Prediction of birth weight by ultrasound in the third trimester.
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Birth Weight↗
Biomedical subjects
G G Nahum
Publications and source records attributed to G G Nahum.
Rudimentary uterine horn pregnancy.
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Female↗
Accurate prediction of term birth weight from prospectively measurable maternal characteristics.
OBJECTIVE: To determine whether accurate prediction of individual term birth weight is possible based on maternal characteristics routinely measured remote from term in healthy women. STUDY DESIGN: Two hundred sixty-two nonsmoking, nondiabetic, white gravidas with uncomplicated term gestations were studied. A cross-validated, split-sample multiple regression analysis was performed to evaluate the predictive value of seven maternal characteristics and two fetal characteristics to identify an optimal combination for accurately estimating birth weight. Fifty-nine terms were assessed for predictive accuracy. RESULTS: Significant predictors of term birth weight were gestational age, parity, fetal sex, maternal height, maternal weight and third-trimester maternal weight gain rate. Combinations of these prospectively measurable variables explained 33% of the variance in birth weight and predicted birth weight to within +/- 267 g (+/- 7.6% of individual birth weight). Term fetal macrosomia was predicted with 80% sensitivity using a prediction cutoff of 3,550 g. CONCLUSION: Individual term birth weight can be accurately predicted in normal gravidas using routinely measurable maternal characteristics. Birth weight estimates using our equation are both prospectively derivable from the beginning of the third trimester and more accurate than any previously devised algorithms, including those that incorporate fetal ultrasonographic data. Our equation can also identify pregnancies at risk for fetal macrosomia so that the timing and mode of delivery may be prospectively modified to minimize peripartum risks to both fetus and mother.
Adult↗
Uterine anomalies. How common are they, and what is their distribution among subtypes?
OBJECTIVE: To establish the prevalence and distribution of uterine anomalies in the general population and to enumerate them among septate, bicornuate, didelphic, unicornuate, hypoplastic/aplastic and solid forms. STUDY DESIGN: A Medline search and standard reference tracing were employed to locate 47 studies from 14 countries regarding the prevalence and distribution of uterine anomalies. Twenty-two studies involving 573,138 women undergoing universal screening for uterine malformations were analyzed to establish the prevalence of uterine anomalies among fertile women. A separate analysis of uterine anomalies among 6,512 infertile women was also performed. Nineteen studies incorporating 1,092 fertile and 456 infertile women with unselected uterine anomalies were reviewed to establish the distribution of müllerian malformations among major subtypes. Seventeen studies incorporating 161 women with unicornuate uteri were analyzed to establish the distribution of unicornuate müllerian defects among various subtypes, including those with and without cavitary contralateral uterine horns. RESULTS: Uterine anomalies were identified in 1 in 594 fertile women (0.17%) and in 1 in 29 infertile women (3.5%). This difference was statistically significant (chi 2 = 3,424, df = 1, P < .00001). The prevalence of uterine anomalies in the general population was 1 in 201 women (0.50%). Their distribution was: 7% arcuate, 34% septate, 39% bicornuate, 11% didelphic, 5% unicornuate, and 4% hypoplastic/aplastic/solid and other forms. CONCLUSION: Congenital uterine malformations are more common than generally recognized. Knowledge concerning their prevalence and varieties is important in recognizing and managing the obstetric and gynecologic complications that may result.
Female↗
Rudimentary uterine horn pregnancy. A case report on surviving twins delivered eight days apart.
BACKGROUND: Surviving twins were born to a woman with a unicornuate uterus having a noncommunicating rudimentary uterine horn; this was the first such case reported. Further, it is the first report on a multiple gestation with one twin delivered successfully by cesarean section and the second vaginally at a later date. CASE: The first twin in a unicornuate uterus was delivered via cesarean section at 28 2/7 weeks due to intractable preterm labor with breech presentation. The ipsilateral hypogastric and ovarian arteries were ligated intraoperatively to arrest myometrial hemorrhage. Continuing preterm contractions resulted in contralateral rudimentary uterine horn rupture eight days later, allowing successful vaginal delivery of the second twin. CONCLUSION: Neonatal survival in rudimentary uterine horn pregnancies is poor, occurring in only 11% of cases during the past half century. The probability of attaining a favorable outcome is increased if aggressive antenatal management is instituted after establishing an early prenatal diagnosis. In the case of dual-chamber uterine anomalies, it is possible to effect surgical delivery of one fetus while maintaining a second preterm fetus in utero. This maneuver can decrease preterm morbidity for later-born siblings and enhance neonatal survival.
Adult↗
Fetal weight gain at term: linear with minimal dependence on maternal obesity.
OBJECTIVE: Our purpose was to determine the shape of the function relating birth weight to gestational age between 37.0 and 42.0 weeks of pregnancy and to determine the effect of maternal obesity on term fetal weight gain in normal pregnancies. STUDY DESIGN: Birth weights in 326 singleton, term gestations were studied in nondiabetic, nonsmoking white women who had well-dated, uncomplicated pregnancies. RESULTS: Birth weight was a linear function of gestational age between 37.0 and 42.0 weeks. Mean (+/- SD) fetal weight gain was 12.7 +/- 1.4 gm per day (95% confidence interval 9.9 to 15.5 gm/day). Fetal weight gain was only 0.6 gm per day greater for obese pregnant women than for those of normal weight for height. Male fetuses gained weight 0.5 gm per day faster than females. CONCLUSION: Fetal weight gain is a linear function of gestational age between 37.0 and 42.0 weeks of pregnancy for normal gestations. The effect of maternal obesity on fetal weight gain at term is small and not clinically significant.
Adult↗
Racial differences in oral glucose screening test results: establishing race-specific criteria for abnormality in pregnancy.
OBJECTIVE: To determine whether the 1-hour glucose screening test threshold of 140 mg/dL yields similar results in identifying gravidas with gestational diabetes mellitus in different races and, if not, to establish consistent race-specific thresholds. METHODS: Nine hundred twenty-one gravidas undergoing routine third-trimester glucose screening were categorized as white, black, Asian, or Filipino. Mean (+/- standard deviation) glucose screening test values, the proportions with results exceeding 140 mg/dL, and the positive predictive values for gestational diabetes mellitus were calculated by race. Race-specific thresholds were calculated by standardizing the percentile rank cutoff for test results in each group. RESULTS: Mean glucose screening test results differed significantly by race: blacks 116.4 +/- 31.6 mg/dL, whites 123.2 +/- 28.4 mg/dL, Filipinos 127.6 +/- 26.3 mg/dL, and Asians 134.7 +/- 25.0 mg/dL (P < .001). No significant difference was found between Hispanic and non-Hispanic whites (123.2 +/- 28.3 versus 123.5 +/- 28.5 mg/dL). Significant different proportions of gravidas exceeded the 140-mg/dL threshold by race: blacks 17.5%, whites 27.4%, Filipinos 31.3%, and Asians 40.6%. The proportions with results above 140 mg/dL who had abnormal 3-hour glucose tolerance tests also varied markedly by race: blacks 42.9%, whites 17.3%, Filipinos 11.5%, and Asians 11.5%. Adjusted screening test thresholds, calculated for each race to establish consistency of the screening test, were 130 mg/dL for blacks, 140 mg/dL for whites, 145 mg/dL for Filipinos, and 150 mg/dL for Asians. CONCLUSION: Race-specific glucose screening test thresholds should be used to ensure consistency in properly identifying gravidas at risk for gestational diabetes mellitus.
Adult↗
Correlation between first- and early third-trimester glucose screening test results.
One hundred twenty-four normal gravidas had paired first- and early third-trimester (26-32 weeks) 1-hour oral glucose screening tests performed. First-trimester oral glucose screening test values correlated significantly with third-trimester glucose screening test results for the entire population, for whites and non-whites, and for normal-weight and obese patients. First-trimester oral glucose screening test values at or below 110 mg/dL were seldom associated with third-trimester oral glucose screening test results at or above 135 mg/dL and were not associated with abnormal 3-hour glucose tolerance test (GTT) results. Nine of the gravidas (7.3%) were diagnosed with gestational diabetes mellitus during the third trimester, all of whom had first-trimester glucose screening test results above 110 mg/dL. The difference in incidence of gestational diabetes mellitus between gravidas having first-trimester glucose screening test results at or below 110 mg/dL (0%) and those having values above 110 mg/dL (16.4%) was highly significant (P less than .0001). For patients with first-trimester glucose screening test values at or below 110 mg/dL, third-trimester glucose screening may be unnecessary. In contrast, for gravidas having first-trimester glucose screening test results at or above 135 mg/dL, there is a high positive predictive value for elevated repeat glucose screening test results during the early third trimester. Patients having elevated first-trimester glucose screening values at or above 140 mg/dL are at particularly high risk for elevated glucose screening test results later in pregnancy and should forego repeat 1-hour third-trimester glucose screening in favor of a direct third-trimester 3-hour GTT.
Adult↗