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E Dreazen

Publications and source records attributed to E Dreazen.

34 records · Page 2Linked to original sources
PubMed1999

Implementation of nuchal translucency image-scoring method during ongoing audit.

OBJECTIVE: The aim of this study was to evaluate the contribution of an ongoing audit, using the image-scoring method, to the quality of nuchal translucency images and to set the basic standards required from the examiners. DESIGN: Evaluation of nuchal translucency images, before, during and after the implementation of an ongoing audit, without knowledge of the time period or the examiner. SUBJECTS: A total of 315 nuchal translucency scans were performed by three examiners. METHODS: Each of the retrospective, intermediate and prospective time periods included blind scoring of 105 images. The effect of the ongoing audit was examined by comparing the distribution of the quality groups and the mean final score between the time periods, for all cases and for each examiner separately. Improvement of the criteria was assessed by comparing the rate of scans meeting the demands between the time periods. RESULTS: The quality of the images improved significantly as the mean final score changed from 4.62 +/- 0.21 to 6.19 +/- 0.19 and to 6.91 +/- 0.16 (p < 0.0001) and the rate of obtaining acceptable scans rose from 72% to 88% and to 92% (p < 0.001), respective to the three time periods. Whereas the three major criteria improved significantly before and after implementation of the audit (mid-sagittal section from 48% to 94%, caliper placement from 60% to 75% and skin line from 19% to 77%), the minor criteria remained unchanged (image size 90%, amnion demonstration 25% and head position 77%). The average scores of two examiners, for whom improvement was more pronounced, were used to determine the basic standards required from examiners subjected to the audit as follows: unacceptable, none; intermediate, 5%; reasonable, 65%; excellent, 30%; with a mean final score of 7.25. CONCLUSIONS: Implementation of an ongoing audit, using the image-scoring method, proved to be an efficient method for surveillance and improving the quality of nuchal translucency images. We recommended centers or individuals practicing first-trimester ultrasound screening to consider its routine utilization, in an unbiased and strict manner.

Analysis of Variance↗
PubMed1999

Can nuchal cord cause transient increased nuchal translucency thickness?

When detected in a first trimester scan, an increased thickness of nuchal translucency (NT) may be associated with chromosomal, cardiac or genetic disorders. However, less attention has been devoted to the outcome of those fetuses who have confirmed normal anatomies and karyotyping, but have abnormal first trimester scans. Thus, a challenging new issue is how to counsel such cases of transient increased NT in which the translucency rapidly vanishes with no evidence of other underlying abnormalities. Two cases of transient increased thickness of NT are reported. In both, a nuchal cord was ultrasonographically demonstrated and a thorough work-up revealed chromosomally and anatomically normal fetuses. The pathophysiological theories behind these observations and their significance are discussed. Based on these observations, we suggest that transvaginal sonography combined with Doppler flow studies should be utilized for the presize detection of cord patterns to accomplish the work-up in cases of increased NT.

Adult↗
PubMed1999

The feasibility of nuchal translucency measurement in higher order multiple gestations achieved by assisted reproduction.

Nuchal translucency (NT) measurement for screening chromosomal abnormalities and detecting fetal anomalies is an effective ultrasonographic marker, originally developed for singleton pregnancies. This study sought to evaluate the feasibility of NT measurements in higher order multiple gestations. Pregnant patients who conceived following assisted reproduction and were carrying three or more fetuses were enrolled in the study. Each fetus was ultrasonographically assessed, a NT measurement was obtained, and the findings were used for counselling prior to any invasive procedure. In all, 24 pregnant patients, initially carrying 79 fetuses aged 10-14 weeks of gestation, were compared with 79 consecutively matched, singleton controls, naturally conceived, having similar crown-rump lengths (+/- 3 mm). NT measurements were feasible for both study and control fetuses, which exhibited similar NT measurements for 5th, 50th and 95th centiles. Also, mean NT thicknesses [measurements in mm or multiple of the medians (MOM)] were similar for both groups (1.41 +/- 0.41 and 1.35 +/- 0.39 mm respectively and 0.87 +/- 0.23 and 0.83 +/- 0.25 MOM respectively). Prenatally no chromosomal abnormalities were detected in either group, and, of those infants who had no karyotyping, no traits were observed that warranted chromosomal analysis. NT measurements are feasible in higher order multiple gestations. Since there is no other effective screening modality for these pregnancies, it seems reasonable to recommend NT measurement for antenatal screening services for higher order multiple gestations.

Chromosome Aberrations↗
PubMed1999

Comparison of nuchal translucency measurement and mid-gestation serum screening in assisted reproduction versus naturally conceived singleton pregnancies.

It has been reported that second-trimester serum markers may be affected by assisted reproduction leading to a higher false-positive rate. The current study compares 10-14 week nuchal translucency (NT) measurement and early mid-trimester serum screening in pregnancies resulting from assisted reproduction versus naturally conceived pregnancies. 75 pregnant women with a singleton pregnancy achieved by assisted reproduction underwent both 10-14 weeks NT measurement and second-trimester triple test and were followed throughout gestation. They were compared with matched controls for gestation and maternal ages. A risk of 1:380 or higher or having a fetus with Down syndrome was considered as screen-positive in both tests. The mean maternal age (30+/-3 years) and crown-rump length (61+/-9 mm) were similar, and there was no difference in NT thickness distribution between the groups. Based on NT measurement, 4 (5 per cent) women in the study and 2 (3 per cent) in the control groups, were defined as screen positive (p=NS). However, 11 (15 per cent) women in the study group and 4 (5 per cent) in the control group were found screen-positive by the triple test (p<0.05). A significantly higher amniocentesis rate of 20 per cent was noted in the study group compared with 8 per cent in the controls (p<0.05). All karyotypes were normal and no miscarriages or structural malformation were diagnosed in either group. We confirm the observation that assisted reproduction may adversely affect second-trimester screening results, which did not affect the NT screening test. Since these series are relatively small, larger series may be needed to clarify the most beneficial screening policy for this highly selected group of pregnant women.

Adult↗
PubMed1998

Image magnification does not contribute to the repeatability of caliper placement in measuring nuchal translucency thickness.

The objective of this study was to assess whether nuchal translucency image magnification contributes to the repeatability of caliper placement. Twenty-seven women undergoing first-trimester ultrasound screening at 11-14 weeks were examined by two qualified examiners. Fetal nuchal translucency thickness was measured twice by each examiner on a regular-sized image and subsequently on the same still image magnified. Intraobserver repeatability coefficients of the regular-sized images were 0.28 mm and 0.34 mm for examiners A and B, respectively. Identical intraobserver repeatability coefficients of 0.28 mm were attained for both examiners on the magnified images. Interobserver repeatability of regular-sized image measurements showed a significant difference (p < 0.01) but the mean difference (+/- standard deviation) of 0.10 (0.18) mm was negligible. Similarly, interobserver repeatability of the magnified-image measurements yielded a significant difference (p < 0.02), but again with a small mean difference of 0.13 (0.26) mm. There were also significant differences when regular-sized images and magnified images were compared for both examiners: 0.08 (0.16) mm for examiner A (p < 0.02) and 0.10 (0.17) mm for examiner B (p < 0.01). Our results demonstrate that nuchal translucency image magnification does not contribute to the reproducibility of the measurement. Despite significantly smaller mean values obtained from the magnified images, compared to the regular-sized measurements, those differences do not justify modification of the criteria for caliper placement on magnified images. Blind repeated measurements on a regular-sized and/or magnified image are recommended as a tool for self-assessment, quality control and training.

Female↗
PubMed1998

Nuchal translucency audit: a novel image-scoring method.

OBJECTIVE: The aim of this study was to evaluate the feasibility and reproducibility of a novel image-scoring method of first-trimester nuchal translucency measurement as an objective tool of ongoing audit and training. DESIGN: This was an independent evaluation of nuchal translucency images by three separate reviewers unaware of the examiner. SUBJECTS: There were 105 consecutive singleton pregnancies undergoing first-trimester screening. METHODS: Each image was scored according to the following criteria: section (oblique, 0; mid-sagittal, 2), caliper placing (misplaced, 0; proper, 2), skin line (nuchal only, 0; nuchal and back, 2), image size (unsatisfactory, 0; satisfactory, 1), amnion (not visualized, 0; visualized, 1) and head position (flexion/hyperextension, 0; straight, 1). The final score was categorized into one of four quality groups: excellent (8-9), reasonable (4-7), intermediate (2-3), unacceptable (0-1). RESULTS: The distributions of the four quality groups were similar between the three reviewers: 11.4% were classified as excellent, 57.1% as reasonable, 25.7% as intermediate and 5.7% as unacceptable. Inter-reviewer agreement showed identical classification, by each pair of reviewers, from 65.7% to 74.3%, and partial agreement to neighboring quality groups from 25.7% to 34.3% of the cases. In none of the cases did the reviewers differ in categorizing cases to remarkably different quality groups. Application of the auditing method to the examiners showed similar distribution to the various quality groups and similar mean final score of 4.69 (0.39, SE), 4.54 (0.15, SE) and 4.65 (0.15, SE). CONCLUSIONS: The described image-scoring method represents a new approach towards the evaluation of ultrasound performance as a whole and nuchal translucency measurement in particular. It may be employed by every center in an independent manner with minimal resources and regardless of the method of risk assessment. More studies will be needed to determine the standards required from the examiners and to elucidate the contribution of the proposed auditing method to the examination's quality and the process of training.

Female↗
PubMed1998

[Trisomy 18 anomalies on sonography and calculated risk of chromosomal abnormalities during first trimester].

Trisomy 18 is a chromosomal disorder giving multiple anomalies. Its frequency depends on maternal age. We report a 28-year-old woman in her first pregnancy, who underwent first trimester scanning for screening. Due to increased nuchal translucency and exomphalos, chorionic villous sampling was performed. Cytogenetic diagnosis was trisomy 18 and termination of pregnancy was carried out immediately.

Abortion, Induced↗
PubMed1995

Severe maternal and fetal electrolyte imbalance in pregnancy after gastric surgery for morbid obesity. A case report.

BACKGROUND: Gastric surgery for morbid obesity is considered a safe procedure with favorable effects on reproductive performance. Pregnancies after gastric restrictive operations are usually well tolerated by both mother and fetus. Some postoperative complications, however, do occur, although an association between such complications and adverse pregnancy outcomes has not been reported. CASE: A 40-year-old woman had a successful gastric operation for weight reduction but developed chronic, low grade gastro-intestinal obstruction as a late complication of surgery. Subsequent pregnancies ended in late abortion or premature delivery. During her last pregnancy, reported here in detail, severe and life-threatening fetomaternal electrolyte imbalances developed. CONCLUSION: Pregnancy following a gastric operation for morbid obesity may be complicated by severe metabolic disturbances that can jeopardize both the pregnant woman and her fetus. These pregnancy complications, which are related to the primary gastric surgery, are reported here for the first time.

Adult↗
PubMed1990

Reduced fetal hepatic alpha-fetoprotein levels in Down's syndrome.

In the majority of pregnancies involving a Down's syndrome (DS) fetus, the level of alpha-fetoprotein (AFP) measured in maternal serum and amniotic fluid is reduced to about 70 per cent of the level attained in normal pregnancies. Causes of this decrease may include the production of an altered AFP molecule with modified turnover or transport properties, or a reduction in the level of AFP synthesis. We examined hepatic AFP mRNA transcripts and compared AFP polypeptide isoforms in liver tissue samples obtained from a group of DS and normal abortuses. No differences was detected in the structure of the AFP mRNA transcript or in the charge or mass of AFP polypeptides in the two sample groups. However, the hepatic AFP level, expressed as microgram AFP/mg protein, was significantly lower in a group of 28 DS cases relative to a group of 47 normal controls (p = 0.04). This difference in hepatic AFP concentration did not appear to be the result of a general reduction in the level of total protein or total RNA production. The greatest difference between the AFP levels of the DS and normal groups was observed in the earliest samples examined (i.e., at 17-19 weeks of age) where the median AFP levels differed by about 20 per cent.

Base Sequence↗
PubMed1985

Prevention of premature labor by 17 alpha-hydroxyprogesterone caproate.

Eighty pregnant women at high risk of giving birth prematurely were divided randomly into two groups. Treatment with either 17 alpha-hydroxyprogesterone caproate, 250 mg by intramuscular injection once a week, or a placebo was given in a double-blind fashion. Imminent premature labor occurred in 29.0% of the treated group and in 59.4% of the control group (p less than 0.025). The rate of premature deliveries was also significantly lower in the treated group (16.1%) than in the control group (37.82%) (p less than 0.05). There were no cases of perinatal death or fetal malformations in either group. The mean birth weight of all infants of the treated group was significantly higher than in those of the control group (3111.9 +/- 905 gm versus 2680 +/- 813.4 gm, p less than 0.05). The results support treatment with progesterone caproate for the prevention of premature labor.

17-alpha-Hydroxyprogesterone↗
PubMedDate not supplied

Antenatal screening for Down's syndrome in assisted reproductive pregnancies.

The wide use of assisted conception methods has risen dramatically. The greater proportion of singletons, twins and high order of multiplicity conceived by those methods have already focused the medical community to various obstetric complications. Recently, there have been suggestions that the levels of mid-gestation serum markers, particularly human chorionic gonadotrophin (HCG), might be affected by assisted conception, leading to higher false-positive results. Furthermore, women who conceived after assisted reproduction methods are on average older, and in many cases their current pregnancy was achieved after long-standing infertility and might even be their last one. This is why they are extremely wary of any invasive fetal karyotyping. Therefore, every effort should be made to provide them with the most accurate screening of Down's syndrome (DS) risk. In this respect, nuchal translucency (NT) measurement, which has been reported to be another effective screening method, might be a more reliable marker in these pregnancies. This review explores the problematic issue of antenatal DS screening in assisted conception pregnancies. For the singletons and twins, a sequential NT and second-trimester serum marker screening can be offered, thus producing a single risk estimation which seems to be more accurate. For the high order of multiplicity, the NT offers additional important data, which can be taken in consideration both as a screening tool for DS and if fetal reduction is planned.

Adult↗
PubMedDate not supplied

Three-dimensional vaginal sonography in obstetrics and gynaecology.

Great strides have recently been made in obstetrics and gynaecology secondary to the development of high-performance transvaginal ultrasound (TVS) instruments. However, even this advanced technology can provide only two-dimensional (2D) views of three-dimensional (3D) structures. Although an experienced examiner can easily piece together sequential 2D planes for creating a mental 3D image, individual sectional planes cannot be achieved in a 2D image because of various difficulties. Today, 3D TVS can portray not only individual image planes, it can also store complex tissue volumes which can be digitally manipulated to display a multiplanar view, allowing a systematic tomographic survey of any particular field of interest. The same technology can also display surface rendering and transparency views to provide a more realistic 3D portrayal of various structures and anomalies. The current review provides examples and discussions of the various applications in obstetrics, gynaecology and assisted reproduction in which 3D TVS is a useful supplement to image modality.

Congenital Abnormalities↗
PubMedDate not supplied

Utilization of the nuchal translucency image-scoring method during training of new examiners.

Training of new examiners, utilizing 1st-trimester nuchal translucency ultrasound screening, is mandatory for obtaining reproducible measurements. This study examined the contribution of the nuchal translucency image-scoring method to the process of training and its utilization as an objective tool of image evaluation and a tool for approving qualification. The study included an evaluation of the performance of two new examiners (examiners A and B) before and after intervention, using the image-scoring method. The preintervention period included 75 images evaluated by two reviewers using general evaluation and the scoring method. The report of the scoring method was submitted to the examiners and was applied to 55 images performed afterwards. The agreement between two reviewers in classifying the first 75 images as 'accepted' or 'rejected' was tested using general evaluation versus the scoring method. The effect of the intervention was examined by comparing the quality of the images between the two time periods. A chart indicating final scores of 80 successive images analyzed by examiner A was used to set criteria for assessing qualification. Using general evaluation, the reviewers disagreed on 19 (25%) of the images, whereas using the scoring method they disagreed on only 5 (7%, p < 0.01). Comparison before and after application of the intervention demonstrated significant improvement expressed by the increased rate of better quality groups (p < 0.001) and improved mean scores from 4.31 +/- 0.31 to 6.15 +/- 0.32 (p < 0. 001). Enhanced improvement of examiner's A performance could be attributed to the intervention rather than to his learning curve. Improvement was demonstrated in all the criteria examined; however, it was significant only for images size (from 33 to 98%), amnion demonstration (from 13 to 42%), and caliper placement (from 49 to 71%). Examiner's A chart enabled us to set standards for assessing competence, based on the scoring method. These included a minimum of 40 scans, followed by more than ten sequential images of acceptable quality. The scoring method contributed to the process of training, as it made possible to objectively evaluate the images, pointed out specific errors, served as an efficient tool of intervention, and might be used for ascertaining competence. We recommend to consider its utilization in centers running 1st-trimester ultrasound screening during training new examiners.

Education, Medical, Continuing↗