Search

A large group of patients are studied to evaluate whether there is a nuchal translucency (NT) measurement, independent of gestational age, above which immediate diagnostic testing should be offered without waiting for first trimester serum markers. The analysis has shown that during first trimester Down syndrome screening, there is minimal benefit in waiting for serum screening results whenever an NT measurement is 3.0 mm or greater and no benefit for NT of 4.0 mm or greater.

A study was undertaken to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications. Results show that low free-beta subunit human gonadotropin levels and large nuchal translucency could result in early fetal loss.

A study was conducted to determine whether the obesity is associated with obstetric complications and cesarean delivery. The conclusion derived is that obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.

The risk of adverse outcome for pregnancies, with first-trimester threatened abortion, due to first-trimester vaginal bleeding, occurring in 16 to 25 percent of all pregnancies, is discussed. Various outcomes of the first-trimester bleeding during pregnancy include the pregnancy loss, preterm delivery, intrauterine growth restriction (IUGR), gestational hypertension, preeclampsia, preterm premature rupture of membranes (PPROM), placental abruption, placenta previa, and cesarean delivery.

While a single course of antenatal corticosteroids improves neonatal outcomes among infants born prematurely, the efficacy and safety of repetitive courses of ACS (including rescue dosing) is less clear. In [...]

When the stomach, liver, or intestines herniate into the chest cavity of a fetus with this anomaly they compress the fetal lung. Fewer than one third of all fetuses diagnosed [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1067/mob.2000.104802 Byline: Fergal D. Malone, Richard L. Berkowitz (b), Jacob A. Canick (c), Mary E. D'Alton (a) Abstract: First-trimester screening for Down syndrome has been proposed as a significant improvement with respect to second-trimester serum screening programs, the current standard of care, because of apparently higher detection rates and an earlier gestational age at diagnosis. First-trimester nuchal translucency on ultrasonography forms the basis of this new form of screening, although studies of its efficacy have yielded widely conflicting results, with detection rates ranging from 29% to 91 %. Studies of first-trimester serum screening with measurements of pregnancy-associated plasma protein A and free [beta]-human chorionic gonadotropin serum concentrations have been much more consistent, with Down syndrome detection rates of 55% to 63% at a 5% false-positive rate. The combination of first-trimester ultrasonographic and serum screening has the potential to yield a Down syndrome detection rate of 80% at a 5% false-positive rate, although this approach has not been adequately studied. There have been no studies performed to date to directly compare the performance of first-trimester and second-trimester methods of screening. Two major trials are underway that will address this issue, one in the United Kingdom and one in the United States. Until the results of these trials are available, the current standard of care with respect to Down syndrome screening should not be changed, and first-trimester screening should remain investigational. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia-Presbyterian Medical Center, New York, New York, USA (b) Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Medical Center, Providence, Rhode Island, USA (c) Division of Prenatal and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants'Hospitale, New York, New York, USA

Further research is needed before doctors begin testing pregnant women for Down's syndrome in their baby in the first trimester. Many doctors believe it is best to detect Down syndrome as early as possible, they must first identify the most accurate test.

Byline: Lynn L. Simpson, Karen Harvey-Wilkes, Mary E. D'Alton Keywords: Congenital heart disease; prenatal diagnosis; SNAP score; score for neonatal acute physiology Abstract: Objective: It has been hypothesized that delivery in a tertiary care center might improve the clinical condition and outcome of infants born with congenital heart disease. The purpose of this study was to determine the effect of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology) of infants admitted to the neonatal intensive care unit with major structural cardiac defects. Study Design: This retrospective cohort study included 195 infants with major congenital heart disease admitted to the neonatal intensive care unit at the New England Medical Center between July 1, 1992, and June 30, 1998. SNAP scores were abstracted from the medical record. The values of 97 neonates with major cardiac defects born at the New England Medical Center were compared with those of 98 neonates transferred to our center after delivery in a community setting. A 2-tailed Student t test for independent samples was used to compare the mean SNAP scores between the 2 cohorts. Results: The SNAP scores for infants with major cardiac defects who were born at the New England Medical Center ranged from 0 to 41, with a mean of 10.6 [+ or -] 8.8. The values for infants with congenital heart disease who were transferred to our center after birth in community-based hospitals ranged from 0 to 34, with a mean of 11.1 [+ or -] 7.0. There was no significant difference between the 2 populations (P = .646). A comparison of the mean SNAP scores of infants with prenatally diagnosed disease who were delivered at our center versus infants with postnatally diagnosed disease who were delivered in community hospitals was also statistically not significant (P = .824). Conclusion: Delivery in a tertiary care center does not improve SNAP scores of infants with major structural cardiac defects. (Am J Obstet Gynecol 2000;182:184-91.) Author Affiliation: Boston, Massachusetts From the Departments of Obstetrics and Gynecology.sup.a and Pediatrics,.sup.b New England Medical Center, Tufts University School of Medicine Article History: Received 21 December 1998; Revised 17 March 1999; Accepted 30 July 1999 Article Note: (footnote) [star] Reprint requests: Lynn L. Simpson, MD, New England Medical Center, Box 360, 750 Washington St, Boston, MA 02111., [star][star] 0002-9378/2000 $12.00 + 0 6/1/101827

Being delivered in a tertiary level hospital does not improve the prognosis of babies with congenital heart disease. This was the conclusion of a study of 195 babies with heart defects, half of whom were born in a tertiary level hospital and half of whom were transferred there after delivery in a community hospital.

Ultrasound evaluations performed live but at a remote location through a digitally linked system appear to be as accurate as videotape reviews. These telemedicine systems allow remote satellite clinics to interactively use the services of centralized specialists. Ultrasounds of 200 low-risk pregnant women were directed live by a remote specialist and also videotaped for later review by a specialist blinded to the live interpretation. More anatomic features were visualized using telemedicine than videotape analysis. Poor videotape quality resulted in more repeat ultrasounds.

Fluorescence in situ hybridization (FISH) analysis of uncultured cells from the amniotic sac may be a more rapid method of detecting fetuses with abnormal numbers of chromosomes than conventional methods. Researchers compared results of FISH and of conventional karyotyping in 315 pregnant women undergoing amniocentesis for suspected fetal abnormality as detected by ultrasound, blood tests, or based on maternal age. FISH provided useful, accurate information for 80.6% of pregnancies (254). FISH was quicker than conventional karyotyping, taking 2.8 days versus 8.3 days to complete. FISH was most accurate for pregnancies 24 weeks or earlier.

Byline: Mary E. D'Alton, Fergal D. Malone, David Chelmow, Brian E. Ward, Diana W. Bianchi Keywords: Prenatal diagnosis; fluorescence in situ hybridizationchromosome abnormalities; ultrasonography Abstract: OBJECTIVE: This study examines the role of fluorescence in situ hybridization on uncultured amniocytes for prenatal diagnosis in a population at high risk for aneuploidies. STUDY DESIGN: All patients undergoing amniocentesis for fetal structural abnormality on ultrasonographic examination (performed from 13 to 39 weeks), abnormal maternal serum aneuploidy screening results, or advanced maternal age with substantial parental anxiety were offered both fluorescence in situ hybridization on uncultured cells and conventional metaphase karyotyping on dividing cells. RESULTS: From 1992 to 1995, 315 patients were studied. Mean time to obtain results was 2.8 days for fluorescence in situ hybridization and 8.3 days for karyotype. Fluorescence in situ hybridization was informative in 254 samples (80.6%), and within this group 21 aneuploidies were correctly identified. Among informative specimens there was 100% sensitivity and specificity, with 100% positive and negative predictive values. Of the 315 samples, 61 (19.4%) were uninformative or unreportable. Of 25 total cases of karyotype-proved aneuploidy, 4 were reported as uninformative by fluorescence in situ hybridization, for a total detection rate of 84%. Overall, amniocenteses performed after 24 weeks were significantly more likely to be uninformative than those performed in the second trimester (45% vs 16%, p = 0.01), peaking at a 56% uninformative rate after 33 weeks. Logistic regression analysis showed an 8% increase in the uninformative rate per week of gestational age (odds ratio 1.08, 95% confidence interval 1.04 to 1.14). CONCLUSIONS: Fluorescence in situ hybridization on uncultured amniocytes is a rapid, clinically useful tool for prenatal diagnosis, with informative specimens being highly accurate. The combination of a structural fetal anomaly and an abnormal fluorescence in situ hybridization result should allow for definitive management decisions. The significant increase in uninformative specimens at later gestational ages limits its usefulness in the third trimester. (Am J Obstet Gynecol 1997;176:769-76.) Author Affiliation: Boston and Framingham, Massachusetts Article Note: (footnote) [star] From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University School of Medicine, New England Medical Center,a and Integrated Genetics.b , [star][star] Reprint requests: Fergal D. Malone, MB, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University School of Medicine, New England Medical Center, #360, 750 Washington St., Boston, MA 02111., a 0002-9378/97 $5.00 + 0 6/6/80373

Increased levels of endothelin-1,2 may be found in fetuses with abnormal flow velocity in the umbilical artery or a reduced amniotic fluid volume. Researchers obtained endothelin-1,2 measurements before and at delivery from 16 growth-restricted infants with abnormal umbilical artery flow velocity Doppler waveforms and from 16 growth-restricted infants with normal flow velocity Doppler waveforms, and at delivery from 44 infants of normal size. Endothelin-1,2 levels were much higher in cord blood from growth-restricted infants with abnormal flow velocity waveforms than in growth-restricted infants with normal flow velocity waveforms or in normal-sized infants. Endothelin-1,2 may foster the development of abnormal vascular resistance between the fetus and placenta, leading to intrauterine growth restriction.

Byline: Karen B. Harvey-Wilkes, Heber C. Nielsen, Mary E. D'Alton Keywords: Endothelin; fetal growth restriction; umbilical velocimetry; oligohydramnios Abstract: OBJECTIVE: The purpose of this study was to measure cord blood endothelin-1,2 concentrations in growth-restricted infants with abnormal flow velocity waveforms. STUDY DESIGN: Endothelin-1,2 concentrations were measured by radioimmunoassay in the cord blood of 16 growth-restricted infants with abnormal flow velocity waveforms before delivery, 16 growth-restricted infants with normal flow velocity waveforms before delivery, and 44 appropriately grown infants. Clinical data regarding pregnancy complications and neonatal outcome were collected. RESULTS: The mean endothelin-1,2 concentration in growth-restricted infants with abnormal flow velocity waveforms (50.2 [+ or -] 16.4 pg/ml) was significantly higher than in growth-restricted infants with normal flow velocity waveforms (33.3 [+ or -] 14.2 pg/ml, p < 0.05) or in appropriately grown infants (25.8 [+ or -] 9.7 pg/ml, p < 0.05). Oligohydramnios was also associated with elevated endothelin levels. CONCLUSION: We conclude that endothelin-1,2 concentrations are elevated in growth-restricted infants with abnormal flow velocity waveforms and may play a role in the development of abnormal fetoplacental resistance. (AM J OBSTET GYNECOL 1996;174:1599-604.) Author Affiliation: Boston, Massachusetts Article History: Received 28 March 1995; Revised 8 August 1995; Accepted 19 October 1995 Article Note: (footnote) [star] From the Divisions of Newborn Medicine and Maternal-Fetal Medicine, Departments of Pediatricsa and Obstetrics and Gynecology, b Floating Hospital for Children, New England Medical Center, Tufts University School of Medicine. , [star][star] Reprint requests: Karen B. Harvey-Wilkes, MD, Department of Pediatrics (Newborn Medicine), New England Medical Center, Box 44, 750 Washington St., Boston, MA 02111., a 0002-9378/96 $5.00 + 0 6/1/70001

A major risk factor for poor outcome of pregnancy is preeclampsia. This condition, which develops during pregnancy, is characterized by high blood pressure, headaches, excretion of protein in the urine, and accumulation of fluid in the lower limbs. If untreated, preeclampsia may develop into true eclampsia, which is characterized by coma and convulsive seizures occurring between the twentieth week of pregnancy and the end of the first week after birth. Studies show that the incidence of preeclampsia is greater in diabetic women than nondiabetic women, and that the incidence increases with the severity of diabetes. Diabetic pregnancies complicated by preeclampsia are associated with a poor outcome. Although the course and outcome of diabetic pregnancies have improved within the past 25 years, the effects of these changes on the incidence of preeclampsia in diabetic pregnancies have not been identified. The incidence of preeclampsia and the outcome of the mother and fetus were assessed in 334 diabetic pregnancies and 16,534 nondiabetic pregnancies. Preeclampsia developed in 33 of 334 diabetic pregnancies (9.9 percent) and 716 of 16,534 nondiabetic pregnancies (4.3 percent). The incidence of preeclampsia rose with increasing severity of diabetes, but remained at an incidence of 8.9 percent among diabetic pregnancies when women with kidney disease and chronic hypertension (high blood pressure) were excluded from the analysis. There were 60 newborn deaths per 1,000 births among preeclamptic diabetic patients and 3.3 newborn deaths per 1,000 births among diabetic patients without preeclampsia. The number of previous childbirths, age of the mother, and control of blood glucose levels did not differ between diabetics with and without preeclampsia. These findings show that preeclampsia occurs twice as frequently in diabetic pregnancies as in normal pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

A case report of multicystic encephalomalacia after the demise of a cotwin in the first trimester diagnosed by magnetic resonance imaging and confirmed pathologically is presented. It is observed that multicystic encephalomalacia occurs in almost 20% of the surviving cotwins after the second-and third-trimester intrauterine fetal death of one twin in monochorionic pregnancies.

In Part I of this symposium ('New developments in OB ultrasound,' in the May 2001 issue), we looked at advances in 3-D U/S, compound scanning, tissue harmonics, and telesonography. This [...]

The findings of Molina et al. challenge a 30-year-old recommendation that a cesarean delivery rate of less than 15% should be a target for all health care institutions. The study [...]

A case report of a 34 years old nulliparous woman on whom radiofrequency ablation is used to reduce a monochromatic twin discordant selectively, for abnormality is presented. Monochrionicity was confirmed on pathologic examination of the placenta postnatally.

A Not according to this analysis of data from Massachusetts. It found that women who planned primary cesarean delivery were 2.3 times more likely to be rehospitalized within 30 days […]