Journal of Ultrasound in MedicineVolume 23, Issue 4 p. 565-568 Case Report Fetal Bladder Outlet Obstruction Due to Ureterocele In Utero “Colander” Therapy Graham G. Ashmead MD, Corresponding Author Graham G. Ashmead MD gashmead@metrohealth.org Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USAAddress correspondence and reprint requests to Graham G. Ashmead, MD, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109.Search for more papers by this authorBrian Mercer MD, Brian Mercer MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorMelissa Herbst MD, Melissa Herbst MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorJules Moodley MD, Jules Moodley MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorAnca Bota RDMS, Anca Bota RDMS Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorJack S. Elder MD, Jack S. Elder MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this author Graham G. Ashmead MD, Corresponding Author Graham G. Ashmead MD gashmead@metrohealth.org Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USAAddress correspondence and reprint requests to Graham G. Ashmead, MD, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109.Search for more papers by this authorBrian Mercer MD, Brian Mercer MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorMelissa Herbst MD, Melissa Herbst MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorJules Moodley MD, Jules Moodley MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorAnca Bota RDMS, Anca Bota RDMS Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this authorJack S. Elder MD, Jack S. Elder MD Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio USASearch for more papers by this author First published: 01 April 2004 https://doi.org/10.7863/jum.2004.23.4.565Citations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume23, Issue4April 2004Pages 565-568 RelatedInformation

OBJECTIVE: Our goal was to evaluate various trends including gestational age, birth weight, and mode of delivery in an inner-city obstetric patient population delivered at a tertiary medical center.STUDY DESIGN: We used an 18-year computerized perinatal database collected prospectively since 1975 in an inner-city tertiary medical center. More than 63,500 deliveries from 1975 through 1992 were evaluated. Trends in gestational age, birth weight, and mode of delivery were investigated with Cox-Stuart, regression, and other trend analysis methods.RESULTS: The number of deliveries increased from 2682 in 1975 to 4740 in 1991, an increase of 77%. The median maternal age has increased from 20 years in 1975 to 23 years in 1992 (p < 0.001). Overall, the mean gestational age has declined monotonically from 39.2 +/- 2.84 weeks in 1975 to 38.3 +/- 3.17 weeks in 1992 (p = 0.057). While the median and lower percentiles of birth weight for singleton births have declined, the 75th and higher percentiles of birth weight have increased during 18 years. Overall, the proportion of preterm births (< 37 completed weeks gestational age) has increased from 3.3% in 1975 to 7.8% in 1991 (p < 0.001). During this period the proportion of low-birth-weight infants (< 2,500 gm) increased significantly from 12.7% to 17.3% (p < 0.001). The proportion of cesarean section deliveries for private patients has declined from 37% in 1975 to 25% in 1992 (p = 0.025), while this proportion has increased monotonically for staff patients from 10% to 17% during this period (p < 0.001).CONCLUSIONS: Considering the large size of the database and diverse background of the study population, we believe that these trends can provide a realistic characterization of an obstetric patient population for a large inner-city urban population.

Five fetuses with absent end-diastolic umbilical artery velocity had normal fetal acid-base status assessed by cordocentesis. Each fetus, despite widely differing pathologic conditions, deteriorated over the next several days. These cases confirm an earlier report of normal gases with absent umbilical artery end-diastolic velocity. Normal blood gases on cordocentesis cannot provide extended reassurance in fetuses with absent end-diastolic velocity.

The prenatal sonographic findings of gastroschisis are well defined. This report describes the CT appearance of fetal gastroschisis discovered as an incidental finding when a 25-year-old pregnant woman underwent CT for blunt abdominal trauma.

When computed tomographic (CT) digital radiography is used for pelvimetry, measurement error may occur. Geometric distortion in the lateral direction of the CT digital radiograph can lead to an error in any measurement of the transverse pelvic inlet. The authors measured the magnitude of this error on two scanners and present a general method for correction of this potential error. The authors also showed that an additional dose reduction is possible if the patient is imaged in the posteroanterior rather than anteroposterior projection.

Indomethacin was utilized in 24 pregnancies (31 exposed fetuses) in preterm labor who labored despite intravenous tocolysis. The mean gestational age at the start of indomethacin therapy was 25.1 weeks (+/- 4.4), mean duration of indomethacin therapy was 43.9 days (+/- 31.4), mean gestational age at delivery 33.1 weeks (+/- 3.7). Neonatal follow-up revealed the same incidence of complications in these indomethacin-exposed infants, when they were compared with all other infants born in the same time period and exposed to intravenous tocolytics only when matched for gestational age at delivery.

Percutaneous umbilical blood sampling allows direct access to the fetal circulation. We describe our experience with the procedure in the first 100 patients whose fetuses were at risk for hemolytic anemia, chromosomal abnormalities, coagulopathy, or intrauterine infection. Hematologic indices, including hemoglobin, hematocrit, red blood cell count, white blood cell count, and platelet count, were analyzed from 50 of the fetuses who were normal at delivery. Normal values and gestational age regression curves (from 17 to 37 weeks' gestation) are presented. The technique and complications of the procedure are described. Percutaneous umbilical blood sampling affords useful information in prenatal diagnosis and entails a low rate of complications.

Maternal isoimmunization can result in fetal anemia. Current management of isoimmunized pregnancies involves amniocentesis and spectrophotometry. Pulsed Doppler ultrasound can provide fetal blood flow determinations from the fetal umbilical vein. A pregnancy complicated by severe rhesus isoimmunization was studied with Doppler ultrasound. Increased fetal umbilical blood flow was associated with increased fetal hemolysis. Umbilical vein blood flow decreased after intrauterine transfusion. Doppler ultrasound assessment of fetal blood flow is a useful noninvasive adjunct in isoimmunized pregnancies.

Fifty-six multiple pregnancies were evaluated for evidence of discordant growth using traditional ultrasonic methods and duplex Doppler ultrasound. The pregnancies consisted of 52 sets of twins and four sets of triplets. Duplex Doppler ultrasound predicted normal growth in 44 of 45 normal sets of fetuses, and correctly predicted discordant growth in nine of 11 discordant sets of twins. Among those nine abnormal sets, Doppler ultrasound predicted that six would become discordant before this was recognized by traditional ultrasonic measurements. Duplex Doppler ultrasound is useful in predicting and confirming concordant and discordant growth, and defining the cause of fetal discordancy.

All pregnancies that were complicated by a previous cesarean section were reviewed for a five-year period from 1978 to 1982. Of 799 such pregnancies, 216 underwent a trial of labor, and 66% experienced successful vaginal delivery. When the primary cesarean section was for cephalopelvic disproportion, 54% delivered vaginally, 75% breech, and 70% for fetal distress or other nonrepeating indications. There was no evidence of uterine scar disruption in the vaginally delivered group. Vaginal delivery after previous cesarean section can be a safe alternative for carefully selected patients cared for in the proper environment.