Progression of pulmonary arteriovenous malformation during pregnancy: case report and review of the literature.

Journal Articl

Diagnosis of maternal cystic fibrosis during pregnancy.

Journal ArticleThe third and fourth cases of maternal cystic fibrosis diagnosed during pregnancy are presented. Quantitative pilocarpine iontophoresis (sweat chlorides) must be performed to establish the diagnosis. Other important findings include recurrent or persistent respiratory symptoms, chest x-ray abnormalities, abnormal pulmonary function studies, and abnormal arterial blood gases. Gastrointestinal tract dysfunction and a positive family history for respiratory disease also suggest the diagnosis. Pregnant patients with cystic fibrosis require careful and frequent cardiopulmonary and gastrointestinal surveillance. A higher incidence of premature labor is noted and all patients are best managed in tertiary referral centers. Patients should also be monitored carefully during the puerperium because maternal pulmonary decompensation may occur during this time

Simulation Evaluation of the Combat Value of a Standoff Precision Airdrop Capability

This project is a simulation evaluation of the developmental standoff precision airdrop (SOPAD) capability. SOPAD is a new technology under consideration to deliver supplies to forward-deployed units using either a semi-rigid wing or a guided parafoil. These delivery systems allow airdrop of supplies from altitudes of 25,000 feet and distances 25 miles from the delivery point. Using global positioning system guidance, on board navigational computers, and automatic steering mechanisms, the delivery system flies to the target following a designated flight plan. The concept includes delivering supplies to remote and potentially hostile areas without endangering the supply aircraft. In addition, supplies can be delivered to multiple locations from a single aircraft. The Air Force\u27s THUNDER model was used to simulate the SOPAD capability and observe the impact in the simulated combat environment. The scenario places a light infantry brigade in a position where supply by ground is prohibited due to terrain limitations and it must hold its position until relief forces are available. The unit must fight for a one-week period being resupplied only through airdrop. The results of the simulation are measured through aircraft attrition, unit strength, forward line of troops movement, and the supplies delivered to the unit

Recurrent pregnancy loss.

Journal ArticleRecurrent pregnancy loss is a frustrating clinical dilemma for both patients and physicians because, in most cases, causes are nebulous and few treatments with proven benefit can be offered. Involved, expensive tests have frequently been proposed and their use has often filtered into clinical practice before their utility has been firmly demonstrated. Proposed causes of recurrent pregnancy loss include genetic and environmental etiologies, infectious agents, maternal congenital and acquired anatomic abnormalities, and immunologic and endocrinologic dysfunction. Appropriate management relies upon a realistic understanding of the often substantial limitations of currently available therapies

Robust estimation of fetal heart rate variability using Doppler ultrasound.

Journal ArticleThis paper presents a new measure of heart rate variability (HRV) that can be estimated using Doppler ultrasound techniques and is robust to variations in the angle of incidence of the ultrasound beam and the measurement noise. This measure employs the multiple signal characterization (MUSIC) algorithm which is a high-resolution method for estimating the frequencies of sinusoidal signals embedded in white noise from short-duration measurements. We show that the product of the square-root of the estimated signal-to-noise ratio (SNR) and the mean-square error of the frequency estimates is independent of the noise level in the signal. Since varying angles of incidence effectively changes the input SNR, this measure of HRV is robust to the input noise as well as the angle of incidence. This paper includes the results of analyzing synthetic and real Doppler ultrasound data that demonstrates the usefulness of the new measure in HRV analysis

Episiotomy: techniques and indications.

Journal ArticleIn current obstetric practice episiotomy is generally taken to refer to an incision of the perineum and vagina to facilitate vaginal delivery. While the most precise definition of this incision is perineotomy, episiotomy is the generally employed terminology and thus is used in this article. The evolutionary background and historical perspective of this procedure have been reviewed extensively by Thacker and Banta and are not reviewed here. This article reviews the techniques of the various types of episiotomies as well as their indications and contraindications. It also addresses the relative risks and benefits of episiotomy

Maternal mortality in Utah.

Journal ArticleOBJECTIVE: To determine trends in maternal deaths in Utah, identify opportunities for preventive intervention, and analyze the mechanism of reporting maternal deaths. METHODS: A retrospective review was performed of maternal death certificates and medical records in Utah from January 1, 1982, through December 31, 1994. RESULTS: Sixty-two maternal deaths were identified. The risk of maternal death increased with maternal age and parity. The classic triad of hemorrhage (n = 8), infection (n = 5), and preeclampsia-eclampsia (n = 3) remains an important contributor (16 of 62 or 25.8%). However, trauma (n = 10), pulmonary embolism (n = 10), and maternal cardiac disease (n = 9) now account for 46.8% (29 of 62) of maternal deaths. A greater number of direct obstetric causes of maternal death (n = 20) were deemed preventable than indirect obstetric causes (n = 1) or nonobstetric causes (n = 4). CONCLUSION: Trauma, pulmonary embolism, and maternal cardiac disease have emerged as the most common identifiable causes of maternal death. Improvements in prevention, earlier diagnosis, and aggressive treatment of these conditions are necessary to achieve the Public Health Service year 2000 objective of a 50% reduction in maternal mortality ratios (using the 1987 ratio as a baseline)

Physiologic changes in pregnancy: surgical implications.

Journal ArticlePregnancy has measurable effects on essentially every organ system in a woman's body. An understanding of these changes is vital for determining what is normal or abnormal in a pregnant woman. These changes frequently alter symptoms and signs of surgical diseases during pregnancy. In addition, many surgical diseases, as well as their therapies, have multisystemic effects. It therefore is mandatory to appreciate the physiologic changes that occur in a normal pregnancy to avoid incorrect diagnoses and treatment. These physiologic changes are complex and not always well understood. This article will review these changes, concentrating on an organ-system format, with particular emphasis on manifestations that might be confuses with surgical diseases or that have implication for treatment

Cranial magnetic resonance imaging in eclampsia.

Journal ArticleAlthough the precise neuropathologic basis for eclamptic convulsions remains unclear, intracranial hemorrhage is frequently associated with fatal cases. Magnetic resonance imaging (MRI) is a recently developed neuroimaging technique that appears superior to other processes for defining intracranial anatomy and pathophysiology. This technique has not yet been reported in eclampsia. The authors performed serial MRIs on an eclamptic woman, with findings compatible with previously described neuropathologic changes