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Biomedical subjects

M Y Divon

Publications and source records attributed to M Y Divon.

At least 55 records · Page 3Linked to original sources
PubMed1995

Longitudinal measurement of amniotic fluid index in postterm pregnancies and its association with fetal outcome.

OBJECTIVE: Our purpose was to study the association between dynamic changes in serial amniotic fluid index measurements and adverse fetal outcome in postterm pregnancies. STUDY DESIGN: Serial amniotic fluid index values were obtained semiweekly in 139 reliably dated, uncomplicated, singleton pregnancies at > 41 weeks' gestation. Adverse fetal outcome was defined by the presence of moderate or thick meconium, fetal heart rate decelerations, cesarean delivery for fetal distress, neonatal intensive care unit admission, and perinatal mortality. RESULTS: Prominent changes in the amniotic fluid index (i.e., > 50% increase or decrease) had no association with adverse fetal outcome irrespective of rate of change, provided the final value remained > 5.0 cm. A significant association with fetal heart rate decelerations and the presence of meconium was detected only in patients whose final amniotic fluid index was < or = 5.0 cm (p = 0.007 and p = 0.003, respectively). CONCLUSION: Irrespective of the rate of change in amniotic fluid index, postterm pregnancies are significantly associated with potential complications such as fetal heart rate decelerations and meconium staining when the final amniotic fluid index is < or = 5.0 cm.

Amniotic Fluid↗
PubMed1995

Is oligohydramnios in postterm pregnancy associated with redistribution of fetal blood flow?

OBJECTIVE: Our purpose was to determine whether postterm patients with oligohydramnios differ in their fetal and umbilical blood flow distribution from those with a normal volume of amniotic fluid. STUDY DESIGN: Pulsed-wave Doppler imaging was used prospectively to determine the resistance index in the fetal middle cerebral, renal, and umbilical arteries in 57 postterm (i.e., > 41 weeks' gestation) pregnancies. Semiquantitative assessment of amniotic fluid volume was obtained by use of the ultrasonographically determined amniotic fluid index. RESULTS: Oligohydramnios (amniotic fluid index < 5 cm) was detected in 15 patients; 42 patients with a normal amniotic fluid index served as a control group. The various resistance index values and the ratio s among them were not significantly different when patients with oligohydramnios were compared with controls (0.51 +/- 0.1 vs 0.52 +/- 0.06, 0.63 +/- 0.1 vs 0.64 +/- 0.08, and 0.71 +/- 0.08 vs 0.73 +/- 0.05 for the umbilical, middle cerebral, and renal arteries, respectively). However, the mean birth weight (in grams) was significantly lower (3297 +/- 438 vs 3742 +/- 448, p < 0.003), in the oligohydramnios group. CONCLUSION: Oligohydramnios was not associated with a major redistribution of blood flow in postterm patients, suggesting that the cause of oligohydramnios in these patients is related to birth weight rather than to renal perfusion.

Amniotic Fluid↗
PubMed1995

Is polyhydramnios in an ultrasonographically normal fetus an indication for genetic evaluation?

OBJECTIVE: Our purpose was to determine the frequency of fetal chromosomal anomalies in pregnancies complicated by polyhydramnios. STUDY DESIGN: Between Jan. 1, 1992, and July 31, 1993, an amniotic fluid index was measured prospectively in 2730 third-trimester pregnant women. Polyhydramnios was defined as an amniotic fluid index > or = 24 cm. A computer search identified all infants born with structural or chromosomal anomalies. RESULTS: Polyhydramnios was detected in 49 of 2730 women (1.7%). The incidence of chromosomal anomalies was two in 49 (4.1%) compared with three in 2681 (0.12%) among women with normal fluid (p < 0.05). Six of the 49 newborns had structural anomalies (12.2%), whereas 48 of 2681 (1.8%) structural anomalies occurred in the control group (p < 0.05). Among study patients both fetuses with chromosomal anomalies were growth retarded; four of the six structural anomalies were associated with an amniotic fluid index > 30 cm. CONCLUSIONS: (1) Polyhydramnios is associated with an increased incidence of congenital fetal anomalies. (2) Growth-retarded fetuses with polyhydramnios warrant genetic evaluation. (3) A genetic study is not absolutely indicated for patients with polyhydramnios and a sonographically normal fetus.

Amniocentesis↗
PubMed1995

Ultrasound in twin pregnancy.

This review evaluates the role of ultrasound in twin gestation. Ultrasound is essential in the diagnosis and management of perinatal complications common in twins, including fetal anomalies, conjoined twins, acardiac twinning, fetal demise, prematurity, intrauterine growth retardation, and twin-to-twin transfusion. Indications for first-trimester scanning are reviewed, as well as its use in determining type of placentation, chorionicity, and amnionicity. The focus of this article will be the use of ultrasound and Doppler velocimetry in the evaluation of fetal growth and subsequent management of intrauterine growth retardation in twins, as well as the value of real-time ultrasound and Doppler evaluation in the diagnosis of discordant growth and twin-to-twin transfusion syndrome.

Computer Systems↗
PubMed1995

Assessing the risk of gestational diabetes in twin gestation.

This study examines the hypothesis that twin gestation is a risk factor for gestational diabetes. In a retrospective analysis, the incidence of gestational diabetes in twin and singleton pregnancies was determined in groups matched for maternal age, weight, and parity. One-hour oral glucose challenge tests (50 g) were used to screen 9185 pregnant women. Gestational diabetes was diagnosed when abnormal screens (> or = 130 mg/dL) were followed by two or more abnormal values on a 3-hour (100 g) glucose tolerance test using National Diabetes Data Group (NDDG) criteria. A twin gestation was identified in 1.5% (138/9185) of the pregnancies. Gestational diabetes was diagnosed in 5.8% (8/138) and 5.4% (439/9047) of the twin and singleton pregnancies, respectively. The incidence of gestational diabetes is similar for singleton and twin gestations.

Adult↗
PubMed1995

Induction of labor.

Several mechanical and biochemical methods have been used to induce labor throughout modern obstetrics. We review and compare mechanical and medical methods of labor induction, along with several new uterotonic agents such as mifepristone (RU 486) and misoprostol, which can be conveniently administered orally and managed in the outpatient clinic.

Female↗
PubMed1994

Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus.

OBJECTIVE: Our purpose was to determine the association between amniotic fluid volume and recent glucose status in gestational diabetes. STUDY DESIGN: Serial amniotic fluid index values, mean blood glucose levels, and percent hyperglycemia (> or = 120 mg/dl) 1 day and 1 week before the ultrasonographic examinations were prospectively collected in 399 gestational diabetics. Patients demonstrating at least one amniotic fluid index measurement within the normal range (i.e., 5 cm < amniotic fluid index < or = 20 cm) and at least one elevated measurement (i.e., amniotic fluid index > 20 cm) formed the study group. With each patient serving as her own control, glucose index values preceding normal and elevated amniotic fluid index values were compared. RESULTS: Significantly higher mean blood glucose values 1 day (114.7 mg/dl vs 102.8 mg/dl, p < 0.01) and 1 week before (111.0 mg/dl vs. 102.0 mg/dl, p < 0.05) were calculated for examinations resulting in elevated amniotic fluid index values compared with normal amniotic fluid index values, respectively. Similarly, significantly higher percents of hyperglycemia 1 day (32% vs 16.5%, p < 0.05) but not 1 week (30.8% vs 21.7%, p > 0.05) before the elevated amniotic fluid index were documented. CONCLUSION: Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus.

Adult↗
PubMed1994

Fetal surveillance.

The primary objective of fetal surveillance is to prevent antenatal fetal deaths, which still account for greater than one half of perinatal mortality. Several techniques for assessing fetal well-being are available to the practicing obstetrician, including fetal movement counting, nonstress testing, contraction stress testing, fetal biophysical assessment with real-time sonography, and Doppler ultrasonography for measuring umbilical and fetal blood flow. Despite several unanswered questions regarding fetal surveillance, identification of high-risk pregnancies allows appropriate fetal evaluation that can reduce intrauterine fetal death rates.

Exercise Test↗
PubMed1993

Amniorrhexis lowers the incidence of positive cultures for group B streptococci.

OBJECTIVE: Our purpose was to determine the effect of amniorrhexis on cultures for group B streptococci. STUDY DESIGN: Intrapartum vaginal cultures for group B streptococci were obtained before and after rupture of membranes in 166 women; in addition, rectal cultures were obtained from the last 35 patients. RESULTS: Before rupture of membranes 49 of 166 (30%) of the vaginal cultures were positive for group B streptococci; only 28 of 166 (17%) remained positive after rupture of membranes (p = 0.0009). Similarly, before rupture of membranes 10 of 35 (30%) rectal cultures were positive, whereas only three of 35 (0.9%) remained positive for group B streptococci after rupture of membranes (p = 0.03). CONCLUSION: The prevalence of positive genital cultures for group B streptococci is significantly lower immediately after rupture of membranes.

Amnion↗
PubMed1993

Twin gestation: fetal presentation as a function of gestational age.

OBJECTIVE: Our objective in this study was to evaluate the rate of spontaneous version in twin gestation throughout the third trimester. STUDY DESIGN: Serial ultrasonographic examinations were performed on 119 consecutive patients with twin gestation. The incidence of spontaneous version as a function of gestational age was calculated. RESULTS: The mean birth weight and gestational age at delivery were 2640 gm and 37 weeks, respectively. Nineteen percent had birth weight discordancy, and 37% were delivered by cesarean section. The incidence of spontaneous version decreased from 60% at 28 to 30 weeks' gestation to 25% to 30% at term. The lowest incidence of spontaneous version was observed in pregnancies with a cephalic-cephalic presentation (7%). All other presentations were relatively unstable. Neither the patients' parity nor the presence of birth weight discordancy, the placental location, or the amniotic fluid volume had a significant association with the incidence of spontaneous version. CONCLUSION: These data should be incorporated into the routine antepartum counseling of patients with twin gestation. Their use in this capacity may result in a decreased cesarean delivery rate if clinicians realize that malpresentations may spontaneously resolve before the onset of labor.

Adolescent↗
PubMed1993

Miliary tuberculosis in pregnancy.

Although miliary tuberculosis is uncommon in pregnancy, it is difficult to diagnose when present and is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection. This article reports two antepartum cases of miliary tuberculosis without any of these risk factors. Bronchial washings for Pneumocystis carinii and HIV screening were negative for both patients. Acid-fast bacilli stains of the bronchial washing and ascitic fluid were also negative. Several weeks were required for ascitic fluid and bronchial biopsy Mycobacterium cultures to be positive. In contrast, acid-fast bacilli were seen within 24 hours in multiple sections of the delivered placentas. Confirming the diagnosis of miliary tuberculosis is an arduous process requiring a high index of suspicion. During pregnancy, pathologic examination of tissue obtained by placental biopsy may facilitate making an early diagnosis of extrapulmonary tuberculosis.

Adult↗
PubMed1993

Fetal vibroacoustic stimulation.

OBJECTIVE: To review the literature on fetal vibroacoustic stimulation as a method of changing the fetal sleep state during nonstress testing. DATA SOURCES: The MEDLINE data base and reference lists were used to select articles pertaining to human and animal fetal vibroacoustic stimulation. METHODS OF STUDY SELECTION: We reviewed the English-language literature with respect to sound intensity, stimulus duration, and repetition rate as possible means of altering fetal sleep-wake cycles. DATA EXTRACTION AND SYNTHESIS: Several criteria have been used to measure fetal response: gestational age, fetal heart rate, fetal movements, fetal breathing movements, fetal habituation, and fetal behavioral states. The use of vibroacoustic stimulation for antepartum and intrapartum fetal assessment and safety issues are also reviewed. CONCLUSION: Although further research is needed, the ability of vibroacoustic stimulation to elicit FHR accelerations has been established, thus decreasing the false-positive rate associated with nonreactive nonstress testing.

Acoustic Stimulation↗
PubMed1993

Metastatic placental lymphoma associated with maternal human immunodeficiency virus infection.

BACKGROUND: Pregnancy complicated by maternal human immunodeficiency virus (HIV) infection is increasing in frequency. This report describes a maternal malignancy associated with HIV infection that may complicate pregnancy. CASE: A 33-year-old primigravida was delivered by cesarean. Histologic examination of the placenta revealed the presence of metastatic non-Hodgkin lymphoma of B-cell origin. The patient was then found to be infected with HIV. Nine months postpartum, she was diagnosed with immunoblastic lymphoma. She is currently undergoing chemotherapy. CONCLUSION: Non-Hodgkin lymphoma of B-cell origin is an indication of AIDS. Pregnancies associated with maternal HIV infection may be complicated by this malignancy, which may metastasize to the products of conception. Careful examination of the placenta can detect metastases in women with non-Hodgkin B-cell lymphoma.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Macrosomia in postdates pregnancies: the accuracy of routine ultrasonographic screening.

OBJECTIVE: The purpose of this study was to assess the efficacy of routine ultrasonographic assessment of fetal weight in predicting fetal macrosomia in postdates pregnancies. STUDY DESIGN: A total of 519 pregnancies of > or = 41 weeks' duration were subjected to ultrasonographic estimation of fetal weight within 1 week of delivery. Estimated fetal weights were compared with birth weights. Linear regression analysis was performed and prediction limits for estimated fetal weights were generated. RESULTS: Twenty-three percent of infants had birth weights > or = 4000 gm and 4% had birth weights > or = 4500 gm. The mean percent absolute error was 7.7%. At a birth weight of > 3750 gm, the Hadlock model (which uses abdominal circumference and femur length) systematically overestimated the birth weight. The sensitivity, specificity, and positive and negative predictive values for the ultrasonographic diagnosis of macrosomia were 56%, 91%, 64%, and 87%, respectively. The prediction limits generated determine the range of birth weights predicted for a given estimated fetal weight. CONCLUSION: Routine ultrasonographic screening for macrosomia in postdates pregnancies is associated with a relatively low positive predictive value.

Birth Weight↗
PubMed1992

Sonographic diagnosis of IUGR-macrosomia.

Many sonographic methods have been suggested for identification of the fetus with a growth abnormality. Clearly, optimal management depends on early diagnosis. In recent years, advances in sonography have improved the ability to identify abnormal growth patterns and evaluate fetal well-being. When abnormal fetal growth is suspected, a thorough sonographic evaluation should be performed. This evaluation includes measurements of the abdominal circumference, femur length,) BPD, HC, AC, FL, and amniotic fluid volume. If these measurements confirm the suspicion of abnormal fetal growth, careful search for anomalies is mandatory. If there is no evidence of fetal compromise that would warrant delivery, measurements should be repeated in 2-3 weeks to evaluate interval growth. The following conclusions could be drawn from this literature review: 1. Intrauterine growth retardation and macrosomia are multifactorial diseases with varying degrees of severity. It is unlikely that a single sonographic parameter will allow an accurate diagnosis of all cases. 2. The type and degree of growth retardation and macrosomia depend on the intensity and duration of the underlying disease. Thus, an ultrasound assessment performed long before delivery may be of limited value. 3. Most of the sonographic parameters reviewed in this chapter are gestational age dependent. Unfortunately, gestational age is often unknown. Gestational age independent indices such as the amniotic fluid volume, FL/AC ratio, and the rate of fetal growth should be helpful in this situation. 4. The constitutionally small infant whose only problem is low birth weight should not be expected to present with any abnormal indices other than a low EFW. On the other hand, newborns who appear to be malnourished but whose birth weight is at or slightly above the tenth percentile for gestational age, may present with abnormal indirect indices indicating growth retardation (ie, HC/AC, FL/AC, Doppler velocimetry or oligohydramnios) despite a normal estimate of fetal weight. In addition, if the diagnosis of IUGR is made only with the use of birthweight for gestational age criteria, these infants are likely to be misclassified and labelled AGA. However, an abnormal ponderal index would indicate that these neonates are growth retarded. It can be concluded from this review that the use of sonographic measurements for diagnosing IUGR or macrosomia is associated with a high specificity and a somewhat lower sensitivity. Therefore, it would seem that the current ultrasound methods are more useful for excluding the possibility of abnormal fetal growth rather than for confirming it.

Anthropometry↗