Search PubMed⌕ Search

Biomedical subjects

J C Konje

Publications and source records attributed to J C Konje.

At least 19 recordsLinked to original sources
PubMed2003

Antenatal detection of a single umbilical artery: does it matter?

The presence of a single umbilical artery is recognised as a soft marker for congenital anomalies, aneuploidy, earlier delivery and low birthweight. Most of the available data are derived from case series or highly selected populations and are therefore likely to be unrepresentative. In this retrospective case-comparison study, we firstly aimed to determine the incidence of a single umbilical artery in an unselected population and secondly to examine the clinical significance of this soft marker. Over a 40-month period, 107 cases were identified from a cohort of 35 066 births giving an incidence of 3.1 per 1000 total births and late pregnancy losses. The antenatal detection rate was only 30%. Compared to fetuses with normal cord vasculature, fetuses with a single umbilical artery were more likely to be delivered at an earlier gestation and to weigh less, were 1.7 times more likely to be delivered by a Caesarean section and 19% of the cases had a congenital anomaly. The perinatal mortality was 49.0 per 1000 total births, which was 6 times higher than the background hospital rate. The presence of a single umbilical artery is associated with a poorer perinatal outcome compared to that in fetuses with three vessels in the cord. Unfortunately, the antenatal detection rate is poor. Recognising the importance of this soft marker in counselling and management of pregnancies should provide the stimulus to improve detection rates.

Abnormalities, Multiple↗
PubMed2002

Invasive testing for the karyotyping of mid-trimester intrauterine fetal death (IUFD): a pilot study.

INTRODUCTION: Aneuploidy remains a common cause of fetal loss after the first trimester. Conventional karyotyping from fetal solid tissues post-delivery unfortunately has a poor success rate particularly where the fetus is macerated. To overcome this we obtained amniocentesis and/or chorionic villus samples from mid-trimester intrauterine fetal deaths (IUFDs) prior to medical termination of pregnancy. SUBJECTS: Ten women with diagnosed IUFD between 12 and 24 weeks' gestation underwent amniocentesis and/or CVS performed after counselling. RESULTS: Successful karyotypes were obtained in all pregnancies. Five of the ten pregnancies were complicated by aneuploidy (two with trisomy 21, two with trisomy 18, and one with trisomy 13). CONCLUSION: The high rate of aneuploidy (50%) in this small cohort emphasises the need for karyotyping. A successful karyotype in all ten pregnancies demonstrates the value of offering these procedures before a termination of pregnancy. We would recommend the adoption of this approach in the management of IUFD occurring after the first trimester.

Adolescent↗
PubMed2002

Determination of gestational age after the 24th week of gestation from fetal kidney length measurements.

OBJECTIVE: To evaluate the application of kidney length measurement to the determination of gestational age between the 24th and 38th weeks and to compare its accuracy with that of other fetal biometric indices. STUDY DESIGN: Seventy-three women with singleton uncomplicated pregnancies underwent standard ultrasound fetal biometry and kidney length measurement every 2 weeks between 24 and 38 weeks' gestation. These measurements were used to date the pregnancies relative to crown-rump length dating between 8 and 10 weeks' gestation. Linear regression models for estimation of gestational age were derived from the biometric indices and kidney length. In addition, stepwise regression models were constructed to determine the best model for determining gestational age between 24 and 38 weeks. Comparisons were then made between the accuracy of these models in the determination of gestational age. RESULTS: The best model for estimating gestational age in late pregnancy included the variables kidney length, biparietal diameter, head circumference, femur length and abdominal circumference. This model accurately predicted gestational age with a standard error of +/- 8.48 days. A model including kidney length, biparietal diameter, head circumference and femur length accurately predicted gestational age with a standard error of +/- 8.57 days. These models were slightly more accurate than models derived from the biometric indices of biparietal diameter, head circumference and femur length (+/- 9.87 days), biparietal diameter, head circumference, femur length and abdominal circumference (+/- 9.45 days) and biparietal diameter and femur length (+/- 9.9 days). Kidney length and femur length were the most accurate single parameters for predicting gestational age using simple linear regression models (+/- 10.29 and 10.96 days, respectively); the abdominal circumference was the least accurate (+/- 14.54 days). CONCLUSION: Kidney length is a more accurate method of determining gestational age than the fetal biometric indices of biparietal diameter, head circumference, femur length and abdominal circumference between 24 and 38 weeks' gestation. When combined with biparietal diameter, head circumference and femur length, the precision of dating is improved by 2 days. This measurement is easy to make and could therefore be easily incorporated into the model for dating pregnancies after 24 weeks of gestation, in particular when measurements of the biparietal diameter and head circumference are difficult.

Crown-Rump Length↗
PubMed2002

Assessment of stillbirth risk and associated risk factors in a tertiary hospital.

We aimed to calculate the stillbirth rate at each gestation and also determine antenatal factors, which may be associated with unexplained stillbirth in a large UK teaching hospital. This was a retrospective study of all the stillbirths between January 1995 and October 1998. There were 27 170 births at > or =24 weeks, gestation during the study period. Of these 161 were stillbirths giving a stillbirth rate of 5.9/1000; 149 (92.5%) were antepartum. Eighty-two (50.9%) were unexplained. The "risk" of unexplained stillbirth per 1000 ongoing pregnancies was 0.3 at 24-25 weeks, fell steadily to 0.07 at 30-31 weeks and then rose to a peak of 1.16 at 40-41 weeks. About half (49.2%) of the pregnancies that ended in unexplained stillbirths had a normal antenatal course with no associated factors. Associated factors in the unexplained stillbirth group were identified in 50.8% of cases. The most common was intrauterine growth restriction, identified in 41.5% of cases. The "risk" of stillbirth increases at term. No significant antenatal associated factor, detection of which would aid prevention, could be identified in the majority of cases.

Female↗
PubMed2001

Knowledge of Down syndrome in pregnant women from different ethnic groups.

The uptake of any screening test is influenced by knowledge of the condition being screened for. In the present study, the knowledge and the source of knowledge of women offered antenatal screening for Down syndrome (DS) was assessed by means of a self-administered questionnaire. The questionnaire was administered to 300 consecutive women booking for antenatal care, of the 245 (82%) women who completed and returned the questionnaire, 117 (48%) were Caucasian, 85 (35%) were Asian born outside the UK, 32 (13%) were Asian born in the UK and ten (4%) belonged to other categories. Only 30% of the cohort had a good understanding of the condition. Racial groups other than Caucasian had a poorer understanding of DS. The factors which affected knowledge of DS included quality of spoken English, knowing an affected child, parity and religion. The most significant factor affecting acceptance of screening was the woman's knowledge of DS. The source of information for the condition varied widely: 42% from a general practitioners (GP), 24% from the hospital and 16% from midwives. The proportion with good knowledge was similar in those women whose source of information was the GP (45%) and the midwife (41%). These proportions were, however, higher (though not significantly) when the source of information was from magazines and newspapers (67%) and from friends (53%). Uptake of the screening test was best in those with good knowledge (53%) compared to those with poor knowledge (23%) (p<0.02). Between 28% and 66% (depending on the ethnic group) of women had a screening blood test "allegedly" without knowing why it had been performed. In order to improve uptake of the screening test for DS there is need for better education and counselling of women attending for antenatal care.

Adolescent↗
PubMed2001

A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies.

OBJECTIVE: The purpose of this study was to examine longitudinally changes in quantified blood volume flow in the uterine arteries during pregnancy with the use of color power angiography. STUDY DESIGN: Color power angiography was used to quantify volume flow in the uterine arteries of 57 women with singleton uncomplicated pregnancies between 20 and 38 weeks' gestation. Comparisons were made between blood flow in the 2 arteries in relation to the location of the placenta. Linear regression models were used to estimate gestational age derived volumetric changes in these vessels. RESULTS: The diameter of the uterine arteries increased from 2.6 mm (SD, 0.2 mm) at 20 weeks to 4.8 mm (SD, 0.7 mm) at 38 weeks of gestation. The total uterine artery blood volume flow increased from 513 mL/min (SD, 127 mL/min) at 20 weeks to 970 mL/min (SD, 193 mL/min) at 38 weeks. The rate of increase was maximum between 20 and 24 weeks (39 mL/min per week). The laterality of the placenta significantly affected the diameter and blood volume flow in each uterine artery. The diameters on the ipsilateral side were significantly greater (by 10.8% +/- 2.4%) than the diameters on the contralateral side at all gestations (P < .05). Similarly, blood volume flow was significantly greater (by 17.8% +/- 2.2%) on the ipsilateral side at all gestations (P < .05). There were, however, no statistically significant differences between the vessel diameters and blood volume flow in those cases in which the placenta was central. Total uterine artery volume flow per kilogram of estimated fetal weight decreased from 1544 mL/kg per minute at 20 weeks to 296 mL/kg per minute at 38 weeks of gestation. CONCLUSION: Total quantified uterine artery blood volume flow increases while blood flow per kilogram of fetal weight decreases with gestation. Blood volume flow in the ipsilateral artery to the placenta was significantly higher than that in the contralateral artery. Calculating total uterine artery volume flow by doubling the blood flow from 1 artery (as was previously done) may therefore either result in an over or underestimation, depending on the relationship between the vessel and the laterality of the placenta. Color power angiography is a simple noninvasive tool for determining uterine artery blood volume flow.

Angiography↗
PubMed2001

How discriminatory is the objective structured clinical examination (OSCE) in the assessment of clinical competence of medical students?

A prospective collection and analysis of examination marks for three consecutive academic years was undertaken to determine the correlation between the objective structured clinical examination (OSCE) and various other components of medical students' examination, and also to examine how discriminatory the OSCE examination is in the assessment of clinical competence. Out of 388 students, 96.3% passed the examination at the first attempt. Of those who passed, 15.5% had merit while 1.0% had a distinction. When the OSCE component was excluded from the analysis, 11.6% and 2.8% had merits and distinctions, respectively, but when the clinical examination was excluded, there were 17.8% and 6.2% merits and distinctions, respectively. Correlations between the various components of the examination were significant except for that between the clinical examination and the project. Although the OSCE and clinical components of examinations for clinical students are complementary, the OSCE component awards more merit and distinction categories. Although there were statistically significant correlations between the various components of the examination, only 11% of the variability in clinical examination scores could be explained by the performance in OSCE suggesting that the different components are testing different aspects of the student's clinical competence. Completely replacing clinicals with an OSCE may not necessarily be the best way of assessing medical students' clinical competence.

Journal Article↗
PubMed2001

Abnormal Doppler velocimetry and blood flow volume in the middle cerebral artery in very severe intrauterine growth restriction: is the occurence of reversal of compensatory flow too late?

OBJECTIVES: To determine the time course of quantified volumetric flow and pulsatility index changes in the middle cerebral arteries of severe intrauterine growth restricted fetuses with absent or reversed end diastolic flow velocities (AREDFV) on umbilical artery Doppler with a view to defining the threshold for early intervention before the onset of reversal of adaptation. SETTING: Fetal growth clinic of a large UK teaching hospital. SAMPLE: Seventeen severe intrauterine growth restricted (AC < third centile for gestation and gender) fetuses with abnormal umbilical artery Doppler velocimetry and oligohydramnios (amniotic fluid index <third centile for gestation). METHODS: One to three daily Doppler velocimetry and quantified volume flow of the middle cerebral artery Doppler velocimetry of the umbilical arteries and daily cardiotocography. RESULTS: Reversal of adaptation occurred in eight fetuses, four of which ended as stillbirths and four as neonatal deaths. In two of these fetuses, this had already occurred before the diagnosis of intrauterine growth restriction. In the others, the onset was rapid and difficult to predict. Volume flow in the middle cerebral arteries decreased in those fetuses exhibiting reversal of adaptation but rose in the nine in which compensatory Doppler indices persisted. The decrease in volume flow occurred before the onset of reversal of adaptation in the pulsatility index. In the fetuses exhibiting reversal of adaptation, the rise in the pulsatility index was consistent over 48 hours compared with the physiological fluctuations in pulsatility index in some fetuses where the rise was only for 24 hours followed by a fall. Quantified volume flow fell in the fetuses before reversal of adaptation set-in. The umbilical artery Doppler indices fluctuated between absent and reversed end diastolic velocities within the same fetus irrespective of the changes in the middle cerebral artery Doppler indices. CONCLUSION: Reversal of adaptation is of sudden onset and is associated with poor prognosis. Predicting its occurrence on Doppler indices is difficult as the changes may be very rapid. However, volume flow changes appear to be slower and of earlier onset than the pulsatility index changes. This may therefore be a more useful tool in predicting imminent reversal of adaptation and therefore early delivery.

Adult↗
PubMed2000

Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: a randomised controlled trial.

INTRODUCTION: Tamoxifen is currently the most commonly used adjuvant treatment for breast cancer, however, it frequently causes episodes of unscheduled uterine bleeding, which could be associated with proliferative changes of the endometrium, or even endometrial cancer. We aimed to assess whether a levonorgestrel intrauterine system could modulate the uterine responses to tamoxifen. We also aimed to assess women's tolerance of the screening procedures, the insertion, removal, and potential side-effects of the device. METHODS: We did a randomised controlled trial, in which postmenopausal women who had had at least 1 year of adjuvant tamoxifen treatment and who were undergoing regular follow-up for breast cancer were randomly assigned to either endometrial surveillance alone, or endometrial surveillance before and after insertion of the levonorgestrel intrauterine system for 12 months. We assessed tolerance of the surveillance procedures and the device with visual analogue scales. FINDINGS: Baseline assessment showed only benign uterine changes in all women (n=122). Hysteroscopic assessment indicated a uniform decidual response (confirmed histologically in 40 of 41 cases) in all women fitted with the intrauterine system; there were no new polyps in these women and 13% had fewer fibroids than in controls. Both screening procedures and device were well tolerated. There was an excess of bleeding in the women fitted with intrauterine systems but this resolved to a baseline similar to those receiving surveillance only. INTERPRETATION: The levonorgestrel-releasing intrauterine system had a protective action against the uterine effects of tamoxifen. The effectiveness of this device in preventing uterine changes in the endometrium needs to be assessed in the context of decreasing the need for repeated investigations of postmenopausal bleeding in women taking tamoxifen.

Aged↗
PubMed2000

The application of color power angiography to the longitudinal quantification of blood flow volume in the fetal middle cerebral arteries, ascending aorta, descending aorta, and renal arteries during gestation.

OBJECTIVE: This study was undertaken to determine by means of color power angiography the longitudinal changes in the diameters and the flow volumes of 4 major fetal arteries during gestation. STUDY DESIGN: The middle cerebral artery, the ascending aorta, the descending aorta, and the renal arteries in 81 appropriate-for-gestational-age fetuses were examined longitudinally between 24 and 38 weeks' gestation by means of color power angiography. In addition to measurement of the diameters of these arteries, Doppler velocimetry was performed. Flow volume was calculated from the cross-sectional areas of the arteries and the velocity integral of the Doppler waveforms. RESULTS: The mean (+/-SD) gestational age at delivery and birth weight were 39.8 +/- 1. 6 weeks and 3326 +/- 345 g, respectively. The diameters and flow volumes of all the arteries increased significantly as gestational age advanced. Flow volume increased from 39 +/- 19.0 mL/min to 140 +/- 63.9 mL/min in the middle cerebral artery, from 216.2 +/- 77.6 to 937.4 mL/min in the ascending aorta, from 124.4 +/- 76.6 to 390.0 mL/min in the descending aorta, and from 27.5 +/- 16.8 to 80.3 +/- 57.3 mL/min in the renal arteries. When blood flow volume was adjusted to milliliters per kilogram body weight, an initial significant fall in blood flow was seen in all the vessels to a minimal level at 30 weeks' gestation; blood flow rose thereafter, although not significantly, until term. The ratios of flow volume in the ascending aorta to those in the other vessels increased with gestation, with the highest ratio being that between the ascending aorta and the renal arteries. CONCLUSION: Identification of fetal arteries with color power angiography is easy and highly sensitive. The distributions of blood flow in various fetal arteries exhibited regional differences, with significantly more blood flow to the brain. These normative baseline values may be useful in the diagnosis of congenital cardiac anomalies and also in the diagnosis and monitoring of fetuses with intrauterine growth restriction.

Angiography↗
PubMed2000

Nutrition and obstructed labor.

Obstructed labor is one of the most common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Among the common causes are cephalopelvic disproportion, malpresentation, and malposition. Recognizing the causes of obstructed labor is important if the complications are to be prevented. Adequate prevention, however, can be achieved only through a multidisciplinary approach aimed in the short term at identifying high-risk cases and in the long term at improving nutrition. Early motherhood should be discouraged, and efforts are needed to improve nutrition during infancy, childhood, early adulthood, and pregnancy. Improving the access to and promoting the use of reproductive and contraceptive services will help reduce the prevalence of this complication.

Anthropometry↗
PubMed2000

Müllerian agenesis: etiology, diagnosis, and management.

UNLABELLED: Mullerian agenesis, a congenital malformation of the genital tract is the second most common cause of primary amenorrhea. Its etiology is poorly understood but it may be associated with renal, skeletal, and other abnormalities. The diagnosis is often made either radiologically or laparoscopically in patients in whom hormonal and karyotypic investigations for primary amenorrhea are normal. Two-dimensional ultrasound is not a reliable method of diagnosis, as exemplified by the two cases presented in this review; however, three-dimensional ultrasound may be a more sensitive diagnostic tool. The management is varied, but we conclude that the treatment of choice should be a nonsurgical approach aimed at creating a neovagina. Because of the implications for reproduction, these patients require psychological support, which should be offered as part of therapy. TARGET AUDIENCE: Gynecologists and Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the pathophysiology and clinical presentation of mülerian agenesis and to list the other abnormalities associated with this condition and to outline potential treatment options for a patient with müllerian agenesis.

Adolescent↗
PubMed1999

Barriers to uptake and use of modern methods of contraception in developing countries.

As the next millennium approaches, the current world population of 5.9 billion will continue to increase by 81 million per year -- 93% of which will come from the developing countries. Poor uptake and utilisation of various modern methods of contraception in the developing countries is mainly responsible. In this article, we identify various barriers responsible for the low prevalence of contraceptive uptake in these countries and suggest how these barriers may be eliminated. We conclude that by increasing contraceptive availability and utilisation, population explosion can be significantly controlled.

Contraception↗
PubMed1999

Gastroschisis associated with bladder evisceration complicated by hydronephrosis presenting antenatally.

We report here a case of gastroschisis associated with bladder evisceration and complicated by rapidly developing hydronephrosis diagnosed antenatally. The timing of delivery was determined by the hydronephrosis, associated bowel dilatation and polyhydramnios. The case highlights the need for continuing ultrasonographic surveillance of fetuses with gastroschisis to identify further associated complications which were hitherto absent but whose presence may influence the timing of delivery and neonatal care.

Abnormalities, Multiple↗
PubMed1999

The effect of the learning curve on the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomy.

BACKGROUND: Hysterectomy is the commonest elective major gynecological operation and the laparoscopic approach is increasingly an option. We evaluated the influence of the learning curve on the duration of surgery and also the peri-operative complications. METHODS: A retrospective study of the case records of patients who had laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy between August 1993 and July 1997. RESULTS: Over a four year period 86 cases of laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy were performed; the main indication being menstrual disorders. The mean duration of surgery was 116 minutes. There was a significant difference in the mean duration of surgery between the first two years (123 minutes) and the last two years (110 minutes) (p<0.02). The difference in the mean duration of surgery performed either by consultants or senior registrars under supervision (115 versus 116 minutes) was not significant (p>0.05). The overall complication rate was 16% with a majority (85%) occurring in the first two years of the study period. Three cases (5%) were converted to conventional abdominal hysterectomy. After the initial learning phase there was a significant reduction in the complication rates. CONCLUSIONS: The impact of the learning curve on the duration of surgery is gradual. The perceived duration of surgery should not be a disincentive for senior trainees provided they are already proficient in minor laparoscopic surgery, cases are suitably selected and adequate supervision is provided.

Elective Surgical Procedures↗
PubMed1999

Genetic amniocentesis: gestation-specific pregnancy outcome and comparison of outcome following early and traditional amniocentesis.

Amniocentesis remains the most common prenatal diagnostic invasive procedure for fetal karyotyping. During counselling prior to this procedure miscarriage rates are often quoted as a single figure. In this review of 2924 amniocenteses, we report that miscarriage rates vary with the gestational age at which the procedure is performed. The total miscarriage rate was 1.0 per cent after early amniocenteses (11 + 0-14 + 6 weeks) and 1.2 per cent after traditional mid-trimester amniocenteses (15 + 0-18 + 6 weeks). The rate was greatest (3.1 per cent) for amniocenteses performed after 18 + 6 weeks' gestation. The cumulative miscarriage risk increased from 0.03 per cent one week after the procedure to plateau at 1.1 per cent five weeks after the procedure. The preterm and still-birth rates following amniocenteses were similar in early and traditional mid-trimester amniocenteses but were significantly higher when amniocenteses were performed after 19 weeks' gestation. Although the incidence of talipes equinovarus was higher after early amniocentesis compared with traditional mid-trimester amniocenteses (1.4 per cent versus 0.2 per cent), none of the affected infants required corrective surgery. We conclude that counselling for this procedure should be tailored to each unit's unintended fetal loss rate based on cumulative rates. Such figures should be available to parents to assist them in their decision-making.

Adult↗