Biomedical subjects
J Iskaros
Publications and source records attributed to J Iskaros.
Thromboembolic disease and air travel in pregnancy: a survey of advice given by obstetricians.
The objective of this study was to document the awareness of risk and the nature of advice given by obstetricians to pregnant women who intend to travel by air and to compare the results with the advice given in an opinion paper of the Royal College of Obstetricians and Gynaecologists. The results were based on a self-completed questionnaire. All registered members of the Royal College of Obstetricians and Gynaecologists comprising 1349 individuals, obtained from a list provided by the RCOG, were invited to participate. An anonymous postal questionnaire was completed by the individuals before publication of the opinion paper of the RCOG. A total of 862 (62%) questionnaires returned, and 690 (51%) were available for analysis; 67% of obstetricians regard flying as being safe throughout pregnancy, 33% only in the 2nd and 3rd trimester. Nearly all obstetricians advised on simple prophylactic measures such as mobilisation, fluid intake and leg exercise. Fifty-three per cent would advise the use of prophylactic aspirin (75 mg), 49% the use of compression stockings; 4% recommended heparinisation; 44% believed this advice to be applicable only for the 2nd and 3rd trimester, while the RCOG emphasises that the risk of developing venous thromboembolism begins in the 1st trimester. Obstetricians as well as other health professionals need to be made aware that advice on air travel in pregnancy needs to start in the 1st trimester. Further research is needed to explore the relevance of the duration of flight when considering the application of thromboprophylactic measures as well as the value and choice of pharmacological treatment such as aspirin and heparin.
Simultaneous intrapartum uterine and bladder rupture.
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Ultrasound markers of fetal chromosomal abnormality: a survey of policies and practices in UK maternity ultrasound departments.
OBJECTIVE: To evaluate the management of pregnancies where the fetus was found to have one or more sonographic markers of possible fetal chromosomal abnormality. DESIGN: Prospective anonymous postal survey of UK obstetric ultrasound units. MAIN OUTCOME MEASURES: The management of pregnancies where the fetus is found to have a sonographic marker of aneuploidy. POPULATION: All 252 maternity ultrasound units in the United Kingdom. METHODS: Postal questionnaire to the superintendent sonographer in routine maternal ultrasound departments. RESULTS: Questionnaires were returned from 179 maternity units (71%). Of the respondents 94% offered a fetal anomaly scan at 16-20 weeks' gestation and 59% performed a dating scan at 10-14 weeks. Screening for Down syndrome was available in 99% of all maternity units. The recognition of sonographic 'soft signs' for possible fetal chromosomal abnormality varied considerably between the units. When sonographers were asked about their unit's policy regarding offering amniocentesis to women with sonographic markers, 8-78% discussed amniocentesis when the marker was isolated and 53-88% when another abnormality was found. Eighty nine percent of units documented the abnormal ultrasound findings in the hospital notes and 88% of the women were informed of the findings regardless of the intention to offer amniocentesis. CONCLUSION: The practice of routine ultrasound examination is well established in UK, though precise policies vary. The existing wide variations in management policies possibly reflect a lack of data derived from low risk populations. There is a need to collect such data from low risk populations with known screening practices so that national guidelines to standardize practice can be formulated.
Thyroid hormone receptor gene expression in first trimester human fetal brain.
Maternal thyroid hormone is transferred to the fetus early in pregnancy and is postulated to regulate brain development. Thyroid hormone nuclear receptor (TR) proteins are present in fetal brain, but their isoformal composition is unknown. We therefore investigated the ontogeny of TR isoforms and related splice variants in first trimester human fetal brain (n = 9) by semi-quantitative reverse transcriptase-polymerase chain reaction analysis. Expression of the TRbeta1, TRalpha1 and c-erbAalpha2 isoforms was detected from 8.1 weeks gestation (wg). An additional truncated species was detected with the c-erbAalpha2 primer set, consistent with the c-erbAalpha3 splice variant previously described in the rat. All c-erbAalpha-derived transcripts were co-ordinately expressed and increased (ca. 8-fold) between 8.1 and 13.9 wg. A more complex ontogenic pattern was observed for TRbeta1, suggestive of a nadir between 8.4 and 12.0 wg. These findings point to an important role for the TRalpha1 isoform in mediating maternal thyroid hormone action during first trimester human fetal brain development.
The pubofascial anchor sling procedure for recurrent genuine urinary stress incontinence.
OBJECTIVE: To evaluate, in a preliminary study, the outcome of a modified pubovaginal sling operation with titanium bone anchors for recurrent genuine stress urinary incontinence (GSI) in women. PATIENTS AND METHODS: This prospective study included 13 consecutive women who underwent the modified sling procedure between September 1994 and August 1996. The subjective and objective cure of urinary stress incontinence, and the occurrence of postoperative osteitis pubis, were assessed. RESULTS: All 13 patients subjectively claimed complete urinary continence and 12 were objectively cured (12 patients agreed to undergo a repeat urodynamic study) during a median (range) follow-up of 26 (19-38) months. There were no cases of postoperative osteitis pubis, bladder injury or major complications. Mild suprapubic pain was a frequent and self-limiting complication. CONCLUSIONS: This innovative modified sling procedure is effective for recurrent urinary stress incontinence, with no complication of osteitis pubis. We suggest that this procedure should be considered as a treatment for recurrent GSI and perhaps for primary GSI. A study incorporating a longer follow-up and more patients has been planned.
Prospective non-invasive monitoring of pregnancies complicated by red cell alloimmunization.
Our purpose was to evaluate the impact of non-invasive assessment of fetal anemia and anti-D antibody quantification on the timing and frequency of invasive procedures in pregnancies complicated by rhesus alloimmunization. Nineteen consecutive non-hydropic pregnancies referred to the fetal medicine center were assigned a prior risk category (none/mild, moderate or severe) and monitored by: (1) serial fetal measurements of umbilical vein maximal flow velocity (UVVmax), liver length and spleen perimeter measurements; and (2) serial anti-D antibody concentration. Invasive tests for fetal anemia (amniocentesis or fetal blood sampling) were deferred in the absence of abnormal ultrasound findings and/or rising antibody levels. In six cases serial non-invasive tests were normal with stable antibody levels, and no invasive tests were performed; four infants were mildly affected, one was unaffected and one required postnatal exchange transfusion. In the remaining 13 affected cases, amniocentesis was performed in nine cases for: elevated UVVmax alone (n = 3), elevated UVVmax and an increased antibody level (n = 2), or normal UVVmax with an increased antibody level (> 15 IU/ml) and severe prior risk category (n = 4). Six fetuses underwent fetal blood sampling (initial hematocrit 9-29%), and five of these had an elevated UVVmax. Liver length and spleen perimeter measurements were increased in only one anemic fetus (hematocrit 13%). Of 17 infants born alive, an elevated UVVmax prior to delivery was predictive of the need for exchange transfusion (six of seven cases with an elevated UVVmax vs. one of ten with a normal UVVmax; chi 2 = 5.73, p = 0.017 with Yates' correction). These preliminary data suggest that pregnancies with a mild or no history of fetal anemia may be monitored by a combination of serial antibody quantification and Doppler monitoring of UVVmax.
Outcome of nonimmune hydrops fetalis diagnosed during the first half of pregnancy.
OBJECTIVE: To evaluate the etiology and outcome of fetal hydrops of nonimmune origin diagnosed in utero during the first half of pregnancy. METHODS: We reviewed 45 cases of nonimmune fetal hydrops presenting between 11 and 17 weeks' gestation over a 4-year period. RESULTS: The median gestational age at diagnosis of fetal hydrops was 14 weeks. Placental edema was most commonly associated with generalized skin edema. Ascites was also observed in four cases, but no case presented with pleural or pericardial effusion. The fetal karyotype was abnormal in 35 cases (77.8%). Of the ten fetuses with a normal karyotype, four were classified as idiopathic, three had isolated atrioventricular septal defect, two were associated with maternal infection, and one had multiple pterygium. Fetal heart rate anomalies were found in both chromosomally normal and abnormal fetuses. All but one of the karyotypically abnormal pregnancies and five of ten euploid pregnancies were terminated. In all six pregnancies that continued, resolution occurred before mid-gestation. Three continuing euploid pregnancies resulted in fetal death, and only two had a normal outcome. CONCLUSION: Nonimmune fetal hydrops diagnosed before 18 weeks' gestation is associated with a higher incidence of aneuploidy than hydrops diagnosed during the second half of pregnancy. In most affected fetuses with a normal karyotype, spontaneous resolution occurred before 24 weeks' gestation, although the outcome was generally unfavorable.
Congenital anterior abdominal wall defects.
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