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Michael Y Divon

Publications and source records attributed to Michael Y Divon.

11 recordsLinked to original sources
PubMed2006

Fetal pyelectasis: does fetal gender modify the risk of major trisomies?

OBJECTIVE: Several studies have noted an increased prevalence of pyelectasis in male fetuses. It is speculated that pyelectasis represents a normal physiologic variant in males, whereas its presence in females indicates an increased risk of chromosomal abnormalities. Thus, we sought to investigate the association between fetal gender and the risk of major trisomies in fetuses with pyelectasis. METHODS: Retrospective analysis of a Genzyme Genetics amniocentesis database (1995 to 2004) was performed. Specimens obtained after an ultrasonographic finding of pyelectasis were eligible for analysis. The prevalence of major trisomies (trisomy 13, 18, or 21) in male and female fetuses with pyelectasis was compared using binomial distribution. RESULTS: A total of 760,495 amniocentesis specimens were analyzed. Fetal pyelectasis was reported in 671 cases. A male predominance, with a male-to-female ratio of 2.14:1 (457 compared with 214) was statistically significant (P < .001). A major trisomy was detected in 26 male fetuses (5.7%): 18 cases of trisomy 21, 2 cases of trisomy 18, and 6 cases of trisomy 13. Nine female fetuses had a major trisomy (4.2%): 6 cases of trisomy 21 and 3 cases of trisomy 13. There was no significant difference in the overall prevalence of trisomies between male and female fetuses (P = .14). CONCLUSION: We concur with previous studies documenting a higher prevalence of pyelectasis in male fetuses. In addition, our results indicate that the prevalence of major trisomies among fetuses with pyelectasis is unlikely to be dependent on fetal gender. Thus, counseling patients with regard to the genetic implications of fetal pyelectasis should be gender independent. LEVEL OF EVIDENCE: II-2.

Amniocentesis↗
PubMed2005

Fetal "nonreassuring status" is associated with elevation of nucleated red blood cell counts and interleukin-6.

OBJECTIVE: Previous studies have established the association between fetal hypoxia and elevated nucleated red blood cells (NRBCs). Animal studies have demonstrated that a rise in plasma erythropoietin (EPO) is not detectable until 4 to 6 hours after the initiation of hypoxia. In contrast, interleukin-6 (IL-6) has the capacity to directly induce erythroid maturation. Therefore, we set forth to evaluate the role of EPO and IL-6 as potential mediators of elevated fetal NRBCs in response to acute hypoxia. STUDY DESIGN: Low-risk pregnancies with a normal fetal heart rate at admission to labor and delivery were eligible for participation. Deliveries for "nonreassuring fetal status" comprised the study group. All other deliveries served as controls. Umbilical cord blood was prospectively collected for blood gas analysis, NRBC counts, EPO, and IL-6. RESULTS: One hundred women participated in the study. Nonparametric univariate analysis demonstrated a significant association between elevated NRBC counts and Apgar scores, arterial cord blood pH, base excess, EPO, and IL-6 levels (all P values <.01). Stepwise regression analysis identified only pH, IL-6, and EPO as independent variables associated with elevated NRBC counts at birth (all P values <.0001 with R2 of 0.27, 0.42, and 0.46, respectively). A significant increase in NRBC counts was noted in study patients. IL-6 was significantly increased in study patients, whereas there was no difference in EPO between groups. CONCLUSION: The fact that NRBC counts were elevated in fetuses who were delivered for "nonreassuring fetal status" with EPO being normal and IL-6 being elevated implies that IL-6 may have a unique, short-term role in elevating fetal NRBC counts.

Apgar Score↗
PubMed2004

Are elevated fetal nucleated red blood cell counts an indirect reflection of enhanced erythropoietin activity?

OBJECTIVE: Animal and human studies demonstrated elevated erythropoietin (EPO) levels in response to intrauterine hypoxic events. Other studies documented an association between fetal hypoxia and elevated nucleated red blood cell (NRBC) counts and have speculated that it is the elevation of EPO that results in an increase in NRBC counts. Thus, the purpose of our study was to determine the correlation between EPO levels and NRBC counts in the human fetus. STUDY DESIGN: Data were collected prospectively between April and July of 2003. Term singleton pregnancies were eligible to participate in the study. Umbilical cord blood was collected immediately after birth for determination of fetal EPO levels and NRBC counts. RESULTS: Forty pregnancies formed the study population. The mean gestational age at delivery was 39.5 +/- 1.2 weeks (+/-SD) and the mean birth weight was 3500 +/- 372 g. The median EPO (mU/mL) was 34 (range 13-427). The median NRBC/100 white blood cells was 10 (range 0-150). A simple regression analysis indicated that NRBC counts are significantly and positively correlated with EPO (P=.0004, R(2)=0.287). CONCLUSION: Our results suggest a significant association between EPO and NRBC counts in term singleton fetuses. These results support the hypothesis that fetal NRBC and EPO are interrelated. However, the relatively low R(2) indicates that there are other (yet to be determined) hypoxia-derived mediators that result in an elevation of fetal NRBC counts.

Adult↗
PubMed2004

Aortic dissection in pregnancy.

BACKGROUND: Aortic dissection is a rare but life-threatening disease. The most common predisposing cause is chronic hypertension. CASE: A 38-year-old multipara with chronic hypertension was admitted at 38 weeks of gestation reporting new-onset severe chest pain. Cardiac enzymes, blood gases, electrocardiogram, and chest radiograph were normal. The chest pain and the hypertension worsened despite treatment with narcotics. Bedside transesophageal echocardiography revealed aortic dissection. Uneventful cesarean delivery was followed by surgical repair of the aorta. CONCLUSION: Aortic dissection should be considered when a pregnant woman presents with preeclampsia superimposed on chronic hypertension and intractable chest pain.

Adult↗
PubMed2004

Nucleated red blood cells in uncomplicated prolonged pregnancy.

OBJECTIVE: Elevated counts of nucleated red blood cells (NRBCs), as well as prolongation of pregnancy, have been suggested as predictors of adverse perinatal outcome. However, the association between these 2 variables has received only minimal attention. We sought to evaluate fetal NRBCs in prolonged pregnancies. METHODS: Umbilical cord blood was prospectively collected at delivery from 75 prolonged (at or beyond 287 days) pregnancies. One hundred and fifty term deliveries (260-286 days) served as controls. All pregnancies were accurately dated with the use of first-trimester sonography. Fetal biophysical profile testing was initiated at 40 weeks of gestation. Patients were delivered if they were in spontaneous labor or the biophysical profile was nonreassuring or by 42 weeks of gestation. Nucleated red blood cell counts were expressed per 100 white blood cells (WBC). Umbilical artery pH studies, as well as other demographic and clinical variables, were obtained. RESULTS: Prolonged pregnancy was associated with a significantly increased incidence of induction of labor and a greater birth weight. There were no other differences between the study group and controls. The median NRBCs per 100 WBCs in prolonged pregnancy was not significantly elevated over the term values (median 3, range 0-35 versus median 3, range 0-34, respectively; P =.25). Neonatal outcome was also comparable between groups. The univariate regression analysis demonstrated a significant association between elevated NRBC counts and low arterial cord blood pH (P <.008, R = 0.175), elevated base excess (P =.02, R = 0.149), low platelet counts (P =.046, R = 0.134), and male gender (P =.028). Stepwise regression analysis revealed that low arterial cord blood pH and male gender were the only independent variables predicting elevated NRBC counts at birth. CONCLUSION: The findings of this study suggest that elevated NRBC counts are associated with specific pregnancy complications rather than uncomplicated prolonged pregnancies in general.

Adult↗
PubMed2003

Fine-needle aspiration in the evaluation of nucleated red blood cells in the human placenta.

OBJECTIVE: The purpose of this study was to evaluate the correlation between placental and umbilical cord nucleated red blood cell counts. STUDY DESIGN: Eighty placentas and their matched umbilical cord blood samples were collected prospectively immediately after delivery. In vitro fine-needle aspiration biopsy specimens were used to obtain placental tissue samples. Nucleated red blood cells were counted by both manual microscopy and flow cytometry. Statistical analysis included Wilcoxon signed rank test and Spearman correlation. RESULTS: The median nucleated red blood cell counts/100 white blood cell counts for manual microscopy in umbilical cord blood; placental samples were 7.5 and 3.0, respectively (P <.0001). The median nucleated red blood cell counts for flow cytometric determination in umbilical cord blood and placental samples were 11.3 and 8.6, respectively (P <.0001). The Spearman correlation between manually counted umbilical cord blood samples and the placental tissue specimens was 0.66 (P <.0001). The Spearman correlation between flow cytometrically counted umbilical cord blood nucleated red blood cell and nucleated red blood cell counts that were obtained from the placenta was statistically significant (r = 0.74, P <.0001). The Spearman correlation between manual microscopy and flow cytometry for umbilical cord samples and their matched placental tissue specimens were 0.80 and 0.58, respectively, with all probability values at <.0001. CONCLUSION: Previous studies have reported an association between acute and chronic hypoxia and elevated nucleated red blood cells. Our results indicate that in vitro placental nucleated red blood cell counts correlate with umbilical cord nucleated red blood cell counts and suggest that antenatal evaluation of fetal nucleated red blood cells could be achieved by placental fine-needle aspiration biopsy.

Adult↗
PubMed2003

The association of fetal heart rate patterns with nucleated red blood cell counts at birth.

OBJECTIVE: The purpose of this study was to evaluate the relationship between fetal heart rate patterns and fetal nucleated red blood cell counts. STUDY DESIGN: Data were collected prospectively from March through September 2000. Umbilical cord blood was used for nucleated red blood cell analysis. The fetal heart rate pattern was analyzed for reactivity; presence, duration, and type of decelerations; and time interval between the last acceleration and delivery. RESULTS: Two hundred seventy-nine singleton term pregnancies formed the study population, 67% of which were delivered vaginally. The median nucleated red blood cells per 100 white blood cells was 7 (range, 0-158). The univariate analysis indicated that nucleated red blood cells are correlated significantly with abnormal fetal heart rate patterns, time interval between the last acceleration and delivery, fetal growth restriction, the presence of meconium, and a 1-minute Apgar score of < or =7. However, the stepwise regression analysis identified the time interval between the last acceleration and delivery as the only variable that independently predicted elevated nucleated red blood cell count at birth (P <.0001, R (2) = 0.26). CONCLUSION: Earlier studies have demonstrated an association between adverse perinatal outcome and elevated nucleated red blood cell count. In view of the high false-positive rate that is associated with the prediction of adverse perinatal outcome by fetal heart rate abnormalities, our results support previous studies that indicate that the presence of fetal heart rate accelerations is a reliable predictor of the nonhypoxic fetus.

Erythroblasts↗
PubMed2002

Male gender predisposes to prolongation of pregnancy.

OBJECTIVE: The purpose of this study was to evaluate the association between fetal gender and prolonged pregnancy. STUDY DESIGN: All deliveries in Sweden between 1987 and 1996 were evaluated for participation in this study. Inclusion criteria included (1) singleton pregnancy, (2) the absence of apparent congenital or chromosomal anomalies, (3) accurate dating established by early second trimester ultrasound examination, and (4) gestational age at delivery of > or =37 weeks (ie, > or =259 days). Initially, we calculated the mean gestational age at delivery and the percentage of prolonged pregnancies by fetal gender. Subsequently, the Mantel-Haenszel chi-square analysis was used to calculate the weekly odds ratios and their corresponding 95% confidence intervals for the delivery of a male fetus beyond 37 weeks of gestation. RESULTS: The study population comprised 656,423 deliveries; 333,192 were male deliveries, and 323,231 were female deliveries (male/female ratio, 1.03). The mean gestational age at delivery was significantly higher in male fetuses (280.6 +/- 8.9 days vs 279.8 +/- 8.6 days, respectively; P <.0001). The percentage of pregnancies that delivered beyond term was significantly higher for male relative to female fetuses (26.5% vs 22.5% [P <.000001] at > or =41 weeks of gestation and 7.6% vs 5.5% [P <.000001] at > or =42 weeks of gestation, respectively). The weekly odds ratios for a delivery of a male fetus beyond term were 1.14, 1.39, and 1.50 at 41, 42, and 43 weeks, respectively. CONCLUSION: Male gender significantly predisposes to the prolongation of pregnancy to the extent that, by 43 weeks of gestation, there are 3 male deliveries for every 2 female deliveries.

Female↗