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Bowman ZS, Eller AG, Kennedy AM, Richards DS, Winter TC, Woodward PJ, Silver RM. Interobserver variability of sonography for prediction of placenta accreta. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2153-2158. [PMID: 25425372 DOI: 10.7863/ultra.33.12.2153] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The sensitivity of sonography to predict accreta has been reported as higher than 90%. However, most studies are from single expert investigators. Our objective was to analyze interobserver variability of sonography for prediction of placenta accreta. METHODS Patients with previa with and without accreta were ascertained, and images with placental views were collected, deidentified, and placed in random sequence. Three radiologists and 3 maternal-fetal medicine specialists interpreted each study for the presence of accreta and specific findings reported to be associated with its diagnosis. Investigator-specific sensitivity, specificity, and accuracy were calculated. κ statistics were used to assess variability between individuals and types of investigators. RESULTS A total of 229 sonographic studies from 55 patients with accreta and 56 control patients were examined. Accuracy ranged from 55.9% to 76.4%. Of imaging studies yielding diagnoses, sensitivity ranged from 53.4% to 74.4%, and specificity ranged from 70.8% to 94.8%. Overall interobserver agreement was moderate (mean κ ± SD = 0.47 ± 0.12). κ values between pairs of investigators ranged from 0.32 (fair agreement) to 0.73 (substantial agreement). Average individual agreement ranged from fair (κ = 0.35) to moderate (κ = 0.53). CONCLUSIONS Blinded from clinical data, sonography has significant interobserver variability for the diagnosis of placenta accreta.
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Affiliation(s)
- Zachary S Bowman
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA.
| | - Alexandra G Eller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA
| | - Anne M Kennedy
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA
| | - Douglas S Richards
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA
| | - Thomas C Winter
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA
| | - Paula J Woodward
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare (Z.S.B., A.G.E., D.S.R., R.M.S.), and Department of Radiology, University of Utah Health Sciences Center (A.M.K., T.C.W., P.J.W.), Salt Lake City, Utah USA
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Dostbil Z, Dag Y, Cetinkaya O, Akdag M, Tasdemir B. Assessment of technetium-99m labeled macroaggregated albumin rhinoscintigraphy for the measurement of nasal mucociliary transport rate: intratest, interobserver, and intraobserver reproducibility. SCIENTIFICA 2014; 2014:982515. [PMID: 24741446 PMCID: PMC3967819 DOI: 10.1155/2014/982515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/02/2014] [Indexed: 06/03/2023]
Abstract
Objectives. The measurement of mucociliary transport velocity by rhinoscintigraphy with Tc-99m-macroaggregated albumin ((99m)Tc-MAA) is reliable measure of mucociliary clearance. The aim of this study is to assess the intratest, interobserver, and intraobserver reproducibility of nasal mucociliary transport rate (NMTR) measurement. Materials and Methods. Twenty-two subjects were evaluated to determine intratest reproducibility and a group of 35 subjects was examined to determine inter- and intraobserver reproducibility. Rhinoscintigraphy with (99m)Tc-MAA was used to measure NMTR in all study subjects. Paired NMTR measurements were compared using a range of statistical methodologies. Intraclass correlation coefficients (ICC) and repeatability coefficients and Bland-Altman plots were applied to assess the degree of intratest, interobserver, and intraobserver variation. Results. Statistical analysis of test and retest experiments demonstrated the statistical equivalence of intratest NMTR measurements, interobserver NMTR measurements, and intraobserver NMTR measurements. The intratest ICC, interobserver ICC, and intraobserver ICC were 0.96, 0.83, and 0.91, respectively, indicating that intratest and intraobserver reproducibility are excellent and interobserver reproducibility is good. Conclusions. Rhinoscintigraphy using (99m)Tc-MAA results in highly reproducible measurement of NMTR. The use of radionuclide imaging in measuring NMTR results in excellent intratest and intraobserver reproducibility and good interobserver reliability.
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Affiliation(s)
- Zeki Dostbil
- Department of Nuclear Medicine, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey
| | - Yusuf Dag
- Department of Nuclear Medicine, Faculty of Medicine, Harran University, 63300 Sanliurfa, Turkey
| | - Ozlem Cetinkaya
- Department of Nuclear Medicine, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey
| | - Mehmet Akdag
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey
| | - Bekir Tasdemir
- Department of Nuclear Medicine, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey
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Ghosh SK, Raheja S, Tuli A, Raghunandan C, Agarwal S. Can maternal serum placental growth factor estimation in early second trimester predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction? A prospective cohort study. J Obstet Gynaecol Res 2013; 39:881-90. [PMID: 23496304 DOI: 10.1111/jog.12006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
AIM To determine whether maternal serum placental growth factor (PlGF) estimation in early second trimester (20-22 weeks of gestation) can predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction (IUGR). MATERIAL AND METHODS A prospective cohort study was conducted on 722 women with singleton pregnancies, screened from the antenatal clinic, and serum PlGF levels were estimated at 20-22 weeks of gestation. A cut-off value of <155 pg/mL for serum PlGF was determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia and/or early onset IUGR. Preeclampsia and IUGR were classified as early onset when diagnosed by 32 weeks of gestation. Univariate logistic regression analysis was used to analyze the association between serum PlGF level <155 pg/mL and the two outcome measures (i.e. early onset preeclampsia and early onset IUGR) and odds ratio (OR) was computed. P-value < 0.05 was considered statistically significant. RESULTS Maternal serum PlGF level <155 pg/mL at 20-22 weeks of gestation had a strong association with early onset preeclampsia (OR 8.35; 95% CI 1.79-18.94; P = 0.007) and with early onset IUGR (OR 10.73; 95% CI 4.08-20.23; P = 0.000). The sensitivity of serum PlGF < 155 pg/mL for predicting early onset preeclampsia and early onset IUGR were 82 and 84, respectively. CONCLUSION Maternal serum PlGF level estimation in early second trimester (20-22 weeks of gestation) may be useful in predicting the occurrence of early onset preeclampsia and/or early onset IUGR.
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Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India.
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Ghosh SK, Raheja S, Tuli A, Raghunandan C, Agarwal S. Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2012; 161:144-51. [DOI: 10.1016/j.ejogrb.2011.12.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 11/02/2011] [Accepted: 12/20/2011] [Indexed: 11/16/2022]
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Clark EAS, Lacoursiere DY, Byrne JLB, Ponder R, Silver RM, Esplin MS. Reliability of fetal middle cerebral artery velocity measurements: a randomized controlled trial of sonographer training. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:19-25. [PMID: 19106352 DOI: 10.7863/jum.2009.28.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the reliability of fetal middle cerebral artery (MCA) peak systolic velocity (PSV) measurements at a tertiary care center and to evaluate the effect of targeted training for sonographers. METHODS Six sonographers were randomized to training modules for fetal MCA PSV or amniotic fluid volume (AFV) measurements. Six fetuses of uncomplicated pregnancies were selected for participation. Middle cerebral artery and AFV measurements were obtained before and after a training module. The intraobserver and interobserver variability (reliability) was calculated with intraclass correlation coefficients and was compared between groups. RESULTS Administration of the MCA training module increased the number of technically adequate MCA images obtained (odds ratio, 3.95; 95% confidence interval, 1.07-14.65). The intraobserver and inter-observer variability for MCA measurements was significantly reduced after the targeted training module (P = .05). CONCLUSIONS The reliability of fetal MCA PSV measurements improved after a targeted training program.
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Affiliation(s)
- Erin A S Clark
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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Castro VD, Moraes SAD, Freitas ICMD, Mondini L. Variabilidade na aferição de medidas antropométricas: comparação de dois métodos estatísticos para avaliar a calibração de entrevistadores. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2008. [DOI: 10.1590/s1415-790x2008000200009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudos que incluem medidas antropométricas exigem, além da padronização de técnicas de aferição, o emprego de métodos estatísticos para a avaliação de erros de mensuração. OBJETIVO: Comparar duas técnicas estatísticas para avaliar a calibração de entrevistadores, em treinamento para a aferição de medidas antropométricas. METODOLOGIA: Treze entrevistadores participaram da fase de treinamento, que foi programado de modo que, em cada sessão, sub-grupos de entrevistadores realizassem duas aferições de medidas de peso e duas de altura em voluntários (em média, 10 voluntários/sessão). Ao todo, foram realizadas seis sessões para a aferição das medidas de peso e onze para a aferição das medidas de altura. Para as medidas de peso foram utilizadas balanças eletrônicas e, para as de altura, estadiômetros de parede. Para avaliar a calibração, dois métodos estatísticos foram comparados: a) o coeficiente de correlação intraclasse (CCI) e b) a precisão e a exatidão das aferições, segundo Habicht. RESULTADOS: Os entrevistadores foram submetidos, em média, a duas sessões para a calibração das medidas de peso e a três sessões para a calibração das medidas de altura, sendo a precisão atingida antes da exatidão. Os valores dos respectivos CCIs indicaram medições fortemente concordantes desde a primeira sessão. CONCLUSÃO: O método de Habicht apresentou melhor desempenho que o CCI, pois, além do cálculo da precisão, indicou a magnitude da divergência das aferições realizadas pelos entrevistadores, em relação às do supervisor (exatidão).
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Gómez O, Figueras F, Martínez JM, del Río M, Palacio M, Eixarch E, Puerto B, Coll O, Cararach V, Vanrell JA. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:802-8. [PMID: 17063456 DOI: 10.1002/uog.2814] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR). METHODS Sequential uterine artery Doppler recordings were obtained in a final cohort of 870 singleton pregnancies over two gestational age intervals: 11-14 weeks and 19-22 weeks. The left and right uterine arteries were examined by color and pulsed Doppler and the mean pulsatility index (PI) as well as the presence of a bilateral protodiastolic notch were recorded during both intervals. Pregnancies were followed for occurrence of hypertensive disorders and IUGR. RESULTS Mean uterine artery PI showed a significant linear decrease within each of the two intervals considered, while the prevalence of a bilateral notch showed decreasing values only throughout 11-14 weeks of gestation. Sixty-four (7.3%) pregnancies developed a hypertensive disorder and/or IUGR, including three (0.34%) cases of gestational hypertension, 24 cases of pre-eclampsia (2.75%) and 37 (4.25%) of IUGR. Compared with pregnancies with a normal outcome, complicated pregnancies showed a significantly higher prevalence of a bilateral notch and a higher mean PI in each of the two intervals studied. Compared with normal pregnancies, complicated pregnancies had a significantly higher persistence of a bilateral notch (30% vs. 8%), a higher proportion of women with an abnormal first-trimester uterine artery PI shifting to normal in the second trimester (14% vs. 4%) and a higher incidence of a normal first-trimester mean PI that shifted to abnormal in the second trimester (13% vs. 4%). Persistence of an abnormal mean PI from the first to the second trimester identified the group with the greatest risk for adverse perinatal outcome (OR, 10.7; 95% CI, 3.7-30.9). In addition, women in whom the uterine artery mean PI shifted from abnormal to normal between the two trimesters and women in whom the reverse shift occurred showed a similar intermediate risk (OR, 5; 95% CI, 2.1-10.6), comparable to that in women with persistence of a bilateral notch (OR, 5.6; 95% CI, 2.9-10.7). CONCLUSIONS The sequence of changes in uterine flow between the first and second trimesters correlates with the subsequent development of hypertensive disorders and IUGR. Women with a persistent abnormal mean PI represent the group with the greatest risk for adverse perinatal outcome.
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Affiliation(s)
- O Gómez
- Department of Obstetrics and Gynaecology, ICGON, Hospital Clínic, Barcelona, Spain.
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Gómez O, Martínez JM, Figueras F, Del Río M, Borobio V, Puerto B, Coll O, Cararach V, Vanrell JA. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:490-4. [PMID: 16184511 DOI: 10.1002/uog.1976] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To establish reference values for the first-trimester uterine artery (UtA) pulsatility index (PI) and to investigate the role of UtA Doppler in the early prediction of hypertensive disorders and their associated complications in an unselected Mediterranean population. METHODS A prospective study including 1091 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11-14 weeks of gestation was performed. The left and right UtA were examined by color and pulsed Doppler transvaginally. The mean PI and the presence of bilateral protodiastolic notching were cross-sectionally recorded. Reference ranges were calculated and the pregnancies were followed for occurrence of pre-eclampsia, gestational hypertension, intrauterine growth restriction, placental abruption and stillbirth. The sensitivity and predictive values of a mean UtA-PI>95th percentile and the presence of bilateral notching in the prediction of these pregnancy complications were calculated. RESULTS A total of 999 women were finally included. Both the mean UtA-PI and the prevalence of bilateral notches showed a significant linear decrease between 11 and 14 weeks' gestation. Sixty-seven (6.7%) pregnancies developed at least one of the formerly described complications, including 22 (2.2%) cases of pre-eclampsia and 37 (3.7%) cases with intrauterine growth restriction. Compared with women with a normal outcome, complicated pregnancies showed a significantly higher mean PI (2.04 vs. 1.75; P<0.05, t-test) and a higher prevalence of bilateral notching (58% vs. 41%; P<0.05, Chi-square test). Using the 95th percentile in mean UtA-PI as a cut-off, 23.9% (95% CI, 13.7-34.1) of complicated pregnancies and 30.8% (95% CI, 5.68-55.85) of severe cases were identified. CONCLUSIONS Our results suggest that pregnancies with an increased risk of developing hypertensive disorders and related complications already have an abnormally increased UtA-PI in early pregnancy. However, the use of a single uterine Doppler measurement for screening purposes in unselected early pregnancy populations has limited clinical value. The use of UtA-PI combined with other screening tests needs to be determined by further investigation.
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MESH Headings
- Abruptio Placentae/diagnosis
- Abruptio Placentae/diagnostic imaging
- Arteries/diagnostic imaging
- Case-Control Studies
- Chi-Square Distribution
- Female
- Fetal Growth Retardation/diagnosis
- Fetal Growth Retardation/diagnostic imaging
- Humans
- Hypertension, Pregnancy-Induced/diagnosis
- Hypertension, Pregnancy-Induced/diagnostic imaging
- Observer Variation
- Pre-Eclampsia/diagnosis
- Pre-Eclampsia/diagnostic imaging
- Predictive Value of Tests
- Pregnancy
- Pregnancy Trimester, First
- Prenatal Diagnosis
- Prospective Studies
- Reference Values
- Statistics, Nonparametric
- Stillbirth
- Ultrasonography, Doppler/methods
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Doppler, Pulsed/methods
- Ultrasonography, Prenatal/methods
- Uterus/blood supply
- Uterus/diagnostic imaging
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Affiliation(s)
- O Gómez
- Department of Obstetrics and Gynaecology, ICGON, Hospital Clínic, Barcelona, Spain.
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