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Biomedical subjects

V Berghella

Publications and source records attributed to V Berghella.

At least 19 recordsLinked to original sources
PubMed2003

Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?

OBJECTIVE: To determine whether high-risk patients manifest cervical length < 25 mm on transvaginal ultrasound before 14 weeks of gestation, and if this finding is predictive of preterm delivery. METHODS: Asymptomatic pregnancies at high risk for preterm birth were followed prospectively from 10 + 0 weeks to 13 + 6 weeks with transvaginal sonographic measurement of the cervix. A cervical length < 25 mm was considered a short cervix at this gestational age and at the follow-up ultrasound examinations, performed between 14 and 24 weeks. The primary outcome was preterm birth at < 35 weeks of gestation. RESULTS: One hundred and eighty-three pregnancies met the study criteria and were included in the analysis. Only 10 (5%) patients had a cervix < 25 mm before 14 weeks. The sensitivity, specificity and positive and negative predictive values of a short cervix were 14%, 97%, 50%, and 82%, respectively (relative risk, 2.8; 95% confidence interval, 1.4-5.6). The mean transvaginal sonographic cervical length before 14 weeks of gestation was 33.7 +/- 6.9 mm in pregnancies which delivered preterm (n = 36), and 35.0 +/- 6.8 mm in those delivering at term (n = 147) (P = 0.3). Follow-up transvaginal ultrasound examination of the cervix to 24 weeks revealed that the average gestational age at which a short cervix was detected was 18.7 +/- 2.9 weeks. CONCLUSION: A cervical length < 25 mm on transvaginal sonographic assessment rarely occurs before 14 weeks even in high-risk patients destined to deliver preterm; in these patients cervical changes predictive of preterm birth develop mostly after this gestational age.

Adult↗
PubMed2003

Abdominal wall defects and congenital heart disease.

OBJECTIVES: To determine the incidence of cardiac disease associated with abdominal wall defects of fetuses and associated parameters including maternal age, sex, gestational age at delivery, outcome, karyotypes, Apgar scores and associated congenital anomalies. METHODS: This was a retrospective study of fetuses with a prenatal diagnosis of gastroschisis or omphalocele. The Maternal-Fetal Medicine Fetal Therapy (MFM) database was reviewed for all fetuses with abdominal wall defects identified prenatally. All available MFM records, fetal echocardiograms, neonatal echocardiograms and neonatal charts were reviewed for the types of abdominal wall defects and associated cardiac disease identified by ultrasound. Other parameters reviewed included: maternal age, sex, gestational age at delivery, outcome, karyotypes (when available), Apgar scores and associated congenital abnormalities. RESULTS: Forty-eight fetuses with an abdominal wall defect and cardiac disease findings were identified. Of these fetuses 26 had gastroschisis and 22 had omphalocele. The mean maternal age was 24.0 +/- 5.40 years in the gastroschisis and 29.2 +/- 7.23 years in the omphalocele group (P < 0.01). Differences in mean gestational age at delivery, mean birth weight and median Apgar scores at 1 and 5 min were not statistically significant. Abnormal cardiac findings were seen in 4/26 (15%) cases of gastroschisis and included one case of peripheral pulmonary stenosis, two cases of supraventricular tachycardia and one case of persistent pulmonary hypertension (PPHN) of the newborn. Abnormal cardiac findings were seen in 10/22 (45%) cases of omphalocele and included one muscular ventricular septal defect, two atrial septal defects of the secundum variety, one ectopia cordis, one coarctation of the aorta, one dysplasia of the tricuspid valve, one large pericardial effusion and four cases of PPHN. CONCLUSIONS: Fetuses with omphalocele appear to have an increased risk not only of congenital heart disease (CHD) but also of perinatal cardiac abnormalities, especially PPHN. A prenatal maternal hyperoxia test may be of predictive value in determining which patients may develop PPHN. The fact that both CHD and PPHN are increased in fetuses with abdominal wall defects may be of value in counseling parents prenatally, and stresses the importance of performing echocardiography both prenatally and postnatally in these cases.

Abdominal Wall↗
PubMed2002

Prediction of preterm premature rupture of membranes by transvaginal ultrasound features and risk factors in a high-risk population.

OBJECTIVE: To determine the transvaginal ultrasound features and risk factors that predict preterm delivery (PTD) preceded by either preterm premature rupture of membranes (PPROM) or preterm labor (PTL) in a high-risk population. STUDY DESIGN: Singleton gestations at high-risk for preterm delivery were screened prospectively with transvaginal ultrasound between 14 and 24 weeks. Univariate and multivariate regression analyses were performed for historical obstetric risk factors and transvaginal ultrasound features (cervical length (CL) and cervical funneling (CF)) for the prediction of PTD preceded by PPROM or PTL at < 32 and < 35 weeks' gestation, respectively. Indicated preterm deliveries were excluded. RESULTS: Of 321 patients screened, 71 (22%) delivered at < 35 weeks, 40 (56%) after PPROM and 31 (44%) after PTL. Preterm delivery at < 32 weeks was seen in 47 patients (15%), with 20 (43%) occurring after PTL and 27 (57%) after PPROM. Univariate analysis showed the following to be significant predictors of PPROM at < 35 weeks: a past history of PTD between 25 and 30 weeks (P < 0.008), cerclage in the current pregnancy (P < 0.0001), bacterial vaginosis (P < 0.011), CL < 25 mm (P < 0.0001) and CF > 25% (P < 0.0001). The following were found to be significant predictors of PTL at < 35 weeks: black race (P < 0.02), a cerclage in the current pregnancy (P < 0.01), CL < 25 mm (P < 0.001) and CF > 25% (P < 0.0001). The significant predictors of PPROM at < 32 weeks were cerclage in the current pregnancy (P < 0.006) and CL < 25 mm (P < 0.0001); for PTL at < 32 weeks they were a past history of spontaneous miscarriage between 14 and 24 weeks (P < 0.02), black race (P < 0.021), cerclage in the current pregnancy (P < 0.001) and CL < 25 mm (P < 0.001). Multivariate regression analysis revealed the significant predictors of PPROM at < 35 weeks to be: a history of PTD between 25 and 30 weeks with odds ratio (OR) 4.8 (95% confidence interval (CI), 1.9-11.5) and CL < 25 mm with OR 7.9 (95% CI, 3.6-17.5). The significant predictors of PTL at < 35 weeks on multivariate regression were black race with OR 2.2 (95% CI, 1.0-4.8) and unemployment with OR 1.2 (95% CI, 1.0-1.5). For deliveries < 32 weeks, CL < 25 mm (OR, 10.1; 95% CI, 3.2-32) was the only significant predictor of PPROM. Significant predictors of PTL were unemployment (OR, 1.3; 95% CI, 1.1-1.7), a history of spontaneous miscarriage between 14 and 24 weeks (OR, 6.2; 95% CI, 1.4-25), black race (OR, 8.6; 95% CI, 1.5-47) and CL < 25 mm (OR, 4.4; 95% CI, 1-19). The sensitivity, specificity and positive and negative predictive values of CL < 25 mm for PPROM at < 35 weeks were 73%, 69%, 25% and 95%, respectively; for PTL at < 35 weeks they were 58%, 66%, 15% and 94%; for PPROM at < 32 weeks they were 85%, 68%, 20%, and 98%; for PTL at < 32 weeks they were 70%, 66%, 12% and 97%. CONCLUSION: There are differences in both transvaginal ultrasound findings and risk factors that predict PPROM or PTL. Of the pathways leading to PTD, CL was a more significant predictor of PPROM compared with PTL, while sociodemographic factors were more predictive of PTL.

Adult↗
PubMed2001

Prolapsed cord after external cephalic version in a patient with premature rupture of membranes and transverse lie.

A 29-year-old G6 P3023 woman presented at 37 weeks' gestation with rupture of membranes and oligohydramnios. After informed consent was obtained, a successful external cephalic version (ECV) was performed. The patient went into spontaneous labor, but about 2h after the ECV, the umbilical cord prolapsed, necessitating cesarean section. Umbilical cord prolapse is a possible complication of ECV in patients with rupture of membranes and oligohydramnios.

Adult↗
PubMed2001

Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth.

CONTEXT: Although shortened cervical length has been consistently associated with spontaneous preterm birth, it is not known when in gestation this risk factor becomes apparent. OBJECTIVE: To determine whether sonographic cervical findings between 16 weeks' and 18 weeks 6 days' gestation predict spontaneous preterm birth and whether serial evaluations up to 23 weeks 6 days' gestation improve prediction in high-risk women. DESIGN, SETTING, AND PARTICIPANTS: Blinded observational study performed between March 1997 and November 1999 at 9 university-affiliated medical centers in the United States in 183 women with singleton gestations who previously had experienced a spontaneous birth before 32 weeks' gestation. OBSERVATION: Certified sonologists performed 590 endovaginal sonographic examinations at 2-week intervals. Cervical length was measured from the external os to the functional internal os along a closed endocervical canal. Funneling and dynamic cervical shortening were also recorded. MAIN OUTCOME MEASURE: Spontaneous preterm birth before 35 weeks' gestation, analyzed by selected cutoff values of cervical length. RESULTS: Forty-eight women (26%) experienced spontaneous preterm birth before 35 weeks' gestation. A cervical length of less than 25 mm at the initial sonographic examination was associated with a relative risk (RR) for spontaneous preterm birth of 3.3 (95% confidence interval [CI], 2.1-5.0; sensitivity = 19%; specificity = 98%; positive predictive value = 75%). After controlling for cervical length, neither funneling (P =.24) nor dynamic shortening (P =.054) were significant independent predictors of spontaneous preterm birth. However, using the shortest ever observed cervical length on serial evaluations, after any dynamic shortening, the RR of a cervical length of less than 25 mm for spontaneous preterm birth increased to 4.5 (95% CI, 2.7-7.6; sensitivity = 69%; specificity = 80%; positive predictive value = 55%). Compared with a single cervical measurement at 16 weeks' to 18 weeks 6 days' gestation, serial measurements at up to 23 weeks 6 days significantly improved the prediction of spontaneous preterm birth in a receiver operating characteristic curve analysis (P =.03). CONCLUSIONS: Cervical length assessed by endovaginal sonography between 16 weeks' and 18 weeks 6 days' gestation, augmented by serial evaluations, predicts spontaneous preterm birth before 35 weeks' gestation in high-risk women.

Adult↗
PubMed2001

Does transvaginal ultrasound of the cervix predict preterm premature rupture of membranes in a high-risk population?

OBJECTIVES: To determine in patients with a cervical length < 25 mm on transvaginal ultrasound if the severity of cervical length shortening can be used to predict preterm premature rupture of membranes (PPROM) and the contribution of PPROM to preterm delivery in these patients. METHODS: We retrospectively reviewed asymptomatic singleton pregnancies between 14 and 24 weeks at high risk of preterm delivery by obstetric history and transvaginal cervical length < 25 mm. Cases developing subsequent PPROM were compared with controls for transvaginal sonographic cervical characteristics. RESULTS: Of 69 patients identified to have a cervical length < 25 mm, 27 (39%) had PPROM, and 42 (61%) did not. Mean +/- standard deviation (SD) cervical length was 12.7 +/- 8.7 mm and 17.0 +/- 7.6 mm in the two groups, respectively (P = 0.04). Mean +/- SD cervical funneling was 57.4 +/- 31.4% and 40.0 +/- 28.1%, respectively (P = 0.01). The characteristics most predictive of PPROM were: cervical length of < 10 mm (sensitivity, specificity, positive and negative predictive values of 33, 90, 69, and 68%, respectively; odds ratio, 4.8; 95% confidence interval, 1.3-17.5) and cervical funneling > 75% (sensitivity, specificity, positive and negative predictive values of 33, 93, 75 and 68%, respectively; odds ratio, 6.5; 95% confidence interval, 1.6-26.9). Stepwise logistic regression revealed cervical length to be a significant predictor of PPROM (odds ratio, 4.0; 95% confidence interval, 1.1-14.2). CONCLUSION: In patients at high risk for preterm delivery because of obstetric history and transvaginal sonographic cervical length < 25 mm, a cervical length < 10 mm and cervical funneling > 75% were most predictive of PPROM. PPROM was the major contributor to preterm delivery in these patients.

Adult↗
PubMed2001

Natural history of twin-twin transfusion syndrome.

OBJECTIVE: To determine the natural history of pregnancies with twin-twin transfusion syndrome (TTTS). STUDY DESIGN: All cases of TTTS at our institution since 1991 and in a MED-LINE search since 1966 were retrospectively reviewed. The prenatal diagnosis of TTTS required the presence of monochorionic/diamniotic placentation (absence of twin-peak sign, thin membrane, single placenta, same sex) and of polyhydramnios (largest pocket > 8 cm) in one sac and oligohydramnios (largest pocket < 2 cm or stuck twin) in the other. Only cases diagnosed at < or = 28 weeks were included. Upon diagnosis, all patients were counseled as to the availability, risks and benefits of serial amniocentesis, laser therapy, septostomy, umbilical cord ligation, and other medical and surgical interventions. RESULTS: Of 29 pregnancies identified at our institution with the above strict criteria for TTTS, 5 (17%) declined in utero therapy and were managed expectantly. The mean gestational age at presentation was 19.2 weeks (range, 16-28) and at delivery, 33.8 weeks (range, 22-41). Four (40%) of the twins survived past the neonatal period, and of the three with follow-up, all are free of neurologic sequelae despite the death in utero of their cotwin. From the literature, 136 fetuses with TTTS as defined above and managed expectantly were identified; 37 (27%) survived; 75% (9/12) of survivors with follow-up are neurologically normal. The most recent four studies have reported survival of untreated cases of 50% (17/34) when diagnosed at < or = 26 weeks and of 63% (20/32) when diagnosed at < or = 28 weeks. CONCLUSION: The perinatal survival of TTTS pregnancies managed without in utero procedures is approximately 30% overall and 63% in the four most recent series when diagnosed at < or = 28 weeks. The success of in utero therapeutic intervention should be assessed by randomized studies or at least compared to that in similar cases managed without such intervention.

Amniocentesis↗
PubMed2000

Prediction of preterm birth by second trimester cervical sonography in twin pregnancies.

OBJECTIVES: To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation. METHODS: Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation. RESULTS: Sixty-five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length < or = 25 mm and < or = 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0-10.3 and R.R. 3.6, C.I. 1.6-7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02-0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix < or = 30 mm and any funneling were strongly predictive of PTD. CONCLUSIONS: Both cervical length < or = 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth.

Cervix Uteri↗
PubMed2000

Three-dimensional multiplanar transvaginal ultrasound of the cervix in pregnancy.

OBJECTIVES: To develop a standard technique for using three-dimensional ultrasound (3D US) to study and evaluate the cervix in pregnant women at high risk for premature delivery, comparing the findings on 3D US with those on conventional two-dimensional ultrasound (2D US). STUDY DESIGN: Twenty-one pregnant women at high risk for premature delivery had a total of 37 transvaginal 2D and 3D US examinations of the cervix between 11 and 32 weeks' gestation. A 3D US vaginal probe (5.0-8.0 MHz, Voluson 530D, Medison, Pleasanton, CA, USA) was used. Measurements made from the 2D and 3D US were compared. RESULTS: Of the 37 cervical length measurements in 3D US sagittal plane, seven were shorter and three were longer than on 2D US (varying by 5-15 mm) indicating that the true mid-sagittal plane was not obtained in ten (27%) of the 37 2D US examinations. Of 21 examinations showing funneling, funneling was seen on both 2D and 3D US in 15, but was seen only on 3D US in six. There was a significant (P < 0.05) difference between funnel width as measured in the coronal 3D plane versus 2D US, as well as between funnel width in the coronal 3D US plane versus sagittal 3D US plane (P < 0.05). The cerclage was seen in its entirety in nine of 10 examinations; the 3D US axial plane was most valuable for imaging the cerclage. CONCLUSIONS: 3D US appears to offer a more complete assessment of the cervix than 2D US. Multiplanar correlation shows that the standard 2D US sagittal view may under- or over-estimate cervical length. Our preliminary data suggest that 3D US has the potential to improve our understanding of cervical morphology.

Adult↗
PubMed2000

Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage.

OBJECTIVE: Our purpose was to compare the incidence of preterm birth after a prior failed vaginal cerclage in patients who had a subsequent transabdominal or a transvaginal cerclage. STUDY DESIGN: We conducted a retrospective cohort study of singleton pregnancies in women who had undergone (9-14 weeks) either a transabdominal or a transvaginal prophylactic cerclage after >/=1 prior failed transvaginal cerclage. Prior failed transvaginal cerclage was defined as a preterm birth at <33 weeks' gestation in the immediate prior pregnancy despite a transvaginal cerclage. All transabdominal cerclage procedures were performed by a single attending physician (George Davis, DO). Patients with a cervix too short for transvaginal cerclage placement, placenta previa, or major fetal anomalies were excluded. Primary outcome was preterm birth at <35 weeks' gestation. RESULTS: Forty transabdominal and 24 transvaginal cerclage pregnancies were analyzed. These 2 groups were similar in race and payer status but differed in age (34.0 +/- 4.2 vs 31.3 +/- 4.6 years, respectively; P =.01). The transabdominal cerclage group had more prior failed cerclage procedures per patient (1.8 +/- 1.0 vs 1.1 +/- 0.3; P =.02) and more prior 14- to 24-week spontaneous abortions per patient (2.4 +/- 1.3 vs 1.5 +/- 1.0; P =.02) than the transvaginal cerclage group. Preterm delivery at both <35 and <33 weeks' gestation was less common in the transabdominal cerclage group (18% vs 42%, P =.04; 10% vs 38%, P =.01; respectively) than in the transvaginal cerclage group. Gestational age at delivery was 36. 3 +/- 4.1 weeks in the transabdominal cerclage group and 32.8 +/- 8. 6 weeks in the transvaginal cerclage group (P =.03). Preterm premature rupture of membranes also occurred less often in the transabdominal cerclage group than in the transvaginal cerclage group (8% vs 29%, P =.03). CONCLUSION: In patients with a prior failed transvaginal cerclage, transabdominal cerclage is associated with a lower incidence of preterm delivery and preterm premature rupture of membranes in comparison with transvaginal cerclage.

Abdomen↗
PubMed2000

Timing of cerclage removal after preterm premature rupture of membranes: maternal and neonatal outcomes.

OBJECTIVE: Our aim was to evaluate immediate versus delayed removal of cerclage for women with preterm premature rupture of membranes with respect to maternal and neonatal outcomes. STUDY DESIGN: We retrospectively analyzed women with preterm premature rupture of membranes at <34 weeks' gestation with prior cerclage placement. Exclusion criteria included presentation with chorioamnionitis, active labor, or nonreassuring fetal status. Timing of cerclage removal, immediate (<24 hours) or delayed (>24 hours), was compared. RESULTS: There were 25 women in the delayed-removal group and 37 in the immediate-removal group. Average times to removal were 206.8 +/- 7.4 and 5.4 +/- 0.2 hours, respectively. Use of betamethasone was similar for both groups; however, antenatal antibiotic use (100% vs 80%; P =.03) and short-term tocolytic use (20% vs 3%; P =.04) were higher in the delayed-removal group. Duration of latency was significantly longer with delayed removal (10.1 vs 5.0 days; P <. 001). Delivery occurred >48 hours from preterm premature rupture of membranes in 96% (24/25) versus 54% (20/37; P <.001) and >7 days from rupture in 56% (14/25) versus 24% (9/37; P =.02), respectively. Rates of neonatal sepsis (at <10 days) and maternal infection were not statistically different. Neonatal outcomes did not significantly differ regarding mortality, respiratory distress syndrome, birth weight, or duration of stay in the intensive care nursery. CONCLUSION: With the current management scheme for preterm premature rupture of membranes, cerclage retention significantly increases duration of latency without significantly altering maternal or neonatal outcomes.

Delivery, Obstetric↗
PubMed2000

Neurosarcoidosis diagnosed during pregnancy by thoracoscopic lymph node biopsy. A case report.

BACKGROUND: Sarcoidosis is a multiorgan-system granulomatous disease causing respiratory complaints in most patients. Eye involvement, most commonly granulomatous uveitis, is seen in 5% of black patients with sarcoidosis. Neurosarcoidosis is also rare, affecting 5% of patients with sarcoidosis. Thoracoscopic lymph node biopsy in pregnancy has never before been reported. CASE: An otherwise-healthy, 25-year-old woman, gravida 2, para 1001, presented at 25 weeks' gestation with a painful facial palsy and visual defects. Ophthalmologic examination revealed uveitis, and a chest radiograph revealed asymmetric hilar adenopathy. At 28 weeks' gestation, the patient underwent thoracoscopic lymph node biopsy, which confirmed the diagnosis of sarcoidosis. The symptoms were stabilized with therapeutic corticosteroids, and the patient delivered a healthy neonate at term. CONCLUSION: The diagnosis of sarcoidosis remains one of exclusion and requires a high index of suspicion. Tissue confirmation is often necessary, especially when patients have extrathoracic complaints. For patients without other lesions amenable to biopsy, thoracoscopic lymph node biopsy can be considered despite pregnancy.

Biopsy↗
PubMed1999

Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity?

OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of <25 mm or funneling of >25% or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at <35 weeks' gestation. RESULTS: One hundred sixty-eight women were followed, including 97 (58%) with >/=1 prior 14- to 34-week preterm deliveries. Of 63 (37. 5%) patients identified as having cervical changes, 23 (37%) had preterm delivery; of 105 patients with no cervical changes, 8 (8%) had preterm delivery (relative risk, 4.8; 95% confidence interval, 2. 3-10.1). The sensitivity, specificity, and positive and negative predictive values of either a short cervix of <25 mm or funneling of >25% or both were 74%, 70%, 37%, and 92%, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery between the groups with and without cerclage (odds ratio, 1.1; 95% confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27% vs 23%, respectively; P =.7), as did days from cervical changes to delivery (111 vs 96, respectively; P =.2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.

Cervix Uteri↗
PubMed1998

Opioid dependence during pregnancy. Effects and management.

This article describes the complex problems associated with opioid dependence during pregnancy. Medical, obstetric, and psychosocial problems are presented. Methadone maintenance for the treatment of opioid dependence is described in this article. Specific issues of appropriate methadone dose during pregnancy, medical withdrawal, and the relationship of methadone dose and the severity of neonatal abstinence also are discussed.

Delivery, Obstetric↗
PubMed1998

Prenatal confirmation of true fetal trisomy 22 mosaicism by fetal skin biopsy following normal fetal blood sampling.

Trisomy 22 mosaicism diagnosed at 20 weeks' gestation by amniocentesis in a 35-year-old woman was not confirmed by fetal blood sampling. Subsequent fetal skin biopsy revealed trisomy 22 in 7 of the 15 fibroblasts analysed. We conclude that, depending on the chromosome involved, fetal skin biopsy should be considered in the diagnostic work-up when mosaicism is found in amniotic fluid.

Abortion, Induced↗
PubMed1997

Cervical ultrasonography compared with manual examination as a predictor of preterm delivery.

OBJECTIVE: Our purpose was to compare the accuracy of ultrasonographic and manual cervical examinations for the prediction of preterm delivery. STUDY DESIGN: One hundred two singleton pregnancies at high risk for preterm delivery were followed up prospectively from 14 to 30 weeks with both serial cervical ultrasonography measurements and manual examinations of the length of the cervix. The primary outcome studied was preterm (< 35 weeks) delivery. RESULTS: Excluding six induced preterm deliveries, 96 pregnancies were analyzed. The mean cervical length measured by ultrasonography was 20.6 mm in pregnancies delivered preterm (n = 17) and 31.3 mm in pregnancies delivered at term (n = 79) (p = 0.003); the mean cervical lengths measured by manual examination were 16.1 mm and 18.6 mm in the same preterm and term pregnancies, respectively (not significant). The sixteenth- and twentieth-week ultrasonographic cervical lengths predicted preterm delivery most accurately (p < 0.0005). The 25th percentiles of ultrasonographic (25 mm) and manual (16 mm) cervical lengths showed relative risks for preterm delivery of 4.8 (95% confidence interval 2.1 to 11.1, p = 0.0004) and 2.0 (95% confidence interval 0.5 to 4.7, p = 0.1), respectively; sensitivity, specificity, and positive and negative predictive values were 59%, 85%, 45%, 91%, and 41%, 77%, 28%, and 86%, respectively. CONCLUSION: Cervical length measured by ultrasonography is a better predictor of preterm delivery than is cervical length measured by manual examination. Cervical ultrasonography in patients at high risk for preterm birth seems to be most predictive of preterm delivery when it is performed between 14 and 22 weeks' gestation.

Cervix Uteri↗
PubMed1997

Successful pregnancy in a neurologically impaired woman with Wilson's disease.

Patients with treated Wilson's disease and no residual impairments should have successful pregnancies. We report a case of a neurologically impaired patient with Wilson's disease who had a successful pregnancy with no complications. This is the first case to document that compliance with penicillamine therapy as low as 500 mg/day avoids placental and fetal copper accumulation.

Adult↗