Fruit of the Womb

Grand Rounds 4.34 at Health Business Blog!

2008-05-13T08:37:00.000-07:00

Thanks to David E. Williams at Health Business Blog for a most entertaining Grand Rounds and for including a link to my recent post regarding Consequences of Decreased Amniotic Fluid in pregnancy. This is the 4th post in my series on amniotic fluid that aims to provide a very basic understanding of what the 'bag of waters' is all about and the causes, complications, and managemnt of amniotic...

Amniotic Fluid - 5 - Evaluation and Management of Oligohydramnios

2008-05-12T18:13:00.000-07:00

Just as the fetal outcome depends on the degree, underlying cause, timing during development and longevity of decreased amniotic fluid, to some extent, so do the management options. When the baby has complete absence of both kidneys (bilateral renal agenesis), or absence of functional kidneys (bilateral multicystic or polycystic renal dysplasia), and no amniotic fluid, then as we pointed out...

Amniotic Fluid - 4 - Consequences of Decreased Amniotic Fluid

2008-05-11T11:20:00.000-07:00

In the last three posts, we have reviewed basic aspects of amniotic fluid production and measurement and common causes of decreased amniotic fluid, or oligohydramnios. Now let’s look at reasons decreased amniotic fluid increases the risk for fetal (and newborn) complications and death. Complications related to decreased amniotic fluid depend on the underlying cause, the degree of the decrease,...

Amniotic Fluid - 3 - Oligohydramnios: Causes of Too Little Amniotic Fluid

2008-05-09T16:30:00.000-07:00

Having discussed where amniotic fluid comes from and how we assess amniotic fluid volume, let’s address the most common amniotic fluid abnormality – too little fluid or oligohydramnios. There are 3 primary reasons why there is too little amniotic fluid: 1) rupture of membranes; 2) fetal abnormalities; 3) placental abnormalities. Spontaneous rupture of membranes (SROM) can occur at any time in...

Amniotic Fluid - 2 - Assessment of Amniotic Fluid Volume

2008-05-06T17:45:00.000-07:00

We closed our last post with the comment that BOTH too much fluid (polyhydramnios, otherwise termed hydramnios) or too little fluid (oligohydramnios) are associated with fetal abnormalities and/or poor perinatal outcome. In fact, the greater the amniotic fluid abnormality, one way or the other, the greater the likelihood is of fetal complications or loss and, for that matter, maternal...

Amniotic Fluid - 1 - The Basics

2008-05-03T17:44:00.000-07:00

We have readers with a wide range of backgrounds and medical sophistication. One of the things I have tried to do on this site is to provide information which appeals to readers across this spectrum. In some instances, we have discussed very basic information related to pregnancy and pregnancy complications, in others we have provided in depth analysis of subjects that may have more general...

Low PAPP-A in Presence of Low Risk for Fetal Aneuploidy

2008-05-01T16:59:00.000-07:00

Below are comments from a woman aged 44 who is carrying a pregnancy conceived by in vitro fertilization (IVF) using a ‘donor egg’ from a 21 year old woman. She had combined first trimester screening done with composite results that were very reassuring with regard to risks for having a baby with trisomy 21 or trisomies 18 or 13, however she is concerned that the PAPP-A level in the screen was...

Request to My Readers...

2008-04-27T17:39:00.000-07:00

I have been writing posts for “Fruit of the Womb” for almost 20 months now. It continues to be a source of great fun and greater satisfaction. It has been an opportunity to refresh, review, explore, and relate my understanding and experiences regarding a profession I dearly love. However, the last several months have taken a lot out of me, physically and emotionally. I tell you this not as an...

Understanding Interpretation of First Trimester Screening Results

2008-04-22T19:21:00.000-07:00

Based on the very large number of comments and questions I continue to receive related to the interpretation of the results of ‘combined first trimester screening for aneuploidy’, it is clear that there is a lot of confusion among both patients and providers alike regarding the meaning of the results and the contributions of the individual values to the actual ‘risk assessment’. My response to...

Thanks Dr. Val for Grand Rounds 4.31!

2008-04-22T08:16:00.000-07:00

Thanks Dr Val Jones at RevolutionHealth for all the time and attention put into this week's Grand Rounds 4.31. The link to my recent post on the "Use of Fondaparinux During Pregnancy" is also much appreciated! A growing number of women are being identified who might require or benefit from anticoagulation therapy during pregnancy. Indications include prior history of thromboembolic...

Use of Fondaparinux During Pregnancy

2008-04-17T19:46:00.000-07:00

I felt the comment below from a reader deserved a more thorough response than could be accommodated under the post upon which it was left and also might be of interest to other readers and providers who frequent this site. Anticoagulation during pregnancy has become more widely used to treat, both prophylactically and therapeutically, women who have had problems with thromboembolic...

Grand Rounds 4.30 at Women's Health News - Thanks Rachel!

2008-04-15T08:55:00.000-07:00

Sincere thanks to Rachel at Women's Health News for including a link to my recent post "Pancreatic Cancer Takes Another Young Life" in this week's Grand Rounds 4.30. The post was written in memory of my brother-in-law, John Darrek Offutt, who succumbed this past week after a two year battle against pancreatic cancer. Like ovarian cancer, pancreatic cancer is insidious in onset and is usually not...

Pancreatic Cancer Takes Another Young Life...

2008-04-10T20:57:00.000-07:00

Early yesterday morning, my brother-in-law died of pancreatic cancer. He was only 44 years old. As is so often the case with this insidious and horrible disease, he was diagnosed with the condition at a time when it was already too late to do anything about it except chemotherapy – in otherwords, the tumor could not be removed surgically. Darrek lived with us for 6 months after he found out...

Visit Dr. Wes for Grand Rounds 4.29!

2008-04-08T10:07:00.000-07:00

Thanks to Dr. Wes for including my post regarding the "Affect of Smoking on PAPP-A Levels in First Trimester Screening for Aneuploidy" in this week's Grand Rounds 4.29. As has been the case in many of my recent posts, the topic was chosen based on reader's questions, comments, and concerns left under previous posts. Offering combined first trimester screening for aneuploidy is becoming a...

The Gonzalez Quintuplets - HAPPY BIRTHDAY!

2008-04-06T18:29:00.000-07:00

In a very few hours, we will be celebrating a very special event – a VERY special first birthday. At about 4:00 AM (4:11-4:13 AM to be exact) on April 7, 2007, Abram, Adal, Ian, Noelani, and Nadia were delivered to Joy and Andres Gonzalez at 28 weeks gestation by cesarean section in Greenville, South Carolina. Over the course of many months, the obstetrical and neonatal teams had coordinated...

Elective Late Preterm Birth – Why Aren’t Patients and Providers Listening?

2008-04-05T16:08:00.000-07:00

In several posts over the past 18 months we have discussed the neonatal (and, to a lesser, though still significant degree, maternal) risks of “late preterm” or “near term” birth especially when this is done ‘electively’ and by cesarean section prior to the onset of labor. Personally, I have spent the last two years repeating the litany at each of the local hospitals throughout our perinatal...

Elevated hCG Detected at the Time of First Trimester Screening for Aneuploidy

2008-03-30T17:32:00.000-07:00

Below are comments and questions from a reader who underwent combined first trimester screening for aneuploidy. Although the composite screening results did not place her at increased risk for having a baby with trisomy 21 (Down syndrome) or trisomies 18 and 13, she expressed some concern about the significance of the high free-β-hCG result. High free-β-hCG accompanied by low PAPP-A levels...

Reader's Questions Related to Low PAPP-A in First Trimester Screening for Aneuploidy

2008-03-27T19:38:00.000-07:00

The following comments and questions were left on my previous post regarding Low Pregnancy-Associated Plasma Protein-A (PAPP-A) and Pregnancy Outcome. The questions are excellent and summarize the concerns of many of our readers who have a low PAPP-A value detected at the time of first trimester screening for aneuploidy, so I thought it worthy of a full post. My responses are in italics after...

Affect of Smoking on PAPP-A Levels in First Trimester Screening for Aneuploidy

2008-03-25T17:34:00.000-07:00

The reader below underwent combined first trimester screening for aneuploidy. The composite result was very reassuring with regard to her risks for Down syndrome and trisomies 18/13, however, she also observed that both her PAPP-A (Pregnancy-Associated Plasma Protein-A) and hCG levels were “low,” a combination that often accompanies an ‘increased risk’ for trisomy 18. She then also noted that...

Grand Rounds 4.27 at Monash Medical Student

2008-03-24T16:43:00.000-07:00

Many thanks to Jeffrey Leow at Monash Medical Student for the hard work in putting together a great collection of Grand Rounds offerings. Thanks also for including a link to my recent post that reviewed Chromosomal Mosaicism Detected at the Time of Chorionic Villus Sampling. Not only is the decision to have invasive diagnostic testing done during early pregnancy a difficult one, but sometimes...

Chromosomal Mosaicism Detected at the Time of Chorionic Villus Sampling

2008-03-22T14:58:00.000-07:00

Since the widespread acceptance of first trimester screening for fetal chromosomal abnormalities (aneuploidy), and following the recommendations that this should be offered to all pregnant women, not just those considered to be ‘at risk’ for indications such as ‘advanced maternal age’, early invasive testing by chorionic villus sampling (CVS) has become more widely employed as a means of...

Folate Receptor Antibodies and Congenital Birth Defects

2008-03-17T17:56:00.000-07:00

We have such great readers! The comment and questions below were shared with us by a physician who had a twin pregnancy in which both of her babies were lost early in third trimester with different major congenital birth defects - one involving the neural tube and one with a complex congenital heart abnormality. Both of these types of abnormalities have been found to be associated with folic...

Grand Rounds 4.25 at Canadian Medicine

2008-03-11T17:42:00.000-07:00

Many thanks to the good folks at Canadian Medicine for including a link back to us at Fruit of the Womb in this week's Grand Rounds 4.25. So what did Jane Austen really die of?!? I suggested acute intermittent porphyria and will defend that possibility in a post sometime in the future. Do any of you have any ideas? Would love to hear from you myself! Dr T

Congenital Sebaceous Cysts and Familial Adenomatous Polyposis?

2008-03-10T19:14:00.000-07:00

The comments and questions below recently left by one of our readers are interesting because they raise the possibility (again) that the congenital conditions with which all three of her children (and perhaps even the one she is currently carrying) were born could be related to a single genetic defect. It may be a bit of a ‘stretch’ on my part, but if my readers didn’t challenge me to think,...

Symptoms Accompanying Methotrexate Therapy for Ectopic Pregnancy

2008-03-08T13:09:00.000-08:00

Below is a comment with questions from a reader who is undergoing methotrexate therapy for a tubal ectopic pregnancy. Ectopic pregnancy has been on the rise over the past 30-40 years and current rates are in the range of 1-2 per 1000 pregnancies. Fortunately, with early diagnosis, facilitated by rapid quantitative assays for hCG (human chorionic gonadotropin, the ‘pregnancy hormone’ measured in...