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Biomedical subjects

A Lippman

Publications and source records attributed to A Lippman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Malformations and minor anomalies in children whose mothers had prenatal diagnosis: comparison between CVS and amniocentesis.

The frequency of abortion following chorionic villus sampling (CVS) is similar to that following amniocentesis. However, there is no information on long-term effects, such as malformations in liveborn children exposed to CVS. We evaluated 189 infants whose mothers had either CVS or amniocentesis as participants in the Canadian Collaborative Randomized Trial, a prospective assessment of the safety of CVS compared with amniocentesis. The participation rate of children who could be contacted was 95%. Ninety-five of the 189 infants (50.2%) had been exposed to CVS, 87 (46%) to amniocentesis, and 7 (3.8%) to both. (The latter group was excluded from calculations.) One hundred twenty-eight (128) children had greater than or equal to one minor anomalies but no major abnormalities: 58 of 95 (60%) in the CVS and 70 of 87 (80%) in the amniocentesis group. Twenty-six children had malformations: 17 (17.8%) in the CVS and 9 (10.3%) in the amniocentesis group. Only one anomaly, Sturge-Weber dysplasia (amniocentesis group), was potentially severe and none were life-threatening. Superficial cavernous hemangiomas (strawberry nevi) were noted more frequently in children in the CVS group (12.6%) than in the amniocentesis group (3.4%), but only slightly higher than in the general public. We conclude that exposure to CVS is not associated with an increased frequency of malformations or minor anomalies in infants compared with amniocentesis although we observed a higher frequency of superficial cavernous (strawberry) hemangiomas in the children in the CVS group.

Amniocentesis↗
PubMed1989

An investigation of report bias in a case-control study of pregnancy outcome.

The role of report (recall) bias in case-control studies of possible reproductive hazards was investigated in a study of women who gave birth at the Royal Victoria Hospital, Montreal from September 1983 to May 1985. Women were questioned twice (early in pregnancy; after delivery) about exposures that might influence pregnancy outcome. The two sets of responses of case mothers, control mothers, and mothers of infants of intermediate health status were then compared. Similar inconsistencies in the reporting of 39 exposure variables were common in all three groups, with postdelivery deletion of previous reports more frequent than addition of new information. Changes in reporting were not associated with pregnancy outcome, maternal concern about the baby or maternal sociodemographic characteristics. Odds ratios of exposure estimated from the two sets of data did not differ importantly. Moreover, there was no postdelivery trend to increases, or decreases, in the estimates of the odds ratios. The data do not provide evidence of biased reporting of exposures.

Epidemiologic Methods↗
PubMed1988

Prenatal diagnosis and the Canadian collaborative randomized trial of chorionic villi sampling: the physician's view.

Women eligible for the Canadian randomized trial of chorionic villi sampling (CVS) often cite physician influence as a reason for refusing to participate. To measure directly physicians' attitudes to and knowledge of prenatal diagnosis (PND), amniocentesis, CVS, randomized trials, and the Canadian trial, a 3-page questionnaire was mailed to all registered obstetricians in British Columbia (BC) and in Montreal (Mtl). The overall response rate was 70%. Most physicians thought PND was important and that it was their role to discuss and advise PND to their patients. Physicians were split in their preferences for amniocentesis or CVS (32% vs. 34%); reasons for their preferences paralleled those given by women studied previously by us. Physicians who thought CVS was too experimental, who were hesitant about the trial or who were less likely to discuss the study with patients were older, less likely to have participated in a randomized trial previously and less comfortable with randomization and discussing uncertain risks with patients. Mtl physicians were less aware and more hesitant about the Canadian trial than those in BC. Moreover, Mtl physicians were more likely to consider the ongoing trial inappropriate and too experimental than BC physicians. Because physicians act as "gatekeepers," educating them about new technologies and about randomized studies is essential for ensuring both participant's access to a new procedure and success of the randomized trial.

Attitude of Health Personnel↗
PubMed1988

Psychological aspects of ultrasound imaging during pregnancy.

The psychological impact of ultrasound examination on expectant parents is assessed through direct observation, interviews and the administration of a questionnaire to a large group of parents. The examination was a positive and reassuring experience for most parents. Among a wide array of variables that could account for the effects of the exam, the results were the most important. Women viewing their first ultrasound, specially primiparae were more moved. The results did not confirm that there is a traumatic effect when viewing precedes quickening. Contrary to previous reports, fathers were as emotionally involved as the mothers. The presence of the father seemed also to have a beneficial effect on the mother. One-half of parents wanted to know the sex of the fetus before birth. These findings are discussed, along with implications for problems arising from introduction of new technologies during pregnancy.

Adult↗
PubMed1987

Maternal age and primary cesarean section rates: a multivariate analysis.

To study the effect of maternal age on primary cesarean section rates, 3458 consecutive deliveries were analyzed. The cesarean section rates in primiparous women less than 25, 25 to 34, and over 34 years of age were 13.1%, 18.5%, and 28.2%, respectively. A similarly dramatic rise with advancing maternal age was seen in multiparous women with rates of 3.4%, 4.7%, and 10.1%, respectively, in the three age groups. The strong association between cesarean section and maternal age persisted after multivariate adjustment for induction of labor, epidural anesthesia, meconium-stained amniotic fluid, and fetal distress, and thus these factors do not explain the relationship.

Abruptio Placentae↗
PubMed1985

Chorionic villi sampling: clinical experience, immediate complications, and patient attitudes.

To develop chorionic villi sampling as a procedure for prenatal diagnosis, a pilot study was undertaken to perfect the obstetric and laboratory techniques, to evaluate our success with the procedure in continuing pregnancies, and to assess the attitudes of potential users of the procedure. Women about to have elective first-trimester abortions for nongenetic reasons were enrolled in the first phase of the study. Of the patients with a positive pregnancy test, 12.4% were found to have a nonviable pregnancy on ultrasound examination. Samples adequate for cytogenetic analysis were obtained in 130 of the 155 remaining cases, and the success rate was 93% in the 100 most recent cases. Direct cytogenetic analysis was undertaken in those cases successfully sampled, and karyotypes could be prepared in 97%. Immediate complications occurred in 5% of the pregnancies. Eight women at risk of bearing a child with a genetic defect had diagnostic chorionic villi sampling. Cytogenetic analysis was performed successfully on all of them. One had an induced abortion following the procedure because of the fetal diagnosis (a male with a 50% risk of Duchenne's muscular dystrophy). The other pregnancies are continuing uneventfully at 22 to 35 weeks' gestation. Finally, from preliminary analysis of our survey of potential users it appears that women 35 years old or over would prefer chorionic villi sampling to amniocentesis if the risks of the sampling were known to be low.

Adult↗
PubMed1985

Chorionic villi sampling: women's attitudes.

To determine the acceptability of chorionic villi sampling (CVS) to women eligible for prenatal diagnosis, we undertook a survey to identify aspects of this new procedure that made it more or less preferable than amniocentesis. All women greater than or equal to 35 years scheduled for amniocentesis were asked to read some detailed descriptive material about amniocentesis and CVS, to rate the importance of the specific differences between procedures, and to indicate which procedure they would prefer, first considering each difference between them independently and then considering all the factors jointly. In the absence of precise estimates of CVS-associated risk at the time of the survey, almost equal proportions preferred amniocentesis and CVS (50.2 and 45.1%, respectively). Risk information was the most important factor to women preferring amniocentesis; the timing of the test or nature of the termination procedure was most important to those preferring CVS. In the hypothetical case where CVS was stipulated to have the same attributable risk as amniocentesis, 82% of respondents would prefer it. However, if the spontaneous abortion rate following CVS was stipulated to be 5% more than the amniocentesis risk, preferences reversed and only 22% would still prefer it. Thus, the data suggest that the ultimate acceptability of the new procedure for women over 35 years seeking prenatal diagnosis will depend on the risk associated with it and underscore the importance of ongoing trials aimed at establishing this risk.

Abortion, Induced↗
PubMed1985

Cost-benefit analysis of a thalassemia disease prevention program.

We offer an economic perspective on prevention of beta-thalassemia disease by means of genetic screening and prenatal diagnosis in an established program in Quebec province. The program screens 80 per cent of at-risk persons in the high-risk communities, provides diagnosis to 75 per cent of at-risk couples, and prevented two-thirds of new cases in the period of study. We measured the additional costs, in 1981 Canadian dollars, of medical and public health resources, both incurred and avoided, resulting from use of these prevention services. The total direct cost per case prevented in the program is less than the cost for a single year of treatment for an individual with the disease. Sensitivity analysis accommodating demographic assumptions, participation rates, and discounting rates indicates that, even at rates of marriage, endogamy, and participation lower than observed in the current program, treatment costs will still exceed prevention costs when discounting is set at conventional rates of 4 per cent and 8 per cent. Cost effectiveness of the program is confirmed.

Cost-Benefit Analysis↗
PubMed1984

Fetal mortality at the time of chorionic villi sampling.

To estimate the background fetal loss rates among women who might be candidates for chorionic villi sampling (CVS) for prenatal diagnosis, we examined the frequency of spontaneous abortion and of non-viable fetuses in two groups of women thought to be pregnant at 8-12 weeks' gestation. Among 1519 women over 35 years given an appointment for amniocentesis 1978-1981, 9.8% had a spontaneous abortion prior to 16 weeks' gestation. For those under observation before week 12, the loss rate by 16 weeks was 15.3%. Among all 190 candidates for elective termination of pregnancy between 6 and 12 weeks' gestation, 12.6% were found to have a non-viable fetus at the scheduled date of abortion. The frequency of non-viability was 14% among those seen before week 12. The data suggest that the background loss rate between the time of CVS and the time of amniocentesis is approximately 1-2% and is unlikely to be higher than 9%. Until randomized clinical trials of the procedure are completed we will not know how much, if at all, the loss rate associated with CVS is increased above this background. Nevertheless, knowledge of these background risk estimates may be useful in counseling women considering participating in trials of CVS.

Abortion, Spontaneous↗
PubMed1984

Fetal mortality in sibships of cases with neural tube defects.

It has been suggested that rates of fetal mortality in sibships of probands with a malformation inherited as a multifactorial threshold trait may reflect their liability to the malformation. If so, spontaneous abortion rates should be more frequent in sibships thought to have greater liability. For anencephaly and spina bifida (ASB), then, spontaneous abortion should be higher in the sibships of male probands and in families with more than one affected case (multiplex families). This hypothesis was tested using data on cases from The Montréal Children's Hospital and from the literature. Approximately 5000 pregnancies were analyzed. Rates of abortion did not vary with the sex or diagnosis of the proband. The spontaneous abortion rate was slightly higher in multiplex than in simplex families, but the difference was not statistically significant and most likely reflects the differing reproductive patterns in the two types of families. Thus, if male probands and multiplex sibships do have, on average, more liability for ASB, this liability cannot be detected in spontaneous abortion rates in the sibships available for this analysis.

Abortion, Spontaneous↗