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Biomedical subjects

Aaron B Caughey

Publications and source records attributed to Aaron B Caughey.

At least 19 recordsLinked to original sources
PubMed2007

Nuchal translucency screening: how do women actually utilize the results?

OBJECTIVE: To examine how women use the nuchal translucency (NT) risk adjustment in decision-making for invasive prenatal diagnosis. STUDY DESIGN: Retrospective cohort study of 1083 consecutive NT screening exams. A screen-positive test was defined as a risk > or = 1/300. Primary outcome was what proportion of screen-positive or screen-negative women chose to undergo chorionic villus sampling or amniocentesis. RESULTS: Of the women tested, 79% (858/1083) were > or = 35-years-old and 88% (756/858) of these women had a decrease in age-related risk after NT. Of the screen-negative women, 31% (238/756) > or = 35 years of age chose to have invasive testing as compared to only 11.2% (25/223) of those < 35 years of age (p < 0.001). Of the screen-positive women, 71% (72/102) > or = 35 years of age and 100% (2/2) < 35 years of age chose to obtain invasive testing (p = 0.368). CONCLUSION: First-trimester NT screening for Down syndrome (DS) enables a significant number of women over age 35 to lower the risk for DS several fold and avoid the risks of invasive testing. However, despite significant reductions in age-specific mid-trimester DS risks, a relatively high proportion of women > or = 35 years of age still opted for invasive testing.

Adult↗
PubMed2006

Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins.

OBJECTIVE: The purpose of this study was to define the association between unequal placental sharing and birth weight discordance in monochorionic/diamniotic twin pregnancies. STUDY DESIGN: The study comprised a prospective cohort of monochorionic/diamniotic twin pregnancies who were delivered in Kaiser Permanente-Northern California, 1997-2003. Dye injection studies of fresh postpartum placentas were performed. Placental sharing, cord insertion combinations, vascular anastomoses, gestational age, and birth weights were recorded. Statistical comparisons of birth weight and gestational age were made with the Student t test. Rates of birth weight discordance were compared with the chi-square test. Multivariate logistic regression models analyzed the relationship between variables of interest. RESULTS: Mean birth weights for larger and smaller twins were 2400 g and 2109 g, respectively. Twenty-two percent of the monochorionic/diamniotic twin pairs had birth weight discordance > or = 20%, and 8% of these pairs had twin-twin transfusion syndrome. Monochorionic/diamniotic twin pairs with unequal placental sharing had a 9.8 times greater likelihood of birth weight discordance (95% CI, 5.4-17.9) as compared with those pairs with equal placental sharing. CONCLUSION: Unequal placental sharing is a significant risk factor for birth weight discordance in monochorionic/diamniotic twins. Antenatal diagnosis of unequal placental sharing would enable improved counseling in the setting of monochorionic/diamniotic twins.

Amnion↗
PubMed2006

Are women who are treated for hypothyroidism at risk for pregnancy complications?

OBJECTIVE: The purpose of this study was to investigate the outcomes that are associated with pregnancy and treated hypothyroidism. STUDY DESIGN: This was a retrospective cohort study of all women who received prenatal care and were delivered at the University of California, San Francisco, between 1989 and 2001. All patients with hypothyroidism diagnosed before pregnancy or early in pregnancy were identified. Maternal, fetal, and obstetric outcomes were then collected and analyzed for women with hypothyroidism and compared with women without hypothyroidism. RESULTS: Among 20,499 deliveries, there were 419 women (2.1%) who were treated for hypothyroidism during the study period. Hypothyroidism was more common among women > or =35 years old, white women, and women without Medicaid insurance. Treated hypothyroidism was not associated with any increase in maternal, fetal, or neonatal complications. In addition, hypothyroidism did not affect mode of delivery. CONCLUSION: Compared with patients without hypothyroidism, patients with treated hypothyroidism are not at any increased risk for perinatal morbidity.

Adult↗
PubMed2006

Face presentation: predictors and delivery route.

OBJECTIVE: We sought to identify associated characteristics of face presentation and to examine factors that were associated with mode of delivery in the setting of face presentation. STUDY DESIGN: This was a retrospective cohort study of women who were diagnosed with face presentation during labor. We examined maternal, fetal, and labor characteristics to determine the associations and predictors of cesarean delivery. RESULTS: Fetuses in face presentation were more likely preterm, < 2500 g, and black. An Apgar score of < 7 at 5 minutes was more common in face presentation (10.9%) compared with vertex presentation (4.4%; P = .018). Rates of umbilical artery base excess < -12 or pH < 7.0 were not different. Cesarean delivery was less common in women who received oxytocin (adjusted odds ratio, 0.18; 95% CI, 0.03-0.95) and in women with mentum anterior (14%) as compared with mentum posterior presentation (85%; P < .001). CONCLUSION: This study confirms the association between face presentation and prematurity. The association with black ethnicity may be related to differences in pelvic anatomy. Although face presentation was associated with decreased Apgar scores, no other indicators of fetal asphyxia were identified. Cesarean delivery rates were higher in women with mentum posterior face presentation and in women who did not receive oxytocin.

Apgar Score↗
PubMed2006

Perinatal complications among different Asian-American subgroups.

OBJECTIVE: This study was undertaken to investigate the differences in perinatal outcomes among Asian American/Pacific Islander (AAPI) women. STUDY DESIGN: A retrospective cohort study of all Japanese, Chinese, and Filipina women who delivered at University of California, San Francisco from 1985 to 2001 examined the incidence of gestational diabetes, preeclampsia, and preterm delivery. RESULTS: Among the 6511 women delivered during the study period, the incidence of preeclampsia was highest among Filipina women (6.8%) compared with the Chinese and Japanese women (4.0% and 3.7%, respectively, P < .001). Gestational diabetes was most common in the Chinese and Filipina women (6.5% and 6.1%, respectively) compared with the Japanese women (3.4%, P = .013). Preterm delivery was also highest among Filipina women both before 37 weeks (12.2%, P < .001) and 34 weeks (4.8%, P = .004). These differences remained statistically significant after controlling for potential confounding variables. CONCLUSION: We found significant differences in rates of preeclampsia, gestational diabetes, and preterm delivery in the Chinese, Japanese, and Filipino subgroups. In studies of race and ethnicity, it is important to examine Asian subgroups separately.

Adult↗
PubMed2006

Ultrasound screening of fetuses at increased risk for Down syndrome: how many missed diagnoses?

OBJECTIVE: To determine the number of Down syndrome (DS) fetuses identified, amniocenteses performed, and procedure-related losses incurred when second-trimester ultrasound is used to screen high-risk patients in order to determine who should undergo an amniocentesis. METHODS: A decision analytic model was designed for women at increased risk for a DS fetus due to either advanced maternal age (AMA) or a positive expanded maternal serum alpha fetoprotein (MSAFP) screening test, also known as a triple screen (+triple) test. The model compared: (1) the current standard of offering all at-risk women amniocentesis to (2) a policy of performing amniocentesis only when sonographic markers of DS are seen on ultrasound. Baseline assumptions included a sensitivity of 60.6% for targeted ultrasound and a screen-positive rate of 16.2%. RESULTS: If targeted ultrasound is used to determine whether high-risk patients should undergo amniocentesis, 56% (3933/7025) of all DS fetuses are missed. The diagnosis of DS is missed most frequently among women at highest risk for DS (AMA and +triple). In this subgroup of patients, there are 3152 DS fetuses in the second trimester, of which 2815 (89%) are identified by triple screen test. When an ultrasound screen is added, only 1709 (54%) of DS fetuses will be identified. CONCLUSION: Substantially fewer DS fetuses will be detected when targeted ultrasound is used as a screen among already identified high-risk patients.

Decision Support Techniques↗
PubMed2006

Variation in the decision to terminate pregnancy in the setting of fetal aneuploidy.

OBJECTIVE: To investigate the rate of pregnancy termination for various fetal aneuploidies, and to evaluate predictors of this choice. METHODS: A retrospective cohort study identified all patients with any of seven common fetal aneuploidies (trisomies 21, 18, and 13; 45,X, 47,XXX, 47,XXY, and 47,XYY) at a referral prenatal diagnosis unit from 1983 to 2003. We abstracted type of aneuploidy, time and type of diagnostic procedure, maternal age, and ethnicity as predictors of the decision to terminate. Statistical comparisons were made using the chi-square test. Potential confounding variables were controlled for using multivariate logistic regression. RESULTS: Overall, there were 833 patients who had fetuses with aneuploidy. In our study population, the overall rate of termination was 81%: 86% in cases of autosomal trisomy and 60% in cases of sex chromosome aneuploidy (SCA) (p < 0.001). Rates were lowest in cases with the least severe prognosis, 47,XYY (57%) and 47,XXX (40%) compared with 45,X (65%) and 47,XXY (70%) (p = 0.05). Patients with SCA detected by chorionic villus sampling (CVS) had a higher termination rate than those who had undergone amniocentesis (77% vs 55%, p = 0.015). Increased maternal age was associated with higher termination rates in autosomal trisomy (88% vs 76% p < 0.001) and a trend toward decreased rates in those with SCA (55% vs 71%, p = 0.06). Hispanic women were less likely to terminate pregnancy (69%, p = 0.01) than those from other racial/ethnic groups. CONCLUSION: Type and severity of aneuploidy, type of diagnostic procedure, maternal age, and ethnicity contribute to patients' decision-making in the setting of fetal aneuploidy.

Abortion, Eugenic↗
PubMed2006

Women with one elevated 3-hour glucose tolerance test value: are they at risk for adverse perinatal outcomes?

OBJECTIVE: The purpose of this study was to examine whether women with one elevated value of the 3-hour glucose tolerance test are at increased risk for adverse perinatal outcomes. STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the use of the glucose loading test and with a glucose tolerance test for follow up, if screened values were positive. Perinatal outcomes in women with one elevated glucose tolerance test value were compared with the outcomes in women who screened negative by glucose loading test. The chi-square test was used to compare categorical outcomes, and multivariate logistic regression analysis was used to control for potential confounding factors; a P value of < .05 indicated statistical significance. RESULTS: Of 14,036 women who met the study criteria, women with one elevated glucose tolerance test value exhibited higher rates of cesarean delivery (in nulliparous women only), preeclampsia, chorioamnionitis, birth weight > 4000 g and > 4500 g, and neonatal admission to the intensive care nursery as compared with women who screened negative (P < .05 for all). CONCLUSION: Although women with one elevated glucose tolerance test value are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse perinatal outcomes.

Adult↗
PubMed2006

Manual rotation of the fetal occiput: predictors of success and delivery.

OBJECTIVE: The purpose of the study was to define predictors of successful rotation and rate of cesarean delivery after manual rotation of the fetal occiput from occiput posterior or transverse position. STUDY DESIGN: A retrospective cohort study comprised patients who underwent a trial of manual rotation of the fetal occiput from occiput posterior or occiput transverse position. Successful rotation was defined as delivery in the occiput anterior position. We examined maternal, fetal, and labor characteristics as predictors of both fetal position at delivery and cesarean delivery. RESULTS: Multiparity (odds ratio, 2.5; 95% CI, 1.5-3.8) and maternal age < 35 years (odds ratio, 2.0; 95% CI, 1.1-3.4) were associated with successful manual rotation of the fetal occiput. After successful rotation, the cesarean delivery rate was 2%, compared with 34% if the rotation failed (P < .001). Asian ethnicity, nulliparity, age > 35 years, labor induction, and epidural usage were associated with higher rates of cesarean delivery. CONCLUSION: After successful manual rotation of the fetal occiput, women had lower cesarean delivery rates than women with unsuccessful rotations. Multiparity and maternal age of < 35 years were associated with more successful rotations.

Adult↗
PubMed2006

Are there ethnic differences in the length of labor?

OBJECTIVE: The purpose of this study was to examine the lengths of the first and second stages of labor among different racial/ethnic groups to determine whether different norms should be established. STUDY DESIGN: This was a retrospective cohort study of all laboring, term, singleton, vertex deliveries in a single academic institution. Median lengths of first and second stages of labor were compared among 4 racial/ethnic groups: black, Asian, white, and Latina. Kruskal-Wallis, Wilcoxon rank sum tests, and multivariate linear and logistic regression models were performed. RESULTS: In 27,521 births, the lengths of first stage of labor did not differ significantly among groups in the multivariate analysis. In the second stage of labor, black women had shorter labors, both overall and stratified by epidural use. In the multivariate analysis, when controlled for demographics, parity, epidural, chorioamnionitis, birthweight, delivery year, and labor management, black women had a shorter second stage than did white women (nulliparous women, 22 minutes; multiparous women, 7.5 minutes; P < .001) and lower rates of prolonged second stage (odds ratio, 0.6; P < .001). Nulliparous Asian women had a significantly longer second stage and higher rates of prolonged second stage, and nulliparous Latina women had a shorter second stage, compared with nulliparous white women. CONCLUSION: When data are controlled for confounding factors, black women had a shorter length of second stage of labor than did women in other ethnic groups. These differences appear to be clinically significant. This contributes to the support of a multifactorial redefinition of labor curves, which are used widely in the management of labor.

Black or African American↗
PubMed2006

The relationship of fetal position and ethnicity with shoulder dystocia and birth injury.

OBJECTIVE: The objective of this study was to examine factors associated with the occurrence of shoulder dystocia and subsequent perinatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study of 29,612 consecutive term, singleton, vertex vaginal deliveries. The primary outcome was reported shoulder dystocia. Fetal position, ethnicity, and their interaction terms were examined along with maternal characteristics, induction and length of labor, operative vaginal delivery, epidural, and birth weight in both bivariate and multivariate analyses. RESULTS: Among women who met study criteria, 524 (1.8%) experienced a shoulder dystocia. African American women had the highest risk of shoulder dystocia (2.6%), compared with other races/ethnicities (P = .001). Women who delivered in occiput posterior position were noted to have a lower risk for shoulder dystocia (1.1%) as compared with occiput anterior position (1.8%, P = .046). However, in the setting of a shoulder dystocia, a higher risk of brachial plexus injury was observed in neonates delivered in occiput posterior position (adjusted odds ratio 10.4, 95% confidence interval 3.03 to 35.88) by vacuum-assisted vaginal delivery (adjusted odds ratio 3.24, 95% confidence interval 1.37 to 7.67) and neonates weighing 4000 g or more (adjusted odds ratio 2.53, 95% confidence interval 1.09 to 5.85). CONCLUSION: Overall African American women have an increased risk of shoulder dystocia, but their neonates are not more likely to experience birth injury. Although occiput posterior position has a protective effect for shoulder dystocia, the risk of brachial plexus injury is increased in the setting of a persistent occiput posterior delivery. These factors should be used to consider a patient's prospective risk for shoulder dystocia and associated outcomes.

Adult↗
PubMed2006

Perinatal outcomes among Asian American and Pacific Islander women.

OBJECTIVE: The purpose of this study was to examine perinatal outcomes between Asian American and Pacific Islander subgroups. STUDY DESIGN: This is a retrospective study of all Asian American/Pacific Islander women who were delivered at Stanford University Medical Center from 1998 to 2003. Asian American women were subdivided into the following groups: Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Pacific Islanders (individuals from Tonga, Samoa, Guam, or Polynesia), and Vietnamese. Perinatal outcomes included gestational hypertension/preeclampsia, gestational diabetes mellitus, preterm delivery, cesarean delivery, birthweight <2500 g, and birthweight >4000 g. RESULTS: In the study population of 3779 Asian American women, there were statistically significant differences (P < .01) between most of the outcomes that were examined. Filipina women had the highest risk of gestational hypertension/preeclampsia (adjusted odds ratio, 2.21); Indian/Pakistani women had the highest risk of preterm delivery (adjusted odds ratio, 1.67), gestational diabetes mellitus (adjusted odds ratio, 1.39), and low birthweight at term (adjusted odds ratio, 2.30); and Pacific Islander women had the highest risk of macrosomia (adjusted odds ratio, 3.67). CONCLUSION: Significant differences in perinatal outcomes exist between subgroups of the Asian American and Pacific Islander community. Future research on race/ethnicity and perinatal outcomes should examine heterogeneity among these groups before collapsing these individual subgroups into the larger group "Asian." Individuals should be counseled regarding perinatal risk according to their specific Asian subgroup.

Adult↗