Robert N. Wolfson

Antenatal ultrasonography: The experience in a high risk perinatal center

During a 52-month span, 14,324 ultrasonographic examinations were performed on 9,453 pregnant patients. One-hundred and fifty-one anatomical malformations were found in 122 fetuses (1.29%). Our analysis of patients referred to the perinatal center for ultrasonography indicates that the number of high risk patients has increased, and a parallel increase of neonatal surgical anomalies has resulted. An analysis of fetuses concluded that anomalies of the: gastrointestinal tract had improved care, deaths occurred due to associated anomalies or severe prematurity; genitourinary system received earlier diagnosis and treatment; central nervous system/musculoskeletal system/hydrops--no difference in management, treatment or outcome was noted; teratoma/cystic hygroma--did not effect treatment; cardiovascular system--inutero medical treatment by digitalization of the mother was possible. Paradoxically, an increase in the mortality of diaphragmatic hernia patients was noted and concluded to be secondary to the extremely early detection of this anomaly.

Antenatal investigation of human fetal systolic time intervals

A noninvasive method for measuring the antenatal human fetal systolic time intervals with the use of the transabdominal fetal electrocardiogram and Doppler cardiogram is described. Unique interactive computer routines were developed for rapid and accurate determination of the pre-ejection period (PEP), ventricular ejection time (VET), PEP/VET ratio, and fetal heart rate (FHR). Thirty normal patients were monitored between 20 and 40 weeks of gestation. A regression analysis of the fetal systolic time intervals and FHR against gestational age was done. PEP and PEP/VET ratio were significantly correlated to the gestational age, while VET and FHR were not.

Antenatal diagnosis of sacrococcygeal teratomas: prognostic features

During a 6-year span the prenatal ultrasound diagnosis of a sacrococcygeal mass was made eight times at the High-Risk Perinatal Centers of Case Western Reserve University. The gestational age at the time of diagnosis ranged from 21 to 35 weeks. In one of the pregnancies, the affected fetus was one of a set of fraternal twins. Two patients were delivered vaginally and five were delivered by cesarean section. One fetus died in utero. In seven the diagnosis of sacrococcygeal teratoma (SCT) was confirmed histologically. In the eighth the lesion was a fungating malignant melanoma of the lower sacral region. The decision as to mode of delivery was made based on the size of the tumor relative to the biparietal diameter and fetal presentation. Four of the six remaining patients with SCT survived. In the three with fatal outcome, the ratio of infant weight to tumor weight was below 1.7. This measurement is a clear indication of the very large size of these lesions. The increased blood flow through these tumors can lead to fetal cardiac failure, hydrops, and death. With the almost routine use of ultrasound, more SCT may be identified antenatally. Included in this group and referred to tertiary care centers will be nonviable fetuses as well as very small fetuses with exceptionally large tumors; this will raise the overall mortality in this group of patients traditionally regarded by pediatric surgeons as having a good outlook.

When is an amniocentesis for fetal maturity unnecessary in nondiabetic pregnancies at risk

For several years standard obstetric practice has been to perform an amniocentesis for evaluation of fetal maturity. In order to provide a more definitive answer as to which pregnancies need an amniocentesis, a group of 294 nondiabetic pregnant women in whom an amniocentesis for the evaluation of fetal maturity had been performed for clinical indications were evaluated. Three predictors of fetal maturity--obstetric estimate of gestational age, fetal biparietal diameter, and ultrasonic determination of placental maturation--were evaluated for their ability to predict three outcomes of fetal maturity, including positive amniotic fluid phosphatidylglycerol, pediatric estimate of gestational age greater than or equal to 38 weeks, and absence of hyaline membrane disease. A fetal biparietal diameter of greater than or equal to 90 mm was present in 36% of the total population and was associated with 97% term delivery, 87% positive amniotic fluid phosphatidylglycerol, and 0% hyaline membrane disease. The results associated with an obstetric estimate of gestational age of greater than or equal to 38 weeks were similar. In the present data set over one third of clinically indicated amniocenteses could potentially be avoided without losing any predictive capability for fetal maturity.

Intrauterine atrial fibrillation associated with fetomaternal hemorrhage

Atrial fibrillation is an arrhythmia that is rarely diagnosed in utero. We report a case of fetal atrial fibrillation documented by antepartum echocardiography associated with a fetomaternal hemorrhage.