Re: Fetal lung maturity
From: James S Smeltzer MD (gaperina@mindspring.com)
Mon Jul 16 07:34:25 2001
Hi,
Two days ago delivered a woman whose 25 week baby had LS of 2.7, PG > 1.25,
and the baby was never adequately ventilated and died in the delivery room
S/P two blown pneumothoraces. Infection was present and baby was extremely
immature in appearance but L/S transitional and PG present.
In cases of oligo from PROM, I agree with the use of steroids. Had a baby
with SEVERE oligo documented from PROM at 18 weeks who never had any fluid
followed by another perinatologist, who came to my hosp for emergency
delivery to mine at 34 weeks. Fetal thorax was hypoplastic by CT ratio.
Baby required O2 for about an hour and went to normal nursery.
Jim S.
At 08:12 PM 7/11/2001 -0500, you wrote:
>what would be the pressing need to determine lung maturity in a 26 wk
>pregnancy? aside from administering steroids, would favor managing the
>situation clinically. tough call here to be sure but would not deliver
>solely on the basis of afi at 26 wks.
>
>just my opinion - i could be wrong.
>
>art
>
>At Wed, 11 Jul 2001, DuboseTerryJ@uams.edu wrote:
>>
>>Dear Dr. D'Angelo, your question is an excellent one... one that really
>>needs a solution. If someone could come up with a foolproof method of
>>determining fetal lung maturity using ultrasound they would win the whole
>>set of dishes!
>>
>>A long time ago, in the Dark Ages of sonography, before 1985 there were some
>>papers that proposed that lung maturity might be assessed by comparing it to
>>the liver. The theory was that when the alveoli started filling out the
>>lung would go from being less echogenic than the liver to being more
>>echogenic. Unfortunately, subsequent studies found it to be a very
>>unreliable technique.
>>
>>At the 1998, Edinburgh, Scotland, 8th World Congress on Ultrasound in
>>Obstetrics & Gynecology, there was a Fetal Lung: Round Table Discussion. I
>>have a brief review of this panel discussion at:
>>http://www.obgyn.net/us/us.asp?page=/us/news_articles/ISUOG/Fetal-Lung . In
>>this review I give a brief description of each research project, world wide,
>>that is trying to solve the lung maturity quandary. (Unfortunately, the
>>links to the photographs of some of the panel members and some of their
>>slides are broken... hopefully repaired soon. )
>>
>>There were reports of research on fetal lung maturity and Doppler of the
>>pulmonary arteries and veins in an attempt to solve this problem. No
>>definite results yet, but it is a promising direction to go. My gestalt
>>tells me that there should be some change in the pulmonary perfusion when
>>the lungs mature...probably a drop in the RI, but we need someone to figure
>>out how to do that. Others were trying to use Doppler to measure or estimate
>>the rate of fluid movement in fetal breathing motions... also not successful
>>yet.
>>
>>Sorry I can't give you a better answer.
>>
>>Peace, Terry J. DuBose, M.S., RDMS, APS
>>Assistant Professor & Director, Diagnostic Medical Sonography Program
>>CHRP, University of Arkansas for Medical Sciences
>>Little Rock, Arkansas, USA
>>501-686-6510
>>http://www.io.com/~dubose/
>>http://www.uams.edu/CHRP/dmshome.htm
>>http://www.obgyn.net/us/panel/panel.htm
>>
>>-----Original Message-----
>>From: Pablo D'Angelo [mailto:pjd@post.com]
>>Sent: Wednesday, July 11, 2001 3:26 PM
>>To: Multiple recipients of list ULTRASOUND
>>Subject: Fetal lung madurity
>>
>>Hello
>>
>>Someone knows if there is any RELIABLE way to determine fetal lung madurity
>>with ultrasound?
>>
>>We had a pregnant woman 26 weeks of gestation with premature rupture of
>>membranes from 4 weeks ago, with an AFI that never exceeded 10 mm.
>>We need to know lung madurity.
>>
>>Any idea?
>>
>>Thanks
>>
>>--
>>Pablo D'Angelo, MD
>>from Argentina
>>
>
>--
>art fougner, md
>
>A series of 1000 cases begins with but a single anecdote.
>
