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Biomedical subjects

J F Rodis

Publications and source records attributed to J F Rodis.

At least 37 records · Page 2Linked to original sources
PubMed1997

A randomized clinical trial comparing misoprostol with prostaglandin E2 gel for preinduction cervical ripening.

OBJECTIVE: Our purpose was to perform a randomized trial comparing intravaginal misoprostol to intravaginal prostaglandin E2 gel for preinduction cervical ripening evaluating efficacy and side effects. STUDY DESIGN: Seventy-five women seen for induction of labor were randomized to receive 100 micrograms of intravaginal misoprostol or 5 mg of pharmacy-prepared intravaginal prostaglandin E2 gel for cervical ripening before oxytocin induction. Six hours after placement of the study agent, patients were given oxytocin if they were not in labor. The primary outcome measure was induction-to-delivery time; secondary measures were change in Bishop score, delivery mode, and side effects. Results were analyzed by the Student t test and Fisher's exact test, with p < 0.05 considered significant. RESULTS: There was no difference in the incidence of primiparity or the median initial Bishop score between the two study groups. The mean time to delivery and the need for oxytocin was significantly less for subjects receiving misoprostol. There was no difference in the incidence of uterine hyperstimulation syndrome or cesarean delivery between the groups. CONCLUSIONS: This randomized clinical trial indicates that misoprostol is efficacious for preinduction cervical ripening. Misoprostol use resulted in a significantly shorter induction-to-delivery time compared with prostaglandin E2 gel use. The side effects associated with misoprostol may be dose related, and further studies to identify the optimum dosage and interval are needed.

Adult↗
PubMed1997

Down syndrome and neural tube defect screening: the value of using gestational age by ultrasonography.

OBJECTIVE: Our goal was to determine whether gestational age should be based on ultrasonographic evaluation or last menstrual period data in the interpretation of second-trimester maternal serum screening for Down syndrome and open neural tube defects. STUDY DESIGN: Initial and revised screen-positive rates and detection rates were reviewed for women undergoing triple-marker testing (maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol). The study population consisted of > 24,000 women at 15.0 to 21.9 weeks' gestation with approximately 60% of test interpretations based on ultrasonographic evaluation of gestational age. Gestational age and screening results were compared for 24 Down syndrome pregnancies in which both ultrasonography and last menstrual period dating were available. RESULTS: Both initial and revised screen-positive rates for Down syndrome were significantly lower when ultrasonographic data were used compared with last menstrual period dating. The detection rate for Down syndrome appeared to be higher with ultrasonographic dating (approximately 76% vs 60% for last menstrual period dating). Down syndrome fetuses had a significantly shorter gestational age when evaluated by ultrasonography (relative to last menstrual period dating), but a similar trend was also seen in control pregnancies. Initial and revised screen-positive rates for open neural tube defects were higher for women who had received an ultrasonographic examination compared with the rates for those women referred with only last menstrual period data. The detection rates for open neural tube defects were similar for both methods of pregnancy dating. CONCLUSION: By use of ultrasonographic measurement of gestational age, the number of amniocenteses performed to detect Down syndrome can be substantially reduced while detection rates are maintained or improved.

Adult↗
PubMed1997

Iliac wing angle as a marker for trisomy 21 in the second trimester.

OBJECTIVE: To evaluate the fetal iliac wing angle in detecting trisomy 21 in the second trimester of pregnancy. METHODS: Using an axial view of the fetal pelvis, the angle between the right and left iliac wings (iliac wing angle) was measured ultrasonographically at the time of the second-trimester ultrasound or genetic amniocentesis in 377 singleton fetuses. Trisomy 21 was diagnosed by karyotype results from the amniocentesis or newborn examination with karyotype if trisomy 21 was suspected based on phenotypic features. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were calculated using multiple cutoff points. A receiver operating characteristic (ROC) curve was used to identify the optimum iliac wing angle. Descriptive statistics and Student t test were utilized for analyses with a P of less than .05 considered significant. RESULTS: The average gestational age was 18.8 weeks (range 13-32). Karyotypes were available in 128 fetuses. The overall prevalence of trisomy 21 was 11 of 377 (2.9%). The mean (+/-standard deviation) iliac wing angle in the normal fetuses was 68.2 degrees (+/-15.4 degrees) and 98.5 degrees (+/-11.3 degrees) in fetuses with trisomy 21 (P < .001). Using an ROC-derived absolute cutoff of 90 degrees, an abnormal iliac wing angle had sensitivity of 90.9% (ten of 11), specificity of 94.5% (346 of 366), NPV of 99.7% (346 of 347), and PPV of 33.3% (ten of 30) to detect trisomy 21. CONCLUSION: Fetuses with trisomy 21 have greater iliac wing angles than do normal fetuses. Using an ROC-derived absolute cutoff of 90 degrees, we could detect 90.9% of fetuses with trisomy 21 with a PPV of 33% in our high-risk population. These findings suggest that iliac wing angle is a useful marker in antenatal screening for trisomy 21.

Adolescent↗
PubMed1997

Angiographic embolization of a ruptured renal artery aneurysm during pregnancy.

BACKGROUND: Ruptured arterial aneurysms during pregnancy usually are catastrophic, and the primary approach is surgical. Angiographic embolization is an alternative treatment. CASE: A 28-year-old primigravida with a history of congenital hepatic fibrosis presented at 23 weeks' gestation with abdominal pain, hypertension, and proteinuria. She underwent a cesarean delivery for preeclampsia and a retroperitoneal hematoma was noted. A postoperative angiogram revealed bilateral renal artery and splenic aneurysms. She underwent two angiographic embolizations of a ruptured right renal artery aneurysm and was discharged to undergo outpatient embolotherapy of the left renal and splenic aneurysms. The day after discharge, she died because of rupture of the splenic aneurysm. CONCLUSION: Aggressive management of ruptured and high-risk unruptured aneurysms during pregnancy is indicated. Embolotherapy is an alternate approach if surgery is not possible.

Adult↗
PubMed1997

Effects of transdermal nicotine or smoking on nicotine concentrations and maternal-fetal hemodynamics.

OBJECTIVE: To compare nicotine concentrations and fetal middle cerebral artery resistance indices (RIs) during 21-mg transdermal nicotine use with these values during maternal smoking. METHODS: In this randomized, crossover study, participants smoked approximately 20 cigarettes daily and were between 24 and 36 weeks' gestation. Subjects were randomized to transdermal nicotine or to smoking ad libitum for 8 hours. One week later, they crossed over to the other condition. Maternal plasma nicotine concentrations and hemodynamic measurements were obtained before and after the onset of smoking or patch placement. RESULTS: Area under the plasma nicotine concentration-time curve during patch use was similar to continued smoking (93 versus 89 ng-hour/mL, respectively) (P = .77). The mean (standard error [SE] change in the middle cerebral artery RI from baseline to 4 hours later was similar during patch use and smoking: -.002 (0.008) versus -.02 (0.015), respectively (P = .3). The study had greater than 80% power to detect a 25% difference in nicotine concentrations and a change of 2 standard deviations in the middle cerebral artery RI between conditions. An unexpected finding was that of a loss of fetal heart rate (FHR) reactivity in 5/8 tracings after patch placement versus 1/6 tracings after smoking (P = .12). The baseline FHR increased by a mean (SE) of 8 (4) beats per minute with loss of reactivity in the patch condition, compared with a decrease of 3 (3) beats per minute without loss of reactivity (P = .05). CONCLUSION: Eight-hour use of 21-mg transdermal nicotine yields nicotine concentrations and middle cerebral artery RIs similar to those produced by hourly smoking in pregnant smokers.

Administration, Cutaneous↗
PubMed1996

Elevated second-trimester maternal serum hCG alone or in combination with elevated alpha-fetoprotein.

OBJECTIVE: To evaluate the clinical significance of a second-trimester elevated maternal serum hCG in women carrying singleton, chromosomally normal fetuses. METHODS: The results of second-trimester maternal serum screening (alpha-fetoprotein [MSAFP], hCG, and unconjugated estriol) for 25,438 women were reviewed, and those with hCG values exceeding 3.0 multiples of the median (MoM) were identified. A control population was selected only on the basis of samples accessioned by the laboratory at the same time as the study group. Follow-up information was collected from physicians' offices for both groups. Incidence of fetal or neonatal loss (spontaneous abortion, fetal death, and neonatal death combined), preterm birth (before 37 weeks' gestation), small for gestational age, and preeclampsia were compared. RESULTS: Three hundred twenty-two women (1.3%) had hCG levels exceeding 3.0 MoM. In addition to chromosomal abnormalities and fetal death at the time of testing, this group showed a significantly higher incidence of fetal or neonatal death, preterm birth, low birth weight, and preeclampsia than did controls. For patients with elevated second-trimester hCG, many of the preterm deliveries occurred before 34 weeks' gestation. Logistic regression analysis indicated that hCG, MSAFP, and race were significant independent factors in predicting risk for adverse outcome. CONCLUSIONS: Similar to elevated AFP, elevated hCG is associated with poor pregnancy outcome. By combining the results of the two tests, it may be possible to improve substantially the identification of patients at very high risk for adverse outcomes.

Adult↗
PubMed1996

Atypical presentation of preeclampsia in high-order multifetal gestations.

OBJECTIVE: To describe our experience with preeclampsia in high-order multifetal gestations. METHODS: Records for all triplet and quadruplet pregnancies delivered after 24 weeks' gestation from January 1988 through June 1994 were reviewed. All patients were treated with bed rest from 20 weeks' gestation onward and received corticosteroids weekly beginning at 24 weeks. Tocolytics were used as needed. RESULTS: Twenty-one triplet and eight quadruplet pregnancies were studied. The mean gestational age at delivery was 32.3 and 27.9 weeks, and mean birth weights were 1547 and 1028 g, respectively. Seventeen of 29 patients developed preeclampsia, 14 of the 21 triplet mothers and three of the eight quadruplet mothers. Among 16 patients who were delivered for preeclampsia, only eight had blood pressure (BP) elevation before delivery, whereas ten had epigastric pain, visual disturbances and/or headache; nine had elevated liver enzyme levels; and seven had low platelet counts. Only three patients had proteinuria, and only six had edema. Five women developed the syndrome of hemolysis, elevated liver enzymes, and low platelets postpartum, all of whom had normal BP before delivery. Two patients developed preeclampsia after delivery. A total of 95 infants were delivered, all by cesarean, of whom 93 (98%) survived. CONCLUSION: Preeclampsia is common in high-order multifetal gestations and often presents in an atypical manner. Hypertension is not always the presenting sign, and symptoms consistent with severe preeclampsia and abnormal laboratory values predominate.

Adult↗
PubMed1996

The use of second-trimester genetic sonogram in guiding clinical management of patients at increased risk for fetal trisomy 21.

OBJECTIVE: To test the efficacy of ultrasound in detecting fetuses with trisomy 21. METHODS: From November 1, 1992, to December 31, 1995, a second-trimester genetic sonogram was offered to all women with singleton fetuses at increased risk (at least 1:274) for trisomy 21, who had either declined genetic amniocentesis or chose to have a sonogram before deciding whether to undergo an amniocentesis. In addition to standard fetal biometry, the following ultrasound markers for aneuploidy were evaluated: structural anomalies (including face, hands, and cardiac [four-chamber view and outflow tracts]), short femur, short humerus, pyelectasis, nuchal fold thickening, echogenic bowel, choroid plexus cysts, hypoplastic middle phalanx of the fifth digit, wide space between the first and second toes, and two-vessel umbilical cord. Outcome information included the results of genetic amniocentesis, if performed, or the results of postnatal pediatric assessment and follow-up. RESULTS: Five hundred seventy-three patients had a genetic sonogram between 15 and 23 weeks' gestation: 378 patients had advanced maternal age (at least 35 years), 141 had abnormal serum biochemistry, and 54 had both. The majority (495, or 86.3%) had a normal genetic sonogram (absence of abnormal ultrasound markers); 51 (9%) had one marker present, and 27 (4.7%) had two or more markers present. Outcome was obtained on 422 patients (the remaining were ongoing pregnancies or were lost to follow-up). Twelve of 14 fetuses with trisomy 21, one fetus with trisomy 13, and one fetus with triploidy had two or more abnormal ultrasound markers present; one fetus with trisomy 21 had one abnormal marker and one had a completely normal ultrasound. When one or more abnormal ultrasound markers were present, the sensitivity, specificity, and positive and negative predictive values for trisomy 21 were 92.8%, 86.7%, 19.4%, and 99.7%, respectively. When two or more abnormal ultrasound markers were present, the corresponding values were 85.7%, 96.8%, 48%, and 99.5%. In the study population, the amniocentesis rate was 12.7% overall and 17.3% in cases with known outcome. CONCLUSION: Second-trimester genetic sonogram may be a reasonable alternative for patients at increased risk for fetal trisomy 21 who wish to avoid amniocentesis. In experienced hands, this approach may result in a high detection rate of trisomy 21 (93%), with an amniocentesis rate of less than 20%.

Adult↗
PubMed1996

Adjusting the risk for trisomy 21 by a simple ultrasound method using fetal long-bone biometry.

OBJECTIVE: To establish the efficacy of second-trimester fetal long-bone biometry (femur, humerus, tibia, and fibula length) in detecting trisomy 21 and to generate tables for adjusting the risk of trisomy 21 according to long-bone biometry. METHODS: Four long-bones--femur, humerus, tibia, and fibula--were measured ultrasonically in singleton fetuses before genetic amniocentesis. Fetuses with normal karyotypes were used to derive regression equations describing predicted lengths on the basis of the biparietal diameter measurement. The efficacy of each abnormally short bone, alone and in combination, was determined in 22 fetuses with trisomy 21 encountered during the study period. After the sensitivity and specificity of long-bone biometry were established, appropriate tables were generated by Bayes' theorem to adjust the risk of trisomy 21 in the second trimester depending on long-bone biometry. RESULTS: Of 515 patients between 14 and 23 weeks' gestation, 493 had normal fetal karyotypes and 22 had trisomy 21. The sensitivity of an abnormal ultrasound, as defined by the presence of one or more short bones, was 63.6% and the specificity was 78.5%. According to Bayes' theorem, genetic amniocentesis may not be recommended for women less than 40 years old in the presence of normal long-bone biometry (ie, all four bones normal). CONCLUSION: Second-trimester fetal long-bone biometry is useful in detecting trisomy 21 and may be used to adjust the a priori risk of both high- and low-risk women for trisomy 21 and, therefore, the need for genetic amniocentesis.

Anthropometry↗
PubMed1996

Obstructive sleep apnea in pregnancy.

Obstructive sleep apnea is a common medical condition characterized by periodic apneas during sleep that produce hypoxia and sleep disruption. Several cases of obstructive sleep apnea in pregnancy have been reported. In the case reported the woman admitted for evaluation and management of preeclampsia was observed experiencing apneic episodes and oxygen desaturation during sleep. Subsequent evaluation confirmed the diagnosis of obstructive sleep apnea. Pregnancy may be complicated by obstructive sleep apnea with potential adverse effects on the mother and fetus. Prompt diagnosis would allow early treatment and may prevent low birth weight and the development of preeclampsia.

Female↗
PubMed1996

Prenatal diagnosis of intracranial lipoma associated with agenesis of the corpus callosum.

BACKGROUND: Lipoma of the corpus callosum is a congenital malformation present in 1:1700 individuals. Only three cases of prenatal sonographic diagnosis have been described. CASES: Two cases of prenatal sonographic diagnosis of intracranial lipoma are described. The first case was visible at 26 weeks' gestation and was associated with partial agenesis of the corpus callosum, a characteristic midline gyral pattern, and fetal colpocephaly. The second case was an isolated lipoma diagnosed at 37 weeks. In both cases transvaginal scanning and color Doppler studies were useful adjuncts in making the diagnosis. CONCLUSION: Prenatal sonographic diagnosis of intracranial lipoma associated with agenesis of the corpus callosum is possible as early as 26 weeks' gestation. Because prognosis depends on associated anomalies, a detailed examination of fetal intracranial anatomy and a complete anatomic survey should be performed. Awareness of this lesion can be expected to increase its detection on prenatal sonography.

Adult↗
PubMed1996

Predicting pregnancy outcome from the degree of maternal serum alpha-fetoprotein elevation.

OBJECTIVE: To determine if a correlation exists between the level of maternal serum alpha-fetoprotein (MSAFP) elevation and the rate of adverse pregnancy outcome, to examine the timing of pregnancies ending in fetal or neonatal death, and to develop a protocol for antepartum surveillance in an effort to prevent these adverse outcomes. STUDY DESIGN: Singleton pregnancies with a single second-trimester elevated MSAFP > or = 2.0 multiples of the median (MoM) were eligible if a targeted ultrasound evaluation (< 24 weeks) was in agreement with the dates and no fetoplacental anomaly was detected. Three groups were established based on the second-trimester MSAFP elevation: 2.0-2.49, 2.5-2.99 and > or = 3.0 MoM. RESULTS: Among the 383 patients enrolled, delivery data were available on 333 infants. Stratified by MSAFP elevations of 2.0-2.49, 2.5-2.99 and > or = 3.0 MoM, the rates of adverse pregnancy outcome were: (1) preterm birth: 14.3%, 15.6%, 20.3%; (2) small for gestational age at birth: 7.4%, 11.1%, 22.2%; and (3) perinatal deaths (neonatal and fetal): 2.6%, 3.3%, 5.6%. Seven pregnancy losses (three neonatal and four fetal deaths) occurred prior to 28 weeks. Of these seven, six fetuses exhibited intrauterine growth retardation by 23-26 weeks' gestation, and five of six were associated with MSAFP levels > or = 2.5 MoM. Four losses (two neonatal and two fetal deaths) occurred after 28 weeks. Of these, three involved structurally normal infants with normal growth who died after 34 weeks. All three of these pregnancies exhibited MSAFP elevations < 2.5 MoM. CONCLUSION: In pregnancies with an unexplained elevated second-trimester MSAFP, the rate of adverse pregnancy outcomes is increased with higher elevations. Any proposed program to improve pregnancy outcome in patients with unexplained MSAFP elevations must include efforts aimed at preventing preterm delivery, repeat ultrasound at 24-26 weeks to rule out early-onset intrauterine growth retardation in pregnancies with elevations > or = 2.5 MoM and fetal biophysical monitoring, even in normally grown fetuses, instituted at 32 weeks to detect fetuses at risk for intrauterine death.

Adolescent↗
PubMed1995

Trisomy 16 fetus surviving into the second trimester.

A 27-year-old gravida 4, para 3 was found to have anhydramnios at 14 weeks' gestation following a size/date discrepancy noted at her routine prenatal visit. A detailed ultrasound revealed multiple fetal anomalies including congenital heart defect, chest hypoplasia, and bilateral dysplastic kidneys. Karyotype revealed trisomy 16 in 15/15 cells from a tissue specimen obtained from the fetal cord insertion site following elective pregnancy termination.

Abnormalities, Multiple↗
PubMed1995

Gender-specific second-trimester biometry.

OBJECTIVE: This study was designed to evaluate the significance of gender differences for commonly used biometric parameters obtained ultrasonographically from second-trimester euploid fetuses. STUDY DESIGN: Gender-specific linear regression equations were developed for gestational age dependent and independent biometry from second-trimester ultrasonographically normal singleton euploid fetuses by use of biparietal diameters and femur and humerus lengths. Regression lines for male fetuses were compared with those for females by determining overlap of 95% confidence intervals at specific points. RESULTS: A total of 288 male fetuses (mean gestational age 16.7 +/- 1.0 weeks) and 251 female fetuses (mean gestational age 16.8 +/- 1.2 weeks) (not significant) were evaluated. Small statistically significant gender differences in fetal biometry were identified. The largest gender difference for gestational age-dependent parameters was a biparietal diameter difference of 1.15 mm at 21 weeks. The largest gender difference for gestational age-independent parameters was a femur length difference of 1.7 mm at a biparietal diameter of 50 mm. CONCLUSION: Statistically, but not clinically, significant gender differences of small magnitude exist for second-trimester fetal biometry, suggesting that gender-specific nomograms may be of limited value.

Biometry↗
PubMed1995

Second-trimester abortion by intramuscular 15-methyl-prostaglandin F2 alpha or intravaginal prostaglandin E2 suppositories: a randomized trial.

OBJECTIVE: To compare intramuscular (IM) prostaglandin 15 methyl-F2 alpha (15M-PGF2 alpha) with prostaglandin E2 (PGE2) vaginal suppositories for second-trimester abortion in terms of efficacy and side effects. METHODS: Fifty-one women were randomized to receive either 15M-PGF2 alpha IM injections or PGE2 intravaginal suppositories for second-trimester abortion. Efficacy and side effects of the two agents were analyzed by two-tailed t tests, chi 2 analysis with Fisher exact test, and survival analysis. RESULTS: The mean times to rupture of membranes, delivery of fetus, and delivery of placenta were significantly less for women receiving PGE2 vaginal suppositories. The cumulative abortion rate after 24 hours for the PGE2 group was 96%, compared with 69% for the 15M-PGF2 alpha group. Although there were few differences in side effects, the 15M-PGF2 alpha group had significantly fewer headaches, fevers, and chills. CONCLUSION: Intravaginal PGE2 is superior to IM 15M-PGF2 alpha for second-trimester abortion.

Abortion, Induced↗
PubMed1995

Low-dose aspirin therapy and placental pathology in women with poor prior pregnancy outcomes.

PROBLEM: To determine if low dose aspirin therapy improves placental histology in women with a prior complicated pregnancy demonstrating uterine vascular pathology. METHOD: A retrospective chart review identified patients with a prior complicated pregnancy with placental changes showing uterine vascular pathology (control pregnancy, CP). In the treated pregnancy (TP), 81 mg/day of ASA was started prior to 10 weeks. Placental reports from the CP and TP were reviewed. Pregnancy outcomes and placental histology from the CP were compared to the TP for each patient. RESULTS: Thirteen patients were enrolled. The majority of patients (8/13, 61.5%) exhibited recurrent, histologic evidence of uterine vascular pathology in the TP. The TP was more likely to be uncomplicated (P < 0.05), delivered after 36 weeks (P < 0.05), and result in the delivery of a viable infant (P < 0.05) compared to the CP. CONCLUSIONS: Despite an improvement in outcomes in the aspirin treated pregnancy, histologic evidence of uterine vascular pathology persisted in the majority of women with a prior complicated pregnancy demonstrating similar placental lesions. Abnormal placental histology may be useful in identifying a group of women with poor obstetrical histories who could benefit from low-dose aspirin therapy.

Adolescent↗
PubMed1994

Use of the transverse cerebellar diameter/abdominal circumference ratio in pregnancies at risk for intrauterine growth retardation.

A prospective study was conducted to evaluate the ability of the transverse cerebellar diameter/abdominal circumference ratio to identify growth-retarded fetuses. Of the cases analyzed, 48 of 87 (55%) were growth retarded by birth weight. The transverse cerebellar diameter/abdominal circumference ratio identified growth retardation with a sensitivity of 71%, specificity of 77%, positive predictive value of 79%, and negative predictive value of 68%. Fourteen growth-retarded fetuses were missed by the ratio; however, 57% of the missed cases were severely growth retarded. The transverse cerebellar diameter/abdominal circumference ratio can be useful for the assessment of fetal growth retardation; however, the ratio may be normal in cases of severe fetal growth retardation.

Abdomen↗