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Biomedical subjects

G R DeVore

Publications and source records attributed to G R DeVore.

At least 19 recordsLinked to original sources
PubMed2001

The genetic sonogram: its use in the detection of chromosomal abnormalities in fetuses of women of advanced maternal age.

Real-time and color Doppler ultrasound were used to examine 103 second trimester fetuses with abnormal chromosomes (trisomies 13, 18, 21 and sex aneuploidy =86; other =17) and 2000 controls from women of advanced maternal age who electively underwent genetic amniocentesis. Ten ultrasound markers were analyzed and likelihood ratios were computed for each abnormal ultrasound finding and for a normal ultrasound study if none of the ten markers were present. Abnormal ultrasound markers were present in 81% of fetuses with abnormal karyotypes. The false-positive rate was 13%. The likelihood ratios and the 5% and 95% confidence limits for each of the ultrasound markers were as follows: choroid plexus cyst(s) 1.5 (0.7-3.6); central nervous system abnormalities 16.2 (4.4-60.3); abnormal nuchal skin fold 20.9 (8.4-52.1); ventricular septal defect 8.3 (4.7-14.9); outflow tract defects of the heart 3.6 (0.9-14.6); right-to-left chamber disproportion of the heart 36.9 (14.4-94.5); pericardial effusion 7.2 (3.2-16.1); tricupsid regurgitation 4.7 (2.1-10.7); hyperechoic bowel 3.7 (1.8-7.7); and pyelectasis 2.7 (1.0-7.7). All ultrasound markers were independent of each other. The likelihood ratio following a normal ultrasound study was 0.20. Isolated ultrasound markers were present in 20.4% (n=21) of fetuses. When all markers were compared to non-cardiovascular markers, the detection rate for fetuses with a chromosomal abnormality decreased from 81% to 52% (p<0.01). Given the above data, the posterior risk following an ultrasound examination using the ultrasound markers evaluated in this study can be used to compute the risk for an abnormal karyotypes in women of advanced maternal age.

Adult↗
PubMed2000

Trisomy 21: 91% detection rate using second-trimester ultrasound markers.

OBJECTIVES: To examine cardiovascular and non-cardiovascular prenatal ultrasound markers and determine which markers physicians of varying skill levels could use to identify fetuses with trisomy 21. METHODS: Eighty second-trimester fetuses with trisomy 21 and 2000 controls underwent real-time plus color Doppler examination of cardiovascular and non-cardiovascular systems followed by amniocentesis. Non-cardiac markers were central nervous system malformations (CNS); choroid plexus cysts (CPC); abnormal nuchal skin fold (NSF); hyperechoic bowel (HB); and pyelectasis (PY). Cardiac markers consisted of ventricular septal defect, right-to-left chamber disproportion (RL); tricuspid regurgitation; mitral regurgitation (MR); pericardial effusion; and outflow tract abnormalities (OFT). Multinomial logistic regression was used to identify interactivity between the markers. Logistic regression was utilized to identify which combinations of markers significantly contributed to the identification of fetuses with trisomy 21 and to compute the likelihood ratio. RESULTS: All but three markers (CPC, MR, OFT) contributed significantly to the identification of 91% of fetuses with trisomy 21 with a false-positive rate of 14%. When only non-cardiovascular markers were examined, all but CPC contributed to the identification of 60% of fetuses with trisomy 21 with a false-positive rate of 5.9%. Combining right-to-left chamber disproportion with CNS, NSF, HB and PY identified 75% of fetuses with trisomy 21 with a false-positive rate of 6.4%. All markers were independent predictors of trisomy 21 except RL and NSF. CONCLUSION: Ultrasound can detect between 60 and 91% of fetuses with trisomy 21 depending upon which markers are selected for evaluation.

Adult↗
PubMed2000

Second trimester ultrasonography may identify 77 to 97% of fetuses with trisomy 18.

Between 1990 and 1999, 30 second trimester fetuses with trisomy 18 and 2000 control fetuses underwent real-time and color Doppler ultrasonographic examination followed by genetic amniocentesis. Abnormal fetal anatomy was present in 97% of fetuses with trisomy 18, with a false-positive rate of 15.7%. Logistic regression identified six markers (choroid plexus cysts, central nervous system malformations, an abnormal nuchal skin fold, ventricular septal defect, outflow tract abnormalities of the heart, and right-to-left chamber disproportion of the heart) and one interaction between markers (right-to-left chamber disproportion and outflow tract abnormalities) to significantly contribute to the identification of 93% of fetuses with trisomy 18, with a false-positive rate of 8.9%. Noncardiovascular markers (choroid plexus cysts, central nervous system malformations, and abnormal nuchal skin fold) identified 77% of fetuses with trisomy 18, with a false-positive rate of 3.9%. Combining right-to-left chamber disproportion of the heart with choroid plexus cysts, central nervous system malformations, and nuchal skin folds identified 83% of fetuses with trisomy 18, with a false-positive rate of 4.4%.

Abnormalities, Multiple↗
PubMed1998

Influence of prenatal diagnosis on congenital heart defects.

The impact of prenatal detection of congenital heart defects (CHD) using the four-chamber screening examination cannot be accurately ascertained because of the wide range of detection rates that affect the cost associated with it. Assuming a screening ultrasound cost of $200 per examination, recent studies in which examiners not trained in fetal echocardiography obtained and interpreted the four-chamber view only identified 5.3% of CHD, for a cost of $476,190 per malformation. When the four-chamber screening examination was performed by an individual trained in fetal echocardiography, the detection rate increased to 55%, for a cost of $45,454 per malformation. This resulted in a savings of 90%, or $430,736. Because individuals trained in fetal echocardiography are not available to perform and interpret all of the heart screening examinations, another approach is for the fetal echocardiographer to review one to two minute video clips of the four-chamber and outflow tracts screening examination obtained by the individual performing the fetal screening examination. It is estimated that at a charge of $30 per video clip review, the cost to detect 50% of CHD would be $7,500 per defect. This would result in a reduction of 98% for the detection of CHD using current screening methods. This approach would increase the detection rate of CHD by 10-fold, remove the liability of missing CHD from the untrained individual performing the screening examination, and provide revenue to tertiary centers in which individuals skilled in fetal echocardiography could maximize their diagnostic skills.

Cost-Benefit Analysis↗
PubMed1995

The use of color Doppler ultrasound to identify fetuses at increased risk for trisomy 21: an alternative for high-risk patients who decline genetic amniocentesis.

OBJECTIVE: To compare color Doppler ultrasound with real-time ultrasound to determine whether it increased the identification of fetuses with trisomy 21. METHODS: Consecutive fetuses with a second trimester risk greater than 1:270 for trisomy 21 were examined with real-time ultrasound (n = 1028) or real-time plus color Doppler ultrasound (n = 1028) before second trimester genetic amniocentesis. The type of abnormal ultrasound findings were compared between fetuses with normal and abnormal chromosomes. Using the Bayes theorem, the ultrasound-adjusted maternal age-related risk (posterior risk) for trisomy 21 was computed after a normal or abnormal real-time plus color Doppler examination. RESULTS: A significantly greater number of fetuses with trisomy 21 (87% [13 of 15] versus 29% [5 of 17], P < .002) were identified with real-time plus color Doppler than with real-time ultrasound. Color Doppler ultrasound identified a significantly higher rate of cardiovascular abnormalities in fetuses with trisomy 21 (60% [9 of 15] versus 12% [2 of 17], P < .008) than did real-time ultrasound. Identification of abnormal fetal anatomy using real-time plus color Doppler in patients 35 years and older increases the likelihood of detecting trisomy 21. A normal real-time plus color Doppler examination of the fetus decreases the risk for trisomy 21 to less than 1:270 until the maternal age of 42, above which the risk for trisomy 21 is greater than 1:270. CONCLUSION: Real-time plus color Doppler ultrasound examination of the fetus is an alternative for the identification of trisomy 21 for patients who may decline genetic amniocentesis based on their age-related risk.

Adult↗
PubMed1995

The mentor.

Explore the source record for details and available documents.

Echocardiography↗
PubMed1995

The value of color Doppler sonography in the diagnosis of renal agenesis.

Real-time ultrasonographic diagnosis of renal agenesis may be difficult because of severe oligohydramnios. Recent reports have suggested that the absence of renal arteries on color Doppler ultrasonography may assist in the identification of renal agenesis. Because the position of the renal arteries is variable owing to fetal size, this study was undertaken to determine the location of the renal arteries as a function of fetal growth. Using color Doppler ultrasonography, 200 normal fetuses were studied in which the length of the aortic segment from the bifurcation of the iliac arteries to the renal arteries was measured. Regression analysis was performed in which the measured aortic segment was the dependent variable and the femur length the independent variable. Four cases of severe oligohydramnios were studied. The regression equation for the length of the aortic segment (Y) was significantly (P < 0.000001; R = 0.921) related to the femur length (X) (Yaortic segment (mm) = 3.1950 + 0.3034Xfemur length (mm); 99% prediction interval +/- 4.6 mm). In three cases of renal agenesis the renal arteries were not imaged with color Doppler sonography. Color Doppler imaging may be useful to identify the location of the renal arteries as they originate from the aorta. Using the data from this study, the location of the renal arteries can be determined for the corresponding femur length. If the renal arteries are not identified within the expected range (+/- 99% prediction interval) in fetuses in whom the kidneys are not identified with real-time ultrasonography, renal agenesis must be considered.

Adult↗
PubMed1994

The Routine Antenatal Diagnostic Imaging with Ultrasound Study: another perspective.

The Routine Antenatal Diagnostic Imaging With Ultrasound Study (RADIUS) has reported that the adoption of routine screening in the United States would add considerably to health care costs, but stated that a potential benefit may be identification of fetal anomalies. To determine whether the cost per detected malformed fetus using data from the RADIUS study is cost-effective, a comparison is made with the California maternal serum alpha-fetoprotein (MSAFP) screening program. When screening ultrasound is performed by individuals who have a diagnostic rate similar to that reported for tertiary centers that participated in the RADIUS study (6.8 per 1000), the cost for identifying a malformed fetus is $10,805 less ($200 per ultrasound examination) than the cost using MSAFP screening ($40,338; $53 per test). However, when the screening examination is performed by individuals whose diagnostic rate is similar to that reported for non-tertiary centers (1.7 per 1000) that participated in the RADIUS study, the cost for identifying a malformed fetus ($115,575) is $75,237 higher than MSAFP screening. Using data from the RADIUS study, a proposal is suggested by which physicians are reimbursed for second-trimester ultrasound based upon their diagnostic skills. This approach maintains the cost per detected malformed fetus at less than $30,000, decreases the current cost of diagnostic ultrasound to third-party payers, and allows second-trimester ultrasound to be offered as a cost-effective screening test for low-risk patients for identification of malformed fetuses.

Congenital Abnormalities↗
PubMed1993

Circulating intercellular adhesion molecule-1 in amniotic fluid, maternal serum alpha-fetoprotein levels, and intrauterine growth retardation.

OBJECTIVE: Our purpose was to determine if circulating intercellular adhesion molecule-1, a marker of chronic inflammation, is present in amniotic fluid in midtrimester, is increased in patients with elevated maternal serum alpha-fetoprotein level, and is associated with intrauterine growth retardation. STUDY DESIGN: Amniotic fluid circulating intercellular adhesion molecule-1 levels were assayed by enzyme-linked immunoassay in 273 samples obtained by midtrimester amniocentesis in gestations involving a single, structurally normal fetus. The control group consisted of 108 patients with normal maternal serum alpha-fetoprotein levels and 165 patients with elevated levels. Intrauterine growth retardation was diagnosed if birth weight was < 10th percentile for the clinically estimated gestational age. RESULTS: Circulating intercellular adhesion molecule-1 was detectable in amniotic fluid in 105 of 273 samples (38%). In the control group it was detectable in amniotic fluid in seven of 108 (6%). In patients with elevated maternal serum alpha-fetoprotein 97 of 164 (59%) had detectable levels (p < 0.001). Of the 273 cases 38 (14%) had intrauterine growth retardation. Of these 23 (59%) had detectable circulating intercellular adhesion molecule-1 levels (p < 0.001). Of the seven cases of intrauterine growth retardation with normal maternal serum alpha-fetoprotein levels, one (14%) had detectable circulating intercellular adhesion molecule-1. Of the 31 cases of intrauterine growth retardation with elevated maternal serum alpha-fetoprotein 22 (71%) had detectable circulating intercellular adhesion molecule-1. When circulating intercellular adhesion molecule-1 was detectable in amniotic fluid, increasing levels was significantly related to decreasing gestational age at delivery (p < 0.005). CONCLUSIONS: Midtrimester amniotic fluid from normal pregnancies does not generally contain detectable circulating intercellular adhesion molecule-1. Detectable amniotic fluid levels are significantly related to a birth weight < 10th percentile at delivery and to elevated midtrimester maternal serum alpha-fetoprotein levels. Increasing circulating intercellular adhesion molecule-1 levels are related to shortened length of gestation. This test may contribute to risk assessment for intrauterine growth retardation and prematurity. Circulating intercellular adhesion molecule-1 is a known marker of inflammatory processes; its further study may also improve understanding of the pathophysiologic mechanisms of certain cases of intrauterine growth retardation and prematurity.

Amniotic Fluid↗
PubMed1993

Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy.

OBJECTIVE: The four-chamber view of the heart is an important component of the ultrasonographic examination of the fetus. However, during the second trimester of pregnancy the fetal heart cannot always be imaged in every patient. The purpose of this study was to ascertain the rate of successful imaging of the fetal heart during the second trimester and to determine factors that may influence imaging. METHODS: Seven hundred and nine second trimester fetuses were examined and an attempt was made to obtain the four-chamber and outflow tract views of the heart. Analysis included multiple logistic regression models of the main effects and interactions of ten candidate variables. RESULTS: The four chambers and outflow tracts were imaged in 643 fetuses (90.7%) and not imaged in 66 (9.3%). Fifty-two of 709 patients (7.3%) had had previous surgery. In the 52 patients with a history of previous surgery, the heart could not be imaged in 18 (34%). Six hundred and fifty-seven patients (92.7%) did not have previous surgery. Of this group, the fetal heart could not be imaged in 48 (7.3%). In only one fetus in which the heart could not be imaged was it because of fetal position. Three independent risk factors that influenced imaging of the fetal heart were gestational age, maternal adipose tissue thickness, and previous lower abdominal surgery. Increasing gestational age increased the probability of imaging the heart, whereas increasing adipose tissue thickness and a history of previous surgery decreased the probability of imaging the heart. COMMENTS: When the fetal heart cannot be imaged during the second trimester, these factors should be identified. Using data from this study, the gestational age at which the highest probability of imaging the heart can be determined if the thickness of the adipose tissue and a history of lower abdominal surgery are known.

Abdomen↗
PubMed1993

Simultaneous Doppler recording of the pulmonary artery and vein: a new technique for the evaluation of a fetal arrhythmia.

We describe a new technique to evaluate cardiac rhythm using color and pulsed Doppler ultrasonography to identify and record pulmonary arterial and venous waveforms. Fifty fetuses were examined during the second and third trimesters of pregnancy. Simultaneous pulsed Doppler recording of the pulmonary artery and vein was obtained in 100% of fetuses between 15 and 40 weeks' gestation. Atrial systole was identified from the pulmonary vein and was manifested by an interruption of venous flow. Ventricular systole was manifested by a sharp peak that returned toward the baseline before it continued through the duration of systole as a lower-velocity waveform. This technique has the following advantages: (1) the lung parenchyma is easily accessible, irrespective of fetal position; (2) the pulmonary arteries and veins are adjacent to each other as they enter and exit the lung, thus making it easy to simultaneously obtain Doppler recordings of these vessels; (3) the pulsed Doppler waveform has an appearance similar to an electrocardiogram.

Adult↗
PubMed1992

Screening for Down syndrome with the femur length/biparietal diameter ratio: a new twist of the data.

OBJECTIVE: The purpose of this study was to determine the value of discordant morphometric measurements as identifiers of Down syndrome by evaluating the relationship of biparietal diameter, femur length, biparietal diameter/femur length ratio, and cephalic index between a group of fetuses with trisomy 21 and a control population. STUDY DESIGN: Biometric measurements from 48 fetuses with trisomy were reviewed and compared with 107 normal fetuses of similar gestational age. Data were analyzed in 2-week gestational age intervals to determine the effect of gestational age on ultrasonographic detection of Down syndrome. Outcome measures were subject to least-squares linear regression and the t test for analysis. RESULTS: A positive relationship between abnormal morphometric measurements and fetuses with Down syndrome was detected but only during specific weeks of pregnancy. CONCLUSION: Although it appears that biometric measurements may be useful for Down syndrome, further study is needed before its widespread introduction into clinical practice.

Down Syndrome↗
PubMed1992

The effect of altitude on the umbilical artery Doppler resistance.

This study examined whether there were differences between the umbilical artery systolic-diastolic (S/D) ratio and resistance index (RI) in patients with normal fetuses living at sea level (group I) and those living between 4,200 and 4,500 feet above sea level (group II). Linear regression demonstrated a significant association (P less than 0.001) between gestational age and the S/D ratio and RI for groups I (n = 100) and II (n = 128). Least-squares regression analysis demonstrated no significant differences in slopes or intercepts between groups I and II. The results would suggest that altitude, up to 4,500 feet above sea level, does not affect umbilical artery Doppler resistance in normal fetuses.

Altitude↗
PubMed1992

The aortic and pulmonary outflow tract screening examination in the human fetus.

Imaging of the aortic and pulmonic outflow tracts in the fetus may be difficult owing to fetal position. This study describes two screening methods for imaging the outflow tracts, depending on whether the interventricular septum was tangential (group I) or perpendicular (group II) to the ultrasonic beam. We performed 170 examinations during the second and third trimesters of pregnancy. The outflow tracts were imaged in 166 (97.6%). Fetuses in group I were identified much less frequently (13.2%) than fetuses in group II (86.8%). This study would suggest that for the outflow tracts to be imaged during a screening examination, the sonographer should become familiar with the sonographic anatomy of the outflow tracts when the interventricular septum is perpendicular to the ultrasound beam.

Aorta↗
PubMed1990

Performing cytogenetic studies on ascitic, amniotic and hygroma fluid.

The importance of obtaining cytogenetic studies on antenatally diagnosed structural malformations is well recognized. In two cases, three fetal compartments were sampled, each resulting in successful cytogenetic studies. Fluid was obtained under ultrasound guidance from amniotic fluid, fetal ascites and cystic hygroma fluid. Fluid from the hygroma itself may be the easiest compartment to analyze.

Amniocentesis↗
PubMed1989

Fetal heart rate transmission with the facsimile telecopier in rural areas.

Over a 30-month period, 24 portable facsimile telecopiers were placed in rural hospitals with delivery services, allowing 24-hour direct transmission of fetal heart rate tracings for consultation. An analysis of the first 209 intrapartum fetal heart rate strips is presented. Variable decelerations were the most frequent indication for consultation, but they were less commonly interpreted as indicating fetal distress. Such units have major advantages in terms of both cost and versatility over previously described systems and have proved extremely valuable to the rural practitioner of obstetrics.

Electrocardiography↗