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Joanne Stone

Publications and source records attributed to Joanne Stone.

10 recordsLinked to original sources
PubMed2005

[Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy].

AIMS: To evaluate the long-term clinical significance of intrauterine hematomas detected in the first trimester of pregnancy in a general obstetric population. METHODS: A prospective study was designed to compare the perinatal outcome in 187 pregnant women with intrauterine hematomas to 6488 controls in which hematomas were not detected at first trimester by ultrasound examination. RESULTS: The incidence of intrauterine hematoma in the first trimester in a general obstetric population was 3.1%. A retroplacental position of the hematoma was significantly correlated with an increased risk for adverse maternal and neonatal complications. The presence or absence of symptoms of threatened abortion did not affect these outcomes. The rates of operative vaginal delivery (RR: 1.9; CI: 1.1-3.2) and cesarean section (RR: 1.4; CI: 1.1-1.8) were significantly greater in the hematoma group as compared to the control group, as well as the rates of pregnancy induced hypertension (RR: 2.1; CI: 1.5-2.9) and preeclampsia (RR: 4.0; CI: 2.4-6.7). Placental abruption (RR: 5.6; CI: 2.8-11.1), and the incidence of placental separation abnormalities was also significantly more frequent in the hematoma group (RR: 3.2; CI: 2.2-4.7). Perinatal complications, including the rate of preterm delivery (RR: 2.3; CI: 1.6-3.2), intrauterine growth restriction (RR: 2.4; CI: 1.4-4.1), fetal distress (RR: 2.6; CI: 1.9-3.5), meconium stained amniotic fluid (RR: 2.2; CI: 1.7-2.9), and NICU admission (RR: 5.6; CI: 4.1-7.6) were also significantly increased in this group. Furthermore, the frequency of intrauterine demise and perinatal mortality was increased in the hematoma group, but this difference did not reach statistical significance (p = 0.6 and p = 0.2). CONCLUSION: The authors' study suggests that the presence of an intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome.

Adult↗
PubMed2005

Long-term outcomes in multiple gestations.

Children born from a multiple gestation are at increased risk for cerebral palsy, learning disability, and language and neurobehavioral deficits. With the increased incidence of multiple pregnancies and use of assisted reproductive technology (ART), these issues are more commonly affecting parents. Long-term outcomes are a critical part of preconceptual and early pregnancy counseling for parents faced with a multiple gestation or considering ART, and the provider should be well versed on issues surrounding zygosity, gestational age, higher-order multiples, and the effects of options such as multifetal pregnancy reduction.

Female↗
PubMed2004

Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes.

OBJECTIVE: This study was performed to evaluate the efficacy of weekly courses of antenatal corticosteroids compared with a single course in women with preterm premature rupture of membranes (PROM). METHODS: A planned secondary analysis of women with preterm PROM who participated in a multicenter, randomized trial of weekly courses of antenatal corticosteroids versus single-course therapy was performed. After their first course of standard antenatal steroid therapy, administered between 24 to 32-6/7 weeks of gestation, consenting women were randomly assigned to receive betamethasone versus placebo injections weekly until 34-0/7 weeks of gestation. Maternal and neonatal morbidities were compared between the 2 groups. RESULTS: Of the 161 women with preterm PROM, 81 women were assigned to receive weekly courses of steroids and 80 to the single-course group. There were no significant differences in composite morbidity between the groups (27 [34.2%] of 81 patients versus 33 [41.8%] of 80 patients, P =.41). Chorioamnionitis was higher in patients who received weekly courses of antenatal steroids (39 [49.4%] of 81 patients versus 25 [31.7%] of 80 patients, P =.04). CONCLUSION: Weekly courses of antenatal steroids in women with preterm PROM did not improve neonatal outcomes beyond that achieved with single-course therapy and was associated with an increased risk of chorioamnionitis. Antenatal steroid therapy should not be routinely repeated in patients with preterm PROM. LEVEL OF EVIDENCE: I

Adult↗
PubMed2003

Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy.

OBJECTIVE: To evaluate the long-term clinical significance of intrauterine hematomas detected in the first trimester of pregnancy in a general obstetric population. METHODS: A prospective study was designed to compare perinatal outcomes in 187 pregnant women with intrauterine hematomas and 6488 controls in whom hematomas were not detected at first-trimester ultrasonographic examination. RESULTS: The incidence of intrauterine hematoma in the first trimester in a general obstetric population was 3.1%. A retroplacental position of the hematoma was significantly correlated with an increased risk for adverse maternal and neonatal complications. The presence or absence of symptoms of threatened abortion did not affect these outcomes. The rates of operative vaginal delivery (relative risk [RR] 1.9; confidence interval [CI] 1.1, 3.2) and cesarean delivery (RR 1.4; CI 1.1, 1.8), as well as the rates of pregnancy-induced hypertension (RR 2.1; CI 1.5, 2.9) and preeclampsia (RR 4.0; CI 2.4, 6.7), were significantly greater in the hematoma group. Placental abruption (RR 5.6; CI 2.8, 11.1) and placental separation abnormalities (RR 3.2; CI 2.2, 4.7) were also significantly more frequent in the hematoma group. Perinatal complications, including the rate of preterm delivery (RR 2.3; CI 1.6, 3.2), fetal growth restriction (RR 2.4; CI 1.4, 4.1), fetal distress (RR 2.6; CI 1.9, 3.5), meconium-stained amniotic fluid (RR 2.2; CI 1.7, 2.9), and neonatal intensive care unit admission (RR 5.6; CI 4.1, 7.6), were also significantly increased in this group. Furthermore, the frequency of intrauterine demise and perinatal mortality was increased in the hematoma group, but this difference did not reach statistical significance (Ps =.6 and.2). CONCLUSION: Our study suggests that the presence of an intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome.

Abortion, Spontaneous↗
PubMed2003

Allelic imbalance in colorectal cancer at the CRAC1 locus in early-onset colorectal cancer.

A susceptibility gene to colorectal adenomas and carcinoma (CRAC1) on chromosome region 15q14 approximately q22 has been proposed on the basis of linkage in a single family. Allele-specific loss of heterozygosity (LOH) in tumors of affected family members suggests that the causative gene functions as a tumor-suppressor gene. The genes that are mutated in inherited cancer syndromes are often involved in the pathogenesis of sporadic cancer. To determine whether CRAC1 plays a role in colorectal carcinogenesis in general, we have studied 277 cases of early-onset colorectal cancers for allele loss at 15q14 approximately q22 using four microsatellite markers (D15S970, D15S117, D15S971, and D15S1028) that define the region of maximal linkage. The frequency of LOH detected was between 14% and 22%, but there was no significant association between LOH at each adjacent marker. Most cancers caused by loss of expression of a tumor suppressor involve large-scale deletion of one allele. On this basis, our findings suggest that CRAC1 is unlikely to be implicated in the development of colorectal cancer in general or, if involved, it is through small somatic mutations or other loss of function mechanisms rather than allele loss.

Allelic Imbalance↗
PubMed2003

Invasive procedures in multiple gestations.

PURPOSE OF REVIEW: The incidence of multiple gestations has increased significantly with advances in assisted reproductive techniques resulting in a concomitant increase in invasive procedures in these pregnancies. Commonly performed invasive procedures include amniocentesis, chorionic villus sampling, multifetal pregnancy reduction, and selective termination. Amniocentesis and chorionic villus sampling are also performed in singleton pregnancies, while multifetal pregnancy reduction and selective termination are procedures that are unique to multiple gestations. RECENT FINDINGS: With increased operator experience, pregnancy loss rates after chorionic villus sampling, multifetal pregnancy reduction, and selective termination have decreased to acceptably low levels. Amniocentesis and chorionic villus sampling continue to have similar loss rates in experienced hands. A recent study suggests that amniocentesis in twins may have a higher post-procedural loss rate than in singletons; this may be due to the higher background loss rate of twins. There has been a recent increase in multifetal pregnancy reduction to a singleton with a trend towards improved outcomes over reduction to twins; future studies should focus on whether this confers a definitive advantage. Newer data suggests that selective termination after 20 weeks gestation in experienced hands does not increase loss rates over those procedures performed before 20 weeks. Newer techniques, such as cord coagulation, continue to be developed for selective termination in monochorionic pregnancies, though still with considerable morbidity and mortality. SUMMARY: In summary, invasive procedures in multiple gestations are now commonly performed with. It is our hope that primary prevention of high order multiple pregnancies by optimization of assisted reproductive techniques will decrease the need for these procedures.

Abortion, Eugenic↗
PubMed2003

Contribution of germline mutations in BRCA2, P16(INK4A), P14(ARF) and P15 to uveal melanoma.

PURPOSE: Reports suggest that a subset of uveal melanoma is familial. The association of uveal melanoma with breast and ovarian cancer and the increased risk in BRCA2-linked families implicates germline BRCA2 mutations as the cause of a subset of uveal melanomas. Similarly, the association between cutaneous and uveal melanomas in some families, coupled with the high frequency of somatic deletions of the INK4A-ARF locus in uveal melanomas, strongly suggests that mutations in P16(INK4A) and P15 account for a proportion of uveal melanomas. METHODS: To examine this proposition, a systematically ascertained series of 385 patients with uveal melanoma were screened for germline mutations in BRCA2, P16(INK4A), P14(ARF), and P15. RESULTS: One patient was found to harbor a Gly35Ala substitution in exon 1alpha of P16(INK4A), which has previously been reported to be pathogenic. No mutations were detected in P14(ARF) or P15. None of the patients harbored germline nucleotide changes that lead to truncation or that create or disrupt consensus splice sites of BRCA2 or missense variants with clear pathogenic potential. CONCLUSIONS: These findings suggest that less than 2% of cases of uveal melanoma can be ascribed to germline mutations in BRCA2, P16(INK4A), P14(ARF), or P15. It is likely that mutations in other genes contribute to an inherited predisposition to uveal melanoma.

Adult↗
PubMed2002

A single center experience with 1000 consecutive cases of multifetal pregnancy reduction.

OBJECTIVE: Multifetal pregnancy reduction (MPR) is a technique developed to reduce the risks of a multifetal pregnancy. The objective of this article was to report the outcome of MPR in the largest single-center experience to date. STUDY DESIGN: A computerized database was used to determine the outcome of 1000 consecutive cases patients undergoing transabdominal MPR between the years 1986 and 1999. Outcomes analyzed included pregnancy loss rates, preterm delivery rates, and mean birth weights. RESULTS: The complete pregnancy loss rate was 5.9%, whereas the unintended pregnancy loss rate was 5.4%. The loss rate was 9.5% in the first 200 cases and remained stable at 4.5% to 6.0% over the next 800 cases. The loss rate was lowest with starting numbers of two fetuses (2.5%), remained stable for three, four, and five fetuses, and increased to 12.9% with starting numbers of six fetuses or greater. Loss rates were similar with a finishing number of one or two (3.5 % and 5.5%, respectively) but were highest for a finishing number of three (16.7%). Analysis of birth weights showed a linear decline with increasing starting and finishing numbers. Mean gestational age of delivery for finishing numbers of one, two, and three fetuses was 37.9, 35.3, and 33.5 weeks. CONCLUSION: Unintended loss rates associated with MPR have stabilized at 5.4%. Loss rates are highest with starting numbers of six or more fetuses, but did not differ for starting numbers of three, four, or five fetuses. Gestational age of delivery for finishing numbers of one, two, and three fetuses are similar to that of nonreduced pregnancies.

Abortion, Spontaneous↗