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C V Ananth

Publications and source records attributed to C V Ananth.

At least 19 recordsLinked to original sources
PubMed2004

Maternal age and risk of fetal death in singleton gestations: USA, 1995-2000.

OBJECTIVE: To determine the magnitude of risk for fetal death among singleton pregnancies in relation to maternal age, and to compare the risks with other common indications for fetal testing. STUDY DESIGN: We performed a retrospective cohort analysis of singleton births delivered between 1995 and 2000 using the US linked birth/infant death data. Gestational age at < 24 weeks and fetuses with anomalies were excluded. Fetal death rates at > or = 24 and > or = 32 weeks were calculated among women aged 15-19, 20-24, 25-29, 30-34, 35-39, 40-44 and 45-49 years, as well as for other common indications for testing: chronic and pregnancy-induced hypertension, diabetes and small-for-gestational age (SGA). The association between maternal age and fetal deaths was derived after adjusting for potential confounders through multivariable logistic regression models. Relative risks (RR) and 95% confidence intervals (CI) were derived from these models after adjusting for the effects of gravidity, race, marital status, prenatal care, education, smoking and placental abruption. RESULTS: Among the 21,610,873 singleton births delivered at > or = 24 weeks, fetal deaths occurred in 58,580 (2.7 per 1000). Births to young (15-19 years) and older (> or = 35 years) women comprised 12.6% and 11.4%, respectively. Compared with women aged 20-24 years, young women did not experience an increased risk of fetal death. However, increasing rates of fetal death at > or = 24 and at > or = 32 weeks were seen with increasing maternal age. The RR for fetal death at > or = 24 and at > or = 32 weeks among women 35-39 years were 1.21 and 1.31, respectively, while the RRs were 1.62 and 1.67 among women aged 40-44 years. Women 45-49 years were 2.40-fold (95% CI 1.77, 3.27) and 2.38-fold (95% CI 1.64, 3.46) as likely to deliver a stillborn fetus at > or = 24 weeks and > or = 32 weeks, respectively. RRs for fetal death at > or = 24 and > or = 32 weeks for hypertensive disease, diabetes, and SGA ranged between 1.46 and 4.95. CONCLUSION: Fetal deaths are increased among older women (> or = 35 years). Fetal testing in women of advanced maternal age may be beneficial.

Adolescent↗
PubMed2004

The impact of route of delivery and presentation on twin neonatal and infant mortality: a population-based study in the USA, 1995-97.

OBJECTIVE: We examined whether the route of delivery for near-term (> or = 34 weeks' gestation) twins, as candidates for vaginal delivery, affected neonatal and infant mortality rates. We further evaluated whether these mortality rates were modified by fetal presentation. METHODS: A population-based retrospective cohort study based on the matched multiple births data in the USA (1995-97) was performed. Analyses were restricted to non-malformed liveborn twins delivered at (> or = 34 weeks' gestation. Twins with breech-breech and breech-vertex presentations were excluded, since they are not candidates for vaginal delivery. Neonatal mortality rates (death within the first 27 days) and post-neonatal mortality rates (death between 28 and 365 days) per 1000 twin live births, by route of delivery and fetal presentation, were derived. The associations between neonatal mortality, post-neonatal mortality and the route of delivery for vertex-breech versus vertex-vertex presentations were expressed based on relative risks (RR) and 95% confidence intervals (CI) derived from logistic regression models based on the method of generalized estimating equations. RESULTS: Of the 177,622 twins analyzed, 87% (n = 154,531) presented as vertex-vertex. Fifty-five per cent (n = 97,692) of twins were both delivered vaginally, 41% (n = 72,825) were both delivered by Cesarean section and, of the remaining 4% (n = 7,105), the first twin was delivered vaginally and the second by Cesarean section. Twins with vertex-breech presentations delivered by Cesarean-cesarean sections, as well as those with vertex-vertex presentations delivered vaginally, had the lowest neonatal mortality rate (1.6 per 1000 live births). The highest neonatal mortality rate in the vertex-breech pairs occurred with vaginal-Cesarean deliveries (2.7 per 1000 live births). Among twins with vertex-vertex presentations, twins delivered via the vaginal-Cesarean route experienced the highest neonatal mortality (3.8 per 1000 live births). The RR for neonatal mortality in this group was 2.24 (95% CI 1.35, 3.72) compared with twins both delivered vaginally. CONCLUSION: Route of delivery and fetal presentation both confer an impact on twin infant mortality rates. Strategies to reduce discordant routes in complicated vaginal deliveries may lead to improved neonatal survival.

Cohort Studies↗
PubMed2004

The influence of obstetric intervention on trends in twin stillbirths: United States, 1989-99.

OBJECTIVE: Although twin stillbirth rates have declined substantially over the past two decades, the contribution of changes in obstetric interventions to reducing twin stillbirths has not been quantified. METHODS: We carried out a retrospective cohort study of twin live births and stillbirths in the United States between 1989 and 1999 (n=1,102,212). Changes in the rate of stillbirth (> or =22 weeks) before and after adjustment for changes in labor induction, Cesarean delivery and sociodemographic factors were estimated through ecological logistic regression analysis. This analysis was based on aggregating data by each state within the United States. RESULTS: Between 1989 and 1999, rates of labor induction and Cesarean delivery among twin live births increased by 138% (from 5.8% to 13.8%) and 15% (from 48.3% to 55.6%), respectively. These changes were accompanied by a 43% decline in the stillbirth rate between 1989 and 1999 (from 24.4 to 13.9 per 1000 fetuses at risk). After excluding births weighing < 500 g, rates of labor induction among twins at 22-27 weeks', 28-33 weeks' and > or =34 weeks' gestation increased by 95%, 131% and 127%, respectively, between 1989 and 1999. Cesarean delivery rates also increased by 55%, 29% and 2% in these same gestational age categories. The 48% (relative risk (RR) 0.52, 95% confidence interval (CI) 0.49-0.55) decline in stillbirth rate between 1989-91 and 1997-99 was reduced to a 25% (RR 0.75, 95% CI 0.72-0.79) decline after adjustment for changes in labor induction and Cesarean delivery. The decline in the rate of twin stillbirths was larger at later gestational ages (at > or =32 and > or =34 weeks) where the largest absolute increases in labor induction rates were observed. CONCLUSIONS: The use of Cesarean delivery and especially labor induction for twin pregnancies has increased substantially in the United States over the last decade and these changes have been associated with a large decline in the rate of stillbirth among twins.

Adolescent↗
PubMed2004

Modeling multivariate binary responses with multiple levels of nesting based on alternating logistic regressions: an application to caries aggregation.

Clustered binary responses are commonly encountered in dental research. Data analysis may include modeling both the marginal response probabilities (i.e., risk) and the dependence structure between pairs of responses (i.e., aggregation). While second-order generalized estimating equations (GEE2) is a well-known approach for such data, alternating logistic regressions (ALR) is a computationally efficient alternative method, especially for large clusters. We illustrate ALR with an application to caries aggregation using a dataset with 3 levels of nesting: tooth surfaces within an interproximal (IP) region, IP regions within a jaw, and jaws within a subject. Caries lesions appear to aggregate strongly within subjects with a spatially distributed risk. The minimum within-IP-region odds ratio (OR) was 2.25 (95% confidence interval 1.15, 4.41), and the within-IP-region ORs were always greater than the between-IP-region ORs. ALR is a convenient and useful regression technique for explicit modeling of the dependence structure, and may be applicable to other dental research problems involving clustered or nested responses.

Cluster Analysis↗
PubMed2003

Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies.

OBJECTIVE: Several clinical and epidemiologic studies have reported disparate data on the prevalence rate as well as risk factors associated with placenta previa--a major cause of third-trimester bleeding. We performed a systematic literature review and identified 58 studies on placenta previa published between 1966 and 2000. STUDY DESIGN: Each study was reviewed independently by the two authors and was scored (on the basis of established criteria) on method of diagnosis of placenta previa and on quality of study design. We extracted data on the prevalence rate of placenta previa, as well as associations with various risk factors from each study. A meta-analysis was then performed to determine the extent to which different risk factors predispose women to placenta previa. RESULTS: Our results showed that the overall prevalence rate of placenta previa was 4.0 per 1000 births, with the rate being higher among cohort studies (4.6 per 1000 births), USA-based studies (4.5 per 1000 births) and hospital-based studies (4.4 per 1000 births) than among case-control studies (3.5 per 1000 births), foreign-based studies (3.7 per 1000 births) and population-based studies (3.7 per 1000 births), respectively. Advancing maternal age, multiparity, previous Cesarean delivery and abortion, smoking and cocaine use during pregnancy, and male fetuses all conferred increased risk for placenta previa. Strong heterogeneity in the associations between risk factors and placenta previa were noted by study design, accuracy in the diagnosis of placenta previa and population-based versus hospital-based studies. CONCLUSION: Future etiological studies on placenta previa must, at the very least, adjust for potentially confounding effects of maternal age, parity, prior Cesarean delivery and abortions.

Epidemiologic Studies↗
PubMed2002

The effects of labor on infant mortality among small-for-gestational-age infants in the USA.

OBJECTIVE: To determine whether the presence of labor affects infant mortality among small-for-gestational-age (SGA) infants. METHODS: Data were derived from the United States national linked birth/infant death data sets for 1995-97. Singleton SGA live births in cephalic presentation delivered at 24-42 weeks' gestation were included. Mortality rates for SGA infants exposed and unexposed to labor were compared, and relative risks (RR) were derived using multivariable logistic regression models, after adjusting for potential confounding factors. RESULTS: Of 986 405 SGA infants, 87.4% were exposed to labor. Infants exposed to labor at 24-31 weeks had greater risks of dying during the early neonatal period (RR 1.79-1.86). Decreased risks of late and postneonatal death were observed at all gestational ages in the presence of labor. CONCLUSIONS: Exposure to labor is associated with an increased risk of early neonatal death among SGA infants, especially at gestational ages below 32 weeks. Future randomized trials are warranted to determine the optimal obstetric management of these high-risk infants.

Female↗
PubMed2001

Rates of preterm delivery among Black women and White women in the United States over two decades: an age-period-cohort analysis.

The authors assessed the influence of age, period, and cohort effects on rates of preterm delivery in the United States. Rates of preterm delivery for singleton births (<37 weeks) in seven age groups (15-19, 20-24,., 45-49 years), five periods (1975, 1980, 1985, 1990, 1995), and 11 maternal birth cohorts (1926-1930, 1931-1935,., 1976-1980) were examined. Over the 20-year study interval, preterm delivery increased by 3.6% among Blacks (from 15.5% in 1975 to 16.0% in 1995) and by 22.3% among Whites (from 6.9% to 8.4%). Among Black primigravid women, rates of preterm delivery increased from 1975 to 1990 and began to decline thereafter; among Whites, the rates increased between 1975 and 1995. In Blacks, women aged 25-29 years had the lowest rates for the first and second births, and women aged 30-34 years had the lowest rate for subsequent births. In Whites, the age groups with the lowest preterm delivery rates were 20-24 years for first births and 25-29 years for subsequent births. Cohort-specific rates of preterm delivery remained fairly constant across age strata and periods for Whites, but a small trend was apparent for Blacks aged 30-44 years. The consistency of the observed age effects across periods and cohorts suggests that the age effect is partly due to biologic factors. The presence of period effects might be linked to the increased survival of premature infants or to increased viability among births occurring at lower lengths of gestation.

Adolescent↗
PubMed2001

Trends in preterm birth and neonatal mortality among blacks and whites in the United States from 1989 to 1997.

Preterm birth, a major determinant of infant mortality, has been increasing in recent years. The authors examined trends in preterm birth and its determinants by using the US birth and infant death files for 1989-1997. The impact of trends in preterm birth rates on neonatal and infant mortality was also evaluated. Among Whites, preterm births (<37 completed weeks of gestation) increased from 8.8% of livebirths in 1989 to 10.2% in 1997, a relative increase of 15.6%. On the other hand, preterm births among Blacks decreased by 7.6% (from 19.0% to 17.5%) during the same period. An increase in obstetric interventions contributed to increases in preterm births for both races but was outweighed by other unidentified favorable influences for Blacks. Neonatal mortality among preterm Whites dropped 34% during the 8 years of the study, while the decrease was only 24% among Blacks. This large disparity countered the changes in preterm birth rates so that the percentage decline in neonatal mortality was similar in the two racial groups (18-20%). In conclusion, the anticipated mortality benefit from a lower preterm birth rate for Blacks has been blunted by suboptimal improvement in mortality among the remaining preterm infants. The widening race gap in mortality among preterm infants merits attention.

Black or African American↗
PubMed2001

Placental abruption among singleton and twin births in the United States: risk factor profiles.

The authors performed a population-based epidemiologic study to evaluate and contrast risk factor profiles for placental abruption among singleton and twin gestations. Data were derived from linked US birth/infant death files for 1995 and 1996, comprising 7,465,858 singleton births and 193,266 twin births. The authors also evaluated effect modification between smoking and hypertension and the effect of a dose-response relation with number of cigarettes smoked daily on abruption risk. Abruption was recorded in 5.9 per 1,000 singleton births and 12.2 per 1,000 twin births. Risk factors for abruption among singleton and twin births, respectively, included preterm premature rupture of membranes (adjusted relative risks (RRs) = 4.89 and 2.01), eclampsia (RRs = 3.58 and 1.67), anemia (RRs = 2.23 and 2.33), hydramnios (RRs = 2.04 and 1.66), renal disorders (RRs = 1.54 and 2.56), and intrapartum fever (>100 degrees F) (RRs = 1.17 and 1.69). Chronic hypertension (RR = 2.38) and pregnancy-induced hypertension (RR = 2.34) were risk factors for abruption in singleton births but not in twin births. Number of cigarettes smoked daily demonstrated a dose-response trend for abruption risk in singletons and twins. Abruption was more likely to occur among smokers with chronic hypertension (RRs = 4.66 and 3.15) and eclampsia (RRs = 6.28 and 5.08). The authors conclude that abruption is twice as likely to occur in twins as in singletons with differing risk factor profiles. This suggests that abruption in twins may result from different pathophysiologic processes.

Abruptio Placentae↗
PubMed2001

Placental abruption and perinatal mortality in the United States.

Placental abruption is an uncommon obstetric complication associated with high perinatal mortality rates. The authors explored the associations of abruption with fetal growth restriction, preterm delivery, and perinatal survival. The study was based on 7,508,655 singleton births delivered in 1995 and 1996 in the United States. Abruption was recorded in 6.5 per 1,000 births. Perinatal mortality was 119 per 1,000 births with abruption compared with 8.2 per 1,000 among all other births. The high mortality with abruption was due, in part, to its strong association with preterm delivery; 55% of the excess perinatal deaths with abruption were due to early delivery. Furthermore, babies in the lowest centile of weight (<1% adjusted for gestational age) were almost nine times as likely to be born with abruption than those in the heaviest (> or =90%) birth weight centiles. This relative risk progressively declined with higher birth weight centiles. After controlling for fetal growth restriction and early delivery, the high risk of perinatal death associated with abruption persisted. Even babies born at 40 weeks of gestation and birth weight of 3,500-3,999 g (where mortality was lowest) had a 25-fold higher mortality with abruption. The link between fetal growth restriction and abruption suggests that the origins of abruption lie at least in midpregnancy and perhaps even earlier.

Abruptio Placentae↗
PubMed2001

Effect of labor on infant morbidity and mortality with preterm premature rupture of membranes: United States population-based study.

OBJECTIVE: To evaluate whether labor, in the setting of premature rupture of membranes (PROM), affects infant morbidity and mortality rates. METHODS: We derived data for this population-based cohort study from the United States national linked birth infant death data sets, comprised of singleton live births delivered between 1995 and 1997. We included women (n = 34,594) who had preterm PROM more than 12 hours and delivered between 23 and 32 weeks' gestation. Birth records were used to determine whether delivery occurred with or without labor. Infants with birth weights below the tenth percentile for gestational age were classified as small for gestational age (SGA) on the basis of a nomogram of all singleton births in the United States between 1995 and 1997. Primary outcomes were early neonatal (0-6 days), late neonatal (7-27 days), postneonatal (28-365 days), and infant death (0-365 days). Secondary outcomes included respiratory distress syndrome (RDS), assisted ventilation, and neonatal seizures. Risks of infant mortality and morbidity from labor were examined separately for SGA and non-SGA infants. RESULTS: Overall rates were infant death 11.6%, RDS 15.1%, assisted ventilation 25.9%, and neonatal seizure 0.2%. Labor was associated with higher incidence of early neonatal death in SGA infants (adjusted relative risk [RR] 1.24, 95% confidence interval [CI] 1.11, 1.38) but had no effect on other outcomes. Among non-SGA infants, labor had no effect on infant death but was associated with higher rates of RDS (RR 1.15, 95% CI 1.08, 1.22) and assisted ventilation (RR 1.16, 95% CI 1.08, 1.24). CONCLUSION: Although labor was associated with a slightly higher mortality rate in SGA infants and slightly more respiratory morbidity in non-SGA infants, recommendations regarding clinical treatment should await future clinical trials.

Adult↗
PubMed2001

Association of maternal fever during labor with neonatal and infant morbidity and mortality.

OBJECTIVE: To examine the association of intrapartum fever with infant morbidity and early neonatal (0-6 days) and infant (0-364 days) death. METHODS: We carried out a retrospective cohort analysis among singleton live births in the United States for the period 1995-1997 using the National Center for Health Statistics linked birth-infant death cohort data. RESULTS: Among the 11,246,042 singleton live births during the study period, intrapartum fever (at least 38C) was recorded in 1.6%. Intrapartum fever was associated with early neonatal (adjusted odds ratio [OR], 95% confidence interval [CI] for preterm and term infants respectively: 1.32; 1.11, 1.56 and 1.67; 1.14, 2.46) and infant (OR, 95% CI for preterm and term, respectively: 1.31; 1.14, 1.51 and 1.27; 1.01, 1.59) death among nulliparous mothers. Among preterm infants of parous mothers, intrapartum fever was associated with early neonatal (OR 1.29, 95% CI 1.01, 1.64) death. In the combined analyses (infants of nulliparous and parous mothers), intrapartum fever was a strong predictor of infection-related death. These associations were stronger among term (OR 3.16, 95% CI 1.56, 6.40 for early neonatal; OR 1.75, 95% CI 1.20, 2.57 for infant death) than preterm infants (OR 1.52, 95% CI 1.15, 2.00 for early neonatal; OR 1.29, 95% CI 1.05, 1.57 for infant death). Intrapartum fever was also a risk factor for meconium aspiration syndrome, hyaline membrane disease, neonatal seizures, and assisted ventilation. CONCLUSION: Intrapartum fever is an important predictor of neonatal morbidity and infection-related mortality.

Adult↗
PubMed2001

Relationship among placenta previa, fetal growth restriction, and preterm delivery: a population-based study.

OBJECTIVE: To examine the independent contributions of prematurity and fetal growth restriction to low birth weight among women with placenta previa. METHODS: A population-based, retrospective cohort study of singleton live births in New Jersey (1989-93) was performed. Mother-infant pairs (n = 544,734) were identified from linked birth certificate and maternal and infant hospital discharge summary data. Women diagnosed with previa were included only if they were delivered by cesarean. Fetal growth, defined as gestational age-specific observed-to-expected mean birth weight, and preterm delivery (before 37 completed weeks) were examined in relation to previa. Severe and moderate categories of fetal smallness and large for gestational age were defined as observed-to-expected birth weight ratios below 0.75, 0.75-0.85, and over 1.15, respectively, all of which were compared with appropriately grown infants (observed-to-expected birth weight ratio 0.86-1.15). RESULTS: Placenta previa was recorded in 5.0 per 1000 pregnancies (n = 2744). After controlling for maternal age, education, parity, smoking, alcohol and illicit drug use, adequacy of prenatal care, maternal race, as well as obstetric complications, previa was associated with severe (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.25, 1.50) and moderate fetal smallness (OR 1.24, 95% CI 1.17, 1.32) births. Preterm delivery was also more common among women with previa. Adjusted OR of delivery between 20-23 weeks was 1.81 (95% CI 1.24, 2.63), and 2.90 (95% CI 2.46, 3.42) for delivery between 24-27 weeks. OR for delivery by each week between 28 and 36 weeks ranged between 2.7 and 4.0. Approximately 12% of preterm delivery and 3.7% of growth restriction were attributable to placenta previa. CONCLUSION: The association between low birth weight and placenta previa is chiefly due to preterm delivery and to a lesser extent with fetal growth restriction. The risk of fetal smallness is increased slightly among women with previa, but this association may be of little clinical significance.

Adult↗
PubMed2001

A comparison of sonographic cervical parameters in predicting spontaneous preterm birth in high-risk singleton gestations.

OBJECTIVES: To assess the role of cervical sonography and to compare various sonographic cervical parameters in their ability to predict spontaneous preterm birth in high-risk singleton gestations. DESIGN: A prospective cohort of 469 high-risk gestations were longitudinally evaluated between 15 and 24 weeks' gestation on 1265 occasions with transvaginal cervical sonography and transfundal pressure. The cervical parameters obtained were funnel width and length, cervical length, percent funneling and cervical index. The information obtained was used for patient management. Restriction of physical activities was initiated at cervical lengths of < or = 2.5 cm with cerclage as an option for cervical lengths of < or = 2.0 cm. RESULTS: Receiver operating characteristic curve analyses showed that a cervical length of < or = 2.5 cm between 15 and 24 weeks' gestation was equal to the other sonographic cervical parameters in its ability to predict spontaneous preterm birth. The sensitivities for delivery at < 28, < 30, < 32 and < 34 weeks' gestation were 94%, 91%, 83% and 76%, respectively, while the negative predictive values were 99%, 99%, 98% and 96%, respectively. The placement of a cerclage did not influence the positive and negative predictive values. In comparison to women with other risk factors, cervical length was best in the prediction of preterm birth in women with a prior mid-trimester loss; an optimal cut-off of < or = 1.5 cm had sensitivities for delivery at < 28, < 30, < 32 and < 34 weeks' gestation of 100%, 100% 92% and 81%, respectively. The rate of preterm delivery at < 34 weeks' gestation increased dramatically when the cervical length was < or = 1.5 cm. Cervical length was the only independent variable that entered the logistic regression model for the prediction of preterm delivery at < 34 weeks' gestation. CONCLUSIONS: In high-risk singleton gestations a cervical length of < or = 2.5 cm was equal to other sonographic cervical parameters in its ability to predict spontaneous preterm birth and was better for the prediction of earlier forms of prematurity (at < 28 and < 30 weeks) than later forms (at < 32 and < 34 weeks). The optimal cervical lengths and their performance for predicting prematurity may be influenced by obstetric risk factors.

Adult↗
PubMed2001

Revisiting sonographic abdominal circumference measurements: a comparison of outer centiles with established nomograms.

OBJECTIVE: To construct an institution-specific nomogram of fetal abdominal circumference measurements and determine whether previously published nomograms correctly categorize our population's outer centiles. DESIGN: Using cross-sectional data from a database of sonographic circumference measurements, a nomogram for abdominal circumference measurements was created by modeling the mean and standard deviation separately. The adequacy of the nomogram was confirmed by assessing the normal distribution of data, verifying goodness-of-fit, and checking residuals. Outer centiles were compared with those from other published nomograms. RESULTS: The new nomogram for fetal abdominal circumference measurements from 10 070 fetuses provided sufficient data to derive values for the 5th, 10th, 50th, 90th and 95th centiles based on gestational age. Comparisons with other published nomograms indicated that the false-negative rates for classifying our population as < 10th centile or > 90th centile ranged from 11.3% to 90.5% and from 0 to 66.4%, respectively. CONCLUSION: Institution-specific nomograms of fetal abdominal circumference measurements are important to avoid incorrect categorization of outer centiles.

Abdomen↗
PubMed2001

Defining the relationship between obstetricians and maternal-fetal medicine specialists.

OBJECTIVE: The purpose of this study was to determine how frequently general obstetricians refer pregnant patients to maternal-fetal medicine specialists in the presence of the clinical indications specified as appropriate for referral or consultation by the 1996 statement of the Society of Perinatal Obstetricians. STUDY DESIGN: A questionnaire was mailed to 400 randomly selected general obstetricians across the United States. The obstetricians were asked how often they refer their high-risk pregnant patients to maternal-fetal medicine specialists in the presence of (1) a need for diagnostic or therapeutic procedures, (2) medical/surgical disorders, (3) healthy gravid women with high-risk fetuses, and (4) conditions that necessitate admission for reasons other than delivery. Response categories for each individual procedure/high-risk condition included "always," "frequently," "infrequently," "never," and "not applicable." RESULTS: Overall, 55% of the responses indicated referral (always or frequently) to maternal-fetal medicine specialists for procedures or in the presence of high-risk conditions. More than 75% of the obstetricians always or frequently refer to maternal-fetal medicine specialists for most diagnostic/therapeutic procedures and for the following high-risk conditions: acute fatty liver, portal hypertension, pulmonary hypertension, transplantations, fetal hydrops, fetal anomaly/cytogenetic abnormality, fetal supraventricular tachycardia or congenital heart block, isoimmunization, and twin-to-twin transfusion syndrome. CONCLUSION: Most of the conditions for which >75% of the obstetricians refer to maternal-fetal medicine are rarely seen in practice. Comprehensive ultrasound examination is the only commonly encountered clinical situation that >75% of the general obstetricians refer to maternal-fetal medicine specialists.

Female↗
PubMed2001

Assessing genetic risk: comparison between the referring obstetrician and genetic counselor.

OBJECTIVE: To compare the genetic risk assessment of the referring obstetrician to the risk assessment of the genetic counselor. STUDY DESIGN: All patients evaluated between January 1, 1999, and March 31, 1999, and who required genetic counseling were retrospectively reviewed. The genetic risk assessment of the referring obstetrician was compared to the genetic risk assessment following counseling by a genetic counselor who used a questionnaire and a three-generation pedigree. The number of patients with additional genetic risk factors identified by the genetic counselor were recorded and compared by using the McNemar chi-square test. Group demographics and characteristics were evaluated. RESULTS: Among the 145 patients evaluated, 38% (n = 55) had additional genetic risk factors detected by the genetic counselor (P =.01). The maternal demographics and characteristics did not differ between the two groups. CONCLUSION: The practice of referring high-risk obstetric patients for genetic counseling improves the detection of identifiable genetic risk factors.

Genetic Counseling↗