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C Y Spong

Publications and source records attributed to C Y Spong.

49 records · Page 3Linked to original sources
PubMed1997

Elevated amniotic fluid interleukin-6 levels during the early second trimester are associated with greater risk of subsequent preterm delivery.

PROBLEM: Subclinical intra-amniotic infection is often associated with preterm delivery and may precede it by several weeks. We tested the hypothesis that Interleukin-6 (IL-6) may be elevated in the midtrimester amniotic fluid of pregnancies destined to deliver preterm. METHODS: A historical cohort study was designed to compare the amniotic fluid (AF) concentrations of IL-6 at 14-20 weeks in a group of women subsequently delivering at < or = 34 weeks (n = 13) with those of women delivering at term (n = 166). Included were singleton gestations with no evidence of fetal structural or chromosomal abnormalities, or maternal conditions known to be associated with preterm delivery (n = 179). Levels of IL-6 were measured by immunoassay and correlated with demographic and pregnancy outcome information. Statistical analysis included correlation, one-way ANOVA after log-transformation, contingency tables, logistic regression, and receiver operator characteristic (ROC) curve analysis. RESULTS: There was an inverse correlation between AF IL-6 levels at 15-20 weeks and gestational age at delivery (r = -0.16, P = 0.03). Women delivering at < or = 34 weeks had significantly higher median AF IL-6 levels (570 pg/ml versus 330 pg/ml, P < 0.0001), rate of African American race (50% versus 12%, P = 0.004), and of infants with birth weights < 10th centile (31% versus 7%, P = 0.02) than women delivering at > or = 37 weeks. Logistic regression analysis showed that IL-6 was independently associated with PTD at < or = 34 weeks after controlling for race and birth weight centiles (P = 0.039). CONCLUSIONS: AF IL-6 at 15-20 weeks can identify patients at risk for PTD at < or = 34 weeks, suggesting that a portion of PTD cases have inciting events that take place during the early second trimester.

Adult↗
PubMed1997

Midtrimester amniotic fluid tumor necrosis factor-alpha does not predict small-for-gestational-age infants.

PROBLEM: To evaluate the independent ability of midtrimester amniotic fluid tumor necrosis factor-alpha (TNF-alpha) in the prediction of small-for-gestational-age (SGA) infants. METHOD OF STUDY: In this case-control study, patients delivering a SGA infant were matched with controls based on GA at delivery, maternal age, race, and parity. Patients with immune disease, chronic hypertension, diabetes, asthma, congenital hearts disease, multiple gestation, and fetal anomalies were excluded. Amniotic fluid samples were immunoassayed for TNF-alpha. Potential confounding variables evaluated were maternal serum alpha-fetoprotein level, smoking history, pregnancy induced hypertension, and neonatal gender. Statistical analysis included Fisher's exact test and ANOVA after log transformation with P < 0.05 considered significant. RESULTS: Eighteen patients delivered SGA neonates and were matched with 41 controls. No significant differences were identified in the confounding variables between patients with SGA neonates and controls. Amniotic fluid TNF-alpha levels were not significantly different between patients subsequently delivering SGA neonates and controls [median 7.63 (range 0.25-16.1) pg/mL versus 9.39 (0.25-66.9) pg/mL, P = 0.8]. CONCLUSIONS: Midtrimester amniotic fluid TNF-alpha levels are not predictive of SGA neonates when compared with controls matched for gestational age at delivery.

Amniotic Fluid↗
PubMed1996

Second-trimester amniotic fluid or maternal serum interleukin-10 levels and small for gestational age neonates.

OBJECTIVE: To evaluate if interleukin-10 levels in either early second-trimester amniotic fluid (AF) or maternal serum can be utilized as a predictor of the subsequent occurrence of small for gestational age (SGA) infants after controlling for gestational age at delivery. METHODS: We identified patients who underwent genetic amniocentesis for standard genetic indications or maternal blood sampling for maternal serum alpha-fetoprotein (MSAFP)/triple screen between January 1992 and February 1995 with available follow-up delivery data. Small for gestational age was defined as birth weight less than the tenth percentile for gestational age. Control patients were matched for gestational age at delivery, maternal age, race, and parity with at least two controls for each study patient. We excluded patients with maternal immune disease, chronic hypertension, diabetes, asthma, congenital heart disease, multiple gestation, and fetuses with structural or chromosomal anomalies. Second-trimester AF and serum samples were assayed for interleukin-10. Potential confounding variables considered were MSAFP level, smoking history, pregnancy-induced hypertension, and neonatal gender. The interleukin-10 levels were normalized using natural log transformation for statistical analysis. Statistical analysis included chi 2, Fisher exact test, and analysis of variance, with P < .05 considered significant. RESULTS. From the AF data base, 18 patients (6%) delivered SGA neonates and were matched with 46 controls. From the maternal serum data base, 13 patients (7%) delivered SGA neonates and were matched with 45 controls. Neither AF nor maternal serum interleukin-10 levels were significantly different in patients subsequently delivering SGA neonates compared with controls (AF: median 21.0 pg/mL. [range 13.8-27.6] versus 17.5 pg/mL. [range 8.9-362.12], P = .18; serum: median 15.7 pg/mL [range 9.9-73.5] versus 18.7 pg/mL [range 9.7-71.7], P = .60, respectively). No significant differences were identified in gestational age at sampling, maternal smoking history, pregnancy-induced hypertension, or elevated MSAFP in patients delivering SGA neonates compared with controls (P > .05 for each). As expected, birth weight was significantly lower in patients delivering SGA neonates compared with controls (P < .001). CONCLUSION: Second-trimester AF or maternal serum interleukin-10 levels are not predictive of subsequent delivery of SGA infants.

Adult↗
PubMed1996

Amniotic fluid index predicts the relief of variable decelerations after amnioinfusion bolus.

OBJECTIVE: Our purpose was to determine whether intrapartum amniotic fluid index before amnioinfusion can be used to predict response to therapeutic amnioinfusion. STUDY DESIGN: Intrapartum patients (n = 85) with repetitive variable decelerations in fetal heart rate that necessitated amnioinfusion (10 ml/min for 60 minutes) underwent determination of amniotic fluid index before and after bolus amnioinfusion. The fetal heart tracing was scored (scorer blinded to amniotic fluid index values) for number and characteristics of variable decelerations before and 1 hour after initiation of amnioinfusion. The amnioinfusion was considered successful if it resulted in a decrease of > or = 50% in total number of variable decelerations or a decrease of > or = 50% in the rate of atypical or severe variable decelerations after administration of the bolus. Spontaneous vaginal births before completion of administration of the bolus (n = 18) were excluded from analysis. The probability of success of amnioinfusion in relation to amniotic fluid index was analyzed with the chi(2) test for progressive sequence. RESULTS: The mean amniotic fluid index before amnioinfusion was 6.2 +/- 3.3 cm. An amniotic fluid index of < or = 5 cm was present in 40% of patients (27/67), and an amniotic fluid index of < or = 8 cm was present in 72% of patients (48/67). The probability of success of amnioinfusion decreased with increasing amniotic fluid index before amnioinfusion (76% [16/21] when initial amniotic fluid index was 0 to 4 cm, 63% [17/27] when initial amniotic fluid index was 4 to 8 cm, 44% [7/16] when initial amniotic fluid index was 8 to 12 cm, and 33% [1/3] when initial amniotic fluid index was > 12 cm, p = 0.03). The incidence of nuchal cords or true umbilical cord knots increased in relation to amniotic fluid index before amnioinfusion. CONCLUSIONS: Amniotic fluid index before amnioinfusion can be used to predict the success of amnioinfusion for relief of variable decelerations in fetal heart rate. Failure of amnioinfusion at a high amniotic fluid index before amnioinfusion may be explained by the increased prevalence of nuchal cords or true knots in the umbilical cord.

Adult↗
PubMed1996

Decreased amniotic fluid volume at < 32 weeks of gestation is associated with decreased fetal movements.

The objective of this study was to assess the relationship between amniotic fluid volume (AFV) and fetal movements at < 32 weeks gestation as assessed by routine biophysical profile (BPP). From a database of 465 consecutive nonhypertensive, nondiabetic patients delivering at < 32 weeks gestation, patients with singleton, nonanomalous fetuses with AFV and fetal movements determined as part of a BPP assessment within 24 hours of delivery were studied. Amniotic fluid volume was scored 0 to 2, according to the following criteria: largest pocket in vertical diameter < 1 cm = 0; < 2 but > 1 cm = 1; > or = 2 cm = 2. Fetal movements (FM) were scored over 30 minutes: 0 if absent, 1 if 1 to 2 movements, 2 if > or = 3 gross (limb/trunk) movements. Variables assessed included fetal presentation, gestational age (GA), premature rupture of membranes (PROM) as a principal indication for delivery, clinical chorioamnionitis (diagnosed by previously published criteria), histologic parameters of infection (in amnion and umbilical cord assessed by a single pathologist blinded to clinical data), and neonatal outcome. Statistical analyses included contingency tables and analysis of variance with p < 0.05 considered significant. Three hundred and fifty-two patients met the inclusion criteria. One hundred and sixty-seven patients (47%) had PROM as a primary indication for delivery. Infrequently, decreased fetal well-being manifested by a BPP < 7 of 10 points was an indication for delivery despite prematurity (n = 7). Of the 352 patients, 80 (23%) had AFV = 0, 60 (17%) had AFV = 1, and 212 (60%) had AFV = 2; and 12 (3%) had FM = 0, 30 (9%) FM = 1, and 310 (88%) FM = 2. There was a significant correlation between decreased AFV and decreased fetal movements (p < 0.0001). Fetal presentation and GA were not significantly different between patients based on score of fetal movements. The incidence of clinical chorioamnionitis was significantly greater in patients with FM = 0 (p < 0.005). We conclude that decreased AFV is associated with decreased fetal movements irrespective of fetal presentation or gestational age. Neonatal outcome (umbilical vasculitis, sepsis, intraventricular hemorrhage) is affected only in unusual cases in which otherwise uncompromised (nonhypoxic, nonacidotic) fetuses have low scores on both these antepartum ultrasonographic parameters.

Amniotic Fluid↗
PubMed1995

An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers.

OBJECTIVE: To generate an objective definition of shoulder dystocia by timing the events of the second and third stages of labor, and to define the true incidence of shoulder dystocia. METHODS: In 34 arbitrarily selected 24-hour time periods, a nonparticipating observer prospectively timed intervals of the second stage of labor in all vaginal deliveries and recorded the use of obstetric maneuvers (McRoberts, episiotomy after delivery of the fetal head, intentional extension of initial episiotomy after delivery of the fetal head, suprapubic pressure, posterior arm rotation to an oblique angle, rotation of the infant by 180 degrees, delivery of the posterior arm, and general anesthesia) and whether the obstetric attendant identified a delivery with shoulder dystocia. All data are reported as mean +/- standard error of the mean. RESULTS: Two hundred fifty deliveries were timed and recorded prospectively. Mean intervals (in seconds) in nonmaneuver patients were as follows: head to anterior shoulder 14.8 +/- 1.0, anterior to posterior shoulder 3.9 +/- 0.6, posterior shoulder to body 5.4 +/- 0.8, and total head-to-body time 24.2 +/- 1.3. Three groups of patients were defined after delivery. The maneuver group consisted of 27 patients requiring any of the aforementioned obstetric maneuvers, although the obstetric attendant identified only 16 of these as shoulder dystocia. The prolonged delivery group included 29 patients with the head-to-body delivery interval exceeding the mean plus two standard deviations (60 seconds) of nonmaneuver patients. Sixteen of the 27 maneuver patients were identified as prolonged. The 210 not identified as maneuver or prolonged were considered to be normal. Normal patients had a significantly lower newborn birth weight (3269 +/- 38 g), and a lower proportion of 1-minute Apgar scores of 7 or less (11%) than did the maneuver (4247 +/- 86 g, 41%) and prolonged groups (3952 +/- 118 g, 34%). Defining shoulder dystocia as a prolonged head-to-body delivery time and/or the use of obstetric maneuvers identified 40 patients who had birth weights and 1-minute Apgar scores significantly different from the normal patients. CONCLUSION: The incidence of shoulder dystocia, as defined by the use of ancillary obstetric maneuvers, is higher than that reported previously, and the reporting of shoulder dystocia appears to be unreliable. The interval from head-to-body delivery is delayed significantly in patients with shoulder dystocia, despite the lack of recognition of shoulder dystocia. We propose defining shoulder dystocia as a prolonged head-to-body delivery time (eg, more than 60 seconds) or the need for ancillary obstetric maneuvers.

Adult↗
PubMed1995

Leuprolide acetate treatment and myoma arterial size.

OBJECTIVE: To compare the size of arterial vessels in myomas from women treated with GnRH agonist (GnRH-a) or given placebo. METHODS: Our study group included 46 women about to undergo myomectomy or hysterectomy; 30 were treated with leuprolide acetate (3.75 or 7.5 mg) in three monthly doses, and 16 were given placebo. Arterial diameters of the intramyomatous vessels were measured using an ocular micrometer on hematoxylin and eosin-stained slides. RESULTS: Clinically and radiologically, the uterine volume of GnRH-a-treated patients decreased by an average of 30%, and the diameter of the largest myoma decreased by 27%. The average diameter of intramyomatous arteries was 24% smaller in GnRH-a subjects compared with those receiving placebo (136 +/- 42 versus 178 +/- 60 microns, P < .01). In addition, arteriosclerotic changes, including intimal and medial fibrosis, were seen more often in the GnRH-a-treated subjects (48 versus 25%, P < .05). CONCLUSION: Intramyomatous arteries were smaller and more often showed arteriosclerotic changes in leiomyomas removed from women treated with GnRH-a compared with those given placebo. The estrogen deprivation induced by GnRH-a may cause a relative vasoconstriction of myomatous vessels. Whether this decreased vessel size is the principal contributor to decreased myoma size will require further study.

Adult↗
PubMed1994

Prophylactic amnioinfusion for meconium-stained amniotic fluid.

OBJECTIVE: Previous studies have demonstrated reduced perinatal morbidity in patients receiving amnioinfusion for meconium-stained amniotic fluid compared with control patients receiving no amnioinfusion. Because amnioinfusion for variable fetal heart rate decelerations has become accepted care, we sought to determine the benefit of prophylactic amnioinfusion for meconium compared with standard care, incorporating therapeutic amnioinfusion for variable decelerations. STUDY DESIGN: Ninety-three term patients with moderate to heavy meconium and no variable fetal heart rate decelerations were randomized to immediate prophylactic amnioinfusion (600 ml saline solution bolus followed by 3 ml/min) or to standard care (including therapeutic amnioinfusion for variable decelerations developing later). All babies had DeLee suctioning on delivery of the head. Laryngeal cords were visualized and tracheal suctioning performed when meconium was seen below the cords. Statistical comparisons were performed using Student t test, Fisher's exact test, or chi 2 analysis. RESULTS: There were no significant differences in the incidence of operative delivery, fetal distress, or meconium below the cords or in newborn Apgar scores and umbilical artery gas values between the amnioinfusion (n = 43) and control (n = 50) patients. There were four cases of meconium aspiration, three in the amnioinfusion group, one in the standard care group. The rate of endometritis-chorioamnionitis was higher (p = 0.3) in the amnioinfusion (16%) than in the control group (8%), although time from ruptured membranes to delivery (8.5 hours vs 7.3 hours) and duration of intrauterine monitoring (6.1 hours vs 5.3 hours) were not different. CONCLUSIONS: Although amnioinfusion does dilute amniotic meconium, prophylactic amnioinfusion for meconium in the absence of variable decelerations remains controversial. Prophylactic amnioinfusion in term pregnancies did not improve perinatal outcome and increased the risk for chorioamnionitis-endometritis. Together with recent reports, the current data suggest that the benefit of amnioinfusion for meconium-stained amniotic fluid is a result of the alleviation of variable fetal heart rate decelerations rather than meconium dilution.

Adult↗
PubMed1994

Prophylactic amnioinfusion for oligohydramnios: a reevaluation.

OBJECTIVE: To compare the effects of prophylactic amnioinfusion to standard care plus indicated therapeutic amnioinfusion (for variable decelerations) in term patients with oligohydramnios. METHODS: One hundred sixteen term gestations with oligohydramnios (amniotic fluid index less than 5.0 cm) were randomly assigned to receive prophylactic saline amnioinfusion (600-mL bolus followed by 3 mL/minute) or standard obstetric care (control). Control patients who subsequently developed moderate or severe variable decelerations received therapeutic amnioinfusion. RESULTS: There was no significant difference in overall cesarean delivery (21 versus 17%; P = .68), cesarean delivery for fetal distress (7 versus 10%; P = .83), or umbilical gas values between the prophylactic amnioinfusion group (N = 56) and control group (N = 60), respectively. The rate of intrapartum fever was significantly increased among the prophylactic amnioinfusion patients (23 versus 7%; P = .02), although the duration of intrauterine monitoring (8.8 versus 6.5 hours; P = .06) and time from ruptured membranes to delivery (12.3 versus 14.3 hours; P = .51) were not different. Only 22% of the controls developed moderate or severe variable decelerations in the first stage of labor and received therapeutic amnioinfusion. Thus, in approximately four of five term patients with oligohydramnios, neither prophylactic nor therapeutic amnioinfusion would be indicated. CONCLUSIONS: Compared to indicated amnioinfusion, prophylactic amnioinfusion did not improve perinatal outcome. Amnioinfusion should be reserved for term laboring patients with variable fetal heart rate decelerations, rather than all patients with oligohydramnios.

Adult↗
PubMedDate not supplied

Evaluation of early second trimester maternal serum creatine kinase isoenzyme BB as a marker of poor pregnancy outcome.

We hypothesized that maternal serum levels of the isoenzyme creatine kinase (CK)-BB, which is highly expressed in the placenta, may be elevated during the early second trimester in gestations destined to deliver prematurely or of a small-for-gestational-age infant (birthweight below 10th percentile). To test this hypothesis, we compared maternal serum CK-BB levels and percentage of CK-BB over total CK, in 69 normal pregnancies (delivering at term of appropriate-for-gestational-age infants) with those of 25 cases complicated by preterm delivery at < or = 34 weeks (n = 14), of a small-for-gestational-age infant (n = 8), or both (n = 3). No differences were present in maternal serum CK BB levels between normal and complicated pregnancies. Moreover, no correlation was found between gestational age at delivery and CK BB levels (r = 0.03; p = 0.7).

Adult↗