and renal failure. The present study was undertaken to assess the diagnostic accuracy of antenatal sonography in a population at risk. Nineteen patients with fetuses at risk for infantile polycystic kidney...
Article
The prospect of successful gestational outcome in pregnancies complicated by chronic renal insufficiency, severe hypertension, and diabetic vasculopathy is generally considered poor. This article describes a pregnancy with these complications in which a conservative form of management was utilized and resulted in a successful gestational outcome.
Article
During a 5-year period, a diagnosis of obstructive uropathy was made in 25 fetuses. Eight of them had unilateral obstruction and 17 were affected bilaterally. The most common condition encountered was urethral obstruction by posterior valves. The site and nature of the obstruction were correctly identified in 22 of the 25 fetuses. Among the 17 who...
Article
Ninety-three vertex-breech and 42 vertex-transverse twin gestations were managed at Yale-New Haven Medical Center during a 5-year period. Antepartum diagnosis of twin gestation occurred in 93% of the cases, and diagnosis was made before delivery of the second twin in 97% of the cases. Seventy-two (78%) of the vertex-breech and 22 (53%) of the verte...
Article
Utilizing real-time ultrasound we define the normal fetal adrenal glands from the 20th week of gestational age. The normal acoustic characteristics of the adrenals are described. Potential application of the nomogram derived from this study are suggested.
Article
Careful scanning of the fetus at risk and knowledge of the abnormalities that may be associated with a particular disease can lead to an accurate diagnosis of this group of congenital abnormalities. The decision regarding termination of pregnancy after a positive diagnosis is made will always be difficult and should be truly a decision of the paren...
Article
Examination of the placenta ultrasonically can assist the physician in the management of the high risk patient. In patients presenting with heavy vaginal bleeding, dynamic or static scanning on the delivery floor to determine placental position or abruption should be a routine diagnostic procedure. Placental grading may offer clues as to the respir...
Article
With high-resolution ultrasound equipment, it is now possible to diagnose certain fetal anomalies in the third trimester and in some cases before the twentieth week of gestation. During a 27 month period 2,548 ultrasound scans were performed in high-risk patients. An anomaly was diagnosed in 10 of 122 second-trimester patients who were at risk for...
Article
A practical classification of placental maturity changes has been developed based on a review of multiple ultrasound evaluations of placental texture over a 4 year period. This classification grades placentas from 0 to 3 according to specific ultrasonic findings at the basal and chorionic plates as well as within the substance of the organ itself....
Article
In the future it should be possible to define specific fetal areas more precisely with high-resolution ultrasound and better signal processing. For instance, with three-dimensional imagery it will be feasible to determine the volume of the fetal liver, an organ particularly affected in IUGR. It also will be feasible to measure fetal skin thickness,...

Citations

... El líquido de la amniocentesis puede ser utilizado para el diagnóstico de errores del metabolismo. La amniocentesis debe realizarse a pacientes de grupos específicos, como la presencia de anemia de células falciformes en negros, la presencia de síndrome de Tay-Sachs en judíos, la beta-talasemia en población mediterránea, la alfa-talasemia en poblaciones asiáticas, etc. 21 La amniocentesis permite la determinación de alfafetoproteína para asociar esta medición con otro Recomendaciones específicas para mejorar la atención médica en el diagnóstico prenatal tipo de defectos. Los valores bajos de alfafetoproteína pueden relacionarse en 20% con fetos con síndrome de Down, estos hallazgos deben relacionarse con otros datos (edad materna, peso, raza, etc.). ...
... After embryogenesis, the fetus excretes significant volumes of urine into the amniotic cavity and, in species such as sheep, to the allantoic cavity (a fetal membrane-enclosed diverticulum developed from the hindgut and attached to the fetal bladder via the urachus). Fetal urine flow represents the single most important factor regulating amniotic fluid volume, as marked increases or decreases in urine flow rates are correlated with polyhydramnios (65,143) and oligohydramnios (56), respectively. Relative to urine flow, proportionately smaller volumes of lung fluid are secreted into the amniotic cavity. ...
... [2] Following its first practice together with ultrasonography in 1984, it became popular when fetus blood was used for the determination asphyxia, infection and particularly karyotyping. [3] Cordocentesis is a method which can be applied easily under sterile conditions without any hospitalization, and there is no need for medication and local anesthesia to provide maternal sedation and to decrease fetus movements. [4] Diagnostic cordocentesis has various indications such as blood diseases (coagulopathy, hemoglobinopathy), fetus infections (TORCH group infections), fetal hemolytic diseases (anti-D, Kell isoimmunisation), fetal acid-base, blood gases, pH determination and rapid karyotyping, chorionic villus sampling or mosaicism in amniocentesis cultures, fetal anatomic malformations, non-immune hydrops fetalis, intrauterine growth retardation, late referral of patient and amniocentesis with no result. ...
... Granum et al. [15] reported the linear increase in PT with increasing GA till 33 weeks, after which they showed gradual thinning. Berkowitz et al. [16] reported a reduction in thickness after 32 weeks. In the present study, the PT showed a reduction from 37 weeks till 38 weeks, after which there was an increase in the 39 weeks of gestation with a mean PT of 42 mm. ...
... Mild forms of congenital kidney disease that appear relatively benign during the childhood may progress to ESRD later in adult life [7]. Literature has shown that the incidence of confirmed congenital renal malformations is high among neonates who had an antenatal diagnosis of a renal anomaly during the fetal stage (inside the womb) [8][9][10]. But later study reported the frequency is little lower than previous which showed ambiguity that antenatal diagnosis might have flaws in diagnosis. ...
... Vb lung volume L,, linear intercept Small for gestational age or IGR infants are believed to experience periods of in utero undernutrition (produced by a diversity of pathological conditions), and due to perinatal difficulties may require prolonged O2 therapy after birth (1,2). Acute and chronic lung damage resulting from prolonged treatment with high concentrations of O2 is a frequently encountered problem in sick newborns (3,4). ...
... It does not comprise all pregnant women that are at risk of RhD sensibilisation. Unofficial data display that the prevalence of RhD sensibilisation in Republic of Macedonia is twice higher compared to the rest of the countries in Europe and the world, and it moves from 0,1% to maximum 2%8910. The aim of this study was to investigate the influence of subclasses to IgG anti-D on the intensity of HDFN at 45 fetuses/newborns with symptoms of mild and severe HDFN in Republic of Macedonia. ...
... We therefore are unable to comment on the potential influence of other fetal physiologic adaptations to anemia on MCA PSV, which include the role of increased Relationship between MCA PSV and fetal hemoglobin Z-score atrial natriuretic factor, hepatic insufficiency and hypoalbuminemia, or myocardial responses to hypoxia. 14,15 Our observations indicate that semiquantitative analysis of Doppler waveforms, which has been the preferred method in clinical practice, does not account for all the understood components of the fetal cardiovascular response. These findings provide an additional explanation for the relatively high false-positive rate of MCA PSV when used to predict fetal anemia. ...
... In the literature data, subdural hematoma appears antepartum less often, with around 20 reported cases with principally traumatic etiology, or due to maternal hemostasis disorders. The outcome in cases with prenatally diagnosed subdural hematoma depends on the severity of bleeding, underlying cause, and location, but it is usually poor, with 50 % resulting in intrauterine fetal death and the remaining 50 % demonstrating postnatal pathological sequelae [3]. Subdural hematomas of the infratentorial area are even rarer lesions, with only few cases described so far. ...
... Invasive prenatal testing methods like amniocentesis and chorionic villus sampling are not only used to identify chromosomal abnormalities but also helpful in identifying fetal infections (TORCH titers) and inherited metabolic diseases. Fetal echocardiogram required to rule out congenital cardiac anomaly or cardiac arrhythmia [8]. ...