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Biomedical subjects

F A Manning

Publications and source records attributed to F A Manning.

At least 19 recordsLinked to original sources
PubMed1999

Fetal death after normal biophysical profile score: An eighteen-year experience.

OBJECTIVE: It was our goal to determine the false-negative rate of the biophysical profile, characterize an 18-year variation in the false-negative rate, examine the relationship between the last normal biophysical profile score and death, and compare the false-negative rate of 2 disparate populations. STUDY DESIGN: Biophysical profile scores of 86,955 patients at 2 medical centers were collected and recorded prospectively. All perinatal deaths occurring within 1 week of a normal score were similarly recorded. The annual false-negative rate, the cumulative false-negative rate, and the ratio of false-negative results in cases of subsequent fetal death to the perinatal mortality rate were calculated. RESULTS: There were 65 fetal deaths among 86,955 fetuses. Over an 18-year study period at one institution, the false-negative rate varied but not significantly. The cumulative false-negative rate was 0.708 per 1000 at one medical center studied and 2.289 per 1000 at the other center. The average interval between last normal score and fetal death was 3.62 days and did not vary significantly between the medical centers. CONCLUSIONS: False-negative results in cases of subsequent fetal death reflect events that are subsequent to the last normal test result. Fetomaternal hemorrhage was the single most identifiable fetal cause of false-negative results in cases of subsequent fetal death. The ratio of the false-negative rate in cases of subsequent fetal death to the perinatal mortality rate should be used as a more objective approach to reporting this value, because the false-negative rate likely reflects the underlying perinatal mortality.

False Negative Reactions↗
PubMed1999

Fetal biophysical profile.

This article begins with an outline of the theoretic basis of the fetal biophysical profile, the method for the biophysical profile score (BPS), and the timing and frequency of testing. The article further discusses the clinical management based on test scores; modified methods of the BPS; and clinical application, predictive accuracy, and impact on outcome of BPS. The authors specifically examine the relationship between BPS and cerebral palsy. They conclude with a discussion of adult sequelae and fetal adaptation to asphyxia.

Adult↗
PubMed1999

Prenatal ultrasonographic diagnosis of conditions associated with potential umbilical cord compression.

The objective of this review is to assess the current literature pertaining to prenatal ultrasonographic diagnosis of various conditions that predispose the fetus to potential umbilical cord compression. We performed a MEDLINE search utilizing the terms:umbilical cord compression, nuchal cord, cord entanglement, and true knot. Additional sources were obtained through cross-referencing. Prenatal ultrasound assists in the diagnosis of nuchal cord(s), true knot of the umbilical cord, cord entanglement in monoamniotic twin gestations, and other unusual etiologies that may lead to umbilical cord compression. Supplementary ultrasonographic measures including color Doppler imaging, Doppler flow velocimetry, and possibly three-dimensional ultrasound may further prenatal diagnosis of these conditions. Doppler flow velocimetry may also assist in detecting impaired or deteriorating umbilical artery flow reflecting increasing cord compression prior to the onset of adverse and potentially nonreversible effects upon the fetus. Close fetal surveillance in cases further complicated by decreased fetal movements, decreased amniotic fluid volume, postdates, fetal growth restriction, and impaired umbilical artery Doppler flow velocimetry may assist in the management of such gestations. Although definitive prospective studies investigating neonatal outcome following prenatal ultrasonographic depiction of potential umbilical cord compression are not currently available, review of the literature suggests that increased fetal surveillance may be indicated in certain clinical conditions.

Animals↗
PubMed1999

First-trimester nuchal translucency screening for fetal aneuploidy.

The objective was to review current literature pertaining to first-trimester nuchal translucency screening for fetal aneuploidy. To this goal, all manuscripts published in the English language regarding this topic obtained from a MEDLINE search for 1966 through November 1998 were selected and reviewed. Additional sources were identified through cross-referencing. Current widespread application of first-trimester ultrasonography has enabled accumulation of an increasing body of knowledge pertaining to early screening for fetal aneuploidy. Following initial reports, recent studies of large populations of patients (> 500 participants) at either high- or low-risk for fetal chromosomal abnormalities, demonstrate that nuchal thickness of > 3 mm between 10 and 14 weeks' gestation by either transabdominal or transvaginal ultrasonography may serve as screening tool for fetal aneuploidy. Sensitivity and specificity rates improve when first-trimester maternal serum free beta-human chorionic gonadotropin (hCG) and pregnancy associated plasma protein A (PAPP-A) levels are added to this ultrasonographic tool. Current data regarding nuchal translucency including: nomograms, repeatability, optimal timing of measurement, accuracy and effect of confounding factors upon this ultrasonographic measurement, pathophysiology, increased associated incidence of fetal cardiac anomalies, and arrhythmias as well as other structural anomalies, Doppler velocimetry, spontaneous subsequent miscarriage, implications of nuchal translucency in twin gestations, and effect upon performance of subsequent midtrimester maternal serum screening are presented.

Aneuploidy↗
PubMed1999

Utilization of real-time ultrasound on labor and delivery in an active academic teaching hospital.

OBJECTIVE: Ultrasound (US) is currently available on most if not all Labor and Delivery (L+D) services. Our objective was to survey utilization of real-time US on L+D in an active academic teaching hospital. STUDY DESIGN: Between April 1, and July 31, 1998, all US examinations performed for clinical purposes on patients presenting to L+D, were documented. Data collected included: gestational age, whether or not the patient was in labor, number of fetuses, and indication for US. All US examinations were performed by OB/GYN housestaff at the PGY 2-3 level, and fellows in Maternal-Fetal Medicine. Statistical analysis included Student's t-test and chi2 when appropriate, with p < 0.05 considered significant throughout. RESULTS: During the 4-month study period, 1316 patients delivered and 1363 were discharged from L+D, not in labor. Of 630 US examinations 31.64% (192 of 630) and 67.69% (418 of 630) were performed in laboring versus nonlaboring patients, respectively. Of all patients delivered during the study period, 14.5% (192 of 1316) underwent intrapartum US, and of all nonlaboring patients, 30.66% (418 of 1363) underwent US on L+D. The mean gestational age at the time of assessment was 37.32 +/- 4.23 weeks' versus 35.74 +/- 5.76 weeks' gestation, in laboring versus nonlaboring patients respectively, p < 0.05. Main indications for US in patients in labor were; fetal presentation in patients with spontaneous rupture of membranes (SROM) 34.4% (n = 66), confirmation of vertex presentation 20.3% (n = 39), preterm labor 12% (n = 23), multiple gestation 7.3% (n = 14), and malpresentation 7.3% (n = 14). Main indications for patients not in labor were; amniotic fluid index 15.8% (n = 66), SROM 15.6% (n = 65), postdates 9.8% (n = 41) placental location 9.6% (n = 40), and decreased fetal movement 9.3% (n = 39). Ultrasound-guided interventions included: all deliveries of multiple gestations (n = 9), version in nonlaboring patients (n = 10), and postpartum curettage for retained placental tissue in conjuction with severe early postpartum hemorrhage (n = 2). The incidences of each separate indication for US were significantly different between laboring versus nonlaboring patients, p < 0.05, respectively. CONCLUSION: US examination is performed in 15% of patients in labor and 31% of patients not in labor assessed on L+D, constituting a widely applied diagnostic tool in this environment.

Delivery, Obstetric↗
PubMed1998

Fetal assessment based on fetal biophysical profile scoring. VIII. The incidence of cerebral palsy in tested and untested perinates.

OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the fetal biophysical profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last fetal biophysical profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, -coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial fetal biophysical profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded biophysical profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the fetal biophysical profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test fetal biophysical profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by fetal biophysical profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy.

Birth Weight↗
PubMed1998

Atraumatic fetal cervical spinal cord injury and cruciate paralysis.

BACKGROUND: Congenital cervical spinal cord injury usually is attributed to intrapartum mechanical trauma. CASE: A fetal cervical spinal cord hemorrhage presented as congenital isolated upper extremity ("cruciate") paralysis and muscle atrophy after an atraumatic delivery. Timely neonatal diagnosis and surgery resulted in complete recovery. CONCLUSION: Paralysis may result from atraumatic spinal cord injuries occurring in the antepartum period.

Adult↗
PubMed1997

Fetal assessment based on the fetal biophysical profile score: relationship of last BPS result to subsequent cerebral palsy.

OBJECTIVE: The prime intent of this study was to determine the relationship if any between the last fetal biophysical profile score and the risk of cerebral palsy at age 3 years. The secondary objective was to examine the clinical characteristics of infants with cerebral palsy whose obstetric management included serial fetal biophysical profile scores. STUDY DESIGN: The incidence of a high risk pregnant population whose antenatal assessment was by serial fetal biophysical profile scoring was determined by cross-referencing two discrete data bases. The completeness and reliability of the data bases was confirmed by secondary audit. Obstetrical, neonatal and post-natal clinical records of index cases of cerebral palsy were subsequently reviewed, categorized and analyzed. RESULTS: Fetal biophysical profile scores (BPS) were recorded in 22,336 high risk pregnancies: 27 patients delivered an infant subsequently identified as having cerebral palsy (rate 1.21 per 1000). The relationship between last BPS result and cerebral palsy was inverse, exponential and highly significant (R2 = 0.987; p < 0.001). Affected infants with a last abnormal BPS result were significantly more likely to exhibit fetal distress (88.8%), acidosis (77.7%), and have neonatal seizures (88.8%). Antenatal asphyxia was the apparent cause of cerebral damage in 29.6% of cases. CONCLUSION: The last fetal biophysical profile score is a predictor of the risk of cerebral palsy.

Cerebral Palsy↗
PubMed1995

High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases.

OBJECTIVE: To inform obstetricians of a serious complication of forceps rotations of 90 degrees or more--high cervical spinal cord injury in neonates. METHODS: We reviewed the obstetric aspects of 15 cases of high cervical spinal cord birth injury diagnosed during 1982-1994 at two tertiary-care children's hospitals in Canada. RESULTS: The common feature in all cases was a forceps cephalic delivery, almost always a rotation of 90 degrees or more from the occipitoposterior or occipitotransverse position. CONCLUSION: High cervical spinal cord injury in neonates is a rare but specific complication of forceps rotation.

Birth Injuries↗
PubMed1995

Antepartum fetal surveillance.

In recent years the advances in prenatal diagnosis of fetal asphyxia have been dramatic and increasing at a remarkable pace. Now that a solid base of multivariable testing has been accepted as the method of choice for assessment of fetal health, the focus of clinical research has shifted towards identification of factors and signs that might predict not only risk of death and immediate morbid outcome but also the quality of life after delivery. The papers reviewed here outline the scope of the problem of cerebral palsy and offer clues as to how fetal disease may become manifest as child or adult sustained neurological injury. Concurrently, the advances in refinement of the testing methods are reviewed. Clearly a better understanding of the etiology, physiology, and range of fetal responses to asphyxia will be the key to effecting not only better survival rates but also a higher quality of survival.

Cerebral Palsy↗
PubMed1995

Fetal assessment in low-risk pregnancy.

The value of directed management based on contemporary fetal assessment techniques in the high-risk pregnancy is undisputed. Whether such benefits are evident in the low-risk pregnancy is now an issue of considerable clinical and economic importance. Recent literature suggests that extension of fetal surveillance to the low-risk pregnancy yields significant improvement in pregnancy outcome.

Adult↗
PubMed1995

Dynamic ultrasound-based fetal assessment: the fetal biophysical profile score.

The advent of ultrasound fetal imaging and the evolution of dynamic imaging (real-time) methods have opened great new vistas in which fetal responses can be monitored with remarkable precision and clarity. Contained within this new wealth of information may lie the key to direct determination of the fetus at risk for death or injury in utero. Consideration of fetal activities so plainly recognized by conventional dynamic ultrasound methods and an assessment of fetal environment appear to be integral parts of this process. It is reasonable to assume that composite assessment by the dynamic ultrasound-based PBS will remain a valuable adjunct in caring for the high-risk fetus.

Amniocentesis↗
PubMed1994

Life without amniocentesis: elevated maternal serum alpha-fetoprotein in the Manitoba program 1986-91.

Pregnant women demonstrating an elevated maternal serum alpha-fetoprotein level are at increased risk for fetal neural tube defect or other anomaly. Diagnostic procedures to evaluate these pregnancies include high-resolution ultrasound and amniocentesis to measure amniotic fluid levels of alpha-fetoprotein and N-acetylcholinesterase. We wished to examine the efficacy of detailed ultrasound examination alone, in evaluation of women with 'unexplained' elevation of maternal serum alpha-fetoprotein. The results showed that no neural tube defects were missed in the assessment of 1325 pregnancies with a raised level of maternal serum alpha-fetoprotein over 6 years, despite complete reliance on ultrasound in 98%. Detailed fetal ultrasound evaluation by experienced personnel is adequate to identify all cases of neural tube defects in a selected high-risk population.

Journal Article↗
PubMed1994

Fetomaternal hemorrhage following funipuncture: increase in severity of maternal red-cell alloimmunization.

OBJECTIVE: To determine the prevalence of fetomaternal transplacental hemorrhage after funipuncture and its effect on maternal red-cell alloantibody levels. METHODS: The prevalence and size of transplacental hemorrhages at the Health Sciences Centre were studied in two groups of patients: 174 women who were not alloimmunized or were carrying fetuses whose red cells were negative for the antigen to which they were immunized, and 122 women who were alloimmunized and carrying fetuses whose red cells were positive for the antigen to which they were immunized. In the alloimmunized group with affected fetuses, we surveyed the incidence of maternal antibody increase in titer by two or more doubling dilutions and the Rh(D) antibody increase (in microgram/mL of serum) of more than 50% after funipuncture. RESULTS: One hundred of the 174 women (57.5%) in the nonimmunized group and 69 of the 122 women (56.6%) in the immunized group had evidence of transplacental hemorrhages ranging in volume from 0.03 mL to greater than 5 mL of fetal red blood cells. In the latter group, antibody titer increases of 2 to 9 and doubling dilutions occurred in 37 of 74 women (50%) in whom such measurements were carried out. Increases of anti-D exceeding 50% occurred in 44 of 53 women (83%) in whom quantitative measurements were assayed. CONCLUSION: Funipuncture carries a high risk of fetal transplacental hemorrhage. In the immunized woman carrying an antigen-positive fetus, this will increase the level of her antibody and probably increase the severity of hemolytic disease in her fetus. In alloimmunized women, funipuncture should rarely be carried out to determine the fetal antigen status. Serial amniocenteses combined with careful serial ultrasound observation of the fetus are safer. Funipuncture should not be done in alloimmunized women before the cord vessels are of adequate size to allow immediate intravascular fetal transfusion, if required.

Blood Group Antigens↗
PubMed1993

Fetal biophysical profile score. VI. Correlation with antepartum umbilical venous fetal pH.

OBJECTIVE: Our objective was to determine the relationship, if any, between the fetal biophysical profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal biophysical profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of biophysical profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between biophysical profile score and umbilical venous pH. Poor biophysical profile score performance (a score of 0 of 10) was always associated with a pH < 7.20, whereas the pH was always > 7.20 when the biophysical profile score was 10 of 10. Sequenced sensitivity of short-term biophysical variables in the detection of acidemia was observed. CONCLUSION: The fetal biophysical profile score accurately predicts antepartum umbilical venous pH.

Analysis of Variance↗
PubMed1993

Observations of intrapartum fetal activities.

OBJECTIVE: The objective of this observational study was to document the frequency of biophysical activities such as breathing and body movements during spontaneous labor in the low-risk, term fetus. STUDY DESIGN: The fetuses of truly low-risk patients without medication during labor were observed serially with real-time ultrasonography for fetal breathing or body movements for a maximum scanning time of 1 hour. Fetal breathing movements, hiccups, and fetal body movements were recorded, as were cervical dilatation, status of the fetal membranes, and Apgar scores. RESULTS: Fetal breathing activity was recorded in 76% of fetuses in early labor and 90% in advanced labor. Fetal body movements were present during 85% of the observations. All babies had 5-minute Apgar scores > 7. CONCLUSION: Ultrasonographic evaluation of fetal breathing and body movements during spontaneous labor was associated with normal birth outcome in this low-risk population. The clinical utility of this noninvasive method in determining intrapartum fetal health remains to be tested in an unselected population.

Apgar Score↗