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Biomedical subjects

R Maymon

Publications and source records attributed to R Maymon.

At least 55 records · Page 3Linked to original sources
PubMed1999

Comparison of nuchal translucency measurement and second-trimester triple serum screening in twin versus singleton pregnancies.

Maternal serum screening for Down syndrome (DS) in twin pregnancies poses difficulties due to a lack of precise biochemical information about each co-twin. The current study attempts, for the first time, to compare two screening methods: nuchal translucency (NT) measurement and serum screening for DS, in twin pregnancies. 60 women with twin pregnancies (study group) underwent both first-trimester NT scanning and mid-trimester triple-marker serum screening, and were followed throughout their gestation. Nuchal translucency measurements were compared with a matched control of 120 singleton pregnancies with a similar (+/-2 years) maternal age and fetal crown-rump length (CRL) (+/-3 mm). In both analyses, a risk of 1:380, or higher, of having a DS newborn was considered screen positive. Both mean maternal age (31+/-3 years) and CRL (62+/-11 mm) were similar in the study and control groups. The median NT measurement expressed as multiples of the median (MOM) for CRL was similar in the study and control groups (0.85 and 0.88, respectively). Based on NT measurements, 5 per cent of the pregnancies in the study group and 2.5 per cent in the control group were defined as screen positive (p =N. S). Mid-gestation serum screening was associated with 15 per cent and 6 per cent screen-positive rate in study and control groups, respectively (p<0. 05). There was a ratio of 1:3 screen-positive rate between first and second-trimester screening tests within the study group. This high false-positive rate results led to 18.3 per cent amniocentesis rate in the study group compared with 7.5 per cent of the control group (p<0.03). Only one co-twin which was picked up by the NT screen was further diagnosed as trisomy 21, and one co-twin with cardiac and neural tube defect was missed by the two screening tests and was later picked up in an anomaly scan. Although the current series is too small to provoke any changes in screening practice, when twin pregnancies are diagnosed, it seems very reasonable to offer them NT measurement. A larger group may be needed to clarify which approach is the most beneficial screening policy for this highly selected group of pregnant women.

Adult↗
PubMed1999

White coat hypertension and pregnancy outcome.

The presence and outcome effect of white coat hypertension in pregnancy was determined with 24-h ambulatory blood pressure (BP) monitoring. Sixty women presenting with high clinic BP (>/=140/90 mm Hg) in the second trimester were included. Patients were divided into two groups based on daytime ambulatory BP findings: <135/85 mm Hg, white coat hypertension (n = 37); >/=135/85 mm Hg, 'true' hypertension (n = 23). Complicated pregnancy outcome was defined as the presence of pre-eclampsia and/or intrauterine growth restriction. Groups were compared for pregnancy outcome and for background and delivery factors. The predictive value of ambulatory BP measurements for pregnancy outcome was determined. Pregnancy outcome was better in the white coat hypertension group than in the true hypertension group: pre-eclampsia-3 (8.1%) vs 13 (56.5%) (P = 0.0046); intrauterine growth restriction-5 (13.5%) vs 10 (43.4%) (P = 0. 0139); and preterm delivery-11 (29.7%) vs 15 (65.2%) (P = 0.015). Night-time ambulatory BP measurements were the best predictor of complicated pregnancy, followed by daytime and 24-h measurements. We conclude that second trimester ambulatory BP monitoring can be used to differentiate patients who have white coat hypertension, which is associated with a better pregnancy outcome than true hypertension.

Adult↗
PubMed1999

Implementation of nuchal translucency image-scoring method during ongoing audit.

OBJECTIVE: The aim of this study was to evaluate the contribution of an ongoing audit, using the image-scoring method, to the quality of nuchal translucency images and to set the basic standards required from the examiners. DESIGN: Evaluation of nuchal translucency images, before, during and after the implementation of an ongoing audit, without knowledge of the time period or the examiner. SUBJECTS: A total of 315 nuchal translucency scans were performed by three examiners. METHODS: Each of the retrospective, intermediate and prospective time periods included blind scoring of 105 images. The effect of the ongoing audit was examined by comparing the distribution of the quality groups and the mean final score between the time periods, for all cases and for each examiner separately. Improvement of the criteria was assessed by comparing the rate of scans meeting the demands between the time periods. RESULTS: The quality of the images improved significantly as the mean final score changed from 4.62 +/- 0.21 to 6.19 +/- 0.19 and to 6.91 +/- 0.16 (p < 0.0001) and the rate of obtaining acceptable scans rose from 72% to 88% and to 92% (p < 0.001), respective to the three time periods. Whereas the three major criteria improved significantly before and after implementation of the audit (mid-sagittal section from 48% to 94%, caliper placement from 60% to 75% and skin line from 19% to 77%), the minor criteria remained unchanged (image size 90%, amnion demonstration 25% and head position 77%). The average scores of two examiners, for whom improvement was more pronounced, were used to determine the basic standards required from examiners subjected to the audit as follows: unacceptable, none; intermediate, 5%; reasonable, 65%; excellent, 30%; with a mean final score of 7.25. CONCLUSIONS: Implementation of an ongoing audit, using the image-scoring method, proved to be an efficient method for surveillance and improving the quality of nuchal translucency images. We recommended centers or individuals practicing first-trimester ultrasound screening to consider its routine utilization, in an unbiased and strict manner.

Analysis of Variance↗
PubMed1999

Development of the fetal uterus between 19 and 38 weeks of gestation: in-utero ultrasonographic measurements.

In-utero assessment of the internal female genitalia is important for determination of fetal gender in fetuses with suspected genital tract anomalies. We therefore measured fetal uterine transverse width and circumference from 19 weeks of gestation until term, using transvaginal and transabdominal high-resolution ultrasound techniques in order to establish nomograms. A prospective, cross-sectional study on 180 normal singleton pregnancies was performed. Data were obtained for 140 normal fetuses. The mean +/- SD uterine width and circumference were 12.9 +/- 4.1 mm (95% confidence interval 12.1-13.7), and 40.2 +/- 12.5 mm (95% confidence interval 37.9-42.5) respectively. Uterine size as a function of gestational age was expressed by the regression equations: uterine width (mm) = 12.9 + 0.7 x gestational age (weeks), and uterine circumference (mm) = 40.2 + 2.1 x gestational age. The correlation coefficients, r = 0.885 and r = 0.888, for uterine width and circumference, by gestational age respectively, were highly statistically significant (P < 0.001). A nomogram of uterine width and circumference per gestational week, and the 95% prediction limits were defined. The present data offer baseline measurements of the fetal uterus that may allow intrauterine assessment of the female genital tract and associated fetal gender.

Cross-Sectional Studies↗
PubMed1999

Can nuchal cord cause transient increased nuchal translucency thickness?

When detected in a first trimester scan, an increased thickness of nuchal translucency (NT) may be associated with chromosomal, cardiac or genetic disorders. However, less attention has been devoted to the outcome of those fetuses who have confirmed normal anatomies and karyotyping, but have abnormal first trimester scans. Thus, a challenging new issue is how to counsel such cases of transient increased NT in which the translucency rapidly vanishes with no evidence of other underlying abnormalities. Two cases of transient increased thickness of NT are reported. In both, a nuchal cord was ultrasonographically demonstrated and a thorough work-up revealed chromosomally and anatomically normal fetuses. The pathophysiological theories behind these observations and their significance are discussed. Based on these observations, we suggest that transvaginal sonography combined with Doppler flow studies should be utilized for the presize detection of cord patterns to accomplish the work-up in cases of increased NT.

Adult↗
PubMed1999

The feasibility of nuchal translucency measurement in higher order multiple gestations achieved by assisted reproduction.

Nuchal translucency (NT) measurement for screening chromosomal abnormalities and detecting fetal anomalies is an effective ultrasonographic marker, originally developed for singleton pregnancies. This study sought to evaluate the feasibility of NT measurements in higher order multiple gestations. Pregnant patients who conceived following assisted reproduction and were carrying three or more fetuses were enrolled in the study. Each fetus was ultrasonographically assessed, a NT measurement was obtained, and the findings were used for counselling prior to any invasive procedure. In all, 24 pregnant patients, initially carrying 79 fetuses aged 10-14 weeks of gestation, were compared with 79 consecutively matched, singleton controls, naturally conceived, having similar crown-rump lengths (+/- 3 mm). NT measurements were feasible for both study and control fetuses, which exhibited similar NT measurements for 5th, 50th and 95th centiles. Also, mean NT thicknesses [measurements in mm or multiple of the medians (MOM)] were similar for both groups (1.41 +/- 0.41 and 1.35 +/- 0.39 mm respectively and 0.87 +/- 0.23 and 0.83 +/- 0.25 MOM respectively). Prenatally no chromosomal abnormalities were detected in either group, and, of those infants who had no karyotyping, no traits were observed that warranted chromosomal analysis. NT measurements are feasible in higher order multiple gestations. Since there is no other effective screening modality for these pregnancies, it seems reasonable to recommend NT measurement for antenatal screening services for higher order multiple gestations.

Chromosome Aberrations↗
PubMed1999

Comparison of nuchal translucency measurement and mid-gestation serum screening in assisted reproduction versus naturally conceived singleton pregnancies.

It has been reported that second-trimester serum markers may be affected by assisted reproduction leading to a higher false-positive rate. The current study compares 10-14 week nuchal translucency (NT) measurement and early mid-trimester serum screening in pregnancies resulting from assisted reproduction versus naturally conceived pregnancies. 75 pregnant women with a singleton pregnancy achieved by assisted reproduction underwent both 10-14 weeks NT measurement and second-trimester triple test and were followed throughout gestation. They were compared with matched controls for gestation and maternal ages. A risk of 1:380 or higher or having a fetus with Down syndrome was considered as screen-positive in both tests. The mean maternal age (30+/-3 years) and crown-rump length (61+/-9 mm) were similar, and there was no difference in NT thickness distribution between the groups. Based on NT measurement, 4 (5 per cent) women in the study and 2 (3 per cent) in the control groups, were defined as screen positive (p=NS). However, 11 (15 per cent) women in the study group and 4 (5 per cent) in the control group were found screen-positive by the triple test (p<0.05). A significantly higher amniocentesis rate of 20 per cent was noted in the study group compared with 8 per cent in the controls (p<0.05). All karyotypes were normal and no miscarriages or structural malformation were diagnosed in either group. We confirm the observation that assisted reproduction may adversely affect second-trimester screening results, which did not affect the NT screening test. Since these series are relatively small, larger series may be needed to clarify the most beneficial screening policy for this highly selected group of pregnant women.

Adult↗
PubMed1998

Image magnification does not contribute to the repeatability of caliper placement in measuring nuchal translucency thickness.

The objective of this study was to assess whether nuchal translucency image magnification contributes to the repeatability of caliper placement. Twenty-seven women undergoing first-trimester ultrasound screening at 11-14 weeks were examined by two qualified examiners. Fetal nuchal translucency thickness was measured twice by each examiner on a regular-sized image and subsequently on the same still image magnified. Intraobserver repeatability coefficients of the regular-sized images were 0.28 mm and 0.34 mm for examiners A and B, respectively. Identical intraobserver repeatability coefficients of 0.28 mm were attained for both examiners on the magnified images. Interobserver repeatability of regular-sized image measurements showed a significant difference (p < 0.01) but the mean difference (+/- standard deviation) of 0.10 (0.18) mm was negligible. Similarly, interobserver repeatability of the magnified-image measurements yielded a significant difference (p < 0.02), but again with a small mean difference of 0.13 (0.26) mm. There were also significant differences when regular-sized images and magnified images were compared for both examiners: 0.08 (0.16) mm for examiner A (p < 0.02) and 0.10 (0.17) mm for examiner B (p < 0.01). Our results demonstrate that nuchal translucency image magnification does not contribute to the reproducibility of the measurement. Despite significantly smaller mean values obtained from the magnified images, compared to the regular-sized measurements, those differences do not justify modification of the criteria for caliper placement on magnified images. Blind repeated measurements on a regular-sized and/or magnified image are recommended as a tool for self-assessment, quality control and training.

Female↗
PubMed1998

Nuchal translucency audit: a novel image-scoring method.

OBJECTIVE: The aim of this study was to evaluate the feasibility and reproducibility of a novel image-scoring method of first-trimester nuchal translucency measurement as an objective tool of ongoing audit and training. DESIGN: This was an independent evaluation of nuchal translucency images by three separate reviewers unaware of the examiner. SUBJECTS: There were 105 consecutive singleton pregnancies undergoing first-trimester screening. METHODS: Each image was scored according to the following criteria: section (oblique, 0; mid-sagittal, 2), caliper placing (misplaced, 0; proper, 2), skin line (nuchal only, 0; nuchal and back, 2), image size (unsatisfactory, 0; satisfactory, 1), amnion (not visualized, 0; visualized, 1) and head position (flexion/hyperextension, 0; straight, 1). The final score was categorized into one of four quality groups: excellent (8-9), reasonable (4-7), intermediate (2-3), unacceptable (0-1). RESULTS: The distributions of the four quality groups were similar between the three reviewers: 11.4% were classified as excellent, 57.1% as reasonable, 25.7% as intermediate and 5.7% as unacceptable. Inter-reviewer agreement showed identical classification, by each pair of reviewers, from 65.7% to 74.3%, and partial agreement to neighboring quality groups from 25.7% to 34.3% of the cases. In none of the cases did the reviewers differ in categorizing cases to remarkably different quality groups. Application of the auditing method to the examiners showed similar distribution to the various quality groups and similar mean final score of 4.69 (0.39, SE), 4.54 (0.15, SE) and 4.65 (0.15, SE). CONCLUSIONS: The described image-scoring method represents a new approach towards the evaluation of ultrasound performance as a whole and nuchal translucency measurement in particular. It may be employed by every center in an independent manner with minimal resources and regardless of the method of risk assessment. More studies will be needed to determine the standards required from the examiners and to elucidate the contribution of the proposed auditing method to the examination's quality and the process of training.

Female↗
PubMed1998

Maternal serum placental isoferritin levels in pregnant women with abnormal uterine artery Doppler velocemitry.

High levels of placental isoferritin (PLF), which is an immunosuppressive cytokine, have been demonstrated in the sera of pregnant women. In the current study, 41 pregnant patients at high risk for placento-vascular complications, such as preeclamptic toxemia (PET) and/or intrauterine growth retardation (IUGR) were preselected if abnormal uterine artery Doppler measurements appeared at the time of the 20th-22nd gestational week scan. Concomitantly, venous blood was collected from each patient. PLF serum concentrations were determined by specific enzyme-linked immunoadsorbent assay (ELISA). The PLF levels were compared to 44 healthy pregnant women at midgestation with uneventful pregnancy outcomes. The aim of the current study was to evaluate the contribution of PLF measurement in this preselected group. Following delivery, two subgroups of abnormal uterine artery Doppler waveforms were retrospectively defined. Twenty-one (51%) patients had normal outcomes, whereas 20 (49%) had pathological outcomes mainly complicated by PET and/or IUGR. Significant differences in PLF serum levels were observed between the control group (84+/-64 U/mL; median 84 U/mL) compared with those of the study subgroup with normal outcome (31+/-19 U/mL; median 23 U/mL) and with the pathological outcome subgroup (19+/-8 U/mL; median 17 U/mL) (p<0.05). Nineteen percent of the normal subgroup compared with 45% of the pathological subgroup were found to have a serum PLF concentration <19 U/mL. This cutoff level was achieved based on receiver operating characteristic (ROC) curve. The combination of abnormal uterine artery waveforms followed by low serum PLF <19 U/mL increased the positive predictive value to 63%, as compared with up to 30% positive predictive value only for the abnormal Doppler waveforms. The current preliminary results concur with previous studies suggesting that low PLF levels may reflect abnormal placentation. The exact contribution of PLF and uterine artery Doppler waveforms in monitoring patients for placento-vascular complications should be the design of a future, larger, prospective study.

Adult↗
PubMed1998

Comparison of placental isoferritin levels in maternal serum and coelomic and amniotic fluids during first trimester human gestation.

Placental isoferritin (PLF) is present in serum at high concentrations throughout normal gestation. The current study compared PLF concentrations in first trimester maternal serum with those of amniotic and coelomic fluids in 25 healthy, pregnant women. Use of a specific enzyme-linked immunosorbent assay indicated concentrations high (22 +/- 3 U/ml) in maternal serum, whereas significantly lower values were detected in both coelomic and amniotic fluids (5 +/- 2 and 3 +/- 2 U/ml, respectively, P < 0.005). It was further demonstrated that when pure PLF was added to amniotic and coelomic fluids, the PLF levels remained low in each compartment, suggesting that bioproducts produced inside the gestational sac may interfere with the PLF immunoassay.

Amniotic Fluid↗
PubMed1998

Pelvic splenosis mimicking endometriosis, causing low abdominal mass and pain.

Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenectomy. The clinical significance of these splenic implants and the need for surgical removal is debatable. A case of a 35 year old woman, with post-traumatic splenectomy presenting with low abdominal pain and pelvic mass is reported. Laparoscopic removal of the pelvic splenic implants dispelled all complaints.

Abdominal Pain↗
PubMed1998

Placental isoferritin levels in pregnant patients with systemic lupus erythematosus and/or antiphospholipid syndrome.

PROBLEM: Low serum placental isoferritin (PLF), an immunosuppressive cytokine-like protein, was found in women with underlying placento-vascular dysfunction, such as intrauterine growth retardation and preeclamptic toxemia. The possible contribution of this placental product in the assessment of pregnant patients with either systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) was investigated. METHOD OF STUDY: Seventy-five healthy pregnant women used as controls and 25 preselected pregnant patients with either SLE and/or APS were enrolled in the study. Study patients were in remission during conception and all patients agreed to give 5 ml of venous blood at midgestation. The samples were frozen and analyzed retrospectively. After delivery, pregnancy outcomes were gathered from hospital records. RESULTS: Seventeen (68%) women had uneventful pregnancies and deliveries (normal) whereas 8 (32%) showed pathologic obstetric outcomes. Mean midgestational serum PLF levels were similar in the control and normal outcome groups (87 U/ml), whereas significantly lower levels (37 U/ml) were measured in the pathologic outcome group. Using a cutoff level of 10 U/ml, 85% from the normal outcome group and 15% from the pathologic outcome group were above this threshold level, with 60% specificity and 100% sensitivity. CONCLUSIONS: These preliminary data suggest that PLF values may reflect placento-vascular functions. These may represent a predictive biomarker for developing obstetric complications in pregnant women with either SLE and/or APS.

Adult↗
PubMed1998

Placental isoferritin in gestational diabetes mellitus.

BACKGROUND: Serum placental isoferritin, an immunosuppressive cytokine like protein, was found to be elevated in type I diabetes at diagnosis and low in high risk pregnant women. Further to this observation, the possible role of this placental product was assessed in pregnant women with gestational diabetes mellitus. METHODS: A comparative study. One hundred and seventy-four pregnant women were included in the study: 28 were diagnosed as gestational diabetes mellitus and 146 were normal controls. MAIN OUTCOME MEASURES: Samples for serum placental ferritin were measured in the second and third trimesters of pregnancy. RESULTS: Serum placental isoferritin values were significantly lower in the second trimester of pregnancy in the gestational diabetes mellitus group (9.4+/-2.6 U/ml) as compared with the control group (21.5+/-2.2 U/ml, p=0.0001), and were also significantly lower in the third trimester (3.7+/-1.9 vs. 19+/-2.6 U/ml, respectively, p=0.00001). CONCLUSIONS: Low serum PLF values detected in gestational diabetes mellitus may reflect placental function and be related to insulin treatment.

Adolescent↗
PubMed1998

[Trisomy 18 anomalies on sonography and calculated risk of chromosomal abnormalities during first trimester].

Trisomy 18 is a chromosomal disorder giving multiple anomalies. Its frequency depends on maternal age. We report a 28-year-old woman in her first pregnancy, who underwent first trimester scanning for screening. Due to increased nuchal translucency and exomphalos, chorionic villous sampling was performed. Cytogenetic diagnosis was trisomy 18 and termination of pregnancy was carried out immediately.

Abortion, Induced↗