摘要:

ObjectiveTo investigate which second-trimester ultrasound markers for aneuploidy are the most diagnostically efficient in detecting fetal trisomy 21.MethodsAll second-trimester genetic sonograms performed since November 1, 1992 for women at increased risk for fetal trisomy 21 were analyzed restrospectively. Statistical analysis included descriptive statistics, the test of proportions, and univariate and multivariable logistic regression analysis using trisomy 21 as the dependent variable and ten aneuploidy ultrasound markers as independent variables.ResultsThere were 581 normal fetuses, 23 with trisomy 21 and four with other chromosomal abnormalities. When one or more abnormal ultrasound markers were present, the sensitivity and flase-positive rate for trisomy 21 were 87% and 13.4%, respectively. After adjusting for confounders, multivariate logistic regression analysis showed the best combination of ultrasound markers for detecting trisomy 21 to be nuchal fold thickening (relative risk [RR] 85.5; 95% CONFIDENCE INTERVAL [CI] 20.4; 95% CI 4.5, 92.1)). The model combining these three ultrasound markers yielded a sensitivity of 87% and a false-positive rate of 6.7%.ConclusionBy using only three ultrasound markers (combination of nuchal fold thickening, pyelectasis, and short humerus) the false-positive rate is decreased from 13.4% to 6.7% without any compromise in the sensitivity (87%). The clinical usefulness of evaluating the various secondtrimester ultrasound markers needs to be evaluated in prospective studies.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether karyotype is indicated when fetal heart echogenic foci are encountered on prenatal sonogram.MehtodsPregnant women who presented at two large district hospitals in Israel that treat 7200 gravidas per year, and in whom fetal heart echogenic foci were diagnosed, were studied prospectively. Identified cases had detailed prenatal and postnatal echocardiographic examinations, and pregnancy outcome was assessed.ResultsDuring 18 months, 2214 low-risk pregnant women were examined sonographically, and 163 (7.4%) cases of fetal heart echogenic foci were detected at the first transvaginal sonography at 13-16 week's gestation. On a repeat scan at 20-22 weeks' gestation, 59.5% of the foci could not be identified, leaving only 66 (3%) cases for postnatal evaluation. Left ventricle-right ventricle ratio for location of the fetal heart echogenic foci was 3:1; 4.9% of all cases had bilateral findings. The karyotypes of 16 fetuses were normal and no additional abnormalities were found. The remaining 50 cases were normal in appearance at delivery without any features that suggested trisomy 21. A review of the English language literature revealed that six of 489 cases with fetal heart echogenic foci (1.2%) had trisomy 21. However, statistical analysis of a hypothetical sample that produced these six cases revealed that the calculated risk of trisomy 21 in a fetus with fetal heart echogenic foci is about 0.002%.ConclusionKaryotyping is unwarranted in the midtrimester fetus with incidental findings of fetal heart echogenic foci.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the advantage of applying uterine fundal pressure to assist transvaginal sonographic imaging of early second-trimester fetal anatomy.MethodsOne hundred consecutive patients with singleton fetuses underwent routine transvaginal sonographic assessment of fetal anatomy between 13 and 17 weeks' gestation. If the entire fetal anatomy including cardiac outflow tracts was not depicted, uterine fundal pressure was applied with the operator's nonscanning hand in a bimanual fashion, to faciliate transvaginal imaging. Transabdominal fashion, to facilitate transvaginal sonography. Observed fetal structures with and without fundal pressure were compare. Factors assessed that may have modified the value of fundal pressure included patient weight, gestational age, fetal presentation, previous abdominal surergy, and the presence of uterine fibroids. Statistical analysis included McNemar test, χ2, Fisher exact test, andttest, withP< .05 considered significant.ResultsVisualization of lower limbs, head (including intracranial structures), upper limbs, kidneys, spine, gender, feet, hands (digits), face, four-chamber view, and cardiac outflow tracts was significantly enhanced by uterine fundal pressure-assisted versus nonassisted transvaginal sonography. Uterine fundal pressure improved transvaginal sonographic imaging in 91% of subjects, and in 51% of all subjects, a complete examination was thus obtained. In 20% of all subjects, transabdominal sonography was required to complete the examination. Complete fetal anatomic scaning was unobtainable despite uterine fundal pressure suplemented by transabdominal sonography in 29% of cases. Completion of the transvaginal sonography in 29% of cases. Completion of the transvaginal sonographic fetal anatomic survey with uterine fundal pressure was related to gestational age (P< .02) and maternal weight (P< .05) yet not related to fetal presentation (P= .13), previous abdominal surgery (P= .06), or uterine fibroids (P= .26).ConclusionUterine fundal pressure applied during early second-trimester transvaginal sonographic evaluation of fetal anatomy significantly improves visualization of fetal structures otherwise loacted beyond the effective range of the transvaginal transducer.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify the source of umbilical venous velocity pulsations, times of transmission from the atrial contraction pressure waveform to velocity waves in the inferior vena cava, ductus venosus, intra-abdominal umbilical vein, and intra-amniotic umbilical vein were examined.MethodsFive lamb fetuses at 125-135 days's gestation were instrumented with solid satte pressure transducers in the inferior vena cava, fluid-filled catheters in the inferior vena cava and descending aorta, ad epicardial pacemakers. Three to 5 days postoperatively, inferior vena cava, ductus venosus, and umbilical vein velocities were examined with Doppler ultrasoound. Normal saline was administered until umbilical vein velocity pulsations developed (180 ± 60 mL). In three fetuses, premature atrial contractions were induced under baseline conditions and after umbilical vein velocity pulsations developed.ResultsTimes of transmission from the atrial contraction pressure waveform until velocity decreases in the fetal venous system were significantly different in the inferior vena cava, ductus venosus, intra-abdominal umbilical vein, and intra-amniotic umbilical vein (P< .001). Times increased with the distnance from the atrium. Inferior vena cava pressure increased with fluid administration from 3.7 ± 4.7 mmHg to 9.3 ± 2.3 mmHg (P< .01). Time from increased pressure waveforms with induced premature atrial contractions to the nadir of subsequent umbilical vein velocity waves decreased from 0.123 ± 0.047 seconds before saline administration to 0.072 ± 0.039 seconds after saline administration (P< .001).ConclusionTransmission time of atrial pressure into the venous circulation increases with distance from the atrum and decreases with volume loading. Umbilical venous velocity pulsations derive from atrial pressure changes transmitted in a retrograde fashion.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investgate the hemodynamic changes occurring in normal pregnanacy and to see if these changes were associated with an increase in myocardial contractility.MethodsIn a longitudinal study, primigravidas were studied with echocardiography in early (15 ± 1.8 weeks), mid (26 ± 1.2 weeks), and late (36 ± 1.0 week) gestation, as well as at 6 weeks postpartum. Carkiac dimensions were measured with two-dimensional and M-mode echocardiography and hemodynamic indices were calculated. All measurements were made with subjects in the left lateral decubitus position. Statistical analysis was performed with repeated measures analysis of variance.ResultsSeventy-six women with normal pregnancy outcomes completed all four studies. From the baseline study to late gestation, an increase in cardiac output of 27% (from [mean ± standard error] 4.2 ± 0.1 to 5.8 ± 0.2 L/min,P= .001). and a decrease in total peripheral resistance of 33% (from 1356 ± 69 to 941 ± 37 dynes/second cm−5,P= .001) occurred. Over this same time period, left ventricular function, while demonstrating a small and non-significant increase in velocity of circumferential fiber shortening (from 1.25 ± 0.02 to 1.27 ± 0.02 cm/second), revealed a 12% decrease in wall stress (from 36.3 ± 1.0 to 31.9 ± 1.0 g/cm2,P= .001) and a 13% decrease in the load-independent wall stress to velocity of circumferential fiber shortening ratio (from 30.0 ± 1.2 to 26.1 ± 1.0,P= .01), impluing enhanced intrinsic myocarial contractility.ConclusionNormal pregnancy is characterized by enhanced myocarial performance.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo describe the occurrence, treatment, and outcome of maternal oxygen desaturation during magnesium sulfate therapy.MethodsA post hoc analysis of a randomized doubleblind trial, designed to determine if mothers at risk for premature delivery treated with phenobarbital and vitamin K had less frequent intracranial hemorrhage in their newborns, was done. A subset of these patients at imminent risk for delivery received both intravenous magnesium sulfate and intravenous study drug (phenobarhital or placebo) and was nonitored with maternal oxygen saturation monitoring.ResultsOne hundred one women (29%) in the trial had pulse oximetry; 47 were assigned to placebo and 54 to the treatment group. The placebo and treatment groups had the following similarities: mean lowest oxygen saturation by pulse eximeter (93.4% ± 3.0 compared with 93.1% ± 3.3), mean highest magnesium levels (6.3 mEq/L ± 1.5 compared with 6.2 mEq/L ± 0.9), frequencies of desaturation events defined as oxygen saturation below 90% (11% compared with 11%), gestational age at delivery, birth weight, Apgar scores, and cord arterial pH. Using regression analysis, multiple gestation was the only one of 14 independent variables associated with low maternal oxygen saturation. Preeclampsia was not associated with a greater risk of desaturation. The satistical powere of this study is limited by its small sample sizes.ConclusionMaternal oxygen desaturation occurs commonly with intravenous magnesium therapy, does not occur more frequently with simultaneous administration of intravenous phenobarbital, and does not cause decompensation in maternal or fetal status. Multiple gestation may be associated with lower maternal oxygen saturation.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess changes in lymphocyte substes during pregnancy and 1 year postpartum in human immunodeficiency virus (HIV)-infected women.MehtodsChanges in CD4+and CD8+cell counts, CD4 and CD8 percents, CD4/CD8 ratio, and total lymphocyte count and percent were assessed in each of 226 HIV-infected women followed during pregnancy and 1 year postpartum, and for each of 100 nonpregnant HIV-infected woman during 1 year. Trends over time were compared between pregnant women with and without several covariates. Postpartum changes over a 1-year period were compared to a 1-year period in the nonpregnant cohort.ResultsThere was a mena increase of 2.76 per week in the CD4+cell count during pregnancy (P= .04). No other characteristics changed significantly during pregnancy. The mean CD4+and CD8+cell counts, the CD8 percent, and the total lymphocyte count and percent increased immediately postdelivery. During the first postpartum year, there were statistically significant declines in the absolute CD4+and CD8+cell counts, the relative CD4 and CD8 percentages, and the total lymphocyte count and percentage. The rate of change for CD4+and CD8+counts, but not for CD4 percent, was less during 1 year in the nonpregnant cohort than in the first postpartum year, and the CD8 percent increased in the nonpregnant women. a wide variability in trends of all measurements during pregnancy was seen.ConclusionDuring pregnancy, CD4 and CD8 percentages remain stable. There are no clinically significant changes during pregnancy or postpartum in any lymphocyte parameter we assessed. Postpartum changes in lymphocytes and lymphocyte subsets most likely represent a return to base-line from the physiologic changes of pregnancy and the immediate postpartum period.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evluate the relationship between anibodies against β2-glycoprotein I or prothrombin and pregnancy losses in women with antiphospholipid antibodies.MethodsWomen with antiphospholipid antibodies, (lupus anticoagulant and/or anticardiolipin antibodies), with (n= 41) and without (n= 61) a history of pregnancy loss were evaluated. Thirty-one out of the frty-one patients with pregnancy loss had early miscarriages (at less than 13 weeks) and ten patients had late iscarriages. Immunoglobulin (Ig)-G and IgM anti-β2-glycoprotein I and anti-linked immunosorbent assay method.ResultsA significant association between pregnancy loss and positive IgM anti-β2-glycoprotein I antibodies was found (odds ratio 2.6; 95% confidence interval 1.03, 6.6;P= .043). Women with late pregnancy loss had higher levels of both IgG and IgM anti-β2-glycoprotein I antibodies compared with controls (P< .05). There was a good correlation between anticardiolipin and anti-β2-glycoprotein I antibodies levels (IgG: r = 0.75; IgM: r = 0.73). In contrast, there was no correlation between the levels of anticardiolipin or anti-β2-glycoprotein I antibodies and the levels of anti-prothrombin antibodies. furthermore, the presence of antiprothrombin antibodies was not associated with a history of pregnancy loss.ConclusionThe result of our study shows that there is a relationship between the presence of IgM anti-β2-glycoprotein I and previous miscarriages in women with antiphospholipid antibodies.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the usefulness of a breakfast test in determining which women with gestational diabetes do not need self-monitoring of blood glucose levels (home monitoring).Methodsa 1-hour post-standardized breakfast blood glucose below 7.8 mmol/L (140 mg/dL) was measured in 227 women and at or above 7.8 mmol/L in 115. Within each group, women were randomized to home monitoring with a meter or to clinic follow-up. Target glucose values were 5.3 mmol/L (95 mg/dL) fasting, 5.6 mmol/L (101 mg/dL) before meals, and 7.8 mmol/L (140 mg/dL) 1 hour postprandial. Up to these thresholds women on clinic follow-up were transferred to home monitoring. Insulin therapy was started on the same thresholds in women randomized or transferred to home monitoring. Large ofr gestational age (LGA) newborns represented the main outcome, with the transfer rate to home monitoring and need of insulin therapy the secondary ones.ResultsThe LGA delivery rate was not significantly different in the two follow-up groups in women with a breakfast result below 7.8 mmol/L (9.8 versus 4.3%) but was higher in the clinic follow-up among women with a breakfast result at or above 7.8 mmol/L (13.3% versus 30.9%;P< .05). Fewer women with a breakfast result below 7.8 mmol/L were transferred to home monitoring (2.6 versus 52.7%;P< .001) or started on insulin therapy (3.6 versus 25.2%;P< .001). The breakfast test cutoff of 7.8 mmol/L predicted insulin need with a sensitivity of 91.0% and a specificity of 72.0%.ConclusionA breakfast test is useful in identifying a low-risk population in which clinic follow-up may be used safely.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the association between the use of hormone replacement therapy (HRT) and coronary calcium, in psotmenopausal women who had no history of coronary artery disease by double helical computed tomography (CT).MethodsWe used CT to compare the prevalence and extent of coronary clacium in 41 postmenopausal women who were on HRT from the first year of menopause and 37 age-matched controls who had never used HRT.ResultsBoth groups had a similar rate of smoking, hypertension, a positive family history, and hypercholesterolemia. Coronary calcification was observed in 28.2% of the 78 women studied. The prevalence of coronary calcium was significantly lower among HRT users; six of the 41 (14.6%), compared with 16 of the 37 nonusers (43.2%) (P< .01). The recorded risk factors had no effect on the prevalence of coronary calcium. Stepwise logistic regression analysis, including age, coronary risk factors, and HRT use as independent variables, yielded HRT as the only variable determining the presence of coronary calcium (odds ratio = 0.2;95% confidence interval 0.06, 0.63;P= .006).ConclusionThe lower incidence of coronary calcium in the HRT users suggests that HRT is associated with decreased prevalence of the coronary aclcification.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID