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M Mongelli

Publications and source records attributed to M Mongelli.

48 records · Page 3Linked to original sources
PubMed1996

Gestation-adjusted projection of estimated fetal weight.

OBJECTIVE: To assess a technique for forward extrapolation of ultrasound-estimated fetal weight to the time of delivery. METHODS: A total of 276 women who delivered within 35 days of ultrasound examination were studied. Fetal weight was estimated according to either Hadlock's formula for the biparietal diameter, abdominal circumference and femur length or Campbell's formula for the abdominal circumference. The extrapolation technique is based on the hypothesis that the fetal weight: median weight ratio remains constant in the third trimester. The weight estimates were either left unchanged or extrapolated to the time of delivery according to this method and compared with a technique described by Spinnato and colleagues (7, 8). The accuracy of the method was assessed by analysing the weight predictions in relation to the birth weights, using non-parametric tests. RESULTS: The mean systematic error using our extrapolation method with Hadlock's weight formula was 5.9%, which was significantly better than using Spinnato's method (8.8%) or making no adjustment at all (-6.5%). The random errors were also significantly reduced (11.2% versus 12.3% and 12.3%, p < 0.0005). With Campbell's formula, the mean systematic error from our method was 3.8%, whereas the unadjusted formula would have yielded an error of -8.5% (p < 0.001). The absolute errors with our technique were also significantly lower than those of the other methods. CONCLUSIONS: In the prediction of birth weight, an antenatal ultrasound estimation of fetal weight needs to be projected to the expected time of birth and for this it must take the time lapse to delivery into consideration. The method presented is able to accomplish this with simplicity and accuracy.

Birth Weight↗
PubMed1995

An adjustable fetal weight standard.

The monitoring of fetal weight is an important aspect of antenatal care. To construct an individually adjustable standard, we developed a model to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy. A formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight, and also defines the 90th and 10th centile curves as normal limits. We analyzed a birth weight database of 38,114 singleton, routine ultrasound-dated pregnancies resulting in term deliveries. By stepwise multiple regression analysis, we derived coefficients for the factors that act as variables on term birth weight in our population. Apart from gestational age and sex, the maternal height, weight at first visit, ethnic group, parity and smoking all have significant and independent effects on birth weight. The variation due to ethnic group appears to be physiological in this population. Smoking is associated with a reduction in birth weight, which is independent of maternal physique and related to the number of cigarettes per day as reported at the first visit. We have developed a software program which calculates, on the basis of pregnancy variables entered at the first visit, an adjusted normal range for fetal size. This can be printed out as a chart and used for antenatal surveillance of growth.

Birth Weight↗
PubMed1995

Longitudinal study of fetal growth in subgroups of a low-risk population.

We investigated fetal weight gain in relation to maternal characteristics within a normal, heterogeneous population in Nottingham, UK. A total of 226 low-risk pregnancies with normal neonatal outcome were examined longitudinally by serial ultrasound examination. Gestation was calculated from early measurements of biparietal diameter. A modified Hadlock's formula for fetal weight was employed, using the biparietal diameter, abdominal circumference and femur length, which was not associated with any significant systematic error. Individual curves were obtained by fitting serial fetal weight estimates and birth weight in a weighted log-polynomial model for fetal growth. The overall growth formula showed an almost linear relationship between gestational age and fetal weight at term. Maternal height and weight at the first hospital visit were positively correlated with fetal weight in the third trimester. The fetuses of parous women were also heavier in late pregnancy, as were those of European compared to Indo-Pakistani mothers. Intrauterine weight gain in the third trimester shows variation with pregnancy characteristics which need to be considered when fetal growth is assessed.

Adult↗
PubMed1995

Duration and variability of normal pregnancy. Implications for clinical practice.

OBJECTIVE: To estimate the true biologic length and variability of normal pregnancy on the basis of early ultrasonography and to assess the implications for clinical practice. STUDY DESIGN: We reviewed the clinical case notes on 476 women whose pregnancies were routinely dated by measurement of the biparietal diameter in the second trimester. After excluding abnormal cases, 355 pregnancies were available for analysis. The duration of pregnancy was studied in relation to maternal characteristics and also to induction of labor for postmaturity. RESULTS: The mean +/- SD for the normal duration of pregnancy were 279.7 and 7.4 days. The length of pregnancy was weakly related to maternal height. Of the 41 women whose labor was induced for postmaturity, only 7 were truly postmature when gestational age was determined by sonography. CONCLUSION: The current definitions of preterm and postterm may need to be revised to allow the increased precision achieved by ultrasound. Inclusion of menstrual data for the determination of gestational age may lead to incorrect clinical decisions.

Adult↗
PubMed1993

Birth weight from pregnancies dated by ultrasonography in a multicultural British population.

OBJECTIVE: To produce standard curves of birth weight according to gestational age validated by ultrasonography in the British population, with particular reference to the effects of ethnic origin. DESIGN: Retrospective analysis of computerised obstetric database. SETTING: Three large maternity units associated with Nottingham University with over 16,000 deliveries a year. PATIENTS: 41,718 women with ultrasound dated singleton pregnancies and delivery between 168 and 300 days' gestation. MAIN OUTCOME MEASURES: Length of gestation, ethnic origin, parity, maternal height and weight at booking, smoking during pregnancy; the effect of these variables on birth weight. RESULTS: Birth weights from ultrasound dated pregnancies have a higher population mean and show less flattening of the birthweight curve at term than those of pregnancies dated from menstrual history. Significant differences were observed in mean birth weights of babies of mothers of European origin (3357 g), of Afro-Caribbean origin (3173 g), and from the Indian subcontinent (3096 g). There were also significant interethnic differences in length of gestation, parity, maternal height, booking weight, and smoking habit which affected birth weight. The ethnic differences in birth weight were even greater when the effect of smoking was excluded. CONCLUSIONS: Birthweight standards require precise dating of pregnancy and should describe the population from which they were derived. In a heterogeneous maternity population the accurate assessment of an individual baby's weight needs to take the factors which affect birthweight standards into consideration.

Birth Weight↗
PubMed1993

Risk assessment adjusted for gestational age in maternal serum screening for Down's syndrome.

OBJECTIVE: To investigate the relation between errors in calculation of gestational age and assessment of risk of Down's syndrome and to analyse the implications for screening programmes. DESIGN: Retrospective analysis of dating of gestational age by menstrual history v ultrasound scan. Computer program with maternal age and concentrations of alpha fetoprotein and free beta human chorionic gonadotrophin to calculate risk for a range of expected dates of delivery. Computer simulated prospective application of new screening programme. SETTING: Teaching hospitals in Nottingham. SUBJECTS: 31,561 women with singleton pregnancies with gestational age based on routine ultrasound scan. Computer simulation of 20,000 women in three age ranges (up to 37; up to 40; all). MAIN OUTCOME MEASURES: Distribution of error between gestational age based on ultrasound scan v menstrual history. Proportion of women in the population who require precise dating of pregnancy; proportion of women who require amniocentesis. RESULTS: With gestational age derived from ultrasound scan as reference the 95% confidence interval for gestational age by menstrual history was -27 to +9 days. A screening programme for Down's syndrome for women up to age 40 would yield a low risk (< 1:250) for this range of days in 86.0% of cases. The 14.0% of women remaining would have one or more high risk values in their report and would thus require an ultrasound scan for precise dating of the pregnancy; 30% of these--that is, 3.7% of the screened population--would be identified as high risk and require consideration for amniocentesis. CONCLUSIONS: Screening programmes for Down's syndrome require the facility for precise dating of pregnancy to improve the accuracy of risk assessment. This can be achieved without introducing additional scans for early dating in the whole population but by selecting only those cases (about 14%) when an error in dates is likely to affect the risk of Down's syndrome.

Down Syndrome↗
PubMedDate not supplied

[Pericardial involvement as initial manifestation of multiple myeloma].

Pericardial involvement is a rare complication of multiple myeloma, caused by amyloidosis, infections, or plasmacell infiltration, usually at late or terminal disease stage. We report a patient with pericarditis coming from a department of Cardiology where a preceding (15 years before) diagnosis of breast cancer and present bloody pericardial effusion with probably malignant cells permitted at first to orientate towards metastatic pericardial involvement in breast cancer. Laboratory findings (pancytopenia, hypogammaglobulinemia, proteinuria) suggested to perform bone marrow aspirate, serum and concentrated urine immunoelectrophoresis, measurement of 24-h urine protein excretion, and further cytologic and immunocytochemical assay of pericardial fluid. Acquired data allowed to diagnose light chain multiple myeloma with pericardial involvement caused by plasmacell infiltration. We diagnosed this complication, representing first and main clinical feature of multiple myeloma, owing to a complete clinical and laboratory evaluation and repetition of cytologic and immunocytochemical assay of pericardial fluid.

Diagnosis, Differential↗