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Biomedical subjects

Jason Gardosi

Publications and source records attributed to Jason Gardosi.

7 recordsLinked to original sources
PubMed2006

Three-stage contingent screening for Down syndrome.

OBJECTIVE: To demonstrate the potential value of three-stage sequential screening for Down syndrome. METHODS: Protocols were considered in which maternal serum pregnancy associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (hCG) measurements were taken on all women in the first trimester. Those women with very low Down syndrome risks were screened negative at that stage and nuchal translucency (NT) was measured on the remainder and the risk reassessed. Those with very low risk were then screened negative and those with very high risk were offered early diagnostic testing. Those with intermediate risks received second-trimester maternal serum alpha-fetoprotein, free beta-hCG, unconjugated estriol and inhibin-A. Risk was then reassessed and those with high risk were offered diagnosis. Detection rates and false-positive rates were estimated by multivariate Gaussian modelling using Monte-Carlo simulation. RESULTS: The modelling suggests that, with full adherence to a three-stage policy, overall detection rates of nearly 90% and false-positive rates below 2.0% can be achieved. Approximately two-thirds of pregnancies are screened on the basis of first-trimester biochemistry alone, five out of six women complete their screening in the first trimester, and the first-trimester detection rate is over 60%. CONCLUSION: Three-stage contingent sequential screening is potentially highly effective for Down syndrome screening. The acceptability of this protocol and its performance in practice, should be tested in prospective studies.

Algorithms↗
PubMed2005

Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study.

OBJECTIVE: To develop and test a new classification system for stillbirths to help improve understanding of the main causes and conditions associated with fetal death. DESIGN: Population based cohort study. SETTING: West Midlands region. SUBJECTS: 2625 stillbirths from 1997 to 2003. MAIN OUTCOME MEASURES: Categories of death according to conventional classification methods and a newly developed system (ReCoDe, relevant condition at death). RESULTS: By the conventional Wigglesworth classification, 66.2% of the stillbirths (1738 of 2625) were unexplained. The median gestational age of the unexplained group was 237 days, significantly higher than the stillbirths in the other categories (210 days; P < 0.001). The proportion of stillbirths that were unexplained was high regardless of whether a postmortem examination had been carried out or not (67% and 65%; P = 0.3). By the ReCoDe classification, the most common condition was fetal growth restriction (43.0%), and only 15.2% of stillbirths remained unexplained. ReCoDe identified 57.7% of the Wigglesworth unexplained stillbirths as growth restricted. The size of the category for intrapartum asphyxia was reduced from 11.7% (Wigglesworth) to 3.4% (ReCoDe). CONCLUSION: The new ReCoDe classification system reduces the predominance of stillbirths currently categorised as unexplained. Fetal growth restriction is a common antecedent of stillbirth, but its high prevalence is hidden by current classification systems. This finding has profound implications for maternity services, and raises the question whether some hitherto "unexplained" stillbirths may be avoidable.

Birth Weight↗
PubMed2004

Perinatal mortality and fetal growth restriction.

Stillbirths are the largest component of perinatal mortality. Most are currently classified as 'unexplained', which is not helpful for counselling and individual care or for setting priorities for maternity services. The new ReCoDe classification reduces the number of stillbirths categorized as 'unexplained' from 66 to 14%. Both stillbirths and neonatal deaths are strongly associated with fetal growth restriction, and increased awareness of intrauterine growth is essential for any strategies which seek to avoid adverse perinatal outcome.

Fetal Death↗
PubMed2004

Customized fetal growth standards: rationale and clinical application.

Accurate assessment of fetal growth status requires the definition of an optimal standard, which represents the growth potential of the baby. Against this standard, individually 'customized' percentiles can be calculated. They improve the distinction between normal and abnormal, and help in our understanding and diagnosis of pathological fetal growth. This method can be used as a tool for epidemiological analysis as well as for prospective clinical monitoring.

Embryonic and Fetal Development↗
PubMed2004

A customised birthweight centile calculator developed for a New Zealand population.

BACKGROUND: Traditionally, small for gestational age is defined as birthweight <10th percentile using sex-adjusted centile charts. However, this criterion includes constitutional variation due to maternal height, weight, ethnic group and parity. AIMS: To develop customised birthweight centiles for a New Zealand population. METHODS: National Women's Hospital database of births from 1993 to 2000 was used to identify eligible women with singleton pregnancies who had data available on the following: scan result for dating at gestation <24 weeks, maternal height and weight at booking, parity and ethnic origin. Multiple regression was used to determine the coefficients applicable to New Zealand. RESULTS: A total of 4707 pregnancies met the inclusion criteria comprising: European 1688 (36.0%), Maori 419 (8.9%) Samoan 506 (10.7%), Tongan 326 (6.9%), Chinese 751 (16.0%), Indian 214 (4.6%) and other 803 (17.1%). Mean term birthweight for an average nulliparous European woman was 3530 g. Babies of Maori and Indian ethnicity were on average 67 g and 150 g lighter, respectively, than European babies. Samoan, Tongan and Chinese babies were 84 g, 124 g and 101 g heavier, respectively. CONCLUSIONS: There are significant differences in birthweight between European and the other major ethnic groups in New Zealand. They relate to maternal physiological variables, for which coefficients have been derived and incorporated into freely available software that enables improved clinical assessment of fetal and neonatal weight.

Algorithms↗
PubMed2002

The risk of preterm delivery in women from different ethnic groups.

OBJECTIVE: To examine whether routinely measured variables explained the increased risk of preterm delivery in some UK ethnic groups. DESIGN: Cross sectional study of deliveries recorded in the Child Health Record System. SETTING: North Birmingham, UK. POPULATION: All North Birmingham women delivering singletons, 1994-1997 inclusive. METHOD: Logistic regression. MAIN OUTCOME MEASURES: Odds ratio (OR) and 95% confidence interval (CI) for preterm delivery, defined as less than 37 weeks, less than 34 weeks and less than 28 weeks, unadjusted and adjusted for maternal age, an area-based socio-economic status measure, and marital status, year of birth, fetal sex and past obstetric history. RESULTS: For Afro-Caribbean women, the ORs (95% CIs) were: for delivery less than 37 weeks, 1.44 (1.26-1.64) unadjusted and 1.22 (1.07-1.41) adjusted; for delivery less than 34 weeks, 1.55 (1.25-1.92) unadjusted and 1.29 (1.02-1.61) adjusted; for delivery less than 28 weeks, 1.66 (1.08-2.55) unadjusted and 1.32 (0.84-2.06) adjusted. For African women, the risk of delivery less than 37 weeks was not significantly raised; for delivery less than 34 weeks, the OR (95% CI) was 1.88 (0.99-3.58) unadjusted and 1.78 (0.93-3.40) adjusted; for delivery less than 28 weeks, the OR (95% CI) was 4.02 (1.60-10.12) unadjusted and 4.10 (1.66-10.16) adjusted. In Afro-Caribbeans, deprivation and marital status explained the differences between the unadjusted and adjusted ORs. There was a linear relation between deprivation and preterm delivery for all ethnic groups, except for Asians. CONCLUSIONS: Factors associated with deprivation and marital status explain about half of the excess of preterm births in Afro-Caribbeans, but not Africans. The risk of preterm delivery might not be related to deprivation in Asians.

Africa↗