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Biomedical subjects

W J Ott

Publications and source records attributed to W J Ott.

At least 19 recordsLinked to original sources
PubMed1995

The accuracy of antenatal fetal echocardiography screening in high- and low-risk patients.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of four-chamber and left ventricular outflow tract views in low-risk patients and comprehensive fetal echocardiographic examinations in high-risk patients to diagnose structural heart disease or thoracic anomalies. STUDY DESIGN: A prospective outcome study of two cohorts was performed; 1136 low-risk patients and 886 high-risk patients were evaluated during a 2-year period. Low-risk patients underwent routine four-chamber and left ventricular outflow tract evaluation whereas high-risk patients had detailed fetal echocardiographic examinations. Accuracy of the ultrasonographic diagnosis was evaluated from neonatal discharge data. RESULTS: Only 2 of 14 patients with congenital heart disease in the low-risk group were correctly identified (sensitivity 14.3%) whereas 10 of 16 patients with congenital heart disease or thoracic anomalies were correctly identified in the high-risk group (sensitivity 62.5%). CONCLUSION: The current study showed poor diagnostic accuracy of the standard four-chamber and left ventricular outflow tract views in low-risk patients for the diagnosis of structural cardiac anomalies. Patients with risk factors for congenital heart disease should be referred for comprehensive fetal echocardiographic examination.

Echocardiography↗
PubMed1995

Comprehensive ultrasound examination in a private perinatal practice.

A retrospective review of the types of patients seen and the accuracy of the diagnosis made was undertaken for patients referred for comprehensive ultrasound examination in a large private perinatal practice. A review of the perinatal ultrasound database, neonatal intensive care database, and hospital charts was done in 1338 patients referred to the perinatal ultrasound laboratory for comprehensive ultrasound examination during a 2-year period. Accuracy of the ultrasound diagnosis and relationships between structural anomalies seen on ultrasound examination and perinatal outcome was undertaken. Positive and negative predictive values for the ultrasonic diagnosis were 82% and 98%, respectively. There were 19 (1.4%) false-positive diagnoses and 38 (2.8%) false-negative diagnoses. There was a high correlation between structural anomalies and chromosomal anomalies, with 15 of the 87 infants (17.2%) with structural anomalies also having chromosomal anomalies. The accuracy of ultrasonic diagnosis for comprehensive examinations in a large private perinatal practice compared favorably with previous reports in the literature. The information presented in this study should be helpful to obstetric centers with similar patient populations.

Congenital Abnormalities↗
PubMed1995

Small for gestational age fetus and neonatal outcome: reevaluation of the relationship.

A retrospective review of 1316 neonates who had been evaluated in the Perinatal Laboratory of my institution during the years 1990 and 1991 was undertaken to study the relationship between birthweight for gestational age, maternal high-risk factors, and neonatal ponderal index with neonatal outcome. Patients were stratified as to gestational age at delivery and the presence of significant congenital abnormalities. Univariant analysis (chi square or t test, where appropriate) was done comparing neonatal outcome for neonates that were or were not small for gestational age (SGA), whose mother did or did not have high-risk factors, and for infants with normal or abnormal ponderal indices. Multivariant analysis was also done using logistic regression analysis. In infants without congenital anomalies delivering at term only the presence of maternal risk factors had prognostic significance, whereas both maternal risk factors and defining infants as SGA had prognostic value in infants delivering preterm, especially less than 34 weeks' gestation. Ponderal index had no significant prognostic value at any gestational age. The data supports the concept that intrauterine growth retardation as defined as an SGA, low birthweight for gestational age infant, may be an inaccurate classification for infants delivering at term, but does have prognostic significance in preterm infants, especially those less than 34 weeks' gestational age.

Birth Weight↗
PubMed1994

Accurate gestational dating: revisited.

Using first trimester fetal crown-rump length (CRL) measurements as the criterion for gestational dating, rather than menstrual history or neonatal gestational age evaluation after birth, may be a more accurate way of evaluating the accuracy of second or third trimester ultrasonic measurements for gestational age estimation. This hypothesis was tested using two study groups to evaluate the accuracy of second or third trimester ultrasound measurements for the estimation of gestational age. Three hundred twenty normal obstetric patients who had first trimester CRL measurements were evaluated in the first study. Stepwise multiple regression analysis was used to determine the best combination of multiple ultrasonic parameters for calculation of gestational age, using each patient's CRL as his or her own control. The best formula derived from the first set of patients was used in a second set of 138 high-risk patients to determine the accuracy of multiple ultrasonic parameters obtained during the second or third trimester to date gestation accurately. The analysis confirmed the accuracy of multiple ultrasonic parameters for gestational dating and indicated that the use of two parameters (head circumference and femur length) was as accurate as the traditional four-parameter technique.

Crown-Rump Length↗
PubMed1993

Intrauterine growth retardation and preterm delivery.

OBJECTIVE: A retrospective study was undertaken to determine if premature infants had a higher incidence of intrauterine growth retardation than term infants did. If premature labor is significantly associated with intrauterine growth retardation, then defining intrauterine growth retardation with a population-specific postnatal birth weight for gestational age curve would underestimate the incidence in preterm infants. STUDY DESIGN: Data for the year 1990 were used to construct a postnatal birth weight for gestational-age curve. This curve was then used to analyze 1991 birth weight data and to determine the incidence of intrauterine growth retardation (< 10th percentile) at each week of gestation. Infants were also classified as having intrauterine growth retardation on the basis of an additional postnatal birth weight for gestational-age curve and two antenatal ultrasonic estimated fetal-weight-for-gestational-age curves. RESULTS: Analysis of the 1991 delivery data indicated that both ultrasonography curves showed a significant decrease in the incidence of intrauterine growth retardation with advancing gestational age, whereas the postnatal curves did not. CONCLUSION: The results give full support to previous reports that suggest intrauterine growth retardation is more common in preterm than in term infants and are consistent with the hypothesis that intrauterine growth retardation is significantly related to premature birth.

Fetal Growth Retardation↗
PubMed1990

Comparison of dynamic image and pulsed Doppler ultrasonography for the diagnosis of intrauterine growth retardation.

Dynamic image and pulsed Doppler ultrasonography were used to evaluate 104 potentially growth-retarded fetuses. The two techniques were compared, and then used together to predict whether or not the neonate would be growth retarded. Both ultrasonic diagnostic techniques showed good correlation with neonatal outcome, but their combined use improved diagnostic accuracy.

Blood Flow Velocity↗
PubMed1990

Defining altered fetal growth by second-trimester sonography.

A method of predicting birth weight from a single ultrasound examination between 18-28 weeks' gestation was evaluated prospectively in 315 obstetric patients with singleton pregnancies. Estimated fetal weight at the time of the ultrasound examination was used to predict actual birth weight. At delivery, the percent difference between the projected and actual birth weights was then used to define whether an infant was small, appropriate, or large for gestational age. This method appeared to be accurate and showed identical relationships to the presence of abnormal fetal heart rate patterns in growth-retarded infants as did the traditional birth-weight-for-gestational-age method of defining intrauterine growth retardation.

Adult↗
PubMed1988

The diagnosis of altered fetal growth.

The antenatal recognition of altered fetal growth should be an important goal for every obstetrician, because significant neonatal complications can be associated with both ends of the spectrum of altered growth. This article discusses the problems related to altered fetal growth, the difficulty in defining and diagnosing it, and some of the methods available for its antenatal diagnosis.

Birth Weight↗
PubMed1987

Ultrasonically estimated weight and gestational age. Predictors of neonatal respiratory distress syndrome.

Information from 504 women who had undergone real-time ultrasound examination within 72 hours of childbirth was used to evaluate the relationship between the product of ultrasonically estimated fetal weight (in kilograms) times ultrasonically estimated gestational age (in weeks) and neonatal morbidity and mortality. If this product was greater than 40, there were no neonatal deaths (excluding severe congenital abnormalities); if the product was greater than 80, there were no cases of significant respiratory distress syndrome. These data may prove to be highly useful in the rapid evaluation of preterm labor or other obstetric complications.

Amniocentesis↗
PubMed1986

Accurate ultrasonic estimation of fetal weight. Effect of head shape, growth patterns, and amniotic fluid volume.

Four hundred sixty-four fetuses underwent real time ultrasound examination within 72 hours before birth to evaluate other factors than the weight formula itself that might influence the accuracy of ultrasound weight estimation. The results indicated that fetal sex had no effect on weight estimation accuracy, but that fetal growth patterns, cephalic index, and the amount of amniotic fluid did. The weights of small-for-gestational age infants were significantly overestimated. Infants with oligohydramnios and low cephalic indexes were significantly underestimated by the ultrasonic weight formula. The weights of infants with high cephalic indexes were slightly overestimated and infants that were large-for-gestational age were slightly underestimated.

Amniotic Fluid↗
PubMed1986

Accurate ultrasonic estimation of fetal weight. Prospective analysis of new ultrasonic formulas.

Five new ultrasonic weight formulae incorporating head circumference, fetal femur length, and a correction for oligohydramnios were prospectively analyzed in a group of 198 unselected patients scanned within 72 hours of birth. Comparison with the Shepard formula showed that inclusion of these parameters slightly, but significantly, improved the random error of weight estimation. The best-fit formula was: Log(10) BW = .04355HC + .05394AC - .0008582HC X AC + 1.2594 (FL/AC) - 2.0661.

Birth Weight↗
PubMed1986

The design and implementation of a computer-based ultrasound data system.

A detailed description of the development of a computer-based ultrasound data system is presented to provide the background for those physicians interested in developing or using such a system. The system was found to be highly useful for acquisition and organization of ultrasound data, and proved to be an aid both teaching and patient care.

Computers↗
PubMed1985

Accurate ultrasonic estimation of fetal weight.

The accuracy of eight ultrasonic fetal weight formulas were analyzed in 1099 fetuses who underwent real-time ultrasound examination within 72 hours prior to delivery. Shepard's formula was most consistently found to give the lowest systematic and random errors throughout all weight categories, though Deter's formula had an almost identical accuracy. The Shepard formula was further analyzed in respect to the effects of fetal sex and birthweight centile grouping on the accuracy of fetal weight estimation. The results indicated that fetal sex had no effect on the accuracy of fetal weight estimation, but that birthweight centile grouping did. The weights of small-for-gestational age infants were systematically overestimated, while the weights of large-for-gestational age infants were systematically underestimated.

Birth Weight↗
PubMed1985

Fetal femur length, neonatal crown-heel length, and screening for intrauterine growth retardation.

Early ultrasonic diagnosis of intrauterine growth retardation (IUGR) can be very beneficial. However, most methods of ultrasonic diagnosis require an accurate knowledge of gestational age. The current study was designed to prospectively evaluate the relationship between fetal femur length and neonatal crown-heel length, and to study the femur length/abdominal circumference ratio as a method of screening for IUGR. Three hundred twenty-six infants who had undergone real-time ultrasound examination within 72 hours before birth were used for the study. Fetal femur length was compared with neonatal crown-heel length, although the most accurate relationship was geometric (r2 = .7474), and a strong linear relationship was also observed: y(crown-heel length) = 11.887 + 5.158 X (femur length), (r2 = .7067; SD = 3.34 cm). Mean femur length/abdominal circumference ratios were significantly different for average-for-gestational-age (22.33 +/- 1.86%), small-for-gestational-age (23.34 +/- 1.89%), and large-for-gestational-age (20.99 +/- 1.32%) infants, but did not reveal a discriminatory value for the diagnosis of IUGR as positive as that reported by Hadlock et al. The femur length/abdominal circumference ratio should be evaluated further as a screening tool in the diagnosis of IUGR.

Abdomen↗
PubMed1985

Accurate gestational dating.

Gestational age by four ultrasonic parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) was calculated for 210 normal obstetric patients divided into four gestational age groups based on time of first ultrasound examination. Accuracy of the calculations was determined by comparison of each technique and a simple arithmetic average of the four techniques to the gestational age calculated from the Dubowitz examination of the neonate after delivery. The analysis indicated that each ultrasonic technique has certain advantages and disadvantages, but that the simple arithmetic average of the four techniques had the lowest systematic and random error.

Abdomen↗
PubMed1984

The use of ultrasonic fetal head circumference for predicting expected date of confinement.

An ultrasonic fetal head circumference curve was developed from a group of 1278 ultrasound examinations in 710 normal obstetrical patients. These data were then used to compare the accuracy of head circumference (HC) to last menstrual period (LMP) and biparietal diameter (BPD) for the prediction of an accurate expected date of confinement (EDC) and, thereby calculate gestational age. The mean error of the signed differences (+/- standard deviation) for HC was -0.8 +/- 11.1 days, which was statistically different from the mean error of -6.1 +/- 10.6 days for BPD and -2.8 +/- 17.8 days for LMP. HC may have an advantage over BPD in situations where head shape (cephalic index) is significantly altered.

Female↗
PubMed1984

Significance of exaggerated fetal heart rate accelerations during active labor.

One hundred fifty-three of 1,289 patients (11.9%) monitored during labor were identified as having exaggerated fetal heart rate accelerations (EFHRAs), defined as accelerations of the fetal heart rate above the baseline of 30 beats/min or greater and lasting at least 30 seconds. Comparisons of patients with and without EFHRAs showed that the only difference between the two groups was a higher percentage of nulliparous patients in the EFHRA group. Comparisons of intrapartum complications showed a decreased incidence of meconium staining and an increased percentage of abnormal labor patterns in the EFHRA group. Comparisons of neonatal outcome statistics showed lower perinatal morbidity and higher mean birth weight in the EFHRA group.

Apgar Score↗