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Biomedical subjects

D W Skupski

Publications and source records attributed to D W Skupski.

At least 19 recordsLinked to original sources
PubMed2004

Intraobserver and interobserver reproducibility of fetal biometry.

OBJECTIVE: To assess the intra- and interobserver reproducibility of ultrasound measurements of fetal biometric parameters. METHODS: We assessed the intraobserver and the interobserver agreement in measurements of fetal biparietal diameter (BPD), abdominal circumference (AC), head circumference (HC) and femur length (FL) on 122 singleton pregnancies. Patients were each examined twice by the first sonographer to determine the intraobserver reliability of measurements of fetal biometry. Subsequently, during the same ultrasound examination, a second blinded sonographer measured fetal biometric parameters to assess interobserver reliability. The consensus between and among observers was analyzed using the intraclass correlation coefficient (intra-CC) and interclass correlation coefficient (inter-CC) and the reliability coefficients (RC, alpha) for the four biometric measurements. A value > 0.75 was considered a reliable consensus for the intra-CC and inter-CC. A Bland and Altman plot was also created for the fetal biometric parameters to assess the repeatability of the measurements. RESULTS: Reliable consensus was observed for both the intra-CC and inter-CC and RC for all four biometric parameters. The intra-CC with the 95% CI and RC for the BPD, AC, HC and FL were as follows: 0.996 (0.995, 0.997), alpha 0.998; 0.994 (0.992, 0.996), alpha 0.997; 0.996 (0.994, 0.997), alpha 0.998; and 0.994 (0.992, 0.996), alpha 0.997, respectively. Similarly, the inter-CC with the 95% CI and RC for the same parameters were as follows: 0.995 (0.993, 0.997), alpha 0.998; 0.980 (0.971, 0.990), alpha 0.990; 0.994 (0.992, 0.996), alpha 0.997; and 0.990 (0.985,0.993), alpha 0.995, respectively. The Bland and Altman plots demonstrated a high degree of repeatability of BPD, AC, HC, and FL measurements. CONCLUSION: Our results demonstrate that the intra- and interobserver reproducibility of ultrasound measurements of fetal biometry are highly reliable.

Abdomen↗
PubMed2000

Twin-twin transfusion syndrome: an update.

Twin-twin transfusion syndrome leads to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficult diagnosing and treatment. Current therapies are suboptimal and have not been tested through randomized controlled trials. Parent counseling at the time of diagnosis includes informing on poor chance of double survival, relatively high chance of long term neurologic handicap, almost certain prematurity, and the probability of cesarean delivery. Improvement in therapies awaits a better scientific understanding of the etiology of this condition.

Female↗
PubMed1999

Intrauterine sling: a complication of the stuck twin syndrome.

Stuck twin syndrome usually presents with polyhydramnios in the recipient sac and severe oligohydramnios in the donor sac. The donor is displaced against the uterine wall and remains adherent in that position. We present a case in which the diagnosis was more complicated, owing to the suspension of the stuck twin by a sling within the sac of the recipient. A monochorionic diamnionic twin gestation was complicated by twin-twin transfusion syndrome at 18 weeks of gestation. In our example, the stuck twin was suspended by a sling from the placenta. The sling band represented the intertwin membrane that was folded upon itself. Amniotic fluid from the recipient twin was present in three dimensions around the stuck twin, except for the sling band. The suspension of the stuck twin by a sling within the amniotic fluid of the recipient is an unusual manifestation of the stuck twin syndrome.

Adult↗
PubMed1999

Twin pregnancy.

Recent advances regarding twin pregnancies have focused on several problems, including the detection and definition of risk in relation to chorionicity, the management of a pregnancy with a single anomalous fetus, the prediction of prognosis and the management of twin-twin transfusion syndrome, and the detection of preterm labor. These questions will be considered in this review.

Female↗
PubMed1999

Alloimmune thrombocytopenia.

For the fetuses who are at risk for antenatal or postnatal sequelae from AIT, prevention and treatment are now possible. This requires the attention of the obstetrician to factors in the patient's history and early referral to a center experienced in the diagnosis and management of fetal AIT.

Antibodies↗
PubMed1998

Prenatal diagnosis of gastrointestinal anomalies with ultrasound. What have we learned?

The use of routine obstetric ultrasound has been shown to accurately diagnose fetal gastrointestinal anomalies, both during and after the midtrimester. These are among the most accurately diagnosed of all anomalies, comprising 5-7% of all fetal anomalies. From a review of the literature it is clear that the use of routine ultrasound allows: (1) the detection of multiple anomalies that are often present and affect outcome significantly, (2) preparation for delivery at a tertiary center where neonatal surgical experience will allow optimal outcome, and (3) decisions about mode and timing of delivery in cases where this is important, i.e., cases of omphalocele and gastroschisis.

Delivery, Obstetric↗
PubMed1998

How accurate is fetal biometry in the assessment of fetal age?

OBJECTIVE: The purpose of the study was to assess the accuracy of fetal biometry in the midtrimester of pregnancy in the assignment of fetal age. STUDY DESIGN: A total of 152 singleton, 67 twin, and 19 triplet gestations resulting from in vitro fertilization with ultrasonographic fetal biometry from 14 to 22 weeks made up the study population. A gestational age prediction equation was derived from singletons with the use of stepwise linear regression. This equation was compared with 38 previously published equations and then applied to the twin and triplet populations. RESULTS: Head circumference was the best predictor of gestational age (random error [SD] 3.77 days). Addition of abdominal circumference and femur length to head circumference improved the accuracy of the dating equation (random error 3.35 days). Most dating formulas had systematic errors of <1 week. The systematic error was -0.32 day for averaging the singleton-based predictions for twins and -1.26 days for triplets. CONCLUSIONS: Gestational age assessment with the use of fetal biometry from 14 to 22 weeks is accurate for singleton, twin, and triplet gestations.

Abdomen↗
PubMed1997

The rate of severe preeclampsia is increased in triplet as compared to twin gestations.

The objective of this study was to determine if the rate of preeclampsia is increased in triplet as compared to twin gestations. Fifty-three triplet pregnancies between 1986 and 1993 at The New York Hospital-Cornell Medical Center were reviewed. These were matched for maternal age, parity, and race to twin gestations (N = 53) from the same population. Severe preeclampsia was defined by standard criteria. Student's t-test, Fisher exact test, and Chi-square were used for statistical analysis. The rate of severe preeclampsia was increased significantly in the triplet group 12 of 53 (22.6%) as compared with the twin group 3 of 53 (5.7%) (OR = 4.9, 95% CI 1.2-23.5, p = 0.02). The rate of overall preeclampsia was not significantly different in the triplet 18 of 53 (33.96%) or twin 12 of 53 (22.6%) groups. In this retrospective, case-controlled study, the rate of severe pre-eclampsia was significantly increased in triplet gestations as compared to twins although the overall rate of preeclampsia was not. This information may be useful in counseling patients with high order multifetal gestations.

Adult↗
PubMed1996

Vascularity of uterine myomas: assessment by color and pulsed Doppler ultrasound.

OBJECTIVE: To evaluate the effects of different clinical and anatomical factors on the vascularity of uterine myomas METHODS: The study group included 195 patients, 153 premenopausal and 42 postmenopausal. Four hundred five myomas, 316 in the first group and 89 in the second, were studied by color Doppler ultrasound. Differences in the visualization of blood flow and resistance index (RI) were analyzed according to several factors, including: menopausal status, phase of menstrual cycle, duration of menopause, size and location of the myomas, and secondary changes within the myomas. RESULTS: The size of myomas was the most important single factor in determining both visualization of blood flow and RI. A higher blood flow visualization rate (BFVR) and a lower RI were found: (1) in the premenopausal compared with the postmenopausal patients (P < 0.05), (2) in the group of larger myomas compared with the group of smaller myomas (P < 0.0001), and (3) in submucosal and subserosal myomas compared with intramural myomas (P < 0.05). Other above-mentioned factors did have some, but not significant, influence on the visualization of blood flow and resistance to blood flow. CONCLUSION: Differences in the vascularity and resistance to blood flow in uterine myomas may limit the clinical use of color Doppler ultrasound.

Case-Control Studies↗
PubMed1996

Cesarean delivery for intrapartum fetal heart rate abnormalities: incorporating survey data into clinical judgment.

OBJECTIVE: To identify the descriptive clinical practice of maternal-fetal medicine specialists when faced with severe intrapartum fetal heart rate (FHR) abnormalities (as determined by continuous electronic fetal monitoring). METHODS: All regular members of the Society of Perinatal Obstetricians (maternal-fetal medicine specialists) were sent a survey questionnaire on the topic of cesarean delivery for intrapartum FHR abnormalities. The time from observation of FHR abnormalities to making the decision to proceed to cesarean delivery was the main outcome measure. Time was allowed for intrauterine resuscitative maneuvers to alleviate the abnormal pattern. Legislative definitions of consensus and strong consensus were applied to the data. Analysis of covariance was performed to determine the effect of physician demographic factors on the times reported. RESULTS: Four hundred thirty-one of 704 (61.2%) questionnaires were returned. Consensus was identified for deciding on cesarean delivery (after intrauterine resuscitation) 1) after 30 minutes for cases of repetitive late and severe variable decelerations, 2) after 10 minutes in cases of fetal bradycardia, and 3) in all scenarios with decreased beat-to-beat variability of the FHR. Consensus was identified for deciding on cesarean delivery in five of eight intrapartum FHR pattern abnormalities. CONCLUSION: The descriptive clinical practice of maternal-fetal medicine specialists demonstrated in this study should be considered in prudential clinical judgment.

Arrhythmias, Cardiac↗
PubMed1996

Fetal seizures: further observations.

BACKGROUND: Previous reports of ultrasonographically diagnosed seizure activity in utero have described fetuses with obvious, gross, tonic-clonic movements of trunk and extremities. CASES: Three fetuses with akinesia deformation sequence are described: two with arthrogryposis multiplex congenita and one with Pena-Shokeir syndrome. Each was demonstrated by serial real-time ultrasound examinations to have joint contractures, absent fetal breathing motions, and lack of gross movements other than sonographically evident subtle seizure activity. CONCLUSION: Fetal seizure activity can be subtle when seen in the presence of fetal anomalies that limit joint movement. The prognosis remains poor.

Abnormalities, Multiple↗
PubMed1996

The impact of routine obstetric ultrasonographic screening in a low-risk population.

OBJECTIVES: Our goal was to develop a framework for evaluating the current controversy regarding routine obstetric ultrasonography in a population of low-risk pregnancies. STUDY DESIGN: A retrospective chart review was performed for all low-risk pregnancies from a single obstetric practice during 1990 to 1994, to determine the accuracy of screening ultrasonography for fetal anomalies. All patients received a routine ultrasonographic examination at 18 to 20 weeks' gestation. Neonatal records for all patients were evaluated for the presence of both major and minor anomalies. The data were analyzed with attention to the classification of anomalies (all anomalies vs major anomalies, detectable vs nondetectable). RESULTS: A total of 860 fetuses in 854 pregnancies were evaluated. Anomalies were present in 5.35% (46/860); these were major anomalies in 1.16% (10/860) and minor anomalies in 4.19% (36/860). The sensitivity, specificity, and positive and negative predictive values for the diagnosis of all anomalies were 8.7%, 99.9%, 80%, and 95.7%, respectively. However, if only major anomalies detectable by ultrasonography are included, these values become 75%, 100%, 100%, and 99.9%, respectively. There was one false-positive diagnosis not affecting outcome, a small ventriculoseptal cardiac defect. Postnatal ascertainment of anomalies was excellent, as determined by an incidence of ventriculoseptal defects of 1 in 120. CONCLUSION: Distinguishing between major and minor anomalies and between ultrasonographically detectable versus nondetectable anomalies is essential in the evaluation of the diagnostic accuracy of screening ultrasonography. Any comparisons of studies examining the effectiveness of prenatal screening for congenital anomalies with ultrasonography should use the same outcome: major anomalies identifiable by ultrasonography.

Congenital Abnormalities↗
PubMed1996

Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations.

OBJECTIVE: Our purpose was to evaluate effects of multifetal pregnancy reduction on pregnancy complications and birth weights of remaining twin fetuses compared with expectantly managed triplets and nonreduced twins. STUDY DESIGN: Medical records of 54 triplet pregnancies, 59 twin pregnancies resulting from multifetal pregnancy reduction, and 88 sets of twins conceived with assisted reproductive techniques and delivered at New York Hospital after 24 weeks were retrospectively reviewed. Birth weights were corrected for gestational age at delivery by use of a formula derived from composite standardized growth curves. Statistical analysis was performed with chi(2) analysis and Student t test. RESULTS: Twins remaining after reduction and nonreduced twins were less likely to have preeclampsia than were triplets (14% and 23% vs 30%) and to be delivered before 36 weeks (39% and 27% vs 72%). They had birth weights that were > 100 gm larger than those of triplets even when corrected for gestational age. Reduced twins were similar to nonreduced twins in all parameters studied. CONCLUSIONS: Multifetal pregnancy reduction results in pregnancy complications, gestational age, and birth weights closer to those of nonreduced twins than to expectantly managed triplets.

Adult↗
PubMed1996

Multiple gestations from in vitro fertilization: successful implantation alone is not associated with subsequent preeclampsia.

OBJECTIVE: Our purpose was to compare the risk for preeclampsia and severe preeclampsia in triplet and twin gestations and to evaluate the effect of successful implantation on the development of preeclampsia and on perinatal outcome in triplet pregnancies conceived by means of in vitro fertilization. STUDY DESIGN: A case control study was conducted of triplet pregnancies (n = 38) matched for maternal age, parity, race, and delivery date with twin pregnancies (n = 38) resulting from a single fetal reduction (spontaneously or by means of multifetal pregnancy reduction) after successful implantation of triplets. All pregnancies were conceived by means of in vitro fertilization. Rates of preeclampsia and other maternal complications, factors affecting implantation, and perinatal outcomes were compared. Preeclampsia and severe preeclampsia were defined by The American College of Obstetricians and Gynecologists criteria. The Student t test and the chi(2) test were used for statistical analysis. RESULTS: The triplet group had a higher rate of severe preeclampsia (26.3%) than the twin (reduced triplet) group (7.9%). The prevalence of preeclampsia (mild and severe combined) also was higher among the triplet group (44.7%) than among the twin group (15.8%). There was no difference in other maternal complications of pregnancy or in factors potentially affecting implantation, such as assisted hatching. Mean fetal weight was lower among the triplet group, but gestational age at delivery was not significantly different. CONCLUSIONS: The rate of preeclampsia is higher among triplets conceived by means of in vitro fertilization than among triplets conceived by means of in vitro fertilization and reduced to twins. This finding suggests that fetal number, placental mass, or factors unrelated to the success of implantation are more important to the development of preeclampsia than is successful implantation alone.

Adult↗
PubMed1996

Fetal transfusion therapy.

Rapid advances are occurring in the diagnosis and treatment of the fetus with a red blood cell or platelet cytopenia. Noninvasive methods of monitoring the alloimmunized pregnancy, invasive methods such as amniocentesis and cordocentesis, and intrauterine transfusion therapy of both red cells and platelets, are being further refined to allow the prompt recognition and treatment of fetal cytopenias. Specialized centers have now accrued a large experience in the management of the fetus severely affected by alloimmunization. Advances in ultrasound, blood banking techniques, and genetic engineering technology have spurred the most recent advances. The indications for diagnosis, timing and frequency of invasive procedures for treatment, and technical considerations regarding preparation of blood products and volume of transfusion, are outlined in this review. Polymerase chain reaction (PCR) determination of fetal Rh(D) genotype by chorionic villus sampling or amniocentesis in the first or second trimesters is a recent clinically useful advance. The advent of hematopoietic stem cell transplantation and the potential for gene therapy are exciting advances in the treatment and prevention of hematopoietic diseases, including, but not limited, to the fetal cytopenias.

Anemia↗
PubMed1995

Routine obstetric ultrasound.

A detailed review of the literature reveals that routine obstetric ultrasound has value in providing more accurate gestational dating and in the diagnosis of fetal anomalies. The recent RADIUS study, which has concluded that routine obstetric ultrasound is of no clinical benefit, is critically analyzed, focusing on four areas: the applicability of the results to the general population, the appropriateness of the outcome parameters, the quality of the ultrasound provided, and the issue of excessive cost. Finally, an ethical analysis of the role of routine obstetric ultrasonography is provided, focusing on the principles of beneficence and respect for autonomy. The offering obstetric ultrasound is necessary in both beneficence-based and autonomy-based ethical analyses, and the use of routine ultrasound is supported from an analysis of the scientific data.

Congenital Abnormalities↗