摘要:

ObjectiveTo evaluate the etiology and outcome of fetal hydrops of nonimmune origin diagnosed in utero during the first half of pregnancy.MethodsWe reviewed 45 cases of nonimmune fetal hydrops presenting between 11 and 17 weeks' gestation over a 4-year period.ResultsThe median gestational age at diagnosis of fetal hydrops was 14 weeks. Placental edema was most commonly associated with generalized skin edema. Ascites was also observed in four cases, but no case presented with pleural or pericardial effusion. The fetal karyotype was abnormal in 35 cases (77.8%). Of the ten fetuses with a normal karyotype, four were classified as idiopathic, three had isolated atrio-ventricular septal defect, two were associated with maternal infection, and one had multiple pterygium. Fetal heart rate anomalies were found in both chromosomally normal and abnormal fetuses. All but one of the karyotypically abnormal pregnancies and five of ten euploid pregnancies were terminated. In all six pregnancies that continued, resolution occurred before mid-gestation. Three continuing euploid pregnancies resulted in fetal death, and only two had a normal outcome.ConclusionNonimmune fetal hydrops diagnosed before 18 weeks' gestation is associated with a higher incidence of aneuploidy than hydrops diagnosed during the second half of pregnancy. In most affected fetuses with a normal karyotype, spontaneous resolution occurred before 24 weeks' gestation, although the outcome was generally unfavorable.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the usefulness of ultrasound-derived measurements of intracardiac filling pressures and cardiac performance in the noninvasive management of obstetric patients with an indication for hemodynamic monitoring.MethodsWe included patients with oliguria unresponsive to to crystalloid boluses, with hypertension unresponsive to hydralazine, and at at high risk for pulmonary edema who were determined to be candidates for invasive monitoring. They were first studied with two-dimensional echocardiography and Doppler ultrasound using a technique previously validated at our institution. Cardiac dimensions, filling pressures, and function were assessed at the bedside. Subsequently, management decisions were made based on these findings.ResultsFourteen patients were studied. Two received a pulmonary artery catheter after noninvasive evaluation indicated a need for continuous monitoring. The 12 patients managed without the need for a pulmonary artery catheter included women with intractable hypertension (one patient), pulmonary edema (two patients), complex cardiac lesions (two patients), oliguria (five patients), intractable hypertension and oliguria (one patient), and unexplained dyspnea with peripheral arterial oxygen desaturation (one patient). Although some patients received as much as 8 L of crystalloid, none developed pulmonary edema or left ventricular failure. In all 12 cases, the ultrasound monitoring allowed successful noninvasive management of the patient.ConclusionThis pilot study suggests that two-dimensional echocardiography and Doppler examination may be an effective alternative to invasive monitoring in the management of selected pregnant patients.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the accuracy of three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight with that of other commonly used formulas composed of biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) by two-dimensional ultrasound.MethodsWe assessed the thigh volume of 100 fetuses using three-dimensional ultrasound. Meanwhile, their BPD, AC, and FL were measured by two-dimensional ultrasound. All infants were delivered within 48 hours after the ultrasound examinations. From polynomial regression analysis, we generated a best-fit formula for the thigh volume to predict birth weight. The accuracy of this thigh-volume formula was compared with those of three formulas commonly used in the United States. In addition, another group of 50 fetuses was measured for prospective validation.ResultsThe thigh volume assessed by three-dimensional ultrasound was highly correlated with birth weight (r= 0.89,n= 100,P< .0001). The best-fit formula for thigh volume to predict birth weight was linear, and it was superior to the other commonly used two-dimensional formulas in predicting birth weight. The predicting error (0 g), percent error (0.7%), absolute error (176.1 g), and absolute percent error (5.8%) of the thigh-volume formula were all smaller than those of the other formulas (n= 100, allP< .05). In addition, the thigh-volume formula predicted birth weight more accurately than the other two-dimensional formulas in the prospective-validation group. The three-dimensional formula had smaller mean values of predicting error (38.6 g), percent error (1.5%), absolute error (160.0 g), and absolute percent error (5.1%) than the two-dimensional formulas (n= 50, allP≤ .001), as well as the smallest variances of the above errors (178.1 g, 5.6%, 84.3 g, and 2.9%, respectively).ConclusionThe three-dimensional ultrasound-assessed thigh volume has better accuracy in predicting birth weight than the commonly used formulas by two-dimensional ultrasound, and it may improve fetal weight prediction in clinical practice. However, a large-scale prospective validation study may be needed to confirm our conclusions.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine whether maternal meal ingestion affects the fetal circulation in uncomplicated pregnancies.MethodsA simple crossover blinded study was designed for late uncomplicated singleton pregnancies. After overnight fasting, two different maternal meal states were tested. In one state, pregnant women had a standard 600-kcal breakfast at 8 AM (phase A). The other state consisted of maintaining fasting (phase B). Both states were assigned to each woman within 3 days in randomized order. Fetal Doppler studies of the umbilical, middle cerebral, and renal arteries and the descending aorta were performed at 7 AM (the fasting state) and at 10 AM (the fed state or the continuous fasting state).ResultsTwenty women underwent the crossover study. Regardless of the maternal meal state, no significant change was observed in the pulsatility index (PI) of either the umbilical artery (n= 20), the middle cerebral artery (n= 19), or the descending aorta (n= 15). However, the PI of the fetal renal artery decreased significantly after maternal meal ingestion (n= 14) (phase A, 2.36 ± 0.16 versus 2.09 ± 0.33;P= .021). There was no such change in the PI after prolonged fasting (phase B, 2.44 ± 0.32 versus 2.39 ± 0.44;P= .75).ConclusionFetal renal artery resistance decreased after maternal meal ingestion in normally grown fetuses during late pregnancy. This decrease in the resistance may be associated with increased fetal urine production after maternal meals.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate the incidence of fetal laceration injury in cesarean delivery.MethodsA retrospective review was conducted using a computer-based data coding system. All neonatal records were reviewed for infants delivered by cesarean during a 2-year period. Maternal records were reviewed in those cases of documented fetal laceration injury. The Fisher exact test was used when indicated.ResultsThere were 904 cesarean deliveries performed during the study period; of these, 896 neonatal records (98.4%) were available for review. Seventeen laceration injuries were recorded (1.9%). The incidence of laceration appeared higher when the indication for cesarean was nonvertex (6.0% versus 1.4%,P= .02). One of 17 (5.9%) maternal records indicated the presence of the laceration of the fetus.ConclusionFetal laceration injury at cesarean delivery is not rare, especially when it is performed for nonvertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo estimate the pediatric costs associated with the Centers for Disease Control and Prevention (CDC) guidelines for the management of infants born to mothers receiving intrapartum antimicrobial prophylaxis for prevention of early-onset group B streptococcal disease.MethodsFor an annual United States birth cohort of 3.95 million infants, we estimated the cost of pediatric care provided to full-term asymptomatic infants when pediatricians followed the CDC algorithm for the management of infants exposed to intrapartum antimicrobial prophylaxis under culture-based and risk factor-based maternal care approaches. We calculated the relative contribution of pediatric costs to the total costs of preventing a case of earlyonset group B streptococcal sepsis.ResultsTotal pediatric costs were $41 million for a culture-based approach and $33 million for a risk factor-based approach. Hospital and physician costs accounted for more than 78% of this total. The majority (over 95%) of the pediatric costs were associated with vaginal deliveries. Incorporating pediatric costs into previous cost-effectiveness analyses increased the cost per sepsis case averted by as much as 51% for culture-based strategies and by as much as 112% for risk factor-based strategies. Pediatric costs varied with the average length of stay for full-term infants and with the average cost of a hospital day.ConclusionSubstantial pediatric costs are associated with the implementation of an obstetric strategy for minimizing the risk of early-onset group B streptococcal disease. Such costs should be included in future cost-effectiveness analyses of different strategies for minimizing the risk of group B streptococcal disease in newborns.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo establish whether first-trimester obstetric ultrasonography interpreted by a live video telemedicine link is comparable to an established videotape review network in a low-risk patient population.MethodsAn integrated services digital network was established from three satellite offices to our central prenatal diagnostic center. All patients had a sonographic evaluation of the uterus, adnexa, and gestational sac recorded onto videotape by a trained sonographer. A live, interactive video telemedicine link was established, and a perinatologist directed the sonographer through the scan. Subsequently, a different perinatologist, blinded to the telemedicine interpretation, reviewed the original videotaped examination. The reports generated from both modalities then were compared by means of a score of 12 sonographic characteristics.ResultsThe first 100 patients were included. The mean gestational age (± standard deviation) was 8.9 ± 2.3 weeks (range 5.7–14.4), and the mean duration for telemedicine scans was 7.8 ± 2.9 minutes (range 3.8–20.1). Telemedicine and videotape review scores were the same in 95 cases, and the final diagnosis was identical in 98 cases. This study had 80% power to detect a 10% difference in diagnosis at a significance level of .05. The ability to detect abnormalities was equivalent using both systems.ConclusionThe interpretation of first-trimester obstetric ultrasonography using live video telemedicine is equivalent to a system of videotape review. Obstetric telemedicine may prove to be a useful tool for providing sonographic imaging for low-risk obstetric patients.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare, in singleton and twin pregnancies, the effectiveness of transvaginal ultrasound versus digital examination in predicting preterm delivery in women with suspected preterm labor.MethodsTransvaginal ultrasound and pelvic examinations were performed on patients admitted with suspected preterm labor between 23 and 33 weeks' gestation. Ultrasound assessment of cervical length and the presence of funneling with fundal pressure were recorded for each patient, and the results were compared with dilatation and effacement as assessed by digital examination for the prediction of preterm delivery in the two groups (singletons and twins).ResultsOne hundred sixty-two subjects were recruited (136 singletons and 26 twin pregnancies), with no significant demographic differences between the groups. Overall, 33% of the participants delivered preterm (27% of singletons, 62% of twins). Using receiver operating characteristic curves, the best cutoff points were 30 mm for endocervical length at ultrasound, 50% for effacement, and 1.5 cm for dilatation. Of these, the best predictor was endocervical length, which was a better predictor in singleton than in twin pregnancies. Of the potential predictors, including endocervical length, funneling, dilatation, and effacement, only endocervical length was an independent predictor of preterm delivery at less than 34 weeks' gestation for both singletons and twins by multiple logistic regression. When analyzed for delivery at less than 37 weeks' gestation, this relation held true for singletons but not twins. Endocervical length less than 30 mm had a sensitivity of 81% and 75%, specificity of 65% and 30%, positive predictive value of 46% and 63%, and negative predictive value of 90% and 43% for singleton and twin pregnancies, respectively, in predicting spontaneous birth at less than 37 weeks' gestation.ConclusionBetween 23 and 33 weeks' gestation, transvaginal ultrasound assessment of endocervical length is superior to funneling and digital examination in predicting preterm delivery in patients who present with suspected preterm labor, and is a better predictor in singletons than in twins.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the effects of autoantibodies on the course of pregnancy and fetal growth.MethodsOne thousand one hundred seventy-nine healthy women with singleton gestations were screened in early pregnancy for seven kinds of autoantibodies: antithyroid microsomal antibody, antithyroglobulin antibody, two kinds of rheumatoid factor, antinuclear antibody, anti-DNA antibody, and antimitochondrial antibody.ResultsIn 228 cases (19.3%), at least one autoantibody was found; however, overlap of autoantibodies in the same individual was unexpectedly rare, and only two cases were positive for as many as four autoantibodies. A significantly higher rate of spontaneous abortion was observed in antibody-positive subjects, especially those with antithyroid microsomal (10.4%) or antinuclear antibodies (16.0%), compared with all antibody-negative subjects (5.5%). There were no significant differences in any outcome assessed among subjects positive for antithyroglobulin antibody, anti-DNA antibody, or antimitochondrial antibody compared with all antibody-negative subjects. None of the seven autoantibodies affected the rates of preterm delivery, stillbirth, pregnancy-induced hypertension, malformation, or gender ratio.ConclusionAntithyroid microsomal antibody and antinuclear antibody are the only autoantibodies that increase the abortion rate.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the ability of second-trimester maternal serum free β-hCG to detect fetal Down syndrome and to compare free β-hCG to intact hCG in the multiple-marker screening test for Down syndrome.MethodsFrom our bank of stored maternal sera, we selected 40–50 samples from euploid pregnancies at each week of gestation from 14 to 20 weeks and 31 samples from Down syndrome pregnancies. Free β-hCG was measured by enzyme-linked immunosorbent assay, and week-specific multiples of the median (MoM) were derived. The free β-hCG Down syndrome detection and false-positive rates were determined. Free β-hCG was then substituted for intact hCG in the multiple-marker screening test, and the Down syndrome detection and false-positive rates at various risk cutoffs were compared.ResultsThe mean (± standard deviation) maternal age of all study samples was 35.6 ± 5.3 years. The mean Down syndrome free β-hCG MoM was significantly higher than the mean euploid MoM (2.4 ± 1.1 versus 1.2 ± 1.0;P< .001). A free β-hCG level of at least 1.7 MoM identified 68% of Down syndrome pregnancies at a false-positive rate of 20%. When intact hCG was replaced with free β-hCG in the multiple-marker screening test, a higher Down syndrome detection rate was achieved at a lower false-positive rate at each of several screen positive risk cutoffs.ConclusionElevated free β-hCG levels identify Down syndrome pregnancies. Replacing intact hCG with free β-hCG in the multiple-marker screening test results in a higher Down syndrome detection rate at a lower falsepositive rate.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID