[Show abstract][Hide abstract] ABSTRACT: To estimate whether body mass index (BMI) affects the evaluation of nuchal translucency or the nasal bone during first-trimester ultrasound examination for aneuploidy risk assessment.
Six hundred ninety-four women with singleton gestations undergoing first-trimester aneuploidy risk-assessment ultrasound examinations were identified. Weight categories were defined as normal (body mass index [BMI] less than 25), overweight (25-29.9), and obese (at or above 30). chi, chi for trend, Student t test, one-way analysis of variance, and Pearson correlation were used for statistical analysis where appropriate to estimate the effect of BMI on first-trimester ultrasound examination. P<.05 was considered statistically significant.
Increasing BMI was significantly associated with an inadequate nasal-bone assessment (3% compared with 12.7%, P<.001), increased ultrasound examination time (15.23+/-8.09 minutes compared with 17.01+/-7.97 minutes, P=.028), and an increased need to perform a transvaginal ultrasound examination (23% compared with 41.8%, P<.001). Prior abdominal surgery was not significantly associated with nasal-bone assessment inadequacy (7.8% compared with 4.4%, P=.125), the need to perform transvaginal ultrasound examination (33.6% compared with 28.6%, P=.279), or longer examination time (16.22+/-8.6 minutes compared with 15.92+/-7.8 minutes, P=.704).
In singleton pregnancies, increased BMI is not associated with suboptimal visualization of nuchal translucency, but it is associated with a longer time to perform the first-trimester ultrasound examination for aneuploidy risk assessment, increased need for transvaginal ultrasound examination for nuchal-translucency visualization, and a lower likelihood of obtaining an adequate nasal-bone image. Previous abdominal surgery did not affect the ability to visualize the nasal bone.
Obstetrics and Gynecology 10/2009; 114(4):856-9. DOI:10.1097/AOG.0b013e3181b6bfdc · 5.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in patients with cervical cerclage treated with weekly 17 alpha-hydroxyprogesterone caproate (17P) injections versus daily outpatient nursing surveillance (ONS) without 17P. Included in this retrospective cohort study were singleton gestations with cerclage placed at the discretion of the provider due to prior SPTD, delivering between January 1, 2004 and May 1, 2006. The study group (n = 232) consisted of women receiving once-weekly nursing visit and 17P injection. The control group (n = 1650) consisted of women enrolled for ONS (twice-daily electronic uterine contraction monitoring and nursing assessment). Data were further stratified by the number of prior preterm deliveries (1, > 1). Primary study outcome was the incidence of SPTD. No difference in rates of recurrent SPTD at < 37 or < 35 weeks were observed between the study and control groups. Study patients were less likely to be diagnosed with preterm labor (PTL) than controls (45.7% versus 70.8%, respectively; P < 0.001). The incidence of preterm premature rupture of membranes was similar between the groups (8.6% versus 8.1%; P = 0.770). We concluded that the incidence of recurrent SPTD was similar in women with cerclage treated with 17P or ONS, although women receiving 17P had a lower incidence of PTL. This benefit of 17P should be considered when managing patients with prior SPTD and cerclage.
American Journal of Perinatology 05/2008; 25(5):271-5. DOI:10.1055/s-2008-1064935 · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Progesterone has a known diabetogenic effect. We sought to determine whether the incidence of gestational diabetes mellitus (GDM) is altered in women receiving weekly 17alpha-hydroxyprogesterone caproate (17P) prophylaxis for the prevention of recurrent preterm birth.
Singleton gestations in women having a history of preterm delivery were identified from a database containing prospectively collected information from women receiving outpatient nursing services related to a high-risk pregnancy. Included were patients enrolled for outpatient management at <27 weeks' gestation with documented pregnancy outcome and delivery at >28 weeks. Patients with preexisting diabetes were excluded. The incidence of GDM was compared between patients who received prophylactic intramuscular 17P (250-mg weekly injection initiated between 16.0 and 20.9 weeks' gestation) and those who did not.
Maternal BMI and age were similar. The incidence of GDM was 12.9% in the 17P group (n = 557) compared with 4.9% in control subjects (n = 1,524, P < 0.001; odds ratio 2.9 [95% CI 2.1-4.1]).
The use of 17P for the prevention of recurrent preterm delivery is associated with an increased risk of developing GDM. Early GDM screening is appropriate for women receiving 17P prophylaxis.
Diabetes care 09/2007; 30(9):2277-80. DOI:10.2337/dc07-0564 · 8.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Microchimerism from fetal or maternal cells transferred during pregnancy has been implicated in the pathogenesis of systemic sclerosis (SSc).
To determine whether a prior pregnancy influenced disease progression and cause of death in patients with SSc.
The patients comprised a retrospective study cohort of 111 women with SSc: 78 patients with prior pregnancies (PP) and 33 who were never pregnant (NP), followed up at Thomas Jefferson University. Differences in age at onset, disease subset, organ involvement, cause of death, and type of antinuclear autoantibodies were evaluated statistically, including regression analysis.
The age at onset of SSc in NP patients was 32.0 years compared with 45.7 years in patients with one or two prior pregnancies (p<0.0001), 46.6 years in patients with three or four pregnancies (p<0.0001), and 51.3 years in patients with five to seven pregnancies (p<0.0005). In the 16 patients who had an elective pregnancy termination, 14/16 (87.5%) had diffuse SSc v 2/16 (12.5%) with limited SSc (p<0.0001; odds ratio (OR)=49.0). Of the NP women, 7/30 (23%) died from SSc related causes v 3/78 (4%) women who had pregnancies (p=0.0058; OR=7.6). A carbon monoxide transfer factor (TLCO) of <60% and disease duration >10 years was found in 10/13 (77%) NP patients v 10/23 (43%) patients who had pregnancies (p=0.05; OR=4.7), and a TLCO <50% and disease duration >10 years was identified in 7/13 (54%) NP patients v 6/23 (26%) of the patients who had pregnancies (p=0.09; OR=3.2).
There are differences in the age at onset, clinical course, severity of lung involvement, and cause of death in women who develop SSc before pregnancy compared with those who develop it after pregnancies. The NP patients with SSc had onset of disease at an earlier age, more severe lung involvement, and higher rate of death due to SSc.
Annals of the Rheumatic Diseases 04/2002; 61(4):346-50. DOI:10.1136/ard.61.4.346 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hyperemesis gravidarum (HG) was once a major cause of maternal mortality. The impact of prolonged and severe nausea and vomiting on the fetus and mother can be devastating. Disturbances in fluid, electrolyte, and acid-base balances are common. The reduction in maternal deaths associated with HG is a result of improved understanding and more aggressive treatment of these metabolic alterations. HG is the most common reason for nutrition support intervention during pregnancy. However, little information is available regarding the nutritional issues associated with HG or the effects of providing nutrition support on pregnancy outcome. This review discusses the nutritional implications of HG and strategies for clinical management, including hydration, pharmacologic therapies, and the provision of enteral and parenteral nutrition. Implications for home care and future research are also presented.
Nutrition in Clinical Practice 04/2000; 15(2):65-76. DOI:10.1177/088453360001500203 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this retrospective study was to evaluate maternal and perinatal outcomes and complications of parenteral nutrition during pregnancy in our institution.
This study was a review of medical records of all women who required parenteral nutrition during pregnancy at our institution from 1990-1997. The frequency of maternal and perinatal complications was calculated.
Twenty-six pregnancies required parenteral nutrition for the following indications: hyperemesis gravidarum (n = 16), cholecystitis/pancreatitis (n = 3), small bowel obstruction (n = 2), intracranial bleed (n = 2), ulcerative colitis (n = 1), and other (n = 2). The mean gestational age at initiation of therapy was 16.2 weeks and the mean duration of therapy was 30.6 days. Five pregnancies were terminated prior to fetal viability. Of the remaining pregnancies, obstetric complications occurred in 11, including two cases of idiopathic preterm labor resulting in preterm deliveries. Maternal complications resulting from the central venous catheters included four infections, two thromboses, one occlusion, one pneumothorax, and one catheter dislodgment. The complication rate for centrally inserted central catheters (50%) was significantly greater than the rate for peripherally inserted central catheters (9%).
Successful outcomes can be achieved in obstetric patients requiring parenteral nutrition. In this group of patients, the frequency of maternal complications secondary to centrally inserted central venous catheters was greater than that reported in nonpregnant patients. Peripherally inserted central catheters may be preferable when parenteral nutrition is required during pregnancy.
The Journal of Maternal-Fetal Medicine 07/1999; 8(4):164-7. DOI:10.1002/(SICI)1520-6661(199907/08)8:4<164::AID-MFM5>3.0.CO;2-Z