Lyndon M. Hill

Ultrasonic evidence for luteinization of unruptured preovulatory follicles

Luteinization of an unruptured ovarian follicle has been reported as a cause of infertility and has heretofore been diagnosed only by direct visualization of the ovarian surface. Four patients who demonstrated defects in ovulation requiring therapy to induce ovulation and who were not achieving desired conception despite apparently adequate treatment were studied with serial pelvic ultrasonic examinations for 17 cycles. Luteinization, characterized by the loss of a clear demarcation of the follicular cyst wall and the presence of intrafollicular echoes, was suspected in each of these cycles by the absence of ultrasonic signs of ovulation--that is, a rapid decrease in follicular size and the appearance of free fluid in the cul-de-sac. Histologic confirmation of a persistent luteinized cyst is presented.

Oligohydramnios: Ultrasonically detected incidence and subsequent fetal outcome

Oligohydramnios is a hallmark for intrauterine growth retardation (IUGR) and has been evaluated in populations suspected of having IUGR. We chose to evaluate its incidence in a routine obstetric population. During a 16-month period, ultrasound scans were performed on 1,408 patients. Severe oligohydramnios was identified in six patients (0.43%); Two infants had congenital malformations, and four had severe IUGR. A subset of 317 patients scanned within 2 weeks of delivery was reviewed. Although none of the patients fulfilled our original criterion of oligohydramnios (absence of a pocket of amniotic fluid 1 cm or more in broadest diameter), three of six small-for-gestational age infants had a subjective decrease in amniotic fluid volume for their stated gestational age. By changing the criterion of oligohydramnios to a subjective decrease in amniotic fluid volume, the sensitivity of this ultrasonic marker was increased to 50% and the specificity to 100%. We believe that the semiquantitative assessment of amniotic fluid volume can effectively screen for IUGR and thereby delineate a population, regardless of gestational age, that is at risk for perinatal morbidity and mortality.

Ovarian surgery in pregnancy

A series of 57 cases of ovarian disease during pregnancy is presented; 10 of the patients were referred to the Mayo Clinic for treatment. During the 17 year period under investigation (1955 through 1971), there were 25,189 deliveries in Rochester, Minnesota. Thus, the corrected incidence of operable ovarian disease in pregnancy was one case in every 536 deliveries. Simple ovarian cysts were the most common lesions found (38 of 57 cases). The over-all abortion rate was about 25 per cent (14 of 57 patients); six of the patients were threatening to abort prior to surgery. Therefore, the incidence of spontaneous abortion after surgery was 16 per cent (eight of 51 patients). Progestational agents given before and after operation did not affect the abortion rate.

Prenatal detection of congenital malformations by ultrasonography: Mayo clinic experience

Routine obstetric ultrasonography has been performed at our institution since 1974. During a recent 41-month period, 64 neonates with 83 congenital abnormalities had been scanned before delivery. The detection rate according to the organ system involved and the year in which the study was performed is reviewed. Suggestions, based upon the data presented, are given for the various anatomic sites and fetal dimensions that should be evaluated during each stage II ultrasound examination.

Ultrasonic assessment of subsequent unexplained infertility after ovulation induction

Summary. The development of ovarian follicles was studied ultra‐sonographically in 21 cycles in eight infertile patients with the diagnosis of ovulatory dysfunction in whom conception did not occur after the defect had apparently been corrected. Pelvic ultrasound demonstrated three patterns in 20 of the 21 cycles studied: ovarian hyperstimulation in seven cycles; follicular atresia before ovulation in three cycles; persistent unruptured follicular cysts in 10 cycles. Recognition of these patterns has been helpful in modifying therapy in infertile patients.

Fetal distress secondary to vancomycin-induced maternal hypotension

Abstract The rapid administration of intravenous vancomycin may produce fetal distress secondary to maternal hypotension.

Variable interference of meconium in the determination of phosphatidylglycerol

In 1971, Gluck and co-workers’ developed the lecithin-sphingomyelin (L/S) ratio to evaluate pulmonary maturity from a sample of amniotic fluid. It has become the standard test against which other predictors of fetal maturity (“shake test,” microviscometry) must be compared. Determination of the quantity of phosphatidylglycerol. a marker of complete pulmonic maturity, has increased the reliability of the L/S ratio.’ Reports on the effect of meconium on the L/S ratio have been conflicting: Some authors have reported an increase and others have found a decrease in the values obtained. Studies in our laboratory have shown that meconium has a variable pattern on a two-dimensional chromatogram. As a result, the effect on the lecithin and sphingomyelin spots is variable and unpredictable. Since phosphatidylglycerol encompasses a relatively narrow area of the two-dimensional plate, we sought to evaluate the effect of meconium on this marker of fetal pulmonic maturity. Fig. 1 is a two-dimensional chromatogram with a mature L/S ratio and a high concentration of phosphatidylglycerol. In Fig. 2, the diffuse pattern of meconium interferes with the appropriate region for analysis of not only the L/S ratio but also phosphatidylglycerol. In Fig. 3, a distinct spot of phosphatidylglycerol can be discerned despite the presence of meconium. When meconium-stained amniotic fluid is obtained on amniocentesis, the reliability of the L/S ratio and the differentiation and quantitation of phosphatidylglycerol will vary on an individual basis. Careful review of the chromatogram may permit an accurate assessment of pulmonic maturity in a certain percentage of cases. However, if the requisite area of the chromatogram is

Value of a postvoid scan during adnexal sonography

The position of the uterus and ovaries can be affected by the degree of bladder filling. A postvoid scan may bring into view ovarian pathologic conditions not previously discerned.

Unstressed Antepartum Cardiotocography in the Management of the Fetus Suspected of Growth Retardation.

Sir, In their article, the authors divide the non-stress test into two groups: reactive and non-reactive. The non-reactive test is further subdivided in order of severity as suspect, flat and ominous. The ‘suspect’ group appears to only have a decrease in baseline variability; an evaluation that is often difficult to make with an external monitoring system. A ‘flat’ tracing would be characterized as non-reactive in the United States and followed by a contraction stress test to further evaluate fetal states. I would submit that an ‘ominous’ tracing is merely a spontaneously positive contraction stress test, a group with a much higher perinatal mortality if further evaluation (amniocentesis, real-time ultrasound assessment of fetal biophysical parameters) and possible intervention is not undertaken (Martin and Schifrin, 1977). The above points in no way detract from the authors’ contribution; I merely wished to clarify their results with respect to current terminology in this country.