[Show description][Hide description] DESCRIPTION: Abstract
Ultrasound Obstet Gynecol. 2008 Oct;32(5):646-51. doi: 10.1002/uog.6211.
Cervical length and maternal factors in expectantly managed prolonged pregnancy: prediction of onset of labor and mode of delivery.
Rao A1, Celik E, Poggi S, Poon L, Nicolaides KH; Fetal Medicine Foundation Prolonged Pregnancy Group.
Gajewska K, Molina F, Granvillano O, Kaur A, Paramasivam G, Khoury O, Nikolopoulou D, Fonseca E, Palaniappan V, Raffaelli R.
To examine the value of combining cervical length and maternal characteristics in a prolonged-pregnancy clinic in the prediction of the probability of firstly, spontaneous onset of labor within the subsequent 10 days and secondly, the need for Cesarean section.
This was a prospective study of women with singleton pregnancies attending an ultrasound-based prolonged-pregnancy clinic at 40 + 4 to 41 + 6 weeks of gestation. The policy was to delay induction of labor by 7-10 days unless there was evidence of a specific medical or obstetric indication or the mother wanted earlier delivery. The measurement of cervical length was not given to the obstetrician, midwife or patient. Regression analysis was used to determine which of the following factors had a significant contribution in predicting induction of labor: maternal age, body mass index (BMI), ethnic origin, parity and cervical length. Regression analysis was also used to determine which of the factors amongst the maternal characteristics, onset of labor and cervical length provided significant prediction of Cesarean section.
We examined 2316 pregnancies but we excluded from further analysis 452 (19.5%) cases because iatrogenic delivery was carried out within the subsequent 6 days, including 427 cases of induction of labor (340 at the request of the mother and 87 for medical indications) and 25 cases of Cesarean section. In the remaining 1864 cases there was spontaneous onset of labor and delivery within 10 days in 1536 (82.4%) and induction of labor in 7-10 days in 328 (17.6%). The rate of Cesarean section was 15.2% (233 of 1536) in those with spontaneous onset of labor and 36.0% (118 of 328) in those whose labor was induced. Regression analysis demonstrated that in the prediction of induction of labor there were significant contributions from cervical length, BMI, parity and gestational age, and in the prediction of Cesarean section there were significant contributions from onset of labor, cervical length, BMI, parity and ethnicity.
Ultrasonographic measurement of cervical length at 41 weeks together with maternal factors can define the patient-specific probability of spontaneous onset of labor in the subsequent week and the risk of Cesarean section.
[Show abstract][Hide abstract] ABSTRACT: To describe a new sign of cleft lip and palate (CLP), the maxillary gap, which is visible in the mid-sagittal plane of the face used routinely for measurement of fetal nuchal translucency thickness.
This was a retrospective study of stored images of the mid-sagittal view of the fetal face at 11-13 weeks' gestation from 86 cases of CLP and 86 normal controls. The images were examined to determine if a maxillary gap was present and the size was measured offline.
In 37 (43.0%) cases of CLP the defect was isolated and in 49 (57.0%) there were additional fetal defects. In the isolated CLP group, the diagnosis of facial cleft was made in the first trimester in 9 (24.3%) and in the second trimester in 28 (75.7%). In the group with additional defects, the diagnosis of facial cleft was made in the first trimester in 46 (93.9%) and in the second trimester in 3 (6.1%). A maxillary gap was observed in 96% of cases of CLP with additional defects, in 65% of those with isolated CLP and in 7% of normal fetuses. There was a large gap (>1.5 mm) or complete absence of signals from the maxilla in the midline in 69% of cases of CLP with additional defects, in 35% of those with isolated CLP and in none of the normal controls.
The maxillary gap is a new simple marker of possible CLP, which could increase the detection rate of CLP especially in isolated cases.
This article is protected by copyright. All rights reserved.
Ultrasound in Obstetrics and Gynecology 08/2015; DOI:10.1002/uog.15675 · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To examine performance of screening for major trisomies by a policy of first-line assessment of risk with maternal age, fetal nuchal translucency thickness (NT) and ductus venosus pulsatility index for veins (DV-PIV) followed by cell-free (cf) DNA testing, in pregnancies with an intermediate risk.Methods
We estimated the distribution of risks based on maternal age, fetal NT and DV-PIV in a dataset of 86 917 unaffected and 491 trisomic pregnancies undergoing prospective screening for trisomies. Performance of screening for trisomies by cfDNA testing was derived from a meta-analysis of clinical validation studies. We estimated performance and cost of screening for trisomies by different combinations of ultrasound screening and cfDNA testing.ResultsScreening for trisomies 21, 18 and 13 by a combination of maternal age, fetal NT and DV-PIV in all pregnancies, followed by invasive testing in the high-risk group (≥1:10) and cfDNA testing in the intermediate-risk group (1:11–1:3000) can potentially detect about 96%, 95% and 91% of cases, respectively, with an FPR of 0.8%. On the assumption that the costs for ultrasound screening, cfDNA testing and invasive testing are €150, €500 €1000, respectively, the overall cost of such a policy would be about €250 per patient. The alternative policy of universal screening by cfDNA testing, can potentially detect about 99%, 97% and 92% of cases of trisomies 21, 18 and 13, but at the overall cost of more than €500 per patient.Conclusion
Combined screening by first-trimester ultrasound examination and cfDNA testing can detect a high proportion of trisomies with a low FPR.
Ultrasound in Obstetrics and Gynecology 07/2015; 45(1). DOI:10.1002/uog.14691 · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To investigate the value of fetal biometry at 35-37 weeks’ gestation in the prediction of delivery of small for gestational age (SGA) neonates, in the absence of preeclampsia (PE).Methods
Screening study in singleton pregnancies at 35-37 weeks, including 278 that delivered SGA neonates with birth weight <5th percentile and 5,237 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors and Z-scores of fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) or estimated fetal weight (EFW) had significant contribution in predicting SGA neonates.ResultsMultivariable logistic regression analysis demonstrated that the likelihood of SGA<5th decreased with maternal weight and height, and in parous women the risk increased with inter-pregnancy interval. The risk was higher in women of Afro-Caribbean and South Asian racial origins, in cigarette smokers, in nulliparous women, and in those with prior history of SGA, with or without prior PE. Combined screening by maternal characteristics and history with EFW Z-scores at 35-37 weeks, predicted 85% of SGA neonates with birth weight <5th percentile delivering at <2 weeks of assessment, at 10% false positive rate. The respective detection rate for the prediction of SGA neonates delivering at ≥37 weeks’ gestation was 70%. The performance of screening by a combination of Z-scores for fetal HC, AC and FL was similar to that achieved by the EFW Z-score.Conclusion
Combined testing by maternal characteristics and fetal biometry at 35-37 weeks could identify, at 10% false positive rate, about 85% of pregnancies that subsequently deliver SGA neonates within two weeks of assessment and 70% of those delivering at ≥37 weeks.
Ultrasound in Obstetrics and Gynecology 05/2015; 45(5):559-565. DOI:10.1002/uog.14816 · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
To report clinical implementation of cell-free (cf)DNA analysis of maternal blood in screening for trisomies 21, 18 and 13 in twin pregnancies and examine variables that could influence the failure rate of the test.MethodscfDNA testing was performed in 515 twin pregnancies at 10–28 weeks’ gestation. Failure rate of the test to provide results was compared to that in 1,847 singleton pregnancies and logistic regression analysis was used to determine which factors amongst maternal and pregnancy characteristics were significant predictors of test failure rate.ResultsFailure rate of the cfDNA test at first sampling was 1.7% in singletons and 5.6% in twins. In those with a result, the median fetal fraction in twins was 8.7% (range 4.1-30.0%), which was lower than in singletons (11.7%, range 4.0-38.9%). Multivariable regression analysis demonstrated that twin pregnancy, higher maternal weight and conception by IVF provided significant independent prediction of test failure. Follow-up was available in 351 (68.2%) of the twin pregnancies and included 334 with euploid fetuses, 12 discordant for trisomy 21 and five discordant for trisomy 18. In all 323 euploid cases with a result, the risk score for each trisomy was <1:10,000. In 11 of the 12 cases with trisomy 21 and in the five with trisomy 18, the cfDNA test gave a high-risk result but in one case of trisomy 21 the score was <1:10,000.Conclusions
In twins screening by cfDNA testing is feasible but failure rate is higher and detection rate may be lower than in singletons.
Ultrasound in Obstetrics and Gynecology 01/2015; 45(1). DOI:10.1002/uog.14690 · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The proof-of-principle of diagnosing fetal aneuploidy by shotgun sequencing cell-free DNA from maternal blood was demonstrated independently by two groups in 2008.(1,2) The strength of the initial approach was the fact that it was genome-wide by design, yet it was exclusively or mainly limited in scope to the detection of trisomy 21 (T21). Follow-up studies then substantiated the lower sensitivity of the approach for autosomal trisomies other than T21. This article is protected by copyright. All rights reserved.