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Biomedical subjects

D Hickok

Publications and source records attributed to D Hickok.

17 recordsLinked to original sources
PubMed1998

Prior pregnancy outcome and the risk of intraamniotic infection in the following pregnancy.

OBJECTIVE: Our purpose was to determine whether the outcome of a prior pregnancy influenced the risk of intraamniotic infection in the following pregnancy. STUDY DESIGN: A case-control study was conducted at five King County, Washington, hospitals from 1990 through 1994. Cases (n = 585) of intraamniotic infection were identified by a medical record review for clinical signs of infection during labor and compared with controls (n = 575). Women were classified as having a spontaneous abortion or elective termination if the pregnancy had been diagnosed by a health care professional before 20 weeks and was verified by medical record review. Adjusted odds ratios and 95% confidence intervals were estimated using logistic regression. RESULTS: Women with spontaneous abortion (odds ratio = 4.3; 95% confidence interval 2.9 to 6.4) or elective termination (odds ratio = 4.0; 95% confidence interval 2.7 to 5.8) had an increased risk of intraamniotic infection. The increased risk was similar for women who did and did not have an earlier pregnancy carried beyond 20 weeks. CONCLUSIONS: Women who have had a spontaneous abortion or an elective termination have an increased risk of intraamniotic infection regardless of previous successful pregnancy outcome.

Abortion, Induced↗
PubMed1994

Health status and timing of onset of prenatal care: is there an association among low-income women?

We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low-income women in Snohomish County, Washington. The investigation was a cross-sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low-income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The findings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low-income women.

Adult↗
PubMed1993

Prenatal sonographic findings of trisomy 18: review of 47 cases.

Prenatal sonographic findings were reviewed in 47 consecutive fetuses with trisomy 18. One or more abnormalities, excluding choroid plexus cysts, were found in 39 fetuses (83%), including 21 of 29 (72%) fetuses examined between 14 and 24 weeks and all 18 (100%) fetuses examined after 24 weeks. Abnormalities most frequently detected before 24 weeks included cystic hygromas, nuchal thickening, and meningomyelocele. Intrauterine growth retardation, cardiac defects, and an enlarged cisterna magna were detected more frequently after 24 weeks than before 24 weeks (P < 0.05). Intrauterine growth retardation was the single most common abnormality, detected in 51% of all fetuses and 89% of fetuses examined after 24 weeks. Choroid plexus cysts were identified in 25% (12 of 47) of fetuses, including 11 of 29 (38%) fetuses seen before 24 weeks. Additional abnormalities were identified in 10 of 12 (83%) fetuses with choroid plexus cysts; one of the two remaining fetuses showed clenched hands and a cardiac anomaly at autopsy, and the other showed unusually large, multiple choroid plexus cysts. Awareness of the type of anomalies and the usual menstrual age of diagnosis in fetuses with trisomy 18 should improve patient counseling and prenatal detection of fetuses considered at risk for this disorder.

Abnormalities, Multiple↗
PubMed1992

Maternal smoking and the risk of polyhydramnios.

BACKGROUND: Washington State birth certificates were used to conduct a population-based case-control study to assess the possible association of maternal smoking with polyhydramnios. METHODS: All singleton births complicated by polyhydramnios (n = 557) were identified from the vital records for the years 1984 to 1987. For comparison, 1671 records were randomly selected for the same years from singleton births uncomplicated by polyhydramnios. RESULTS: Women who reportedly smoked prenatally were found to be at increased risk for polyhydramnios (relative risk [RR] = 1.7, 95% confidence interval [CI] = 1.5-2.1, adjusted for marital status, maternal age, and parity). When women with conditions known to be associated with polyhydramnios were excluded, the risk for those who smoked prenatally remained elevated (RR = 1.8, 95% CI = 1.1-2.3). CONCLUSION: Overdistention of the uterus from polyhydramnios may cause a variety of pregnancy complications. The observed association of smoking with polyhydramnios may be a further indication for public health interventions aimed at preventing smoking during pregnancy.

Adult↗
PubMed1991

Enlarged cisterna magna and the Dandy-Walker malformation: factors associated with chromosome abnormalities.

Thirty-three fetuses with an enlarged cisterna magna (10 mm or more) were evaluated to determine factors that might be associated with an underlying chromosome abnormality. Eighteen fetuses (55%) proved to have a chromosome abnormality, including trisomy 18 or trisomy 18 variant (12), trisomy 13 (three), Turner syndrome (one), or other rearrangements (two). Among various risk factors analyzed, the absence of ventricular dilatation correlated most strongly with a chromosome abnormality. Chromosome abnormalities were found in 17 of 22 fetuses (77%) lacking ventricular dilatation, compared with only one of 11 fetuses (9%) with ventricular dilatation (P less than .001). Other factors statistically associated (P less than .01) with an underlying chromosome abnormality included mild enlargement of the cisterna magna (10-14 mm), concurrent anomalies detected sonographically, and fetal growth retardation. However, stepwise logistic regression showed that only the absence of ventricular dilatation and the presence of concurrent anomalies were significant when multiple factors were evaluated. These observations support the utility of evaluating the cisterna magna as part of a routine anatomical survey.

Cerebral Ventricles↗
PubMed1991

Advanced maternal age as a risk factor for cesarean delivery.

The rate of delivery by cesarean has increased steadily in the United States since the 1970s. The reasons for this increase are not fully established. Improved diagnosis of maternal and fetal complications, medicolegal concerns, and the changing age composition of childbearing women have been cited as contributing factors. To assess whether advanced maternal age by itself is an indicator for a primary cesarean delivery, we analyzed data from the vital records of all female residents of King County, Washington 35 years and older (N = 2985) who had a live singleton birth in 1986 or 1987. These women were compared with a sample of women 20-29 years old (N = 6140) who gave birth in the same time period and geographic area. Primiparous and multiparous women 35 years and older were at a similar increased risk of cesarean (relative risk = 1.6, 95% confidence interval 1.1-2.4). Primiparous women of all ages experienced more complications of pregnancy and labor and higher cesarean delivery rates. However, among primiparous mothers with no recorded complications, older women were at significantly increased risk of cesarean birth (relative risk = 2.5, 95% confidence interval 1.8-3.5). This analysis suggests that advanced maternal age alone may influence a physician's decision regarding method of delivery, thereby placing some older women at an unnecessary risk of cesarean.

Adult↗
PubMed1990

Laser laparoscopic herniorraphy: a clinical trial preliminary results.

Laser laparoscopic inguinal herniorraphy represents an extension of current technology. Based on the principles of preperitoneal inguinal herniorraphy, it is performed by internal incision of the peritoneum and identification of the musculofascial defect through a laparoscope. Polypropylene mesh is then passed down the laparoscope, placed into the defect to obliterate the space, and the edges of the peritoneum are then reapproximated. Results in 20 patients with an 11 month followup indicates success in nineteen exhibiting early resumption of activity (3.3 days) and minimal pain (2.1 Tylenol #3 tablets per patient). One early recurrence suggests that anatomic identification of a direct space hernia may be difficult and that routine support of this area with additional mesh may be a requirement of a complete inguinal hernia repair.

Evaluation Studies as Topic↗
PubMed1990

Meckel-Gruber syndrome. Importance of prenatal diagnosis.

Prenatal sonographic findings are reported in six fetuses with the Meckel-Gruber syndrome to illustrate the variety of sonographic findings associated with this disorder and to emphasize the importance of prenatal sonography in helping to establish the correct diagnosis. All six fetuses demonstrated evidence of renal cystic dysplasia. In five cases the kidneys were large and echogenic, demonstrating small discrete cysts in the range of 2 to 5 mm. The remaining fetus demonstrated unilateral renal cystic dysplasia and contralateral renal agenesis. Oligohydramnios was noted in all cases and was evident as early as 14 weeks. An occipital cephalocele was demonstrated on sonography in each case although the size and contents of the cephalocele varied significantly. Two fetuses, both in the same family, also demonstrated a cystic mass in the posterior fossa and partial absence of the cerebellum consistent with a Dandy-Walker variant or cerebellar hypoplasia. The concurrence of marked oligohydramnios and bilateral severe renal anomalies should initiate a search for anomalies of the central nervous system indicative of the Meckel-Gruber syndrome. Recurrence of Meckel-Gruber syndrome may be evaluated as soon as 14 weeks, but it may not be reliably excluded until 20 weeks.

Abnormalities, Multiple↗
PubMed1989

Chromosomal abnormalities in fetuses with omphalocele. Significance of omphalocele contents.

Twenty-six consecutive fetuses with a sonographically detectable omphalocele and known karyotype were reviewed to identify risk factors that might be associated with chromosomal abnormalities. Risk factors that were analyzed included contents of the omphalocele sac, maternal age, fetal sex, sonographically detectable concurrent anomalies, and any major concurrent anomaly. Chromosomal abnormalities were found in 10 cases (38%) from trisomy 18 (n = 4), trisomy 13 (n = 4), trisomy 21 (n = 1), or 45, X (n = 1). The absence of liver from the omphalocele sac (intracorporeal liver) was strongly associated with an abnormal karyotype; chromosomal abnormalities were present in all 8 fetuses with an intracorporeal liver compared to 2 of 18 fetuses with an extracorporeal liver (p less than .0001, two-tailed Fisher exact test). Other risk factors that were statistically associated with chromosomal abnormalities included advanced maternal age (greater than or equal to 33 years, p = .03) and sonographically detectable concurrent malformations (p = .05). We conclude that sonographic findings can help determine the relative risk of chromosomal abnormalities in fetuses with omphalocele; abnormal karyotypes were significantly associated with the absence of liver from the omphalocele sac and sonographically detectable concurrent malformations in this series. Sonographers should also be aware that omphaloceles that contain bowel alone tend to be small and can be missed or mistaken for other abdominal wall defects (gastroschisis or umbilical hernia).

Adolescent↗
PubMed1988

The Dandy-Walker malformation prenatal sonographic diagnosis and its clinical significance.

To determine the usual sonographic findings and clinical significance of the Dandy-Walker malformation (DWM) identified in utero, we reviewed seven proven cases diagnosed by prenatal ultrasound during a 6-year period. All patients demonstrated complete or partial absence of the cerebellar vermis and a posterior fossa cyst. Other central nervous system (CNS) findings included hydrocephalus (five cases) and agenesis of the corpus callosum (one case). Extra-CNS abnormalities were prospectively identified in 3 of 4 fetuses with multiple anomalies. Chromosomal analysis was performed on all four fetuses with multiple extra-CNS anomalies, yielding 2 abnormal karyotypes (trisomy 18 and mosaic trisomy 13). Fetal mortality was directly dependent on the presence of extra-CNS anomalies. Five fetuses ultimately died, including all four with multiple extra-CNS anomalies. The remaining two patients are alive at 1.5 and 6 years of age. We conclude that DWM has a distinctive sonographic appearance that can be identified by prenatal ultrasound and that identification of DWM should initiate a careful search for concurrent anomalies as well as consideration of chromosomal analysis.

Abnormalities, Multiple↗
PubMed1988

Intraperitoneal fetal transfusion under direct ultrasound guidance.

The outcomes of 77 fetal intraperitoneal transfusions in 35 pregnancies managed with direct ultrasound guidance and intensive perinatal management were reviewed. Patients were monitored with amniocentesis, and standard indications were used for timing of transfusions. The mean gestational age at first transfusion was 27.3 weeks (range 22-33). The overall mortality rate was 14% (five of 35). No immediate transfusion-related deaths occurred; all fetuses who were not hydropic at first transfusion survived (26 of 26). The mean gestational age at delivery was 33.6 weeks (range 25-36). One infant developed respiratory distress syndrome (RDS). Transfusion-related complications occurred in five cases (fetal colon infusions in two, fetal retroperitoneal infusion in two, and fetal abdominal wall hematoma in one). None of these infants required urgent delivery or suffered long-term sequelae. In nonhydropic fetuses, intraperitoneal transfusions under direct ultrasound guidance had a low incidence of morbidity and no mortality. These results should provide baseline data against which to compare new techniques, such as direct cord transfusion. With neonatal mortality rates of 10% and significant morbidity rates of 10-20% in infants delivered at 32 weeks who develop RDS, intraperitoneal transfusion should be considered in the 32- to 33-week fetus with marked pulmonary immaturity.

Amniocentesis↗
PubMed1984

Cesarean birth and neonatal mortality in very low birth weight infants.

The authors attempted to relate neonatal mortality to method of delivery in a series of 345 infants, weighing 700 to 1500 g, who were born in King County, Washington, from 1977 to 1979. Overall, 38% of infants delivered vaginally died as opposed to 32% of those with cesarean births. However, after adjustment for birth weight, presentation, and place of delivery, cesarean birth was not associated with reduction in mortality. Even among those infants with a breech presentation, a group believed (on the basis of previous studies) to particularly benefit from cesarean birth, the data failed to show any mortality reduction. Based on the results of this study of very low birth weight singleton infants, it appears that the reduced neonatal mortality associated with cesarean birth, if present at all, is small in magnitude.

Birth Weight↗
PubMed1977

A lethal neonatal dwarfing condition with short ribs, polysyndactyly, cranial synostosis, cleft palate cardiovascular and urogenital anomalies and severe ossification defect.

A case of severe lethal neonatal dwarfism is reported. It appears to be a new variety of short rib-polydactyly dwarfism. It is characterized by severe lack of ossification of all bones except the clavicle and the presence of cleft palate, as well as genitourinary, central nervous system and cardiovascular anomalies. Electronmicroscopy revealed accumulations of granular material in the chondrocytes.

Abnormalities, Multiple↗
PubMedDate not supplied

A health program's effect on neonatal mortality in eastern Kentucky.

We examined the impact of an innovative rural health program in central Appalachia on neonatal mortality by comparing improvements in the neonatal mortality rates of the serviced counties to those of the 13 control counties. Using data on all births and neonatal deaths in the study and control counties from 1970 to 1978 (tabulated by mother's county of residence), an expected neonatal mortality rate of each county was calculated by standardizing for the most important risk components: birth weight, sex, and birth multiplicity. An index of medical care effectiveness, the standardized mortality rate (SMR) for the study and control counties was computed by dividing the observed neonatal mortality rate by the expected rate. The SMRs of the study and control counties were then compared using a standard normal test statistic. The results indicated that the SMRs were significantly different in the control and study counties in the preintervention period 1970-1972. In subsequent years the SMRs converged, resulting in nearly equal rates for 1977-1978. The improvement in neonatal mortality in both areas may be due to their improved economic status rather than health care alone.

Child Health Services↗
PubMedDate not supplied

Transcervical amnioinfusion.

BACKGROUND: Transcervical amnioinfusion is a new and relatively safe, simple procedure that can be performed in most modern hospital maternity units. METHODS: We reviewed the current medical literature concerning this topic by searching MEDLINE files from 1987 to the present, using key words "amnioinfusion," "fetal distress," "premature rupture of membranes," "meconium aspiration," and "oligohydramnios." Older articles were accessed from cross-reference of the more recent publications. RESULTS: When amnioinfusion was used to treat variable fetal heart rate decelerations, it usually reduced the severity of the decelerations, as well as the Cesarean section rate for fetal distress. Prophylactic transcervical amnioinfusion has been studied in three other settings: premature rupture of membranes, meconium passage during labor, and oligohydramnios. A suggested protocol for saline amnioinfusion during labor is given. CONCLUSIONS: Further studies are needed to confirm efficacy reports and to clarify the indications for saline amnioinfusion.

Adult↗
PubMedDate not supplied

Renal calcification: a complication of dexamethasone therapy in preterm infants with bronchopulmonary dysplasia.

We have previously reported a case study in which renal calcification formation may have been a complication of dexamethasone exposure in an infant with bronchopulmonary dsyplasia. To determine whether dexamethasone is associated with renal calcification formation, we conducted a prospective, nonrandomized study of 36 infants < 30 weeks' gestation and weighing < 1250 gm treated with dexamethasone because of bronchopulmonary dysplasia and compared them with a group not receiving dexamethasone. We identified seven infants in the dexamethasone group (n = 19) but no infant in the comparison group (n = 17) with renal calcifications at 2 months of age (p = 0.008). The urinary calcium excretion tended to be increased (15.5 +/- 16.6 vs 6.9 +/- 6.7 mg/kg/day ¿p = 0.05¿) and the calcium/creatinine ratio was significantly greater in the dexamethasone group (1.2 +/- 1.0 vs 0.6 +/- 0.4 ¿p = 0.02¿). Infants who received dexamethasone were significantly smaller 819.1 +/- 141.1 vs 954.6 +/- 141 gm ¿p = 0.008¿), were younger (26.2 +/- 1.7 vs 27.7 +/- 1.2 weeks ¿p = 0.004¿), received ventilator support longer (33.3 +/- 14.7 vs 12.1 +/- 14.7 days ¿p = 0.0001¿), and required more days of supplemental oxygen (54.3 +/- 9.7 vs 36.4 +/- 23.8 days ¿p = 0.009¿). We conclude that smaller, younger, and sicker infants are at the highest risk for the development of renal calcifications and that dexamethasone may be associated with increased urinary calcium excretion, which contributes to renal calcification formation.

Bronchopulmonary Dysplasia↗