摘要:

ObjectiveTo determine the diagnostic accuracy of detecting growth-restricted fetuses in women with and without preeclampsia.MethodsOver 2 years, parturients with reliable gestational ages, preeclampsia, and sonographic estimates of birth weights were matched (1:1) for gestational age with women without preeclampsia. Paired and unpairedttests were used;P< .05 was significant. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.ResultsTwo hundred eighty-seven preeclamptic women were identified and matched. In each group, mean (± standard deviation [SD]) gestational age was 34.9 ± 4.2 weeks, and 166 (57.8%) infants were born preterm. Fetal growth restriction (FGR) was significantly more common among women with preeclampsia (14.9%) than among controls (5.6%; OR 2.98, 95% CI 1.64, 5.44). The percentage of sonographic estimates within 10% of actual birth weight (57.5% versus 53.6%) was similar in the two groups (OR 1.16; 95% CI 0.84,1.62). Compared with normal growth, the mean (± SD) standardized absolute error was significantly higher among those with FGR regardless of group (preeclampsia 109 ± 100 versus 158 ± 152 g/kg;P= .009; control 117 ± 103 versus 233 ± 206 g/kg;P< .001). Fetal growth restriction was detected more commonly among preeclamptic women than among controls (11.6% versus 0%; OR 4.74 95% CI 0.25, 90.31). The sensitivity and positive predictive value of FGR detection were 10% and 50%, respectively, among women with preeclampsia and 0% each among controls.ConclusionAlthough FGR was detected more frequently in fetuses of women with preeclampsia than in those of controls, the ability to predict it with sonography remained poor.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the accuracy of three different sonographic circumference measurement techniques in predicting birth weight in term fetuses, using a standard equation for estimating fetal weight.MethodsFifty-three singleton, term fetuses were examined sonographically within 24 hours of scheduled elective cesarean delivery. The biparietal diameter (BPD) and femur length (FL) were measured using standard techniques, and head circumference (HC) and abdominal circumference (AC) were measured using three separate circumference measurement techniques (Two-diameter, ellipse, and trace). With the use of each circumference method, estimated fetal weights were determined for each fetus according to a weight-estimation formula incorporating BPD, HC, AC, and FL. The accuracy of the formula using each circumference measurement technique for predicting actual birth weight was calculated.ResultsThe mean (± standard deviation [SD]) gestational age was 38.1 ± 0.9 weeks and the mean actual birth weight was 3536 ± 472 g. The two-diameter and ellipse circumference measurements allowed more accurate birth weight prediction than did the trace method, with mean (± SD) percent deviations from the actual birth weight of −0.5 ± 7.8%, 1.9 ± 8.0%, and 8.2 ± 11.6% (P< .05), respectively. The trace method was the least accurate, with a mean birth weight overestimation of 266 g and measurements within 10% of the actual birth weight only 49.1% of the time. The two-diameter and ellipse method yielded predicted birth weights within 10% of actual birth weights in 77.4 and 79.2% of cases, respectively.ConclusionTwo-diameter and ellipse circumference measurement techniques are similarly accurate in predicting birth weight and both are significantly better than the trace technique.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo investigate physiologic blood-flow-velocity waveform patterns of the fetal cerebral venous system during normal pregnancies by transvaginal Doppler studies and to evaluate cases with abnormal venous-flow patterns.MethodsInternal cerebral veins and the three dural sinuses, those of the superior sagittal sinus, vein of Galen, and straight sinus, were examined in normal cephalic-presenting fetuses of 20–40 weeks' gestation. For analysis, the venous index was defined as maximum minus minimum velocity divided by maximum velocity. Different cases with intracranial abnormalities were evaluated with emphasis on abnormal venous blood-flow patterns.ResultsInternal cerebral veins had pulsatile patterns with a venous index of 0.22 in 47.6% of fetuses, whereas all fetuses had pulsations in the dural sinuses. The vein of Galen had a significantly lower venous index (0.31) than the superior sagittal sinus (0.39) and the straight sinus (0.36), indicating that the amplitude of the intracranial venous pulsation might increase as the flow runs from the periphery toward the proximal portion. Significant regression lines of venous index were obtained, indicating the stability of the pulsation during pregnancy. A flat pattern of superior sagittal sinus flow was found in three cases of hydrocephalus and one of craniosynostosis.ConclusionWe showed the normal patterns of fetal cerebral venous blood-flow velocity and the abnormal patterns which might be associated with increased intracranial pressure. Doppler assessment of the intracranial venous system enabled us to evaluate intracranial abnormalities accompanied by increased intracranial pressure that might have prognostic clinical importance.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine sonographic findings in Down syndrome fetuses in the third trimester.MethodsDown syndrome fetuses who had third-trimester ultrasound examinations between 25 and 41 weeks' gestation were matched for gestational age with three controls each. Fetal structural anomalies, Down syndrome dysmorphology markers (abnormal facial profile, sandal gap, tongue thrusting, clinodactyly, or hypoplastic middle phalanx of the fifth finger), and abnormal long-bone biometry (femur, humerus, tibia, and fibula; femur length to biparietal diameter ratio; and femur length to abdominal circumference ratio were abstracted from the ultrasound reports. The fetal face, hands, feet, profile, and cardiac outflow tracts are routinely evaluated in our center.ResultsSeventeen fetuses with Down syndrome who had third-trimester ultrasound evaluations were identified. Anomalies included cardiac defects (five), tongue thrusting (three), clinodactyly (three), abnormal profile (three), sandal gap (two), and duodenal atresia (two). Of the 17 fetuses, at least one long-bone abnormality was found in 13, at least one structural or biometric anomaly was found in 15, and at least two abnormal findings existed in 11. Abnormal ultrasound findings, including structural anomalies, short bones, and Down syndrome dysmorphology markers, were more common in cases than in matched controls.ConclusionAt least one abnormal ultrasound finding was present in 15 of 17 fetuses, and abnormal bone measurements or ratios were discovered in 13 of 17. Abnormal long-bone biometry at third-trimester ultrasound should raise the suspicion of fetal Down syndrome.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the effectiveness of two widely used protocols for second-trimester screening for fetal trisomy 18.MethodsSecond-trimester screening results for 41,565 women were reviewed to determine whether pregnancies could be considered to be at high risk for trisomy 18. The screening test was considered positive if either maternal serum concentrations of alpha-fetoprotein (MSAFP), hCG, and unconjugated estriol (E3) fell below defined levels, or the second-trimester patient-specific risk (based on maternal age and serum analytes) was greater than 1:100. Detection rates, false-positive rates, and pregnancy outcomes for the two protocols were compared.ResultsThe fixed-cutoff method showed a 23% detection rate and a 0.19% false-positive rate for trisomy 18. These low rates were in close agreement with a theoretical expectation for fixed-cutoff trisomy 18 screening. The risk-based approach resulted in a 69% detection rate and a 0.45% false-positive rate. Both methods identified pregnancies with other fetal anomalies.ConclusionOverall, the risk-based method is more effective than the fixed-cutoff approach to trisomy 18 screening.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether prior knowledge of obstetric estimate of gestational age creates a bias in assignment of gestational age by the Ballard assessment score.MethodsThe Ballard assessment score was done on 82 infants weighing less than 2500 g by two examiners, one who had prior knowledge of best obstetric gestational age estimate and the other who was masked to that information. Obstetric gestational age was correlated with masked and unmasked score. Statistical analysis used Spearman rank correlation test, plotting the measurement means against the measurement differences, χ2, Wilcoxon signed-rank test, analysis of variance, and Studentttest. Significance was assumed atP< .05.ResultsThere was high reliability (r= 0.84–0.86) between obstetric gestational age estimates (33.3 ± 3.0 weeks) and the gestational age derived from masked (34.3 ± 3.0 weeks) and unmasked (34.0 ± 3.0 weeks) Ballard scores. The mean difference between unmasked scores and gestational age was 1.38 ± 1.15 weeks and that between masked scores and obstetric gestational age was 1.40 ± 1.15 weeks, a nonsignificant difference. There was no significant difference in the number of cases with 100% agreement between masked and unmasked scores and obstetric gestational age or in the number of cases in which the score (masked or unmasked) differed by more than 2 weeks from obstetric gestational age. This study had over 99% power to detect a 1-week difference between the accuracy of masked and unmasked scores.ConclusionPrior knowledge of obstetric gestational age did not bias the Ballard assessment score.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo examine associations between bacterial vaginosis and other prevalent lower genital tract infections and clinically recognized first-trimester bleeding; possible independent and joint effects of gestational bleeding and bacterial vaginosis or other prevalent infections on preterm birth and premature rupture of membranes; and effects of antimicrobial treatment on reducing risks of preterm birth among these women.MethodsA secondary analysis was conducted of 1100 pregnant women enrolled in a prospective observational study that examined the effects of standardized diagnosis and treatment of lower genital tract infections to prevent preterm birth.ResultsSixty percent of women with first-trimester bleeding had one or more study infections detected at the initial examination. First-trimester bleeding was associated independently with the presence of bacterial vaginosis (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0, 2.3),Trichomonas vaginalis(OR 2.3, 95% CI 1.3, 4.2), andChlamydia trachomatis(OR 2.7, 95% CI 1.4, 5.1). Preterm birth was increased among women with first-trimester bleeding and bacterial vaginosis (relative risk [RR] 4.4, 95% CI 2.0, 9.5) and bacterial vaginosis andT vaginalis(RR 3.0, 95% CI 1.0, 8.8). Systemic antimicrobial treatment reduced the rate of preterm birth among women with bacterial vaginosis without first-trimester bleeding (RR 0.37, 95% CI 0.16, 0.88). Treatment of women with both first-trimester bleeding and bacterial vaginosis reduced preterm birth (RR 0.52, 95% CI 0.18, 1.55), but not significantly.ConclusionFirst-trimester bleeding was increased among women with bacterial vaginosis,T vaginalis, C trachomatis, and combinations of these infections. Women with bacterial vaginosis who also experienced first-trimester bleeding were at heightened risk for preterm birth. Treatment of studied infections reduced significantly the risks of preterm birth among women without first-trimester bleeding.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine if assessment of maternal hemodynamics could predict women at risk for the development of preeclampsia, if treatment directed at hemodynamic abnormalities before the onset of hypertension could prevent preeclampsia, and if mothers could be treated in a way that protects fetal growth.MethodsA double-blinded, randomized controlled trial was conducted. Subjects were considered to be at risk for preeclampsia if their cardiac output was greater than 7.4 L/min before 24 weeks' gestation. Nulliparous and diabetic subjects at risk were treated with 100 mg of atenolol or placebo. Cardiac output was measured by Doppler technique. Inulin and para-aminohippurate clearances were performed.ResultsTreatment with atenolol reduced the incidence of preeclampsia from 5 of 28 (18%) to 1 of 28 (3.8%), (P= .04). Nulliparous women determined to be at risk for preeclampsia were similar to diabetic women at risk. Each was significantly heavier and had inulin and para-aminohippurate clearances greater than the control group. Treatment with atenolol was associated with infants weighing 440 g less than infants in the nulliparous placebo group, (P= .02). No effect on birth weight was seen in the diabetic patients. Mothers of the smallest infants who were treated with atenolol could be identified by unexpectedly large reductions in cardiac output.ConclusionMeasurement of cardiac output in the second trimester identified women at risk for preeclampsia. Treatment with atenolol decreased the incidence of preeclampsia. Nulliparous and diabetic women at risk for preeclampsia were similar with regard to maternal hemodynamics, maternal weight, and renal function. Treatment with atenolol was associated with reduced infant birth weight.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine physician and patient compliance rates for diabetes testing in patients with previous gestational diabetes.MethodsQuestionnaires regarding follow-up testing and personal health history were sent to 66 patients with previous gestational diabetes who did not have diabetes when they participated in a follow-up study conducted 5 years earlier. A 2-hour glucose tolerance test (GTT) was offered to those whose last test was done more than 1 year previously.ResultsAll 66 individuals returned the questionnaire and 20 (30.3%) reported having received a yearly 2-hour GTT. Of the remaining 46, 19 had been tested at least once in the previous 5 years, but 27 had not been tested. Of the patients who had been tested at least once in the 5-year period, their physicians initiated testing 61.5% of the time and the patients initiated the remainder. There were no significant differences between physician specialty and rate or appropriateness of the testing. Of 39 individuals who had been tested at least once in the 5-year period, eight had diabetes and four were glucose intolerant. Of 12 individuals who had not been tested in the past year and agreed to be tested in 1995, four had diabetes and two had glucose intolerance.ConclusionAlthough physicians and their gestational diabetic patients knew the risks of diabetes development, compliance with follow-up testing was poor and the risk of developing diabetes high.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveIt is unclear whether it is cost-effective to universally screen adolescent gravidas for gestational diabetes mellitus (GDM). Our objective was to identify the prevalence of gestational diabetes in our adolescent population and to review risk factors that would most easily identify a subset of adolescent patients at greatest risk for the development of gestational diabetes.MethodsSix hundred thirty-two adolescents were identified from 11,486 deliveries in our institution through International Classification of Diseases (9th edition) codes. Eleven of those adolescents had GDM. Their charts and those of a representative group of nondiabetic adolescent gravidas were analyzed for GDM risk factors, including race/ethnicity, body mass index (BMI), family history of diabetes, other medical disorders, and previous history of GDM, macrosomia, stillbirths, or anomalous fetus. Statistical analyses used χ2and Studentttests as appropriate.ResultsThe prevalence of GDM among adolescent gravidas was 1.7%. No difference was identified between the adolescent pregnancies with GDM and the comparison group for race/ethnicity, family history, or presence of medical disorders. Risk factors requiring a previous obstetric history could not be evaluated adequately because of the high prevalence of nulliparas. There was a higher prevalence of BMI over 27 in adolescents with GDM (P< .001).ConclusionBody mass index is an important risk factor for the development of gestational diabetes in adolescent gravidas. We recommend that selective screening for GDM of adolescent gravidas be performed on the basis of BMI.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID