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43 results on '"Sharland, Gurleen K."'

10. Prognosis in fetal diaphragmatic hernia

Author

Sharland, Gurleen K., Lockhart, Susan M., Heward, Annabel J., and Allan, Lindsey D.

Subjects
Fetus -- Abnormalities, Diaphragm -- Hernia, Congenital heart disease in children -- Complications, Hernia -- Prognosis, Health
Abstract

The reported mortality for prenatally detected congenital diaphragmatic hernia is high. Polyhydramnios and presentation in early pregnancy have been suggested as high-risk factors adversely affecting outcome. We retrospectively reviewed 55 cases of congenital diaphragmatic hernia diagnosed prenatally in our unit. There was an overall mortality of 73%. The mortality in cases with presentation before 25 weeks' gestation was 74%, if the cases resulting in termination of pregnancy are excluded, compared with a mortality of 60% in those seen after this gestational age. Underdevelopment of left-sided cardiac structures was found to be a helpful prognostic factor. We were unable to confirm the predictive nature of hydramnios. Associated chromosomal anomalies were found in two fetuses and major congenital heart disease in nine. Although diagnosis before 25 weeks' gestation is associated with a higher mortality than in cases detected later, it is not universally fatal. If congenital heart disease and chromosomal anomalies are excluded and there is little or no evidence of left heart underdevelopment, the odds for survival will improve. This should be taken into account when the management of these cases is planned. (Am J Obstet Gynecol 1992;166:9-13.)

Published
1992

12. Flecainide in the treatment of fetal tachycardias

Author

Allan, Lindsey D., Chita, Sunder K., Sharland, Gurleen K., Maxwell, Darryl, and Priestley, Kim

Subjects
Fetal death -- Causes of, Fetal distress -- Causes of, Fetal heart -- Abnormalities, Hydrops fetalis -- Drug therapy, Tachycardia -- Drug therapy, Flecainide -- Health aspects, Health
Abstract

Flecainide is a powerful drug used to treat heart arrhythmias (abnormal heart rhythms), which are a major cause of death following heart attacks. The drug has been used safely and effectively in infants and children. Recently, however, studies reported an increased incidence of sudden death in adults who were started on maintenance flecainide therapy after developing heart attack-related arrhythmias. Consequently, the drug has been recommended for use in cases of life-threatening arrhythmias only. Fetal tachycardia is an abnormal, very high heart rate in a fetus and has been associated with 20 to 50 percent mortality. The use of flecainide in 14 cases of fetal tachycardia is reported. All but one fetus had extensive fetal hydrops, or fluid accumulation, and severe heart failure. Twelve of 14 fetuses responded to flecainide within two to five days, and developed normal heart rhythms. Flecainide was discontinued in some cases, restarted if arrhythmia recurred, or continued (without interruption) as maintenance therapy in other cases. One of the 12 fetuses died. The remainder had varying degrees of hydrops resolution, depending on the time remaining until delivery. Abdominal drainage was performed in six cases. Eight of the surviving 11 fetuses were born by normal vaginal delivery before 38 weeks' gestation. Arrhythmia recurred in 6 of the 11 surviving infants after birth, while 5 needed no treatment. The good fetal outcomes in this study are attributed to selective use of flecainide in fetuses with severe arrhythmias, hydrops, and heart failure, and close attention to and management of hydrops, dosage, and heart function of mother and fetus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

41. Patterns of recurrence of congenital heart disease An analysis of 6,640 consecutive pregnancies evaluated by detailed fetal echocardiography

Author

Gill, Harinder K, Splitt, Miranda, Sharland, Gurleen K, and Simpson, John M

Subjects
cardiovascular diseases
Abstract

ObjectivesWe sought to investigate the pattern of recurrence of congenital heart disease (CHD) where there is one or more affected first-degree relative.BackgroundThere are little data on patterns of recurrence of different types of CHD. Analysis of a fetal series allows a high ascertainment of affected cases.MethodsWe performed an analysis of referrals for detailed fetal echocardiography to a tertiary fetal cardiology unit, where there was a first-degree family history of CHD from 1990 to the end of 1999. Data were entered prospectively on a computerized database. Recurrences were exactly concordant if CHD was identical to the index case, and concordant for the group if belonging to a similar group of CHD.ResultsA recurrence of CHD was seen in 178 (2.7%) of 6,640 pregnancies. The referral numbers for sibling, maternal, or paternal CHD cases were 5,151, 1,119, and 370, respectively. Exact concordance was seen in 37% of cases (range 0% to 80%), and group concordance was seen in 44%. In families where there were two or more recurrences, the exact concordance rate was 55%. Exact concordance rates were particularly high for isolated atrioventricular septal defects (4 of 5 [80%]) and laterality defects (7 of 11 [64%]).ConclusionsThe concordance rates of different types of CHD vary widely. Accurate diagnosis of the index case is essential for reliable counseling on patterns of recurrence. Minor CHD in the index case does not exclude more severe disease in recurrences. There appears to be significant under-referral for fetal echocardiography in paternal CHD.

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