M O Ahn

Cedars-Sinai Medical Center, Los Angeles, CA, United States

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Publications (30)65.92 Total impact

  • American Journal of Obstetrics and Gynecology 12/2004; 191(6). DOI:10.1016/j.ajog.2004.10.432 · 3.97 Impact Factor
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    ABSTRACT: Objective: To update our experience with the fetal heart rate (FHR) pattern of singleton term brain-damaged infants.Methods: The FHR patterns of 123 singleton term brain-damaged infants were retrospectively analyzed and compared with 300 previously published cases.Results: For these 423 cases, obstetrical care was provided from 1976 to 1998. With the exception of more recent obstetrical care, the additional 123 cases were statistically similar to the previously published 300 cases. Overall, the admission FHR patterns were reactive: 229 (54%); nonreactive: 175 (41%); bradycardic: 10 (3%); or unclassifiable: 9 (2%). In the reactive group, the FHR did the following: 1) remained reactive: 29 (13%); 2) developed an elevated baseline in association with repetitive decelerations: 107 (47%); or 3) exhibited a sudden prolonged FHR deceleration that lasted until delivery: 93 (40%). In the nonreactive group, the FHR pattern remained nonreactive at a similar baseline rate: 125 (71%); developed a progressive bradycardia: 32 (18%); or developed a prolonged deceleration that lasted until delivery: 18 (10%).Conclusion: Our retrospective review of 123 additional cases continues to demonstrate that brain-damaged fetuses manifest distinctly similar intrapartum FHR patterns that easily can be categorized and identified on the basis of the fetal admission test and subsequent changes in the baseline rate. This distinction, which covers a 22-year period, would appear to be helpful in the management of obstetrical patients in labor.
    Obstetrics and Gynecology 01/2001; 97(4). DOI:10.1016/S0029-7844(01)01219-4 · 4.37 Impact Factor
  • American Journal of Obstetrics and Gynecology 07/2000; 182(6):1645-7. DOI:10.1067/mob.2000.106383 · 3.97 Impact Factor
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    ABSTRACT: To determine whether a term neonate who has had sufficient intrapartum asphyxia to produce persistent brain injury will manifest the following four criteria: profound acidemia (arterial pH <7.00), an APGAR score < or =3 for 5 min or longer, seizures within 24 h of birth, and multiorgan system dysfunction. Singleton, liveborn, neurologically impaired neonates > or =37 weeks gestation who lived at least 6 days and had sufficient documentation of current intrapartum asphyxia criteria were retrospectively analyzed. Of these infants, solely neonates with acute fetal asphyxia due to a sudden prolonged FHR deceleration that lasted until delivery from a catastrophic event, e.g., uterine rupture, cord prolapse, were included. Organ system dysfunction was defined by separate criteria for each organ system. Dysfunction in one or more was defined as multiorgan system dysfunction. Of the 292 eligible infants in the registry, 47 satisfied the entry criteria. In these 47 neonates, 10 (21%) satisfied all 4 criteria for intrapartum asphyxia. Our retrospective study suggests that currently used indicators to define permanent fetal brain injury are not valid.
    The Journal of Maternal-Fetal Medicine 05/1999; 8(3):101-6. DOI:10.1002/(SICI)1520-6661(199905/06)8:3<101::AID-MFM6>3.0.CO;2-L
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    ABSTRACT: The objective of this study was to determine whether neonatal platelet counts can be used in fetal brain injury. The initial platelet counts, expressed as 1000 per mm3, of singleton term infants with and without permanent asphyxial brain injury were compared. Neonates with encephalopathy were divided into 3 groups: I--nonreactive fetal heart rate (FHR) pattern from admission until delivery; II--reactive FHR pattern on admission followed by nonreactivity, tachycardia, a loss of variability and repetitive FHR decelerations; and III--acute: reactive FHR pattern followed by a sudden prolonged FHR deceleration that lasted until delivery. The neonates and platelet counts for each group were as follows: Control: 104 neonates, mean 281 +/- 56, range 154 to 411; I: 60, mean 185 +/- 80, range 28 to 365; II: 34, mean 251 +/- 66, range 100 to 375; and III: 35, mean 267 +/- 93, range 86 to 569. Platelet counts were significantly lower in neonates with encephalopathy (p <0.001). Group I differed statistically from both Groups II and III (p <0.001). These data suggest an association between the FHR pattern, fetal asphyxial brain injury, and the initial platelet count in singleton term neonates. Further investigation should be pursued to clarify the physiological processes leading to this result.
    American Journal of Perinatology 02/1999; 16(2):79-83. DOI:10.1055/s-2007-993840 · 1.60 Impact Factor
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    ABSTRACT: The onset of seizures after birth has been considered evidence of an intrapartum asphyxial event. The present study was undertaken to determine whether the timing of neonatal seizures after birth correlated with the timing of a fetal asphyxial event. Thus, singleton term infants diagnosed with hypoxic ischemic encephalopathy and permanent brain injury had a mean birth to seizure onset interval of 9.8 +/- 17.7 (range 1-90) hours. When these infants were categorized according to their fetal heart rate (FHR) patterns, the acute group (normal FHR followed by a sudden prolonged FHR deceleration that continued until delivery) tended to have earlier seizures than infants did within the tachycardia group (normal FHR followed by tachycardia, repetitive decelerations, and diminished variability) and the preadmission group (persistent nonreactive FHR pattern intrapartum). These seizure intervals were as follows: acute, 6.6 +/- 18.0 (range 1-90) hours; tachycardia, 11.1 +/- 17.1 (range 1-61) hours; and preadmission, 11.8 +/- 17.9 (range 1-79) hours (p < 0.05). But the range varied widely and no group was categorically distinct. In conclusion, the onset of neonatal seizures after birth does not, in and of itself, appear to be a reliable indicator of the timing of fetal neurologic injury.
    Clinical Pediatrics 12/1998; 37(11):673-6. DOI:10.1177/000992289803701105 · 1.26 Impact Factor
  • MO Ahn, LM Korst, JP Phelan
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    ABSTRACT: > Objective: To describe the perinatal characteristics of neurologically impaired infants with normal intrapartum fetal heart rate (FHR) patterns. Methods: In a registry of 300 neurologically impaired singleton term infants, a retrospective chart review was undertaken to analyze those patients with a normal intrapartum FHR pattern, i.e. reactive FHR pattern with a normal baseline rate throughout labor, and a subsequent finding of central nervous system impairment. Neonates with an abnormal intrapartum FHR pattern or a traumatic birth were excluded. In addition, the four criteria necessary for intrapartum asphyxia were as follows: arterial pH <7.00, Apgar score </=3 for 5 min, neonatal neurologic sequelae, such as seizures, and multiorgan system dysfunction. Infants were then categorized according to the timing of probable fetal injury. Results: Of the 300 infants in the registry, 24 (8%) neonates were identified. Six (25%) of these were considered postdates. Primary antenatal complications included early pregnancy bleeding (3 (13%)), cigarette and/or alcohol use (4 (17%)), and polyhydramnios (2 (8%)). Meconium was found in 12 patients (50%) during labor; of these, two (8%) patients had meconium aspiration syndrome and required extra corporeal membrane oxygenation (ECMO). None of the infants satisfied the four criteria for intrapartum asphyxia. Sixteen (67%) neonates were discharged with their mothers. The remaining eight neonates were admitted to the neonatal intensive care unit, and two (8%) neonatal deaths occurred due to meconium aspiration syndrome and sudden infant death syndrome. The long term neurologic outcome of the 22 survivors ranged from 3 to 14 years and included the following: developmental delay (10 (45%)), seizure disorder (7 (32%)), cerebral palsy (11 (50%)), and mental retardation (4 (17%)). None of these infants appeared to have been injured during labor. The probable timing of neurologic injury appeared to be early pregnancy (13 (54%)) or postnatally (11 (46%)). Conclusions: Infants who are later found to be neurologically impaired can have normal intrapartum FHR patterns during labor. These neurologic injuries seem to occur in early pregnancy or after birth. In the absence of fetal trauma, these findings suggest that a reactive intrapartum FHR pattern is not associated with intrapartum fetal asphyxia.
    Journal of maternal-fetal investigation: the official journal of French Society of Ultrasound in Medicine and Biology ... [et al.] 06/1998; 8(2):58-60.
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    ABSTRACT: Our objective was to describe the admission and subsequent intrapartum fetal heart rate (FHR) patterns in 21 singleton term pregnancies with an intrapartum fetal death. Through a retrospective chart review, 21 pregnancies with a term intrapartum fetal death were divided into 2 groups based on the fetal admission test (FAT): Group I-reactive (one or more FHR accelerations of 15 bpm x 15 sec in the first 30 min of monitoring); and Group II-nonreactive (NR [the absence of accelerations]). The FAT was compared with the subsequent intrapartum FHR pattern. Of the 21 deaths, the FAT was reactive in 7 fetuses (33%) or NR in 14 fetuses (67%). While the demographic features of these groups were statistically similar, Group II had higher rates of meconium (12 out of 14 (86%) vs. 2 out of 7 [29%] p = 0.017) and admission FHR decelerations (9 out of 14 (64%) vs. 1 out of 7 [14%] p = 0.06). In Group I, a sudden catastrophic event such as a uterine rupture produced a prolonged FHR deceleration in six fetuses (86%). One (14%) fetus died after a Hon pattern. In Group II, four patients had a stair steps to death pattern. Intrapartum fetal death can occur after a reactive or NR FAT. With a reactive FAT, a catastrophic event appears necessary to cause fetal death. The higher rates of meconium, FHR decelerations, and stair steps to death patterns in the NR group suggest the underlying basis for the fetal demise was related to preadmission fetal compromise.
    American Journal of Perinatology 05/1998; 15(4):273-6. DOI:10.1055/s-2007-993941 · 1.60 Impact Factor
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    ABSTRACT: To determine whether neonatal lymphocyte or nucleated red blood cell (RBC) counts can be used to date fetal neurologic injury. Singleton, term infants with hypoxic-ischemic encephalopathy, permanent neurologic impairment, and sufficient laboratory data were divided into two groups: infants with preadmission injury, manifested by a nonreactive fetal heart rate (FHR) pattern from admission until delivery; and infants with acute injury, manifested by a normal FHR pattern followed by a sudden prolonged FHR deceleration. Lymphocyte and nucleated RBC values were compared with published high normal counts for normal neonates: 8000 lymphocytes/mm3 and 2000 nucleated RBCs/mm3. The study population consisted of 101 neonates. In the first hours of life, lymphocyte counts were elevated among injured newborns, and then the counts rapidly normalized. Brain-injured neonates were 25 times more likely to have a lymphocyte count greater than 8000 than were normal neonates (54 [62%] of 87 versus 6 [7%] of 84; odds ratio 25.5; 95% confidence interval 8.8, 80.1; P < .001). The mean lymphocyte count tended to be higher in the preadmission-injury group than in the acute-injury group. In comparison, nucleated RBC values were not correlated as strongly with neonatal hours of life; nucleated RBC counts tended to be higher and persist longer among neonates with preadmission injury than among those with acute injury. Compared with normal levels, both lymphocyte and nucleated RBC counts were elevated among neonates with fetal asphyxial injury. Both counts appear to be more elevated and to remain elevated longer in newborns with preadmission injury than in infants with acute injury. However, the rapid normalization of lymphocyte counts in these injured neonates limits the clinical usefulness of these counts after the first several hours of life.
    Obstetrics and Gynecology 05/1998; 91(4):485-9. DOI:10.1016/S0029-7844(98)00039-8 · 4.37 Impact Factor
  • JP Phelan, MO Ahn
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    ABSTRACT: >Objective: To describe the fetal heart rate (FHR) patterns of 300 term brain-damaged infants.Methods: The fetal monitor strips of 300 singleton term neurologically impaired neonates were retrospectively analyzed.Results: Of the 300 infants, the admission FHR patterns were: reactive, 152 (51%); nonreactive, 135 (45%); bradycardia, 9 (3%); or unclassifiable, 4 (1%). In the reactive group, the FHR did the following: 1) remained reactive throughout labor [24 (16%)]; 2) developed an elevated baseline FHR in association with repetitive FHR decelerations and, in most instances, a loss of variability [67 (22%)]; or 3) developed a sudden prolonged FHR deceleration that lasted until delivery [61 (20%)]. Finally, the nonreactive admission group exhibited the following: 1) a persistent fixed baseline rate from admission (149 +/- 16 beats/min) [97 (72%)]; 2) a prolonged FHR deceleration that lasted until delivery [12 (9%)]; or 3) a stair steps to death pattern [26 (19%)].Conclusions: While term infants later found to be neurologically impaired do not manifest a uniform FHR pattern, these fetuses do manifest distinct FHR patterns intrapartum that can be easily categorized and identified on the basis of the fetal admission test and subsequent changes in the baseline heart rate. This distinction should prove helpful in the management of obstetrical patients in labor.
    Journal of maternal-fetal investigation: the official journal of French Society of Ultrasound in Medicine and Biology ... [et al.] 03/1998; 8(1):1-5.
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    ABSTRACT: Current understanding of the physiologic mechanisms of intrapartum fetal asphyxial brain injury has suggested a strong association with multiorgan system injury. Thus the purpose here is to describe 14 cases of severe fetal brain injury with absent multiorgan system dysfunction (MSD). The study population was drawn from a national registry for brain injured infants. MSD was defined by clinical criteria demonstrated to reflect asphyxial injury to the pulmonary, renal, cardiac, hematologic, hepatic, and gastrointestinal systems. Involvement of one other organ in addition to the brain was defined as multiorgan system dysfunction. All infants were diagnosed with hypoxic-ischemic encephalopathy (HIE) in the neonatal period and went on to have permanent central nervous system (CNS) injury and MSD criteria were not met. Of the 292 term, singleton infants with HIE and permanent neurologic injury, 57 (20%) satisfied the entry criteria; of these, 14 (36%) had no MSD. The underlying basis for the fetal brain injury were: uterine rupture, 6 (43%), prolonged FHR deceleration, 5 (36%), fetal exsanguination, 1 (7%), cord prolapse, 1 (7%), and maternal cardiopulmonary arrest, 1 (7%). The mean duration of the prolonged FHR deceleration was 32.1 +/- 9.1 (range 19-51) minutes. All infants were later diagnosed with cerebral palsy. Intrapartum fetal asphyxial brain injury may not necessarily proceed through a physiologic mechanism in which the fetal circulation is centralized and endorgans damaged. These acute injuries, associated with a prolonged FHR deceleration, may be linked to severely decreased cardiac output and hypotension that cause vulnerable portions of the brain to be injured before other organs.
    The Journal of Maternal-Fetal Medicine 01/1998; 7(1):19-22. DOI:10.1002/(SICI)1520-6661(199801/02)7:1<19::AID-MFM5>3.0.CO;2-U
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    ABSTRACT: Objective: To determine whether neonatal lymphocyte or nucleated red blood cell (RBC) counts can be used to date fetal neurologic injury.Methods: Singleton, term infants with hypoxic-ischemic encephalopathy, permanent neurologic impairment, and sufficient laboratory data were divided into two groups: infants with preadmission injury, manifested by a nonreactive fetal heart rate (FHR) pattern from admission until delivery; and infants with acute injury, manifested by a normal FHR pattern followed by a sudden prolonged FHR deceleration. Lymphocyte and nucleated RBC values were compared with published high normal counts for normal neonates: 8000 lymphocytes/mm3 and 2000 nucleated RBCs/mm3.Results: The study population consisted of 101 neonates. In the first hours of life, lymphocyte counts were elevated among injured newborns, and then the counts rapidly normalized. Brain-injured neonates were 25 times more likely to have a lymphocyte count greater than 8000 than were normal neonates (54 [62%] of 87 versus 6 [7%] of 84; odds ratio 25.5; 95% confidence interval 8.8, 80.1; P < .001). The mean lymphocyte count tended to be higher in the preadmission-injury group than in the acute-injury group. In comparison, nucleated RBC values were not correlated as strongly with neonatal hours of life; nucleated RBC counts tended to be higher and persist longer among neonates with preadmission injury than among those with acute injury.Conclusion: Compared with normal levels, both lymphocyte and nucleated RBC counts were elevated among neonates with fetal asphyxial injury. Both counts appear to be more elevated and to remain elevated longer in newborns with preadmission injury than in infants with acute injury. However, the rapid normalization of lymphocyte counts in these injured neonates limits the clinical usefulness of these counts after the first several hours of life.
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    ABSTRACT: Our goal was to update our experience with nucleated red blood cells as a marker for fetal asphyxia and to determine whether a relationship exists between the presence of nucleated red blood cells and long-term neurologic impairment. Nucleated red blood cell data from 153 singleton term neurologically impaired neonates were compared with cord blood nucleated red blood cells of 83 term nonasphyxiated newborns. Newborns with anemia, intrauterine growth restriction, and maternal diabetes were excluded. The group of neurologically impaired neonates was separated into the following subgroups: group I, persistent nonreactive fetal heart rate pattern from admission to delivery (n = 69); group II, reactive fetal heart rate on admission followed by tachycardia with decelerations and absent variability (n = 47); group III, reactive fetal heart rate on admission followed by an acute prolonged deceleration (n = 37). The first and highest nucleated red blood cell value and the time of nucleated red blood cell disappearance were assessed. The mean number of initial nucleated red blood cells was significantly higher in the group of neurologically impaired neonates (30.3 +/- 77.5, range 0 to 732 per 100 white blood cells) than in the control group (3.4 +/- 3.0, range 0 to 12 per 100 white blood cells) (p < 0.000001). When the group of neurologically impaired neonates was separated on the basis of timing of the neurologic impairment, distinct nucleated red blood cell patterns were observed. Significant differences were obtained between each of the three groups of neurologically impaired neonates and the normal group, with respect to initial nucleated red blood cells (group I, 48.6 +/- 106.9; group II, 11.4 +/- 9.8; group III, 12.6 +/- 13.4; p < or = 0.000002). Maximum nucleated red blood cell values were higher in group I (mean 51.5 +/- 108.9) than in groups II and III combined (mean 12.7 +/- 11.9) (p = 0.0005). Group I also had a longer clearance time (119 +/- 123 hours) than groups II and III combined (mean 59 +/- 64 hours) (p < 0.001). Our ongoing study indicates that nucleated red blood cells identify the presence of fetal asphyxia. When fetal asphyxia is present, distinct nucleated red blood cell patterns are observed that relate to the timing of fetal injury. In general, intrapartum injuries are associated with lower nucleated red blood cell values. Thus our data continue to support the concept that nucleated red blood cell levels may assist in determining the timing of fetal neurologic injury.
    American Journal of Obstetrics and Gynecology 11/1996; 175(4 Pt 1):843-6. DOI:10.1016/S0002-9378(96)80010-X · 3.97 Impact Factor
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    ABSTRACT: Our purpose was to determine whether a relationship exists between the presence of nucleated red blood cells, hypoxic ischemic encephalopathy, and long-term neonatal neurologic impairment. Nucleated red blood cell data from 46 singleton term neurologically impaired neonates were compared with cord blood nucleated red blood cells of 83 term nonasphyxiated newborns. The neurologically impaired neonates group was also separated as follows: nonreactive, nonreactive fetal heart rate from admission to delivery; tachycardia, reactive fetal heart rate on admission followed by tachycardia with decelerations; rupture, uterine rupture. The first and highest nucleated red blood cells value and the time to nucleated red blood cells disappearance were assessed. The neurologically impaired neonates group exhibited a significantly higher number of nucleated red blood cells per 100 white blood cells (34.5 +/- 68) than did the control group (3.4 +/- 3.0) (p < 0.00001). When the neurologically impaired neonates are separated as to the basis for the neurologic impairment, distinct nucleated red blood cell patterns were observed. Overall, the nonreactive group exhibited the highest mean nucleated red blood cell (51.4 +/- 87.5) count and the longest clearance times (236 +/- 166 hours). In this limited population, nucleated red blood cell data appear to aid in identifying the presence of fetal asphyxia. When asphyxia was present, distinct nucleated red blood cells patterns were identified that were in keeping with the observed basis for the fetal injury. In general, the closer the birth was to the asphyxial event, the lower was the number of nucleated red blood cells. Thus our data suggest that cord blood nucleated red blood cells could assist in the timing of fetal neurologic injury.
    American Journal of Obstetrics and Gynecology 11/1995; 173(5):1380-4. DOI:10.1016/0002-9378(95)90620-7 · 3.97 Impact Factor
  • Jeffrey P. Phelan, Myoung Ock Ahn
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    ABSTRACT: Our goal was to review the perinatal characteristics of 48 singleton term infants with central nervous system neurologic impairment. Medical records were retrospectively reviewed for maternal characteristics, prenatal and intrapartum care patterns, neonatal course, and long-term outcome. Those patients without evidence of an obvious acute asphyxial event, traumatic delivery, or preterm birth were excluded. The study population was then subclassified according to the admission fetal heart rate pattern. Of these 48 term infants the admission fetal heart rate pattern was nonreactive in 33 (69%) and reactive in 15 (31%). Maternal characteristics, prenatal care, and long-term outcome were statistically similar between the two groups. However, the nonreactive group exhibited significantly more characteristics consistent with a prior asphyxial event: thick "old" meconium, "fixed" nonreactive baseline fetal heart rate, meconium-stained skin, and meconium aspiration syndrome. In contrast, in the reactive group a fetal heart rate pattern developed that was consistent with Hon's theory for intrapartum asphyxia and manifested by a prolonged tachycardia in association with persistent nonreactivity, diminished fetal heart rate variability, and fetal heart rate decelerations. Among fetuses later found to be neurologically impaired, a persistent nonreactive fetal heart rate tracing obtained from admission to delivery appears to be evidence of prior neurologic injury.
    American Journal of Obstetrics and Gynecology 09/1994; 171(2):424-31. DOI:10.1016/0002-9378(94)90278-X · 3.97 Impact Factor
  • M O Ahn, K Y Cha, J P Phelan
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    ABSTRACT: In the management of the preterm pregnancy, cesarean delivery cannot be supported in the delivery of the preterm (less than 1500 g) cephalic-presenting fetus. Although cesarean may be of benefit in the management of the preterm breech fetus (less than 1500 g), there is yet no perspective randomized clinical trial to support its use.
    Clinics in Perinatology 07/1992; 19(2):411-23. · 2.13 Impact Factor
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    ABSTRACT: Electronic fetal heart rate and uterine activity monitoring during labor requires expensive equipment and a source of electricity. However, it is not available to most of the women in the world. Intrauterine manometry provides a method which can be employed in underdeveloped settings to assess uterine contractions and to time auscultation. The vertical column of fluid in a standard intrauterine pressure catheter (IUPC) correlated well (R = 0.93) with the intrauterine pressure measurements obtained by a standard IUPC/pressure transducer system. Intrauterine manometry provides an alternative measure of uterine tone which may be employed in underdeveloped areas.
    International Journal of Gynecology & Obstetrics 05/1991; 34(4):315-8. DOI:10.1016/0020-7292(91)90599-Z · 1.56 Impact Factor
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    ABSTRACT: Of 2081 high-risk pregnancy patients who underwent antepartum fetal surveillance tests, 72 (3.5%) patients demonstrated evidence of polyhydramnios using the amniotic fluid index to assess the amniotic fluid volume. In these patients, an increased incidence of fetal macrosomia, premature births, non-reactive nonstress tests, perinatal morbidity, and fetal anomalies was observed. These data suggest that if polyhydramnios is encountered during an ultrasound evaluation, consideration should be given to the possibility of latent or uncontrolled diabetes mellitus or fetal macrosomia or anomaly; fetal surveillance and genetic evaluation also should be considered.
    Journal of Perinatology 01/1991; 10(4):347-50. · 2.35 Impact Factor
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    ABSTRACT: This study examines the usefulness of umbilical artery Doppler velocimetry, amniotic fluid volume assessment, and fetal heart rate data in the early intrapartum period as predictors of subsequent fetal distress. A total of 109 patients seen in the latent phase of labor in the labor and delivery area were studied. Both an abnormal initial fetal heart rate and an amniotic fluid index less than or equal to 5.0 cm were associated with a significant increase in the incidence of intrapartum fetal distress. Conversely, a systolic/diastolic ratio greater than 3.0 by Doppler ultrasonography was not associated with increased fetal morbidity. Overall, the sensitivities, specificities, and positive predictive values of the fetal heart rate tracing and the amniotic fluid volume assessment were comparable. Doppler systolic/diastolic ratios showed very poor sensitivity and positive predictive value. We conclude that the fetal heart rate tracing or the assessment of amniotic fluid volume in the early intrapartum period are reasonable predictors of subsequent fetal condition. The lack of patients with the absence of or reverse umbilical velocity preclude conclusions with regard to Doppler systolic/diastolic ratios for this purpose.
    American Journal of Obstetrics and Gynecology 10/1990; 161(6 Pt 1):1508-14. DOI:10.1016/0020-7292(90)90026-H · 3.97 Impact Factor
  • A P Sarno, M O Ahn, J P Phelan
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    ABSTRACT: The amniotic fluid index (AFI), a semiquantitative technique for assessing amniotic fluid volume, has been shown to be a useful adjunct in antepartum surveillance. We evaluated the usefulness of the AFI in the early intrapartum period as it relates to subsequent fetal morbidity and fetal heart rate patterns. Two hundred term gravidas presenting in the latent phase of labor with vertex-presenting fetuses were studied. An intrapartum AFI less than or equal to 5.0 cm was associated with a significant increase in the risk of cesarean section for fetal distress and of an Apgar score of less than 7 at one minute as well as abnormal fetal heart rate patterns in late labor. The majority (71.4%) of the patients with an intrapartum AFI less than or equal to 5.0 cm had ruptured membranes on entry; however, there was no significant difference in outcome when they were compared to patients with intact membranes and oligohydramnios. Variable decelerations on entry were associated with oligohydramnios in 43.8% of the patients. An AFI less than or equal to 5.0 cm in the early intrapartum period is a risk factor for perinatal morbidity and abnormal fetal heart rate patterns in subsequent labor, and ruptured membranes in early labor are a risk factor for oligohydramnios.
    The Journal of reproductive medicine 08/1990; 35(7):719-23. · 0.58 Impact Factor

Publication Stats

667 Citations
65.92 Total Impact Points

Institutions

  • 1999
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, CA, United States
  • 1998
    • Kaiser Permanente
      • Department of Obstetrics and Gynecology
      Oakland, CA, United States
  • 1989–1998
    • Pomona Valley Hospital Medical Center
      Pomona, California, United States
  • 1995
    • University of California, Irvine
      • Department of Pediatrics
      Irvine, California, United States
  • 1989–1990
    • University of California, Los Angeles
      • Department of Obstetrics and Gynecology
      Los √Āngeles, California, United States
  • 1988
    • University of Southern California
      • Department of Obstetrics and Gynecology
      Los Angeles, CA, United States