ABSTRACT: To develop and evaluate a method of estimating patient-specific risk for fetal loss by combining maternal characteristics with serum markers.
Data were obtained on 36,014 women from the FaSTER trial. Separate likelihood ratios were estimated for significant maternal characteristics and serum markers. Patient-specific risk was calculated by multiplying the incidence of fetal loss by the likelihood ratios for each maternal characteristic and for different serum marker combinations.
Three hundred eighteen women had fetal loss < 24 weeks (early) and 103 > 24 weeks (late). Clinical characteristics evaluated included maternal age, body mass index, race, parity, threatened abortion, previous preterm delivery, and previous early loss. Serum markers studied as possible predictors of early loss included first-trimester pregnancy-associated plasma protein A and second-trimester alpha-fetoprotein, and unconjugated estriol. A risk assessment for early loss based on all of these factors yielded a 46% detection rate, for a fixed 10% false-positive rate, 39% for 5% and 28% for 1%. The only significant marker for late loss was inhibin A. The detection rate was 27% for a fixed 10% false-positive rate and only increased slightly when clinical characteristics were added to the model.
Patient-specific risk assessment for early fetal loss using serum markers, with or without maternal characteristics, has a moderately high detection. Patient-specific risk assessment for late fetal loss has low detection rates.
American journal of obstetrics and gynecology 09/2008; 199(3):290.e1-6. · 3.28 Impact Factor
ABSTRACT: Arteriovenous malformations (AVMs) of the uterus have various clinical presentations. With the advancement of and accessibility to imaging, the diagnosis of the lesions in association with less severe clinical presentations is becoming more common. Contrary to cases with severe hemorrhage, the management of these cases is not clear. The purpose of this study was to describe our experience with diagnosis, management and long-term follow-up of cases with different clinical presentations of uterine AVMs.
The clinical and sonographic presentations of 8 cases diagnosed between July 2000 and July 2003 in our medical center are described. Annual sonographic follow-up was performed for a period of at least 42 months.
Only 3 of the 8 cases presented with heavy vaginal bleeding and 2 of them required selective embolization. Two patients had hysterectomy during the study period which was not related to a severe bleeding event. Long-term follow-up for all other cases was significant for sonographic resolution of the uterine AVM.
Management of uterine AVMs should be influenced by the clinical and not by the sonographic findings. If clinically feasible, conservative management should be considered as the primary approach, since most of these lesions tend to spontaneously resolve.
Gynecologic and Obstetric Investigation 07/2008; 66(3):157-61. · 1.28 Impact Factor
ABSTRACT: To evaluate central nervous system abnormalities in a group of otherwise healthy pregnant women with hyperemesis gravidarum (HG) during the first trimester.
In a case-control study, 17 pregnant women with HG during the first trimester (study group) were compared with 18 pregnant women without nausea and vomiting in pregnancy (NVP). The latter group included women who were planning first-trimester termination of pregnancy for reasons other than health (control group). All the pregnant women enrolled in the study answered a questionnaire and underwent a physical examination, blood tests, urinalysis, EEG, and visual evoked potential (VEP) and brainstem auditory evoked response (BAER) tests.
An abnormal EEG was found in 5 of the 17 women in the study group (29.4%), whereas none of the 18 women in the control group had an abnormal EEG (p = 0.013). The VEP and BAER tests were normal among the women in both groups. There were no clinically significant differences between the 2 groups with regard to maternal age, gravidity, parity, weeks of gestational age, blood count, renal function, liver function or electrolytes. Low thyroid stimulating hormone levels were found in 6 of the 17 women in the study group (35.3%) as compared to 1 of the 18 in the control group (5.5%) (p = 0.028). None of the women in either group had hyperthyroidism. HG in previous pregnancies was a significant risk factor for HG in the present pregnancy.
In pregnant women with HG during the first trimester, the frequency of abnormal EEG findings is significantly higher as compared to that in pregnant women without NVP. However, the mechanism and implications of these findings are yet to be clarified.
The Journal of reproductive medicine 09/2006; 51(8):623-7. · 0.87 Impact Factor
ABSTRACT: The purpose of this study was to evaluate the feasibility of the DNA microarray technology for the study of the differences in gene expression between placentas of pregnancies with trisomy 21 fetuses and placentas of fetuses with a normal karyotype.
Complementary DNA samples from 7 second-trimester placentas of fetuses with trisomy 21 was compared with 7 matched and 7 nonmatched complementary DNA samples from normal karyotype placentas as control samples. For gene expression comparison, a microarray that contained 8976 expressed sequence tags was used. Four experiments were performed: (1) the study samples were compared with matched control samples; (2) the study samples were compared with nonmatched control samples; (3) the study samples were compared with themselves; and (4) the matched and nonmatched control samples were compared. Gene overexpression and underexpression were defined as sample signal differences of >1.7 over each other. Gene overexpression and underexpression were confirmed by Northern blotting studies.
Seven expressed sequence tags of 8976 tags that were examined have met the selection criteria. Overexpression of 2 expressed sequence tags in placentas with trisomy 21 was confirmed by Northern blotting studies.
Our study demonstrates the feasibility of the microarray technique in the study of the differences of gene expression in trisomic placentas compared with placentas with a normal karyotype. This technique may contribute to the identification of additional maternal serum biochemical markers in aneuploid pregnancies.
American Journal of Obstetrics and Gynecology 09/2002; 187(2):457-62. · 3.47 Impact Factor