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Pagan M, Magann EF, Rabie N, Steelman SC, Hu Z, Ounpraseuth S. Idiopathic polyhydramnios and pregnancy outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2023; 61:302-309. [PMID: 35723677 DOI: 10.1002/uog.24973] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze outcomes of singleton pregnancies with idiopathic polyhydramnios through a systematic review and meta-analysis. METHODS Electronic databases, including MEDLINE, OVID, EBSCO, Cochrane collection and Science Citation Index, were searched from 1946 to 2019. Gray literature and tables of contents of relevant journals were also screened. Prospective and retrospective studies with a control group were included. Two authors independently reviewed the abstracts retrieved from the literature search. Inclusion criteria were: studies documented in English, singleton pregnancy and idiopathic polyhydramnios determined by amniotic fluid volume assessment on ultrasound. Exclusion criteria were: maternal diabetes, fetal structural or chromosomal anomaly, alloimmunization and intrauterine fetal infection. RESULTS Twelve studies met the inclusion criteria, giving a total of 2392 patients with idiopathic polyhydramnios and 160 135 patients with normal amniotic fluid volume. Pregnancies complicated by idiopathic polyhydramnios were at a higher risk of neonatal death (odds ratio (OR), 8.68 (95% CI, 2.91-25.87)), intrauterine fetal demise (OR, 7.64 (95% CI, 2.50-23.38)), neonatal intensive care unit admission (OR, 1.94 (95% CI, 1.45-2.59)), 5-min Apgar score < 7 (OR, 2.21 (95% CI, 1.34-3.62)), macrosomia (OR, 2.93 (95% CI, 2.39-3.59)), malpresentation (OR, 2.73 (95% CI, 2.06-3.61)) and Cesarean delivery (OR, 2.31 (95% CI, 1.79-2.99)). CONCLUSIONS This study suggests that pregnancies complicated by idiopathic polyhydramnios are at increased risk of adverse outcome. Future investigations should aim to determine an amniotic fluid volume threshold above which antenatal fetal surveillance is appropriate in the management of these pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Pagan
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - N Rabie
- Department of Obstetrics and Gynecology, Tripler Army Hospital, Honolulu, HI, USA
| | - S C Steelman
- Divison of Academic Affairs, University of Arkansas for Medical Sciences Library, Little Rock, AR, USA
| | - Z Hu
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Odibo IN, Mac Bird T, McKelvey SS, Sandlin A, Lowery C, Magann EF. Childhood Respiratory Morbidity after Late Preterm and Early Term Delivery: a Study of Medicaid Patients in South Carolina. Paediatr Perinat Epidemiol 2016; 30:67-75. [PMID: 26480292 PMCID: PMC5373474 DOI: 10.1111/ppe.12250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing body of research documenting an increased risk of neonatal morbidity for late preterm infants (LPI, 34(0/7) weeks to 36(6/7) weeks) and early term infants (ETI, 37(0/7) weeks to 38(6/7) weeks) compared with term infants (TI, 39(0/7) to 41(6/7) ); however, there has been little research on outcomes beyond the first year of life. In this study, we examined respiratory outcomes of LPI and ETI in early childhood. METHODS South Carolina Medicaid claims data for maternal delivery and infant birth hospitalisations were linked to vital records data for the years 2000 through 2003. Medicaid claims for all infants were then followed until their fifth birthday or until a break in their eligibility. Infants born between 34(0/7) and 41(6/7) weeks were eligible. Infants with congenital anomaly, birthweight below 500 g or above 6000 g, and multiple births were excluded. We fit Cox proportional hazard models from which adjusted hazard ratio (HR) and 95% confidence interval (CI) were derived. RESULTS A total of 3476 LPI, 12 398 ETI, and 25 975 term infants were included. Both LPI and ETI were associated with an increased risk for asthma (LPI: HR 1.24, 95% CI 1.10, 1.40; ETI: HR 1.12, 95% CI 1.06, 1.19), and bronchitis (LPI: HR 1.15, 95% CI 1.00, 1.34; ETI: HR 1.13, 95% CI 1.05, 1.2) at 3 to 5 years of age. CONCLUSIONS Late preterm infants and early term infants are at increased risk for asthma and bronchitis.
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Affiliation(s)
- Imelda N. Odibo
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - T. Mac Bird
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Samantha S. McKelvey
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Adam Sandlin
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Curtis Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - E. F. Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
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Lynch CE, Magann EF, Barringer SN, Ounpraseuth ST, Eastham DG, Lewis SD, Stowe ZN. Pet therapy program for antepartum high-risk pregnancies: a pilot study. J Perinatol 2014; 34:816-8. [PMID: 24968176 DOI: 10.1038/jp.2014.120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/05/2014] [Accepted: 05/19/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This pilot study evaluated the potential benefits of pet therapy on symptoms of anxiety and depression in antepartum hospitalized women with high-risk pregnancies. STUDY DESIGN Eighty-two women in a hospital-based setting completed the State-Trait Anxiety Inventory and the Beck Depression Inventory before and after the pet therapy visit. For both questionnaires, paired t-test was used and adjusted P-values were obtained using the Hochberg step-up Bonferroni method. RESULT The mean scores for depressive symptoms significantly improved from the pre-pet therapy (10.1 ± 6.3) compared with the post-pet therapy (6.3 ± 5.9) (P<0.0001). Likewise mean scores of the state anxiety significantly improved from the pre-pet therapy test (44.8 ± 11.7) compared with the post-pet therapy (34.5 ± 10.5) (P<0.001). CONCLUSION Pet therapy significantly reduced anxiety and depression in antepartum hospitalized women with high-risk pregnancies.
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Affiliation(s)
- C E Lynch
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S N Barringer
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D G Eastham
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S D Lewis
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Z N Stowe
- 1] Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA [2] Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA [3] Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Schuit E, Stock S, Rode L, Rouse DJ, Lim AC, Norman JE, Nassar AH, Serra V, Combs CA, Vayssiere C, Aboulghar MM, Wood S, Çetingöz E, Briery CM, Fonseca EB, Worda K, Tabor A, Thom EA, Caritis SN, Awwad J, Usta IM, Perales A, Meseguer J, Maurel K, Garite T, Aboulghar MA, Amin YM, Ross S, Cam C, Karateke A, Morrison JC, Magann EF, Nicolaides KH, Zuithoff NPA, Groenwold RHH, Moons KGM, Kwee A, Mol BWJ. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014; 122:27-37. [PMID: 25145491 DOI: 10.1111/1471-0528.13032] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
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Chauhan SP, Magann EF, Velthius S, Nunn SL, Reynolds D, Scardo JA, Sanderson M, Thigpen BD, Martin JN. Detection of fetal growth restriction in patients with chronic hypertension: is it feasible? J Matern Fetal Neonatal Med 2009; 14:324-8. [PMID: 14986806 DOI: 10.1080/jmf.14.5.324.328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the utility of sonographic estimated fetal weight (EFW) in diagnosing intrauterine growth restriction (IUGR, birth weight < 10% for gestational age) in patients with chronic hypertension. METHODS All pregnant patients with hypertension delivered during a 5-year period at three centers were identified retrospectively. Patients with gestational hypertension, pre-eclampsia, diabetes mellitus, fetal anomalies and absence of a sonographic examination within 3 weeks of delivery were excluded. Likelihood ratio (LR) and guidelines established by the Evidence-Based Medicine Working Group were used to determine whether sonographic EFW is a reliable diagnostic test to detect IUGR. RESULTS At the three centers, there were 264 patients with chronic hypertension (122, 77 and 65 at centers I, II and III, respectively). The incidence of IUGR ranged from 13% to 27% but was similar at the three locations (p = 0.064). The LR (with 95% confidence interval (CI)) of detecting IUGR was 4.4 (95% CI 2.5, 7.7), 2.3 (95% CI 1.4, 3.7) and 6.1 (95% CI 2.7, 13.7) at centers I, II and III, respectively. Based on the proportions of abnormal growth, we required 253 and 71 newborns with fetal growth restriction at centers I and II, respectively, to have narrow confidence intervals around the clinically important LR of 10. The extremely low incidence of IUGR at center III (13%) precluded the estimation of required sample size. CONCLUSION Use of Evidence-Based Medicine Working Group guidelines indicates that sonographic EFW is slightly to moderately useful in detecting fetal growth restriction in patients with chronic hypertension.
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Affiliation(s)
- S P Chauhan
- Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA
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Lynch AM, McDonald S, Magann EF, Evans SF, Choy PL, Dawson B, Blanksby BA, Newnham JP. Effectiveness and safety of a structured swimming program in previously sedentary women during pregnancy. J Matern Fetal Neonatal Med 2009; 14:163-9. [PMID: 14694971 DOI: 10.1080/jmf.14.3.163.169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether undertaking a swimming program in sedentary women during pregnancy would improve maternal fitness without adverse fetal consequences. METHODS Prospective observational investigation of healthy sedentary pregnant women participating in a monitored swimming program. RESULTS Twenty-three women attended swimming sessions from 16 to 28 weeks of gestation resulting in increasing distances swum and improved aerobic fitness as measured by physical work capacity (PWC170) (p = 0.003). Resting maternal heart rate decreased (p = 0.041) and resting systolic (p = 0.092) and diastolic (p = 0.971) blood pressures remained unchanged over gestation. The mean fetal heart rates decreased with advancing gestational age (p = 0.001), consistent with normal physiology. Non-stress tests and umbilical artery systolic/diastolic ratios were similar before and after swimming sessions, providing evidence that fetal well-being was unchanged. CONCLUSIONS A structured swimming program in sedentary pregnant women increases maternal fitness without any alteration in maternal and fetal well-being.
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Affiliation(s)
- A M Lynch
- School of Human Movement and Exercise Science, University of Western Australia, Perth, Australia
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McCormack RA, Doherty DA, Magann EF, Hutchinson M, Newnham JP. Antepartum bleeding of unknown origin in the second half of pregnancy and pregnancy outcomes. BJOG 2008; 115:1451-7. [DOI: 10.1111/j.1471-0528.2008.01856.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Adkins RM, Krushkal J, Klauser CK, Magann EF, Morrison JC, Somes G. Association between small for gestational age and paternally inherited 5' insulin haplotypes. Int J Obes (Lond) 2007; 32:372-80. [PMID: 17700581 DOI: 10.1038/sj.ijo.0803700] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To test the association between small for gestational age and polymorphisms in the insulin gene in newborns and their mothers, as well as the effect of the parental transmission of haplotypes. SUBJECTS Pairs of healthy African-American full-term newborns (N=207) and mothers were recruited from Memphis TN and Jackson MS with birth weights ranging from 2210 to 4735 g. METHODS Six single nucleotide polymorphisms (SNPs) located in the insulin (INS) and insulin-like growth factor 2 (IGF2) genes were genotyped in mothers and newborns. Haplotypes composed of three SNPs in the 5' region of the INS-IGF2 locus were computationally inferred. Odds ratios for risk of small for gestational age (SGA) birth were calculated for individual SNPs and inferred haplotypes in the newborns and in the mothers using logistic regression. For 162 mother--newborn pairs the parental transmission of the haplotypes could be inferred, and the risks for SGA birth were calculated for the three common haplotypes in this sample. RESULTS Three INS SNPs exhibited significant association with risk for SGA birth. The SNP alleles associated with increased risk for SGA were opposite in the maternal and newborn genomes, implying opposing influences on the rate of fetal growth. Consistent with these results, haplotypes composed of complementary nucleotide sequences (CAC at rs3842738, rs689 and rs3842748, respectively, in the newborn versus GTG in the mother) were significantly associated with risk for SGA birth. In analyses of haplotypes according to parental transmission, the same trend in risk for SGA was observed for both maternally and paternally transmitted haplotypes, although a significant difference in risk was observed only for paternally transmitted haplotypes. CONCLUSION Polymorphisms near the 5' end of the INS-IGF2 locus are significantly associated with risk for SGA birth with a major effect due to the paternally transmitted haplotype, which is preferentially expressed due to imprinting.
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Affiliation(s)
- R M Adkins
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
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Abstract
OBJECTIVE To determine if the second trimester placental location is associated with perinatal outcomes. MATERIALS AND METHODS Observational study of placental location and the subsequent risk of an adverse pregnancy outcome. Placental location was divided into three categories, low, high lateral and high fundal. RESULTS There were 3336 pregnancies analyzed in this study. Low implantation sites had a greater risk of preterm labor (odds ratio (OR) 1.70, 95% confidence interval (CI) 1.38 to 2.90, P<0.001), preterm delivery (OR 1.86, 95% CI 1.36 to 2.54, P<0.001), fewer fetuses with macrosomia (OR 0.56, 95% CI 0.38 to 0.83, P=0.010) and reduced risk of postpartum hemorrhage (OR 0.56, 95% CI 0.46 to 0.95, P=0.026). High lateral implantations had a greater risk of low 1-min (OR 1.80, 95% CI 1.11 to 2.93, P=0.017) and 5-min (OR 3.49, 95% CI 1.46 to 8.36, P=0.005) Apgar scores. CONCLUSIONS Low placental implantation was associated with an increased risk of preterm labor, preterm delivery and a reduced risk of postpartum hemorrhage, and of a macrosomic fetus. High lateral implantation was associated with low Apgar scores.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Western Australia, Perth, Australia
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Doherty DA, Magann EF, Francis J, Morrison JC, Newnham JP. Pre-pregnancy body mass index and pregnancy outcomes. Int J Gynaecol Obstet 2006; 95:242-7. [PMID: 17007857 DOI: 10.1016/j.ijgo.2006.06.021] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 06/26/2006] [Accepted: 06/27/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the effect of maternal pre-pregnancy BMI on pregnancy outcomes. METHODS Pregnancy cohort recruited pregnancies between 16 and 18 weeks. BMI evaluated underweight, BMI<18.5, normal, BMI 18.5-25, overweight BMI 25-30, and obese BMI>30 women. RESULTS Pre-pregnancy BMI classified 331 women as underweight (11.7%), 1982 normal (69.9%), 326 overweight (11.5%), and 188 as obese (6.6%). Obese women were more likely to develop gestational diabetes (p<0.001), hypertension (p<0.001), preeclampsia (p<0.001), need labor induction (p<0.001), cesarean delivery for fetal distress (p<0.001), postpartum hemorrhage (p=0.003), need neonatal resuscitation (p=0.001) and deliver hypoglycemic infants (p=0.007). Being underweight is correlated with fetal growth restriction (p=0.001). CONCLUSION Pre-pregnancy obesity is a risk factor for gestational diabetes, preeclampsia, labor induction, cesarean for fetal distress, postpartum hemorrhage and neonatal hypoglycemic and need for resuscitation. Being underweight is risk factor for fetal growth restriction.
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Affiliation(s)
- D A Doherty
- School of Women's and Infants' Health, The University of Western Australia at King Edward Memorial Hospital, Australia
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Magann EF, Norman PF, Bass JD, Chauhan SP, Martin JN, Morrison JC. Acute tocolysis for suspected intrapartum fetal distress: maternal effects of terbutaline versus magnesium sulfate. Int J Obstet Anesth 2005; 4:140-4. [PMID: 15636996 DOI: 10.1016/0959-289x(95)82968-g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study was undertaken to determine the maternal hemodynamic impact of terbutaline versus magnesium sulfate in the acute treatment of fetal distress prior to cesarean delivery. Forty-six women were prospectively randomized to receive 0.25 mg subcutaneous terbutaline or 4.0 g intravenous magnesium sulfate for in utero fetal resuscitation before cesarean delivery. There were no significant differences between groups in baseline mean arterial pressure, arterial pressure before and after induction of anesthesia, maternal heart rate, maternal oxygen saturation, estimated blood loss, and pre- and postoperative hematocrits. Magnesium sulfate-treated women received significantly more intraoperative intravenous fluids (2365 +/- 877 ml) than the terbutaline group (1624 +/- 564 ml; P < 0.001). However, mean urine output was significantly greater in the terbutaline group (88 +/- 42 ml/h) than in those treated with magnesium sulfate (61 +/- 26 ml/h; P < 0.03). Terbutaline, the superior agent for acute tocolysis, is not associated with an increase in maternal cardiovascular side effects during anesthesia.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA
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Chauhan SP, Magann EF, McAninch CB, Gherman RB, Horrison JC. Application of Learning Theory to Obstetric Maloccurrence. Obstet Gynecol Surv 2003. [DOI: 10.1097/01.ogx.0000088882.02275.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The average fellow of the American College of Obstetricians and Gynecologists performs approximately 140 deliveries per year. Based on this estimation and the established prevalence of three commonly litigated maloccurrences, we calculated the number of years of clinical experience required to encounter one case. Permanent brachial plexus palsy complicates only 1 per 4553 deliveries so a clinician would encounter such a case in 33 years of practice. For every 6667 deliveries, there is a case of cerebral palsy attributable to intrapartum hypoxia, so a practioner would see only one case every 48 years. Since the rate of asphyxia with uterine rupture is 1 per 2819 vaginal births after Cesarean section and the average provider performs seven vaginal births after Cesarean deliveries per year, a clinician would have a case in 403 years of practice. Adverse outcomes expressed as an absolute percentage or as the number of cases per number of deliveries are statistically accurate. Expression of these maloccurrences in terms of the number of years of clinical experience permits the generation of a clinically relevant data point and also allows insight into why their prevalence has not decreased.
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Affiliation(s)
- S P Chauhan
- Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA
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Isler CM, Magann EF, Rinehart BK, Terrone DA, Bass JD, Martin JN. Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome. Int J Gynaecol Obstet 2003; 80:291-7. [PMID: 12628531 DOI: 10.1016/s0020-7292(02)00394-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. METHODS A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. RESULTS Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (-15.3+/-1.4 mmHg vs. -7.5+/-1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). CONCLUSION This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.
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Affiliation(s)
- C M Isler
- Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, NC, USA
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Magann EF, Chauhan SP, Washington W, Whitworth NS, Martin JN, Morrison JC. Ultrasound estimation of amniotic fluid volume using the largest vertical pocket containing umbilical cord: measure to or through the cord? Ultrasound Obstet Gynecol 2002; 20:464-467. [PMID: 12423483 DOI: 10.1046/j.1469-0705.2002.00802.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The purpose of this investigation was to determine the preferable method, either measuring to the umbilical cord or through the umbilical cord to the base of the pocket, of ultrasonically estimating amniotic fluid volume. SUBJECT AND METHODS This was a prospective study carried out in singleton pregnancies undergoing a third-trimester amniocentesis. The amniotic fluid index (AFI) and single deepest pocket (SDP) were measured prior to amniocentesis. If measured spaces contained umbilical cord, measurements were made to and through the cord. Actual amniotic fluid volume was determined by the dye-dilution technique. RESULTS One-hundred pregnancies were evaluated. Low dye-determined volume was identified in a significantly greater number of pregnancies using the AFI to the cord (7/28, 25%) compared to through the cord (2/28, 7%) (P = 0.025). The SDP technique to the cord was superior in low volumes (2/28, 7%) vs. (0/28, 0%) through the cord (although statistical significance could not be determined because there were no low through-the-cord measurements). CONCLUSIONS For the detection of low amniotic fluid volumes, the AFI to the cord is better than through the cord. Measurement to the cord and through the cord had similar accuracy for both the AFI and SDP techniques in normal and high dye-determined amniotic fluid volumes.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, The University of Western Australia, Perth, Australia
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Magann EF, Whitworth NS, Files JC, Terrone DA, Chauhan SP, Morrison JC. Dye-dilution techniques using aminohippurate sodium: do they accurately reflect amniotic fluid volume? J Matern Fetal Neonatal Med 2002; 11:167-70. [PMID: 12380671 DOI: 10.1080/jmf.11.3.167.170] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether the dye-dilution technique using aminohippurate sodium accurately measures amniotic fluid volume. METHODS Singleton pregnancies with intact membranes undergoing a Cesarean delivery had their amniotic fluid volume assessed by the dye-dilution technique and direct measurement. RESULTS Fifteen women were prospectively assessed. Six patients had their amniocentesis on the delivery table and nine patients at 4-24 h prior to the Cesarean delivery. The six women undergoing an amniocentesis just before delivery had good concordance between the dye-determined and direct measurement of amniotic fluid volume (r = 0.99, p = < 0.001). Among the nine women with varying times from amniocentesis to direct measurement, the correlation was not significant (r = 0.36, p = 0.08). The percentage difference between the dye-determined and directly measured amniotic fluid volume was significantly smaller in the women undergoing amniocentesis just prior to delivery (7%) than in the women with varying times from amniocentesis to delivery (37%, P < 0.001). CONCLUSION Dye-determined amniotic fluid volume accurately reflects actual amniotic fluid volume but the dye-determined concentrations, in vivo, may undergo rapid changes.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Abstract
OBJECTIVE To determine whether weekly outpatient administration of prostaglandin gel or estrogen cream initiated labor in women with an unfavorable cervix. METHODS All uncomplicated pregnancies at term gestation who were candidates for a vaginal delivery with a Bishop score of < or = 6 were randomly assigned to receive on a weekly basis: prostaglandin E2 gel (n = 41); estrogen cream (n = 44); or inert lubricant jelly (n = 43). RESULTS In the three groups no differences were observed among 128 subjects in the weekly Bishop scores, cervical dilatation or gestational age upon admission to the labor and delivery suite, the percentage of patients presenting with spontaneous labor or ruptured membranes, the number of post-date inductions or neonatal outcome. CONCLUSIONS Weekly out-patient cervical ripening using either prostaglandin gel or estrogen in women with an unfavorable cervix at 37 weeks' gestation was no more effective than a placebo in Bishop score improvement or in preventing post-date inductions.
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Affiliation(s)
- J E Larmon
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Isler CM, Barrilleaux PS, Rinehart BK, Magann EF, Martin JN. Repeat postpartum magnesium sulfate administration for seizure prophylaxis: is there a patient profile predictive of need for additional therapy? J Matern Fetal Neonatal Med 2002; 11:75-9. [PMID: 12375546 DOI: 10.1080/jmf.11.2.75.79] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To profile patients with hypertensive disorders of pregnancy who require reinstitution of magnesium sulfate therapy for disease exacerbation. STUDY DESIGN A prospective clinical trial enrolling gravidas with pre-eclampsia. The length of postpartum magnesium sulfate seizure prophylaxis was determined by individual patient characteristics. Patients with exacerbation of their disease after discontinuation of magnesium sulfate received a second course of magnesium sulfate lasting 24 h. RESULTS Of a total of 503 patients, 38 (7.6%) required reinstitution of postpartum magnesium sulfate therapy for an additional 24-h period. Patients with chronic hypertension complicated by superimposed pre-eclampsia were most likely to require further therapy (11/61, 18.0%), when compared with other hypertensive disorders. Additionally, patients who required reinstitution of magnesium therapy had significantly shorter gestations (32.4 +/- 4.2 weeks versus 36.3 +/- 4.2 weeks, respectively; p < 0.001), and higher mean arterial pressure during the initial magnesium course (113.2 +/- 11.2 versus 105.6 +/- 11.3 mmHg; p < 0.001). CONCLUSION Patients with chronic hypertension complicated by superimposed pre-eclampsia, patients delivered prior to 35 weeks' gestation and patients requiring a longer initial magnesium prophylaxis are at higher risk for the need of reinstitution of seizure prophylaxis postpartum.
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Affiliation(s)
- C M Isler
- Department of Obstetrics, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
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Magann EF, Chauhan SP, Martin JN, Bryant KS, Bufkin L, Morrison JC. Does uterine wiping influence the rate of post-Cesarean endometritis? J Matern Fetal Med 2001; 10:318-22. [PMID: 11730494 DOI: 10.1080/714904349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To compare two methods of uterine cleansing to remove residual amnion-chorion at the time of Cesarean delivery. METHODS All consenting uninfected parturients undergoing a non-emergency Cesarean delivery at the university were enrolled. All patients received antibiotic prophylaxis of a 1-g intravenous bolus of a first-generation cephalosporin immediately after cord clamping. Postpartum endometritis was defined as a temperature of > or = 100.4 degrees F (38 degrees C) on two occasions 6 h apart after the first 24 h with uterine tenderness and/or foul-smelling lochia. RESULTS Between January 1998 and February 2000 there were 1400 patients enrolled in this investigation. A total of 153 women were determined to have chorioamnionitis present at surgery and 17 women refused participation, leaving 614 women in the uterine wipe group and 616 in the no wipe group. Maternal demographics were similar between patient groups (NS). Intrapartum factors including gestational age at time of Cesarean section, type of anesthesia used for the operative delivery, hours of amnion rupture prior to delivery, use of internal monitoring devices, type of skin incision, method of placental removal, total operative time and estimated blood loss were similar between patient groups (NS). An almost identical number of patients in each arm of the study developed post-Cesarean endometritis (65 out of 614, 10.5%, in the uterine wipe group vs. 66 out of 616, 10.7%, in the no wipe group; p = 1). CONCLUSIONS Both methods of removing residual amnion-chorion membrane tissue and associated debris at surgery were comparably effective, but neither produced a dramatic reduction in the incidence of postoperative endometritis.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
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Chauhan SP, Magann EF, Carroll CS, Barrilleaux PS, Scardo JA, Martin JN. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol 2001; 185:349-54. [PMID: 11518890 DOI: 10.1067/mob.2001.116729] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to describe the peripartum outcome of women weighing >300 pounds (135 kg) who were candidates for trial of labor after a prior cesarean delivery. STUDY DESIGN All pregnant women who weighed in excess of 300 pounds and had a prior cesarean delivery were included in this prospective investigation. Student t test, chi(2) analysis, or Fisher exact tests were used. Odds ratios and 95% confidence intervals were calculated. P <.05 was considered significant. RESULTS During a 2-year period, 69 patients met the inclusion criteria; 39 (57%) underwent an elective repeat cesarean delivery, and 30 (43%) women attempted a vaginal delivery after prior cesarean delivery. The demographics of age, race, gravidity, maternal weight, and preexisting medical conditions were similar for the two groups. Vaginal birth after prior cesarean delivery occurred in 13% (4/30). Reasons for failure included a labor arrest disorder in 46%, fetal distress in 38%, and failed induction in 15%. The rates of endometritis and wound breakdown were higher in the women undergoing trial of labor (30% and 23%, respectively) than in those undergoing repeat elective cesarean delivery (20% and 8%). The combined infectious morbidity rate was significantly higher for women attempting trial of labor (53%) than those undergoing elective repeat cesarean delivery (28%; odds ratio 1.78, 95% confidence intervals 1.05, 3.02). CONCLUSION The success rate for a vaginal delivery in the morbidly obese woman with a prior cesarean delivery is less than 15%, and more than half of the patients undergoing a trial of labor have infectious morbidity.
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Affiliation(s)
- S P Chauhan
- Department of Maternal-Fetal Medicine at Spartanburg Regional Medical Center, SC, USA
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Magann EF, Chauhan SP, Barrilleaux PS, Whitworth NS, McCurley S, Martin JN. Ultrasound estimate of amniotic fluid volume: color Doppler overdiagnosis of oligohydramnios. Obstet Gynecol 2001; 98:71-4. [PMID: 11430959 DOI: 10.1016/s0029-7844(01)01400-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if concurrent use of color Doppler affects ultrasound estimates of amniotic fluid (AF) volume. METHODS Study gravidas underwent ultrasound estimations of AF volume subjectively (visualization without measurements) and objectively (using amniotic fluid index [AFI]) and single-deepest pocket techniques, without and with concurrent color Doppler. Amniocentesis with the dye-dilution technique to measure actual AF volume was utilized for comparison. RESULTS Sixty-seven women at a mean gestational age of 37.1 +/- 2.5 weeks were entered into this investigation between June 1999 and March 2000. Dye-determined AF volume was classified as low in 18 patients and as high in seven, with the remaining 42 within normal range. Using either ultrasound technique with color Doppler produced significantly lower estimates of AF volume (9.3 +/- 4.9) compared to those without color ([11.6 +/- 5], P <.001) for the AFI and (3.7 +/- 1.5) with color compared to those without color ([4.5 +/- 1.5], P <.003) for the single-deepest pocket. Using AFI without color identified two of 67 (3%) of the pregnancies as having low fluid compared to 14 of 67 ([21%] P =.002) using color. The increased classification of oligohydramnios with color did not accurately identify a greater number of dye-determined low volumes; instead, the AFI with color mislabeled nine pregnancies with normal fluid as low. The diagnosis of dye-determined low and high fluid volumes was not significantly different with or without color. CONCLUSION Concurrent use of color Doppler with AFI measurements leads to the overdiagnosis of oligohydramnios.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Abstract
HELLP syndrome is a special type of severe preeclampsia that constitutes a management dilemma for obstetricians. The high maternal and perinatal morbidity (and rarely maternal mortality) that can result from this entity mandates continuing efforts to find an effective treatment or prevention. The traditional therapy for HELLP syndrome has been meticulous medical care of the mother, vigilant fetal surveillance, and timely delivery. Proposed new therapies to permit prolongation of preterm pregnancy and fetal maturation include vasodilation therapy using fluids and antihypertensives and intensive corticosteroid therapy using intravenously administered high dose dexamethasone, usually in a dose of 10 mg every 12 hours. The latter therapy appears to improve fetal and maternal health with the added benefit of accelerating postpartum recovery from HELLP syndrome.
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Affiliation(s)
- E F Magann
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Isler CM, Barrilleaux PS, Magann EF, Bass JD, Martin JN. A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol 2001; 184:1332-7; discussion 1337-9. [PMID: 11408849 DOI: 10.1067/mob.2001.115051] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficacy end points included laboratory values (platelet count, lactate dehydrogenase activity, aspartate aminotransferase activity) and clinical parameters (mean arterial pressure, urinary output). RESULTS Forty patients were enrolled in the study, 19 in the dexamethasone arm and 21 in the betamethasone arm. The adjusted time-averaged changes from baseline were significant for aspartate aminotransferase activity (dexamethasone, -20.4 +/- 9.6 U/L; betamethasone, 9.9 +/- 8.9 U/L; P =.029), mean arterial pressure (dexamethasone, -15.6 +/- 1.4 mm Hg; betamethasone, -8.1 +/- 1.4 mm Hg; P <.001), and urinary output (dexamethasone, 12.9 +/- 8.6 mL/h; betamethasone, -11.9 +/- 8.2 mL/h; P =.043). CONCLUSION Intravenously administered dexamethasone appears to be more effective than intramuscularly administered betamethasone for the antepartum treatment of mothers with HELLP syndrome.
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Affiliation(s)
- C M Isler
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Roberts WE, Gnam EC, Magann EF, Martin JN, Morrison JC. Labor and membrane rupture in twin gestation. Can they affect the ability to estimate fetal weight? J Reprod Med 2001; 46:462-6. [PMID: 11396373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To determine whether labor or fetal membrane rupture adversely affects the ability of ultrasound to accurately estimate fetal weight (EFW) in a twin gestation. STUDY DESIGN A medical record audit was performed of the two-year experience of women delivering live born twins and undergoing a complete ultrasound examination within 72 hours of delivery. Those patients experiencing labor or membrane rupture at the time of the previous ultrasound examination were compared to those without these factors to determine if there was any detrimental impact on the accuracy of ultrasound to EFW. RESULTS The overall ability of ultrasound to accurately EFW was in the range of 64-76%. This was not significantly different from the accuracy in women experiencing labor (62-80%) or in women with membrane rupture (63-81%). The ability of ultrasound to detect fetal discordance is this series ranged from 78% to 100%, with specificity that ranged from 84% to 89%. CONCLUSION The ability of sonography to accurately EFW as well as detect discordant twin gestation is not altered by the presence of labor or membrane rupture.
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Affiliation(s)
- W E Roberts
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA
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Magann EF, Chauhan SP, Bofill JA, Waddell D, Rust OA, Morrison JC. Maternal morbidity and mortality associated with intrauterine fetal demise: five-year experience in a tertiary referral hospital. South Med J 2001; 94:493-5. [PMID: 11372798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Risk factors for and management of intrauterine fetal demise (IUFD) have been investigated, but the maternal morbidity has not been evaluated. METHODS Over a 60-month interval, all cases of IUFD after 20 weeks' gestation were reviewed for maternal trauma and maternal postpartum complications. RESULTS In this retrospective analysis, 498 singleton and 24 twin pregnancies with an IUFD were identified. A cervical or perineal laceration requiring surgical repair complicated 9.4% of pregnancies. One uterine dehiscence and one uterine rupture occurred. Endometritis, the most common postpartum complication, occurred in 63 of 522 patients (12%). One maternal death occurred. Total mean hospital stay was 4.9 +/- 5.7 days. CONCLUSION Maternal morbidity and rarely mortality can follow IUFD, but this morbidity is similar to that observed without IUFD.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Magann EF, Martin JN, Chauhan SP. Lack of utility of amniotic fluid index in predicting perinatal morbidity and mortality. Am J Obstet Gynecol 2001; 184:778-9. [PMID: 11262491 DOI: 10.1067/mob.2001.111090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Magann EF, Chauhan SP, Whitworth NS, Isler C, Wiggs C, Morrison JC. Subjective versus objective evaluation of amniotic fluid volume of pregnancies of less than 24 weeks' gestation: how can we be accurate? J Ultrasound Med 2001; 20:191-195. [PMID: 11270522 DOI: 10.7863/jum.2001.20.3.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study was undertaken to compare subjective versus objective ultrasonic evaluation of amniotic fluid volume in pregnancies of less than 24 weeks' gestation. Amniotic fluid volume was subjectively (visualization without ultrasonic measurements) and objectively (visual interpretation with ultrasonic measurements) evaluated in 42 singleton pregnancies undergoing termination. The actual amniotic fluid volume was then determined using a dye-dilution technique. The women evaluated were in their mid-20s, primarily African American, and between 15 and 23 weeks' gestation. There was no significant difference in the total number of correct estimates of amniotic fluid volume when the data were stratified by level of operator experience (P = .34), ultrasonic technique (P = .33), or the combined correct subjective versus combined correct objective estimates (P = .68). We have concluded that the accuracy of amniotic fluid volume assessment in pregnancies of less than 24 weeks is not influenced by the level of operator experience or the type of ultrasonic measurement.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216, USA
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Rinehart BK, Terrone DA, May WL, Magann EF, Isler CM, Martin JN. Change in platelet count predicts eventual maternal outcome with syndrome of hemolysis, elevated liver enzymes and low platelet count. J Matern Fetal Med 2001; 10:28-34. [PMID: 11332416 DOI: 10.1080/714052712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To profile the rates of change for platelets and lactate dehydrogenase (LDH) in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet count (HELLP) to reflect and possibly predict disease severity. METHODS Serial determinations of the platelet count and serum LDH were analyzed retrospectively for 545 patients with HELLP syndrome and 94 severely pre-eclamptic patients. A repeated measures (mixed model) analysis of variance (ANOVA) was utilized to estimate the rates of change for LDH and platelets in each group. RESULTS Patients who developed class 1 or 2 HELLP syndrome exhibited a rapid deterioration in platelet count of 45-50,000/microl per day compared to 30,000/microl per day for class 3 and non-HELLP severe pre-eclampsia. For LDH, values increased at a rate of approximately 1400 IU/l per day, 600 IU/l per day, 300 IU/l per day and 200 IU/l per day for patients with classes 1, 2 and 3 and for non-HELLP severe pre-eclampsia, respectively. CONCLUSION The rate of change of platelets and LDH appeared to correlate well with eventual syndrome severity and this can be used to enhance patient assessment beyond the value of a single test for either laboratory parameter.
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Affiliation(s)
- B K Rinehart
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Rinehart BK, Terrone DA, May WL, Magann EF, Isler CM, Jr JNM. Change in platelet count predicts eventual maternal outcome with syndrome of hemolysis, elevated liver enzymes and low platelet count. J Matern Fetal Neonatal Med 2001. [DOI: 10.1080/jmf.10.1.28.34-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Magann EF, Chauhan SP, Jr JNM, Bryant KS, Bufkin L, Morrison JC. Does uterine wiping influence the rate of post-Cesarean endometritis? J Matern Fetal Neonatal Med 2001. [DOI: 10.1080/jmf.10.5.318.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Magann EF, Chauhan SP, Barrilleaux PS, Whitworth NS, Martin JN. Amniotic fluid index and single deepest pocket: weak indicators of abnormal amniotic volumes. Obstet Gynecol 2000; 96:737-40. [PMID: 11042310 DOI: 10.1016/s0029-7844(00)01020-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare amniotic fluid index (AFI) with the single deepest pocket in the identification of actual abnormal amniotic fluid (AF) volumes. METHODS One hundred seventy-nine women with singleton pregnancies at the University of Mississippi between March 1994 and June 1999 had ultrasound estimations of AF volume sequentially using the AFI and single deepest pocket techniques. Each woman subsequently had ultrasound-directed amniocentesis with dye-dilution and spectrophotometric calculation of actual AF volume. RESULTS Actual AF volumes were low (under 5% by volume for gestational age) in 62 women, normal (5-95%) in 100 women, and high (more than 95%) in 17 women. An AFI up to 5 cm (sensitivity 10%, specificity 96%) and a single deepest pocket up to 2 cm (sensitivity 5%, specificity 98%) were similarly inadequate in identifying dye-determined low AF volumes. Likewise, AFI above 20 (sensitivity 29%, specificity 97%) and a single-deepest pocket above 8 cm (sensitivity 29%, specificity 94%) were poor in identifying dye-determined abnormally high volumes. CONCLUSION There was no difference between AFI and single deepest pocket techniques for identifying truly abnormal AF volumes. Both techniques were unreliable for identifying true AF volumes.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Abstract
The biophysical profile (BPP) can be used as an initial test of fetal health and as a secondary back-up assessment of fetuses at risk of adverse outcomes when preliminary evaluations are not reassuring. The BPP evaluates five characteristics: fetal movement, tone, breathing, heart reactivity, and amniotic fluid (AF) volume estimation. Three of the most frequently used obstetric textbooks define adequate AF volume differently. In two of the three, the stated method of evaluating AF volume differs from that actually used by the referenced authors. We reviewed articles by Manning and found that his methodology changed from a 1-cm pocket in one plane to a 1-cm pocket in two perpendicular planes, and finally to a 2-cm vertical pocket with a 1-cm horizontal measurement. The 2 x 2-cm pocket is a fourth methodology that has been introduced recently. It is not known how often and in which groups each of the four methods has been used to evaluate abnormal AF volumes. The relevance and importance of determining precisely the ultrasound measurement actually used for investigations are emphasized by looking at women with AF indices < or = 5. Fifty-three percent of those women had a 2 x 2 pocket, 72% had a 2 x 1 pocket, and 95% had a 1 x 1 pocket. The diagnosis of low fluid can lead to additional testing, hydration, and intervention, so the importance of a universal definition linked with pregnancy outcomes cannot be overemphasized.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Terrone DA, Rinehart BK, May WL, Moore A, Magann EF, Martin JN. Leukocytosis is proportional to HELLP syndrome severity: evidence for an inflammatory form of preeclampsia. South Med J 2000; 93:768-71. [PMID: 10963506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND We investigated the possibility that HELLP syndrome is in part a systemic inflammatory response. METHODS We evaluated total white blood cell (WBC) counts of all patients with severe preeclampsia with and without HELLP syndrome admitted to our hospital between 1995 and 1997. Patients were grouped by diagnosis and timing of platelet nadir. Analysis of variance and regression analysis were used for data analysis. RESULTS Of 177 patients, 91 had HELLP syndrome, and 86 had severe preeclampsia alone. The WBC counts were significantly higher in patients with HELLP syndrome (12.5 +/- .442 x 10(9)/L) than in patients with severe preeclampsia (10.3 +/- .288 x 10(9)/L). Regression analysis showed that platelet counts varied inversely with WBC counts. Also, patients with class I HELLP syndrome had significantly higher WBC counts than patients with other classes of HELLP syndrome. CONCLUSION The finding of an association between increasing leukocytosis and worsening thrombocytopenia early in the course of HELLP syndrome supports the hypothesis that it may represent an inflammatory process.
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Affiliation(s)
- D A Terrone
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Martin JN, May WL, Rinehart BK, Martin RW, Magann EF. Increasing maternal weight: a risk factor for preeclampsia/eclampsia but apparently not for HELLP syndrome. South Med J 2000; 93:686-91. [PMID: 10923957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Maternal obesity is a risk factor for severe preeclampsia. We sought to ascertain whether a similar relationship exists between maternal weight and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an atypical form of severe preeclampsia. METHODS In this retrospective investigation, 434 patients with HELLP syndrome were assigned to one of four study groups according to maternal weight and were analyzed in relation to selected maternal and perinatal data reflective of disease severity. RESULTS We found no significant associations between maternal weight and parameters of HELLP syndrome severity, race, delivery mode, gestational age, or perinatal outcome. Significantly associated with increasing maternal weight were maternal age, parity, admission mean arterial pressure, peak peripartum systolic blood pressures, concurrent essential hypertension, and the interval between admission and delivery. Inversely associated were eclampsia and the interval between delivery and discharge. CONCLUSIONS Severity and complications attendant with HELLP syndrome appear unrelated to maternal weight. Paradoxically, eclampsia occurs most commonly in the lighter gravida with HELLP syndrome.
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Affiliation(s)
- J N Martin
- Department of Obstetrics and Gynecology and Preventive Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Magann EF, Sanderson M, Martin JN, Chauhan S. The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy. Am J Obstet Gynecol 2000; 182:1581-8. [PMID: 10871481 DOI: 10.1067/mob.2000.107325] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine normative values for amniotic fluid index, single deepest pocket, and 2-diameter pocket across gestation. STUDY DESIGN Fifty patients with normal pregnancies at each gestational age between 14 and 41 weeks' gestation were recruited prospectively and scanned once. Data were transformed into logarithmic (base 10) values for analysis. Polynomial regression equations were used to predict the normal values for amniotic fluid index, single deepest pocket, and 2-diameter pocket across gestational age and to predict the weekly percentage changes. RESULTS The mean amniotic fluid index, single deepest pocket, and 2-diameter pocket values were significantly lower among patients at <37 weeks' gestation (n = 1150) than among those at > or =37 weeks' gestation (n = 250; P <.001 for all comparisons). The calculated prevalences of oligohydramnios (amniotic fluid index < or =5 cm, single deepest pocket <2 cm, or 2-diameter pocket <15 cm(2)) were significantly different (P <.0001) for the three techniques (8%, 1%, and 30%, respectively). Hydramnios (amniotic fluid index >24 cm, single deepest pocket >8 cm, or 2-diameter pocket >50 cm(2)) was also diagnosed with significantly different (P <.0001) frequencies (0%, 0.7%, and 3%, respectively). CONCLUSIONS This is the largest prospective study to date to provide normative data for each of three ultrasonographic techniques used to assess amniotic fluid volume. The single deepest pocket appears to be the preferable method, because its use is least likely to lead to the false-positive diagnosis of either oligohydramnios or hydramnios.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Magann EF, Chauhan SP, Whitworth NS, Anfanger P, Rinehart BK, Morrison JC. Determination of amniotic fluid volume in twin pregnancies: ultrasonographic evaluation versus operator estimation. Am J Obstet Gynecol 2000; 182:1606-9. [PMID: 10871484 DOI: 10.1067/mob.2000.107440] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine the accuracy of amniotic fluid volume estimation (visually) in diamniotic twin pregnancy versus ultrasonography techniques. STUDY DESIGN In this prospective study the volume of each sac in 23 sets of diamniotic twin pregnancies was subjectively and objectively estimated by a second-year obstetric resident, nurse sonographer, maternal-fetal medicine fellow, and maternal-fetal medicine staff. The actual volume was confirmed by amniocentesis and a dye-dilution technique. RESULTS There was no difference in the total number of correct estimates of volume by level of operator experience (P =.98), ultrasonography technique (P =.87), or combined subjective versus objective correct estimates (P =.87). Identification of low volume was not different among the four evaluators (P =.48), but the percentage of correct estimates was poor (7%-29%). The 2-diameter pocket was a better predictor of oligohydramnios (57%) than the amniotic fluid index or the largest vertical pocket (12.5%; P =.002). CONCLUSION The extremes of volume (low or high) are poorly identified by the subjective or objective assessment of volume.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Abstract
OBJECTIVE This study was undertaken to evaluate the impact of physical abuse on pregnancy outcomes. STUDY DESIGN This prospective investigation identified all women seen in the outpatient obstetric clinic with a history of physical abuse and matched each with the next 2 women seen without a history of physical abuse (case/control ratio, 1:2). RESULTS Twenty-eight abused women were matched with 56 control subjects. The frequencies of preterm birth, mode of delivery, Apgar scores <7 at 5 minutes, umbilical artery pH <7.10 at birth, and unhappy or ambivalent feelings about the pregnancy were not statistically different between the 2 groups. Admission to the neonatal intensive care unit was more common among infants of the abused women (n = 4 [14.2%] vs n = 2 [3.6%]), despite heavier birth weights in the abused group (3501 +/- 581 g vs 3200 +/- 549 g; P =. 023), but this trend did not reach significance. CONCLUSION A history of physical abuse did not result in adverse pregnancy outcomes, although neonatal intensive care unit admission was more likely.
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Affiliation(s)
- J Jagoe
- Department of Obstetrics and Gynecology, Naval Medical Center, University of Mississippi Medical Center, Jackson, USA
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Chauhan SP, Mobley JA, Hendrix NW, Magann EF, Devoe LD, Martin JN. Cesarean delivery for suspected fetal distress among preterm parturients. J Reprod Med 2000; 45:395-402. [PMID: 10845173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Among preterm parturients (< 37 weeks) who underwent cesarean delivery for suspected fetal distress, to determine the factors associated with decision-incision time (DIT) of < or = 30 minutes and to assess if umbilical arterial pH < 7.10 is more common with DIT < or = 30 or > 30 minutes. STUDY DESIGN The peripartum course of all patients who had cesareans for suspected fetal distress over three years was reviewed. The inclusion criteria were reliable gestational age < 37 weeks and a single indication for cesarean delivery, suspected fetal distress. Twenty antepartum and intrapartum factors were used in a univariate analysis. RESULTS The mean DIT among the 84 parturients was 30.5 +/- 21.2 minutes, and 63% of patients had surgery started within 30 minutes. The incidence of pH < 7.10 was 20%. Multivariate analysis indicated that the two factors significantly associated with prolonged time to surgery were tachycardia with decreased variability (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.6-21.6) and use of spinal anesthesia (OR 6.2, 95% CI 1.1-35.0). Though none of the 20 variables had significant univariate associations with neonatal acidosis at alpha = .05, those with P < .20 were considered in multiple logistic regression analysis. None of the 20 factors were associated with pH < 7.10, including DIT of > or = 30 minutes (OR 0.26, 95% CI 0.06-1.03). CONCLUSION DIT is likely to be > 30 minutes if cesarean delivery is due to decreased fetal heart variability or if spinal anesthesia is utilized; neonatal acidosis, however, is not significantly associated with a prolonged interval.
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Affiliation(s)
- S P Chauhan
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, USA
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Abstract
OBJECTIVE To profile the types and frequencies of cardiopulmonary morbidity encountered in patients with severe preeclampsia with or without hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). STUDY DESIGN We initiated a retrospective study of 979 patients with severe preeclampsia with and without HELLP syndrome. Types of cardiopulmonary morbidity were analyzed among the three classes of HELLP syndrome and severe preeclampsia without HELLP syndrome. RESULTS Cardiopulmonary morbidity occurred in 7.6% of study patients. As a group, patients with cardiopulmonary complications were more likely to have cesareans (11% vs 6%, p = 0.019) earlier in gestation (1366 +/- 700 gm birth weight versus 1734 +/- 892 gm birth weight, p = 0.021), with higher peak postpartum blood pressures (< 0.001) and with more abnormal laboratory values indicative of multisystem disease, compared with patients without this complication. Patients with cardiopulmonary complications required almost twice as long to achieve diuresis as comparison patients (22 +/- 23 hours versus 12 +/- 11 hours, p < 0.001). CONCLUSION The probability of cardiopulmonary complications increases significantly when patients develop class 1 HELLP syndrome. Of all cardiopulmonary complications, acute lung injury/acute respiratory distress syndrome is most specific to class 1 HELLP syndrome. Transient renal dysfunction is closely related to cardiopulmonary morbidity.
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Affiliation(s)
- D A Terrone
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Chauhan SP, Magann EF, Morrison JC, Gunter AD, Whitworth NS, Devoe LD. Sonographic measurements of fetal parts to predict pulmonary maturity among twins and singletons. J Miss State Med Assoc 2000; 41:516-20. [PMID: 10731727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
To determine if sonographic examination of fetus can be readily utilized to predict a mature lecithin/sphingomyelin (L/S) ratio among twins and singletons. Twins (n = 36) undergoing amniocentesis for assessment of pulmonary maturity were matched with singleton (1:2) for maternal demographics, gestational age (GA), and indications for procedure. At the time of amniocentesis, twins and singletons with mature L/S ratios differed significantly in mean GA (33.2 +/- 2.7 vs 34.5 +/- 4.6 wks, p = 0.01), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL) and estimate of birth weight (EFW). Based on ten receiver operating characteristics curves constructed, the following diagnostic thresholds predicted a mature L/S ratio with a true positive rate of 100% among twins and singletons, respectively: 1) BPD $84 and $92 mm; 2) head circumference $315 and $320 mm; 3) AC $295 and $350 mm; or 4) FL $64 and $72 mm; or 5) EFW $2400 and $3200 g. Using any one of these five criteria correctly identified pulmonary maturity among 59% of twins and 28% of singletons (p = 0.001). Sonographic measurement of fetal parts or EFW may be a noninvasive method to predict a mature L/S ration among twins as well as singletons.
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Affiliation(s)
- S P Chauhan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Medical College of Georgia, Augusta, USA
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Chauhan SP, Sanderson M, Hendrix NW, Magann EF, Devoe LD. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis. Am J Obstet Gynecol 1999; 181:1473-8. [PMID: 10601931 DOI: 10.1016/s0002-9378(99)70393-5] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our purpose was to perform a meta-analysis of studies on the risks of cesarean delivery for fetal distress, 5-minute Apgar score <7, and umbilical arterial pH <7.00 in patients with antepartum or intrapartum amniotic fluid index >5.0 or <5.0 cm. STUDY DESIGN Using a MEDLINE search, we reviewed all studies published between 1987 and 1997 that correlated antepartum or intrapartum amniotic fluid index with adverse peripartum outcomes. The inclusion criteria were studies in English that associated at least one of the selected adverse outcomes with an amniotic fluid index of </=5.0 cm versus >5.0 cm. Contingency tables were constructed for each study, and relative risks and standard errors of their logs were calculated. Fixed-effects pooled relative risks were calculated for groups of studies that were homogeneous, whereas random-effects pooled relative risks were calculated for significantly heterogeneous groups of studies. RESULTS Eighteen reports describing 10,551 patients met our inclusion criteria. An antepartum amniotic fluid index of </=5.0 cm, in comparison with >5.0 cm, is associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 2.2; 95% confidence interval, 1.5-3.4) and an Apgar score of <7 at 5 minutes (pooled relative risk, 5.2; 95% confidence interval, 2.4-11.3). An intrapartum amniotic fluid index of </=5.0 cm is also associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 1.7; 95% confidence interval, 1.1-2.6) and an Apgar score <7 at 5 minutes (pooled relative risk, 1.8; 95% confidence interval, 1.2-2.7). A poor correlation between the amniotic fluid index and neonatal acidosis was noted in the only study that examined this end point. More than 23,000 patients are necessary to demonstrate that the incidence of umbilical arterial pH <7.00 is 1.5 times higher among those with oligohydramnios in labor than among those with adequate amniotic fluid index (alpha = 0.05; beta = 0.2) CONCLUSIONS An antepartum or intrapartum amniotic fluid index of </=5.0 cm is associated with a significantly increased risk of cesarean delivery for fetal distress and a low Apgar score at 5 minutes. There are few reports linking amniotic fluid index and neonatal acidosis, the only objective assessment of fetal well-being. A multicenter study with sufficient power should be undertaken to demonstrate that a low amniotic fluid index is associated with an umbilical arterial pH <7.00.
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Affiliation(s)
- S P Chauhan
- Spartanburg Regional Medical Center, South Carolina, USA
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Abstract
The best method of ultrasonic mensuration to identify abnormal AFV reliably in singletons and the individual sacs of diamniotic twins remains elusive. With respect to twins, localization of the dividing membrane seems to be necessary for AFV assessments of each amniotic cavity. The relationship of ultrasonic estimates, actual AFV, and pregnancy outcome remains undetermined. In the authors' opinion, the subjective assessment in twin gestation may be as accurate as semiquantitative ultrasonic estimates of AFV, similar to the situation in singleton pregnancies. The authors propose that further prospective research address the following questions: (1) What is the appropriate threshold for intervention when AFI decreases to lower ranges? (2) What other factors (e.g., cervical examination, fetal heart rate patterns, underlying obstetric conditions, fetal growth pattern) are important when the AFI falls to low values in making clinical decisions?
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Chauhan SP, Scardo JA, Hendrix NW, Magann EF, Morrison JC. Accuracy of sonographically estimated fetal weight with and without oligohydramnios. A case-control study. J Reprod Med 1999; 44:969-73. [PMID: 10589409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To determine the accuracy of sonographically estimated fetal weight among women with and without oligohydramnios (amniotic fluid index [AFI] < or = 5.0 cm) and to ascertain the ability to detect fetal growth restriction (FGR) (estimated birth weight < 10th percentile for gestational age [GA]) among patients in two groups. STUDY DESIGN Assuming that 50% of sonographic predictions are within 10% of the birth weight in the study group, 300 parturients are necessary to show a difference of 15% among controls (alpha = .05, beta = .02). The study group consisted of parturients with a reliable GA of > or = 24, no known anomalies and known AFI of < or = 5.0 cm. The control (1:1) was the next patient with the same GA but AFI between 5.1 and 23.9 cm. The paired t test was used, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. P < .05 was considered significant. RESULTS Among the study and control groups (N = 162 each), maternal demographics, mean estimate (P = .078) and actual birth weight (P = .091) were similar. Sonographic estimates within 10% of weight were not significantly different among those with (57%) and without oligohydramnios (59%; OR 0.92; 95% CI 0.59, 1.44). The frequency of FGR was higher among those with inadequate fluid (18%) than controls (9%; OR 2.13; 95% CI 1.10, 4.16). Sensitivity, positive predictive value and likelihood ratio were higher among those with oligohydramnios (76%, 78% and 16) than controls (53%, 42% and 7). CONCLUSION The accuracy of sonographic estimates of fetal weight is not influenced by whether the parturient has oligohydramnios. Moreover, the accuracy of identifying FGR is not diminished among those with AFI < or = 5.0 versus > 5.0 cm.
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Affiliation(s)
- S P Chauhan
- Department of Obstetrics and Gynecology, Spartanburg Regional Medical Center, South Carolina 29303, USA.
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Isler CM, Rinehart BK, Terrone DA, Martin RW, Magann EF, Martin JN. Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 1999; 181:924-8. [PMID: 10521755 DOI: 10.1016/s0002-9378(99)70343-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors contributing to deaths among women with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. STUDY DESIGN Information from multiple sources was scrutinized to distinguish and profile maternal deaths associated with HELLP syndrome. RESULTS Information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal deaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), disseminated intravascular coagulopathy (39%), adult respiratory distress syndrome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), and hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndrome was implicated in 22 of 43 patients' deaths (51.1%). CONCLUSIONS It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mortal consequences, and (3) hemorrhage in the hepatic or central nervous system or vascular insult to the cardiopulmonary or renal system were associated with increased mortality risk.
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Affiliation(s)
- C M Isler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Abstract
The early diagnosis and treatment of HELLP syndrome remains problematic for the obstetric health care provider. The nonspecific signs and symptoms of this disorder early in the disease process make the accurate diagnosis difficult and delays early treatment, which has the best prognosis for both maternal and perinatal outcome. The introduction of high-dose nonmineralocorticosteriods to assist in the treatment of these patients is an exciting new development. Use of the 12-step approach to the diagnosis and management of pregnancies complicated by HELLP syndrome has proven to be a successful tool to help us achieve the best possible maternal and perinatal outcome.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Magann EF, Nevils BG, Chauhan SP, Whitworth NS, Klausen JH, Morrison JC. Low amniotic fluid volume is poorly identified in singleton and twin pregnancies using the 2 x 2 cm pocket technique of the biophysical profile. South Med J 1999; 92:802-5. [PMID: 10456720 DOI: 10.1097/00007611-199908000-00011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was done to determine the accuracy of the 2 x 2 cm pocket identifying low amniotic fluid (AF) volume in singleton and twin pregnancies. METHODS The AF volume was evaluated by ultrasonography for the presence of a 2 x 2 cm pocket before amniocentesis. The actual AF volume was then determined by a diazo-dye reaction with subsequent spectrophotometric analysis using paraminohippurate. RESULTS The AF volume was low in 21 of the 79 singleton pregnancies and normal in 47; hydramnios was present in 11. Among amniotic sacs of the 60 twin pairs, oligohydramnios was found in 33 amniotic sacs. normal AF volume in 80 sacs, and high volume in 7. An AF pocket smaller than 2 x 2 cm was identified in only 3 of the 79 singleton pregnancies and in only 2 of the 120 twin amniotic sacs. CONCLUSIONS Judging AF volume on the basis of a 2 x 2 cm pocket misses more than 90% of cases of oligohydramnios in singletons and twins.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Kinsella MJ, Bidus MA, Magann EF, Morrison JC. May-Hegglin anomaly in a pregnancy complicated by intrauterine growth restriction and ambiguous genitalia. Mil Med 1999; 164:607-8. [PMID: 10459277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVE Thrombocytopenia as a hematologic disorder complicates up to 4% of all pregnancies. May-Hegglin anomaly is a rare cause of low platelets in pregnancy. METHODS A case of May-Hegglin anomaly complicating pregnancy and intrauterine growth restriction in a fetus with ambiguous genitalia is described. RESULTS The antepartum and intrapartum diagnosis and management of a patient diagnosed with May-Hegglin anomaly is discussed. The involvement and consultation of a perinatologist, neonatologist, internist, and anesthesiologist is reviewed, with emphasis on the mode of delivery. CONCLUSION The potential maternal and fetal complications associated with May-Hegglin anomaly warrant early pregnancy diagnosis and access to a tertiary care facility.
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Affiliation(s)
- M J Kinsella
- Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, CA, USA
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Abstract
OBJECTIVE This study was undertaken to evaluate the correspondence in fetal lung development between diamniotic twins. STUDY DESIGN Lecithin/sphingomyelin ratios were determined for amniotic fluid specimens collected from each sac in 58 diamniotic twin pregnancies. RESULTS Overall, the lecithin/sphingomyelin ratios of twin A and twin B and those of the larger and smaller twins of each pair were closely correlated (r >/= 0.83, P <.001). When stratified by gestational age, however, the percentage disparity in lecithin/sphingomyelin ratios between members of twin pairs was significantly greater at </=32 weeks' gestation (25%) than at >32 weeks' gestation (15%, P =.027). An analysis of the lecithin/sphingomyelin ratios of twins with a large lecithin/sphingomyelin ratio disparity (>/=20%) suggested that this disparity was a result of 1 twin having a lecithin/sphingomyelin ratio that was advanced for gestational age with respect to that of the co-twin. Disparities in lecithin/sphingomyelin ratio were not significantly affected by fetal sex or by discordance in size between the twins. CONCLUSION At relatively early stages of diamniotic twin gestation (</=32 weeks' gestation), lecithin/sphingomyelin ratios should be obtained for both amniotic sacs to ensure accurate assessment of fetal lung maturity in both twins.
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Affiliation(s)
- N S Whitworth
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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Martin JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol 1999; 180:1373-84. [PMID: 10368474 DOI: 10.1016/s0002-9378(99)70022-0] [Citation(s) in RCA: 234] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study was undertaken to explore the spectrum of maternal disease with a triple classification system of HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome and compare these classes with severe preeclampsia without HELLP syndrome. STUDY DESIGN In this retrospective analytic study the pregnancies of 777 patients with class 1, 2, or 3 HELLP syndrome were compared and contrasted with those of 193 women with severe preeclampsia but without HELLP syndrome. RESULTS Eclampsia, epigastric pain, nausea and vomiting, significant proteinuria, major maternal morbidity, and stillbirth increased as HELLP syndrome worsened from class 3 to class 1. In contrast, headache and diastolic hypertension were more common among the significantly heavier patients with severe preeclampsia without HELLP syndrome. Approximately half of pregnancies complicated by class 1 HELLP syndrome exhibited significant maternal morbidity, compared with only 11% of those complicated by severe preeclampsia without HELLP syndrome. Although a significant trend was apparent in increasing levels of lactate dehydrogenase, aspartate aminotransferase, and uric acid as HELLP syndrome worsened, there was considerable variation within groups. CONCLUSION Laboratory and clinical indices of disease severity in patients with severe preeclampsia or eclampsia generally were highest with class 1 HELLP syndrome and were lowest when HELLP syndrome was absent. Class 3 HELLP syndrome is considered a clinically significant transitional group.
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Affiliation(s)
- J N Martin
- Departments of Obstetrics and Gynecology and Preventive Medicine, University of Mississippi Medical Center, Jackson, USA
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Magann EF, Chauhan SP, Kinsella MJ, McNamara MF, Whitworth NS, Morrison JC. Antenatal testing among 1001 patients at high risk: the role of ultrasonographic estimate of amniotic fluid volume. Am J Obstet Gynecol 1999; 180:1330-6. [PMID: 10368467 DOI: 10.1016/s0002-9378(99)70015-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Our goal was to compare the accuracy of the amniotic fluid index and the 2-diameter pocket technique with respect to accuracy in predicting an adverse pregnancy outcome among patients at high risk undergoing antenatal testing. STUDY DESIGN All women with high-risk pregnancies and intact membranes who underwent antenatal testing during an 18-month period were prospectively enrolled. Ultrasonographic estimates of amniotic fluid volume were performed by means of the amniotic fluid index and the 2-diameter pocket technique. Relative risks with 95% confidence intervals and receiver operator characteristic curves were calculated for patients with an ultrasonographic estimate of oligohydramnios (amniotic fluid index of </=5 cm or 2-diameter pocket of </=15 cm2) versus normal fluid level (amniotic fluid index of >5 cm or 2-diameter pocket of >15 cm2). Outcome variables studied were intrapartum and neonatal complications. RESULTS Among 1001 patients the mean (+/-SD) amniotic fluid index was 10.5 +/- 5 cm and the mean (+/-SD) 2-diameter pocket was 18.7 +/- 13.6 cm2. Significantly more patients (46%) were considered to have oligohydramnios according to the 2-diameter pocket criteria than according to the amniotic fluid index (21%, P <.0001, relative risk 1.7, 95% confidence interval 1.5-1.8). No significant differences in the incidences of nonreactive nonstress test results, meconium-stained amniotic fluid, cesarean delivery for fetal distress, low Apgar scores, or infants with cord pH of <7.10 were observed between the oligohydramnios and normal amniotic fluid groups (P >.05) when assessed by relative risk with confidence interval and by receiver operator characteristic curves. CONCLUSIONS Current ultrasonographic measurements with the amniotic fluid index and the 2-diameter pocket technique are poor diagnostic tests to determine whether a patient is at high risk for an adverse perinatal outcome.
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Affiliation(s)
- E F Magann
- Departments of Obstetrics and Gynecology, Naval Medical Center, Medical College of Georgia, USA
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