Cyclopia with trisomy D.
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Abnormalities, Severe Teratoid↗
Biomedical subjects
M Y Divon
Publications and source records attributed to M Y Divon.
Predictive value of amniotic fluid index for oligohydramnios in patients with prolonged pregnancies.
The objective of this study was to evaluate the predictive values of the amniotic fluid index for measures of perinatal morbidity and for clinical observations consistent with oligohydramnios. We evaluated positive and negative predictive value of the amniotic fluid index for measures of perinatal morbidity and for clinical observations consistent with oligohydramnios at various cutoff values for amniotic fluid index in a cohort of 449 consecutive postdates patients who had a clinician's observation of amniotic fluid quantity and quality recorded at the time of rupture of membranes. Newborn morbidity was a rare event. Clinical observations consistent with oligohydramnios had significant positive and negative predictive values for some measures of newborn morbidity. The last amniotic fluid index performed during antepartum testing had 95% confidence intervals for relative risks for these measures of newborn morbidity that included unity and therefore were not significant. At a cutoff value of 5.0 cm, the positive predictive value of the amniotic fluid index for clinical observations consistent with oligohydramnios was 50%; the negative predictive value was 85%, with a prevalence of clinical observations consistent with oligohydramnios of 19%. The presence of fetal heart rate decelerations did not significantly improve the positive predictive value of the amniotic fluid index. Higher positive predictive values were obtained at cutoff values of 4 cm and 3 cm with minimal loss in negative predictive value. The amniotic fluid index did not possess significant predictive value for measures of newborn morbidity. Clinical observations consistent with oligohydramnios at the time of rupture of membranes did have predictive value for some of these measures and thus probably are a reflection of the actual amount of fluid present inside the uterus prior to rupture of membranes. The amniotic fluid index is only a fair predictor of clinical observations consistent with oligohydramnios. Thus, a positive test correctly predicted these observations 50% of the time, with 50% false-positive results. Undertaking delivery in the 50% of patients without clinical observations consistent with oligohydramnios may lead to a higher cesarean section rate since these patients do not require induction and are subject to the risk of a failed induction of labor. A negative test correctly predicted observations consistent with normal fluid 85% of the time, with a false-negative rate of 15%. Thus, a negative test was no guarantee that observations consistent with oligohydramnios, and thus newborn morbidity, would not subsequently appear. Frequent testing with multiple modalities and induction of labor when the Bishop score is favorable remain sensible options. Induction of labor in postdates patients with a low amniotic fluid index needs to be evaluated in a yet-to-be-performed prospective randomized control trial before a low amniotic fluid index is assumed to be the sole indicator for induction of labor. More stringent cutoff values for amniotic fluid index may be justified.
Amniocentesis↗
Efficacy of the maternal height to fundal height ratio in predicting arrest of labor disorders.
Numerous methods of identifying fetal-pelvic disproportion to its clinical presentation have been tested, but none has been consistently accurate or economically feasible. The objective of this study was to prospectively evaluate the utility of the maternal-fetal ratio (MFR) with clinical and sonographic estimates of fetal weight (FEW) for predicting active phase arrest disorders and the need for a subsequent cesarean section (C/S). Upon admission, maternal height (MH), symphyseal-fundal height (SFH), and clinical and sonographic FEW were obtained on 140 laboring women at term. The MFR was defined as MH (cm) divided by SFH (cm). A modified MFR was calculated by adjusting the SFH according to the station of the presenting part. Women delivered by C/S had a modified MFR of 3.75 +/- 0.35 compared with 4.0 +/- 0.36 for women delivering vaginally, P = 0.02. An abnormal modified MFR showed a relative risk of 7.3 (95% CI = 1.45-33.2) for predicting a C/S, while a sonographic EFW > 4,000 g had a relative risk of 3.8. The MFR of women delivered by C/S due to arrest disorders is significantly lower than that measured for women delivering vaginally. Women with an abnormal modified MFR have a sevenfold increased likelihood of having an arrest disorder. The modified MFR (which can be measured antenatally) is superior to the birth weight (which can be approximated by sonography) in predicting arrest disorders.
Body Height↗
Diagnosis of macrosomia in the postdates population: combining sonographic estimates of fetal weight with glucose challenge testing.
OBJECTIVE: To evaluate the test characteristics of sonographic estimation of fetal weight in the detection of macrosomia in nondiabetic postdates patients as a function of maternal glucose value measured after glucose challenge testing performed at 24-28 weeks of gestation. METHODS: At or beyond 41 weeks' gestation, 656 nondiabetic patients had sonographic estimation of fetal weight. Receiver-operator characteristic curve analysis was used to define the glucose value at which an optimal number of macrosomic fetuses could be identified. The test characteristics of sonography in the prediction of macrosomia in the two populations defined by that cut-off value were evaluated. RESULTS: A glucose level of 120 mg/dL (6.6 mM) was identified as the optimal cutoff for prediction of birth weight > or = 4,000 g. In the group with a glucose level > or = 120 mg/dL, sonographic estimation of fetal weight in the detection of macrosomia offered a sensitivity, specificity, and positive and negative predictive values of 63%, 91%, 71%, and 86%, respectively. In those with glucose level <120 mg/dL, sonography demonstrated a sensitivity, specificity, and positive and negative predictive values of 65%, 89%, 60%, and 91%, respectively. CONCLUSIONS: In postdates nondiabetic patients, routine glucose challenge testing performed early in pregnancy has limited ability to improve the test characteristics of sonography to predict macrosomia. The positive predictive value of sonographically suspected macrosomia increases from 60-71% in patients whose glucose level was > or = 120 mg/dL (P = 0.002).
Adult↗
Nucleated red blood cells in growth-restricted fetuses: associations with short-term neonatal outcome.
OBJECTIVE: To determine the utility of the neonatal nucleated red blood cell (NRBC) count as an independent predictor of short-term perinatal outcome in growth-restricted fetuses. METHODS: Hospital charts of neonates with a discharge diagnosis indicating a birth weight <10th percentile were reviewed for perinatal outcome. We studied all eligible neonates who had a complete blood count on the first day of life. After multiple gestations, anomalous fetuses and diabetic pregnancies were excluded; 73 neonates comprised the study group. Statistical analysis included ANOVA, simple and stepwise regression. RESULTS: Elevated NRBC counts were significantly associated with cesarean section for non-reassuring fetal status, neonatal intensive care unit admission and duration of neonatal intensive care unit stay, respiratory distress and intubation, thrombocytopenia, hyperbilirubinemia, intraventricular hemorrhage and neonatal death. Stepwise regression analysis including gestational age at birth, birth weight and NRBC count demonstrated that in growth-restricted fetuses, NRBC count was the strongest predictor of neonatal intraventricular hemorrhage, neonatal respiratory distress and neonatal death. CONCLUSION: An elevated NRBC count independently predicts adverse perinatal outcome in growth-restricted fetuses.
Adult↗