Biomedical subjects

David M Stamilio

Publications and source records attributed to David M Stamilio.

25 records · Page 2Linked to original sources

PubMed2005

Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction: evaluating the impact of using gestational age-specific reference values.

OBJECTIVE: The purpose of this study was to compare the impact of using gestational age-specific reference levels of the cerebroplacental Doppler ratio (CPR) with categorical threshold in the prediction of adverse perinatal outcomes in growth-restricted pregnancies. METHODS: A retrospective cohort study of cases of intrauterine growth restriction over a 3-year period was conducted. The umbilical artery and middle cerebral artery pulsatility indices were converted to CPRs. The efficacy of using gestational age-specific reference levels of CPRs in predicting adverse outcomes was compared with the use of a CPR of less than 1.08. Adverse perinatal outcomes evaluated included cesarean delivery for nonreassuring fetal heart tones, umbilical artery pH less than 7.0, 5-minute Apgar scores less than 7.0, intraventricular hemorrhage greater than grade 2, periventricular leukomalacia, respiratory distress syndrome, and perinatal death. RESULTS: Of 183 pregnancies meeting our inclusion criteria, there were 70 with at least 1 adverse outcome. With the use of a CPR ratio below the 5th percentile for gestational age, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 65%, 73%, 73%, and 65%, respectively, with an odds ratio (95% confidence interval) of 5.2 (1.4-19.4; area under the receiver operating characteristic curve, 0.69). With a CPR threshold of less than 1.08, the sensitivity, specificity, and positive and negative predictive values were 72%, 62%, 68%, and 67%, with an odds ratio (95% confidence interval) of 4.2 (1.2-15.3; area under the receiver operating characteristic curve, 0.67). CONCLUSIONS: An abnormal CPR is associated with adverse perinatal outcomes in growth-restricted fetuses. The accuracy of using gestational age-specific reference levels was similar to that of using a categorical threshold.

Adult↗

PubMed2004

Abnormal multiple marker screens are associated with adverse perinatal outcomes in cases of intrauterine growth restriction.

OBJECTIVE: The purpose of this study was to determine if abnormal multiple marker screens (MMS) are associated with adverse perinatal outcomes in intrauterine growth restriction (IUGR) pregnancies. STUDY DESIGN: This was a case control study of IUGR pregnancies (birth weight <10th percentile for gestational age [GA]) delivered in our unit over 6 years. Cases were compared with controls for the association between abnormal MMS and adverse perinatal outcomes (APO). RESULTS: Of the 261 IUGR pregnancies, 39 (16%) had at least 1 APO. An elevated HCG was significantly associated with an APO (OR 2.6, 95% CI 1.1-6.4). A low uE3 was also associated with an APO (OR 5.5, 95% CI 2.2-14). The association between an elevated AFP and APO was not statistically significant (OR 1.6, 95% CI, 0.6-4.6). CONCLUSION: An elevated HCG and low uE3 were associated with APO in cases of IUGR. This information could be useful in identifying a subset of IUGR cases deserving closer surveillance.

Case-Control Studies↗

PubMed2004

What antepartum fetal test should guide the timing of delivery of the preterm growth-restricted fetus? A decision-analysis.

OBJECTIVE: The purpose of this study was to use a decision-analytic approach to explore the best strategy for the timing of the delivery of preterm intrauterine growth-restricted fetuses. STUDY DESIGN: We constructed a decision-analysis model that compared 4 antenatal fetal testing strategies The fetal/neonatal states that were compared included live in utero pregnancy; fetal death; neonatal death; disabled neonate, and healthy neonate. Probability estimates for these states and sensitivity and specificity for Doppler velocimetry and biophysical profile were derived from literature review. Sensitivity analyses were performed on the baseline assumptions. RESULTS: Under the baseline assumptions, biophysical profile was the best test to guide decisions on delivery. Sensitivity analyses revealed the model to be sensitive only to the specificity of a biophysical profile <82%. CONCLUSION: Compared with the other options, biophysical profile was the best strategy to guide physicians on the timing of the delivery of the preterm growth-restricted fetus.

Biophysical Phenomena↗

PubMed2004

Evaluation of a real-time fluorescent PCR assay for rapid detection of Group B Streptococci in neonatal blood.

Streptococcus agalactiae (Group B Streptococcus: GBS) is the major causative agent of neonatal sepsis. Neonates at risk for GBS infections are empirically administered broad-spectrum antibiotics for at least 48 h pending blood culture results. A rapid assay to expedite detection of GBS would facilitate initiation of specific antibiotic therapy. Conversely, expeditious proof of absence of infection will avoid unnecessary antibiotic use. Using the LightCycler, we evaluated a hybridization probe polymerase chain reaction (PCR) assay to detect GBS-specific cfb gene target DNA sequence in blood specimens. Both sensitivity and specificity of the real-time PCR assay was 100%. The assay demonstrated 100% specificity when tested against 26 non-GBS bacteria. This method is capable of detecting as few as approximately 100 copies or 10 pg of GBS genomic DNA. This real-time PCR method is rapid, sensitive, and specific for the detection of GBS in neonatal blood samples and holds great promise in its utility in the diagnostic laboratory.

Base Sequence↗

PubMed2004

False-positive 1-hour glucose challenge test and adverse perinatal outcomes.

OBJECTIVE: To determine whether a false-positive 1-hour glucose challenge test (GCT) is associated with perinatal complications. METHODS: We performed a retrospective cohort study of 1825 eligible pregnant women among a cohort of 1998 patients. Patients were screened for gestational diabetes mellitus (GDM) with the 1-hour 50-g GCT at 24-28 gestational weeks. A false-positive GCT was defined as a result greater than or equal to 135 mg/dL followed by a normal 3-hour glucose tolerance test (GTT). We compared the negative GCT and false-positive GCT cohorts for a composite perinatal outcome variable that included fetal macrosomia, antenatal death, shoulder dystocia, chorioamnionitis, preeclampsia, intensive care nursery admission, and postpartum endometritis. Secondary outcomes included cesarean delivery and each component variable of the composite. Unadjusted, stratified, and multiple logistic regression analyses were used to investigate the association between a false-positive GCT and the development of perinatal complications. RESULTS: We identified 164 patients with a false-positive GCT and 50 patients with GDM. The false-positive GCT cohort on average was older, of higher parity, had a higher body mass index, and more frequently had chronic hypertension, sickle cell trait, and elevated midtrimester human chorionic gonadotropin levels. The false-positive GCT cohort more frequently had adverse perinatal outcomes, including the composite perinatal outcome (odds ratio [OR] 5.96, 95% confidence interval[CI]1.47,24.16), macrosomia greater than 4500 g (OR 3.66, 95% CI 1.30, 10.32), antenatal death (OR 4.61, 95% CI 0.77, 27.48), shoulder dystocia (OR 2.85, 95% CI 1.25, 6.51), endometritis (OR 2.18, 95% CI 1.03, 4.63), and cesarean delivery (OR 1.76, 95% CI 0.99, 3.14). CONCLUSION: A false-positive GCT is an independent risk factor for adverse perinatal outcomes.

Adult↗

PubMed2004

Diagnosis and treatment of a ruptured ectopic pregnancy in a combat support hospital during Operation Iraqi Freedom: case report and critique of a field-ready sonographic device.

This case report describes a novel diagnostic approach for ectopic pregnancy in a combat environment. We diagnosed a ruptured ectopic pregnancy at our combat support hospital by using the SonoSite 180 Plus ultrasound device (SonoSite, Bothell, WA). The live ectopic pregnancy was immediately identified and the entire pelvic anatomy was easily assessed within 5 minutes. The SonoSite ultrasound device proved to be easy to use, durable, and reliable. It produced high-quality images in a variety of applications. The handheld SonoSite 180 ultrasound device is sufficiently portable to be used effectively in a combat support hospital or field situation, such as a forward surgical team. This combat experience suggests that a handheld ultrasound device may also have great utility during patient transport for civilian hospitals.

Adult↗

PubMed2003

Pregnant women with the sickle cell trait are not at increased risk for developing preeclampsia.

The primary objective of this study was to determine whether having the sickle cell trait is independently associated with preeclampsia. We performed a retrospective cohort study of 1998 pregnant patients who either did or did not have the sickle cell trait. All patients were screened for the sickle trait using the "Sickledex" test. Data on neonatal and maternal outcome, including preeclampsia, and potential confounding variables were abstracted from medical records. Unadjusted, stratified, and multiple logistic regression analyses were used to identify interactions, and confounding between multiple variables and the association between sickle cell trait and preeclampsia. With an anticipated 6.5% rate of preeclampsia, and alpha = 0.05, this cohort study has 80% power to detect a relative risk (RR) of 2.3 for preeclampsia. Univariate analysis revealed that the two cohorts were similar with regard to primiparity, maternal age, chronic diseases, birth weight, and gestational age at delivery, but the sickle cell trait cohort was more likely to have gestational diabetes and had a higher mean body mass index (BMI). In the univariate analysis, the sickle cell trait cohort was not at increased risk for preeclampsia [unadjusted RR = 0.5, 95% CI (0.2-1.6)]. After controlling for potential confounding variables with logistic regression analysis, sickle trait was not independently associated with preeclampsia [adjusted RR = 0.5, 95% CI (0.2- 1.6)]. In contrast to prior work, these data suggest that the sickle cell trait is not an independent risk factor for preeclampsia or postpartum complications. In fact, the data are more consistent with the sickle trait being protective for developing preeclampsia.

Adult↗