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ABSTRACT: Discussion of isolated ultrasound (US) markers for fetal aneuploidy can provoke significant patient anxiety. The objective of this study is to quantify maternal anxiety associated with the detection of these markers.
All patients undergoing routine second-trimester US examination for fetal anatomical survey over a one-year period were administered the State-Trait Anxiety Inventory (STAI) for Adults before and after the procedure. Women with isolated fetal markers for aneuploidy were notified of the findings but discouraged from pursuing amniocentesis. Rates of normal US examination, aneuploidy markers, anomalies, amniocentesis, and pregnancy outcomes were assessed across the ethnic groups. Pre- and post-ultrasound STAI surveys were scored and standardized with previously established norms. Student t-tests, Chi-square, and analysis of variance (ANOVA) were used where appropriate.
Among the 798 patients tested, 57% were Hispanic, 30% were Asian, 6% were Black, and 7% were White. Maternal anxiety level was decreased in women after a normal US. The anxiety level increased with aneuploidy markers and was the highest with anomalies. Aneuploidy markers were more common among Hispanic and Asian fetuses, without any associated aneuploidy. Women with isolated aneuploidy markers underwent amniocentesis as often as women with advanced maternal age.
The detection and communication of isolated aneuploidy markers is associated with increased maternal anxiety and unnecessary amniocentesis.
Prenatal Diagnosis 02/2007; 27(1):40-5. · 2.11 Impact Factor
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ABSTRACT: We managed two pregnancies in a woman with congenital afibrinogenemia with increasing amounts of cryoprecipitate to achieve a pre-infusion fibrinogen level of 60 mg/dL. The first pregnancy resulted in placental abruption at 36 weeks, in spite of recent cryoprecipitate infusion. Both placentas showed infarction. Post-partum ovarian and renal vein thromboses complicated the second pregnancy. Mean FVIII (344%) and vWF Antigen (323%) were elevated prior to cryoprecipitate infusion, with mean post-infusion levels of 367% and 363%. The clearance of fibrinogen after cryoprecipitate infusion increased during the course of pregnancy. A paradoxical prothrombotic state with embolization may play a role in the observed complications of pregnancy.
American Journal of Hematology 08/2004; 76(3):267-70. · 4.67 Impact Factor
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ABSTRACT: We sought to determine whether pregnant, inner-city substance abusers, cared for in a multidisciplinary setting, had comparable numbers of missed appointments and similar outcomes in comparison with a low-risk patient population.
A retrospective review was conducted on a sample of 97 patients with uncomplicated prenatal care over a 7-year period (1994-2001). They were compared to a sample of 88 substance abusers cared for and delivered at Bellevue Hospital over the same period. Demographic information was recorded, as well as frequency of prenatal visits, number of missed appointments, birth weight, and gestational age at delivery.
In our population, substance abusers were found to be significantly older (28.9 vs. 25.6 years, p < 0.0001), had had more pregnancies (4.3 vs. 2.4, p < 0.0001) and had had more children (2.0 vs. 0.7, p < 0.0001) than controls. Both substance abusers and control patients had a similar number of scheduled appointments (11.4 in each group, p = 0.99), but substance abusers missed more appointments (1.6 vs. 0.7, p < 0.0005).
When cared for in a multidisciplinary setting, substance abusers will attend an adequate number of prenatal visits. However, they are still more likely than non-substance abusers to miss visits, although the difference may not be clinically significant.
Journal of Maternal-Fetal and Neonatal Medicine 11/2003; 14(5):329-32. · 1.50 Impact Factor
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ABSTRACT: Evidence suggests that hemoglobin, in addition to its function as a carrier of oxygen, also serves to transport nitric oxide, as S-nitroso cysteine, from the lungs to the peripheral circulation, where it can be released. Glutathione peroxidase, besides being an important antioxidant, is known to catalyze the release of nitric oxide from smaller carrier molecules, and may play a role in the distribution of nitric oxide throughout the body. In light of these findings, we sought to determine whether glutathione peroxidase levels differed throughout gestation, and specifically between pre-eclamptic and normal women.
A nested case-control study of women receiving routine prenatal care was conducted. Pre-eclampsia was defined by a blood pressure of at least 140 mmHg systolic and/or 90 mmHg diastolic as well as proteinuria > 300 mg/24 h or > 2+ by dipstick, both occurring on two occasions at least 6 h apart. Blood was collected in heparinized tubes and was then centrifuged in a clinical centrifuge for 10 min. Plasma was frozen promptly at -80 degrees C for later enzyme-linked immunosorbent assay (ELISA), with which plasma glutathione peroxidase was determined.
The maternal demographics of the pre-eclamptic and non-pre-eclamptic study groups did not significantly vary with respect to mean maternal age, gravidity, parity and gestational age at the time of delivery. The median maternal ages were 33 and 34 years, and the median gestational ages at the time of birth were 37.5 and 38.1 weeks, respectively. In evaluating the glutathione peroxidase levels of all patients across the three trimesters, we found that there was essentially no difference in mean levels (83.7, 81.0 and 89.5 ng/ml, respectively). There was no difference between the pre-eclamptic and non-pre-eclamptic patients, again stratified by trimester. A linear regression analysis indicated that the plasma glutathione peroxidase concentration did not correlate with gestational age or the presence of pre-eclampsia.
Plasma glutathione peroxidase expression is similar across all trimesters. There is no change in the glutathione peroxidase levels in pre-eclamptic patients.
Journal of Maternal-Fetal and Neonatal Medicine 11/2002; 12(5):322-6. · 1.50 Impact Factor
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ABSTRACT: Maternal aortic aneurysm can be an unsettling finding for the practicing obstetrician. However, thoracic surgeons generally do not treat asymptomatic aortic aneurysms that are less than 6 cm in diameter in otherwise healthy adults.
A young nullipara was incidentally found to have a 4.5-cm thoracic aortic aneurysm during prenatal care. After extensive counseling and discussions with thoracic surgeons, anesthesiologists, and perinatologists, the patient requested a trial of labor and underwent an uncomplicated assisted vaginal delivery of a healthy female infant.
A vaginal delivery occurred safely in a woman with an asymptomatic aortic aneurysm that was less than 6 cm in diameter and not associated with Marfan's syndrome.
Obstetrics and Gynecology 12/2001; 98(5 Pt 2):935-8. · 4.73 Impact Factor
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ABSTRACT: To classify and compare articles, based on the study design, in four leading US obstetrics and gynecology journals.
One year of each journal, American Journal of Obstetrics and Gynecology (AJOG), Obstetrics and Gynecology (O&G), Gynecologic Oncology (GO), and Fertility and Sterility (F&S), beginning May 1997, was reviewed. Supplementary issues were excluded from review. The percentage of articles devoted to observational versus experimental study design was determined, and the quality of evidence was assessed including how heavily randomized controlled trials were represented versus other study designs.
1,517 articles were reviewed. The average percentage of clinical research articles was 90.4. The percentage of animal studies were 10.7 (AJOG), 1.1 (O&G), 1.1 (GO) and 4.2 (F&S) (chi(2) p < 0.001). There were 5.3, 1.9, 6.5, and 7.5% basic science articles, respectively (chi(2) p = 0.007). The average percentage of observational articles was 68.2 and that of experimental articles was 14.1. The percentages of total articles classified as controlled experimental were 10.9 (AJOG), 14.6 (O&G), 5.1 (GO), and 15.2 (F&S) (chi(2) p = 0.01). There were 8.7, 11.1, 3.3 and 9.5% randomized controlled trials, respectively (chi(2) p = 0.008).
The majority of research reviewed was clinical, and more than half of the articles were observational. Under the US Preventative Services Task Force rating system, the randomized control trial is given the highest rating - class I evidence. The drive toward evidence-based clinical practice may not be fully supported by researchers in obstetrics and gynecology, as reflected by submissions to and publications in the major obstetrics and gynecology journals.
Gynecologic and Obstetric Investigation 01/2001; 51(1):8-11. · 1.28 Impact Factor
