168 research outputs found
Ultrasound is safe. . . right?: Resident and maternal-fetal medicine fellow knowledge regarding obstetric ultrasound safety
Strategies for Prevention of Varicella Pneumonia: A Cost-Effectiveness Analysis
Objective: The objective of this study was to compare the cost-effectiveness of 3 strategies of serologic
enzyme-linked immunosorbent assay (ELISA) testing and post-exposure varicella zoster immune globulin
(VZIG) prophylaxis for the prevention of maternal varicella pneumonia during pregnancy in patients with
negative or uncertain histories of varicella infection
Three-dimensional power Doppler evaluation of cerebral vascular blood flow: A novel tool in the assessment of fetal growth restriction
Randomized Trial of Erythromycin and Azithromycin for Treatment of Chlamydial Infection in Pregnancy
Objective: The purpose of this study was to compare erythromycin and azithromycin in the treatment
of chlamydial cervicitis during pregnancy with regard to efficacy, side effects, and compliance
Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes
ObjectiveâTo investigate the association between the intraoperative diagnosis of placenta accreta at the time of cesarean hysterectomy and pathological diagnosis.
Study DesignâThis is a retrospective cohort study of all patients undergoing cesarean hysterectomy for suspected placenta accreta from 2000 to 2016 at Barnes-Jewish Hospital. The primary outcome was the presence of invasive placentation on the pathology report. We estimated predictive characteristics of clinical diagnosis of placenta accreta using pathological diagnosis as the correct diagnosis.
ResultsâThere were 50 cesarean hysterectomies performed for suspected abnormal placentation from 2000 to 2016. Of these, 34 (68%) had a diagnosis of accreta preoperatively and 16 (32%) were diagnosed intraoperatively at the time of cesarean delivery. Two patients had no pathological evidence of invasion, corresponding to a false-positive rate of 4% (95% confidence interval [CI]: 0.5%, 13.8%) and a positive predictive value of 96% (95% CI: 86.3%, 99.5%). There were no differences in complications among patients diagnosed intraoperatively compared with those diagnosed preoperatively.
ConclusionâMost patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. However, since the diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively
Isolated short femur length on second-trimester sonography: A marker for fetal growth restriction and other adverse perinatal outcomes
Evaluating the optimal definition of abnormal first-trimester uterine artery Doppler parameters to predict adverse pregnancy outcomes
Strategies for Prevention of Varicella Pneumonia: A Cost-Effectiveness Analysis
ABSTRACT Objective: The objective of this study was to compare the cost-effectiveness of 3 strategies of serologic enzyme-linked immunosorbent assay (ELISA) testing and post-exposure varicella zoster immune globulin (VZIG) prophylaxis for the prevention of maternal varicella pneumonia during pregnancy in patients with negative or uncertain histories of varicella infection. Methods: A decision tree was constructed to compare the following strategies: 1) routine serologic testing for varicella immunity followed by targeted post-exposure VZIG prophylaxis, 2) post-exposure serologic testing followed by targeted VZIG prophylaxis, and 3) untargeted post-exposure VZIG administration. The probabilities for the model were obtained from the medical literature and supplemented by expert opinion. The costs were obtained by a review of inpatient hospitalizations for varicella pneumonia. All costs were converted to 1995 dollars. Results: Routine serologic testing followed by targeted post-exposure VZIG prophylaxis was the most costly strategy ($37.22/person), with no demonstrable increase in benefit compared with the other 2 strategies. The disutility of this strategy compared with the others was stable across a wide range of values for the probabilities and costs utilized in the sensitivity analysis. We were unable to differentiate between the cost-effectiveness of the other 2 strategies. Conclusions: Routine serologic testing for varicella immunity in patients with negative or uncertain histories of varicella infection should not be performed. The remaining options of screening and prophylaxis appear to be reasonable alternatives for dealing with varicella exposures. (C
Advanced Maternal Age and the Risk of Major Congenital Anomalies
ObjectiveâThis study aims to determine if advanced maternal age (AMA) is a risk factor for major congenital anomalies, in the absence of aneuploidy.
Study DesignâRetrospective cohort study of all patients with a singleton gestation presenting for second trimester anatomic survey over a 19-year study period. Aneuploid fetuses were excluded. Study groups were defined by maternal ageââ€â34 andââ„â35 years. The primary outcome was the presence of one or more major anomalies diagnosed at the second trimester ultrasound. Univariable and multivariable logistic regression analyses were used to estimate the risk of major anomalies in AMA patients.
ResultsâOf 76,156 euploid fetuses, 2.4% (nâ=â1,804) were diagnosed with a major anomaly. There was a significant decrease in the incidence of major fetal anomalies with increasing maternal age until the threshold of age 35 (pâ<â0.001). Being AMA was significantly associated with an overall decreased risk for major fetal anomalies (adjusted odds ratio: 0.59, 95% confidence interval: 0.52â0.66). The subgroup analysis demonstrated similar results for womenââ„â40 years of age.
ConclusionâAMA is associated with an overall decreased risk for major anomalies. These findings may suggest that the âall or nothingâ phenomenon plays a more robust role in embryonic development with advancing oocyte age, with anatomically normal fetuses being more likely to survive
Efficiency of first-trimester uterine artery Doppler, A-disintegrin and metalloprotease 12, pregnancy-associated plasma protein A, and maternal characteristics in the prediction of preeclampsia
OBJECTIVE: To estimate the efficiency of first-trimester uterine artery Doppler, A-disintegrin and metalloprotease 12 (ADAM12), pregnancy-associated plasma protein A (PAPP-A) and maternal characteristics in the prediction of pre-eclampsia. METHODS: This is a prospective cohort study of patients presenting for first-trimester aneuploidy screening between 11-14 weeksâ gestation. Maternal serum ADAM12 and PAPP-A levels were measured by immunoassay, and mean uterine artery Doppler pulsatility indices (PI) were calculated. Outcomes of interest included pre-eclampsia, early pre-eclampsia, defined as requiring delivery at <34 weeksâ gestation, and gestational hypertension. Logistic regression analysis was used to model the prediction of pre-eclampsia using ADAM12 multiples of the median (MoM), PAPP-A MoM, and uterine artery Doppler PI MoM, either individually or in combination. Sensitivity, specificity, and area under the receiver-operating characteristic curves (AUC) were used to compare the screening efficiency of the models using non-parametric U-statistics. RESULTS: Of 578 patients with complete outcome data, there were 54 (9.3%) cases of preeclampsia and 13 (2.2%) cases of early pre-eclampsia. Median ADAM12 levels were significantly lower in patients who developed pre-eclampsia compared to those who did not. (0.81 v. 1.01 MoMs; p<0.04) For a fixed false positive rate (FPR) of 10%, ADAM12, PAPP-A, and uterine artery Doppler in combination with maternal characteristics identified 50%, 48%, and 52% of patients who developed pre-eclampsia, respectively. Combining these first-trimester parameters did not improve the predictive efficiency of the models. CONCLUSION: First-trimester ADAM12, PAPP-A, and uterine artery Doppler are not sufficiently predictive of pre-eclampsia. Combinations of these parameters do not further improve their screening efficiency
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