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251. Long-term use of magnesium sulfate as a tocolytic agent.

Author

Wilkins, Isabelle A., Goldberg, James D., Phillips, Robin N., Bacall, Charles J., Chervenak, Frank A., Berkowitz, Richard L., Wilkins, I A, Goldberg, J D, Phillips, R N, Bacall, C J, Chervenak, F A, and Berkowitz, R L

Published
1986

256. First- and second-trimester evaluation of risk (faster) trial: principal results of the NICHD multicenter down syndrome screening study

Author

Malone, Fergal D, Wald, Nicholas J, Canick, Jacob A, Ball, Robert H, Nyberg, David A, Comstock, Christine H, Bukowski, Radek, Berkowitz, Richard L, Gross, Susan J, Dugoff, Lorraine, Craigo, Sabrina D, Timor, Ilan E, Carr, Stephen R, Wolfe, Honor M, Dukes, Kimberly A, Bianchi, Diana W, Rudnicka, Alicja, Hackshaw, Allan, Lambert-Messerlian, Geralyn, and D'Alton, Mary E

Published
2003
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259. Fetal Cystic Hygroma

Author

Chervenak, Frank A., primary, Isaacson, Glenn, additional, Blakemore, Karin J., additional, Breg, W. Roy, additional, Hobbins, John C., additional, Berkowitz, Richard L., additional, Tortora, Marge, additional, Mayden, Kara, additional, and Mahoney, Maurice J., additional

Published
1983
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265. Fetal echocardiography

Author

Kleinman, Charles S., primary, Donnerstein, Richard L., additional, Jaffe, C. Carl, additional, DeVore, Greggory R., additional, Weinstein, Ellen M., additional, Lynch, Diana C., additional, Talner, Norman S., additional, Berkowitz, Richard L., additional, and Hobbins, John C., additional

Published
1983
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275. Reply to Fougner and Wilson

Author

Chervenak, Frank A., primary, Berkowitz, Richard L., additional, Johnson, Robert E., additional, Grannum, Peter, additional, and Hobbins, John C., additional

Published
1984
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279. The diagnosis of fetal microcephaly

Author

Chervenak, Frank A., primary, Jeanty, Philippe, additional, Cantraine, Francis, additional, Chitkara, Usha, additional, Venus, Ingeborg, additional, Berkowitz, Richard L., additional, and Hobbins, John C., additional

Published
1984
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284. Fetal Treatment 1982

Author

Harrison, Michael R., primary, Filly, Roy A., additional, Golbus, Mitchell S., additional, Berkowitz, Richard L., additional, Callen, Peter W., additional, Canty, Timothy G., additional, Catz, Charlotte, additional, Clewell, William H., additional, Depp, Richard, additional, Edwards, Michael S., additional, Fletcher, John C., additional, Frigoletto, Frederic D., additional, Garrett, William J., additional, Johnson, Michael L., additional, Jonsen, Albert, additional, de Lorimier, Alfred A., additional, Liley, William A., additional, Mahoney, Maurice J., additional, Manning, Frank D., additional, Meier, Paul R., additional, Michejda, Maria, additional, Nakayama, Donald K., additional, Nelson, Lewis, additional, Newkirk, John B., additional, Pringle, Kevin, additional, Rodeck, Charles, additional, Rosen, Mark A., additional, and Schulman, Joseph D., additional

Published
1982
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293. Reply

Author

Saphier, Carl J., Singla, Angela K., and Berkowitz, Richard L.

Published
2002
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295. LongTerm Use of Magnesium Sulfate as a Tocolytic Agent

Author

WILKINS, ISABELLE A., GOLDBERG, JAMES D., PHILLIPS, ROBIN N., BACALL, CHARLES J., CHERVENAK, FRANK A., and BERKOWITZ, RICHARD L.

Abstract

Two patients in premature labor were treated continuously for six and 13 weeks with intravenous magnesium sulfate MgSO4for tocolysis. In each case, conventional therapy with intravenous and oral ritodrine failed to abate uterine contractions, and attempts to taper the MgSO4were unsuccessful. Both pregnancies proceeded uneventfully otherwise, with normal fetal growth. Longterm MgSO4may be a safe and efficacious alternative for occasional patients not responding to other modes of therapy for the treatment of premature labor.Obstet Gynecol 6738S, 1986

Published
1986

296. Omission of fetal sampling in treatment of subsequent pregnancies in fetal-neonatal alloimmune thrombocytopenia.

Author

Lakkaraja, Madhavi, Berkowitz, Richard L., Vinograd, Cheryl A., Manotas, Karen C., Jin, Jenny C., Ferd, Polina, Gabor, Julia, Wissert, Megan, McFarland, Janice G., and Bussel, James B.

Subjects
THROMBOCYTOPENIA treatment, GAMMA globulins, PREGNANCY complications, BIOMARKERS, CORD blood, THERAPEUTICS, CEREBRAL hemorrhage, COMPARATIVE studies, GESTATIONAL age, IMMUNOGLOBULINS, IMMUNOLOGICAL adjuvants, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, PREDNISONE, PRENATAL diagnosis, RESEARCH, EVALUATION research, THROMBOCYTOPENIA, RANDOMIZED controlled trials, CORDOCENTESIS, PLATELET count, DIAGNOSIS
Abstract

Background: Fetal-neonatal alloimmune thrombocytopenia affects approximately 1 of 1000 live births, most of which are not severely thrombocytopenic. Despite effective treatment with intravenous gammaglobulin and/or prednisone, antenatal management of a subsequent affected pregnancy is complicated by the risks associated with fetal blood sampling. Furthermore, there are no biomarker(s) of high risk other than the occurrence of intracranial hemorrhage in a previous sibling. Management of these high-risk pregnancies requires intensive treatment initiated at 12 weeks of gestation.Objective: The objective of the study was to evaluate whether empiric escalation of therapy at 32 weeks allows the omission of fetal blood sampling in all fetal-neonatal alloimmune thrombocytopenia-affected patients. Specifically, we sought to determine whether intensive intravenous gammaglobulin-based regimens for the treatment of a subsequent fetal-neonatal alloimmune thrombocytopenia-affected pregnancy followed by empirically escalated intravenous gammaglobulin and prednisone treatment would increase the fetal platelet count and thus safely allow omission of fetal blood sampling in the antepartum management of these patients.Study Design: In this prospective, multicenter, randomized controlled study, 99 women with fetal-neonatal alloimmune thrombocytopenia whose prior affected child did not have an intracranial hemorrhage were randomized to receive an intensive intravenous gammaglobulin-based regimen: 2 g/kg per week or intravenous gammaglobulin 1 g/kg per week plus prednisone 0.5 mg/kg per day, starting at 20-30 weeks of gestation. Escalated therapy (intravenous gammaglobulin 2 g/kg per week plus prednisone 0.5 mg/kg per day) was recommended and usually initiated at 32 weeks when fetal counts were <50,000/mL(3) or when fetal blood sampling was not performed. The preliminary report of this study from 2007 demonstrated the efficacy of both intravenous gammaglobulin-based regimens in most patients. Most patients who underwent fetal sampling had adequate fetal counts and therefore did not have their treatment escalated. This post hoc analysis describes the 29 fetuses who had their treatment escalated either because they had low counts at 32 weeks or when sampling was not performed. This study explored whether the empiric escalation of treatment at 32 weeks was sufficiently effective in increasing fetal platelet counts in these patients.Results: Mean fetal and birth counts of fetuses randomized to each of the 2 initial treatment groups were all >100,000/mL(3). Three neonates had an intracranial hemorrhage; all 3 were grade 1 and all had birth platelet counts >130,000/mL(3). In a post hoc analysis, 19 fetuses undergoing fetal blood sampling at 32 weeks had fetal platelet counts <50,000/mL(3) despite their initial treatment. Of these 19, birth platelet counts were >50,000/mL(3) in 11 of 13 fetuses who received escalated treatment compared with only 1 of 6 of those who did not (P = .01); only 3 fetuses that received initial therapy followed by escalated treatment had birth platelet counts <50,000/mL(3) and none had an intracranial hemorrhage. The platelet counts of 14 of 15 fetuses that received empirically escalated treatment without sampling were >50,000/mL(3) at birth. In addition, none of these had an intracranial hemorrhage.Conclusion: The 2 recommended protocols of intensive initial treatment followed by empiric escalation of therapy at 32 weeks of gestation are reasonably safe, effective in increasing fetal platelet counts, and allow omission of fetal blood sampling by increasing the fetal platelet count in almost all cases. [ABSTRACT FROM AUTHOR]

Published
2016
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299. Introduction

Author

D’Alton, Mary E., Berkowitz, Richard L., Platt, Lawrence D., and Wapner, Ronald J.

Published
2005
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