1
|
Anderson JN, Deter RL, Datoc IA, Mack L, Gandhi M, Lee W, Blumenfeld YJ. Second-trimester growth velocities in twin and singleton pregnancies. Ultrasound Obstet Gynecol 2023; 61:33-39. [PMID: 36273412 DOI: 10.1002/uog.26102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Previous small studies used individualized growth assessment (IGA) to characterize prenatal growth velocities of singletons and twins. We aimed to compare second-trimester growth velocities of individual anatomical parameters between monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins and singleton fetuses in a larger study. METHODS This was a study of a novel cohort of 222 MCDA twins and previously published cohorts of 40 DCDA twins and 118 singletons with serial ultrasound data. Fetal biometric measurements of biparietal diameter, head circumference, abdominal circumference and femur diaphysis length from prenatal ultrasound examinations were used to calculate second-trimester growth velocities using direct calculation or linear regression analysis. Linear fit was assessed based on the coefficient of determination (R2 ). Mean growth velocities and variances were compared among the three groups. RESULTS The majority of cases underwent three second-trimester ultrasound examinations with fetal biometry available. All fetuses had linear growth, with R2 > 99% for all parameters. Only 1-2% of all MCDA and DCDA anatomical parameters had abnormal growth velocity scores outside the 95% reference range for singletons. There were no significant differences in mean growth velocity for any parameter between MCDA twins and singletons. Femur diaphysis length growth velocity was significantly lower in DCDA twins than in both MCDA twins and singletons. There were no other significant differences among the groups. CONCLUSIONS Expanding on prior work using IGA, we found that second-trimester growth velocity of the four major anatomical parameters overall was similar between twins and singletons and between MCDA and DCDA twins, supporting the use of singleton-derived growth standards for IGA in twins. Twin growth potential appears to be similar to that of singletons in the second trimester, suggesting that subsequent growth divergence may be due to third-trimester physiological or pathological changes in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- J N Anderson
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - R L Deter
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - I A Datoc
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - L Mack
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - M Gandhi
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - W Lee
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - Y J Blumenfeld
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| |
Collapse
|
2
|
Tsur A, Batsry L, Toussia-Cohen S, Rosenstein MG, Barak O, Brezinov Y, Yoeli-Ullman R, Sivan E, Sirota M, Druzin ML, Stevenson DK, Blumenfeld YJ, Aran D. Development and validation of a machine-learning model for prediction of shoulder dystocia. Ultrasound Obstet Gynecol 2020; 56:588-596. [PMID: 31587401 DOI: 10.1002/uog.21878] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 04/10/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To develop a machine-learning (ML) model for prediction of shoulder dystocia (ShD) and to externally validate the model's predictive accuracy and potential clinical efficacy in optimizing the use of Cesarean delivery in the context of suspected macrosomia. METHODS We used electronic health records (EHR) from the Sheba Medical Center in Israel to develop the model (derivation cohort) and EHR from the University of California San Francisco Medical Center to validate the model's accuracy and clinical efficacy (validation cohort). Subsequent to application of inclusion and exclusion criteria, the derivation cohort included 686 singleton vaginal deliveries, of which 131 were complicated by ShD, and the validation cohort included 2584 deliveries, of which 31 were complicated by ShD. For each of these deliveries, we collected maternal and neonatal delivery outcomes coupled with maternal demographics, obstetric clinical data and sonographic fetal biometry. Biometric measurements and their derived estimated fetal weight were adjusted (aEFW) according to gestational age at delivery. A ML pipeline was utilized to develop the model. RESULTS In the derivation cohort, the ML model provided significantly better prediction than did the current clinical paradigm based on fetal weight and maternal diabetes: using nested cross-validation, the area under the receiver-operating-characteristics curve (AUC) of the model was 0.793 ± 0.041, outperforming aEFW combined with diabetes (AUC = 0.745 ± 0.044, P = 1e-16 ). The following risk modifiers had a positive beta that was > 0.02, i.e. they increased the risk of ShD: aEFW (beta = 0.164), pregestational diabetes (beta = 0.047), prior ShD (beta = 0.04), female fetal sex (beta = 0.04) and adjusted abdominal circumference (beta = 0.03). The following risk modifiers had a negative beta that was < -0.02, i.e. they were protective of ShD: adjusted biparietal diameter (beta = -0.08) and maternal height (beta = -0.03). In the validation cohort, the model outperformed aEFW combined with diabetes (AUC = 0.866 vs 0.784, P = 0.00007). Additionally, in the validation cohort, among the subgroup of 273 women carrying a fetus with aEFW ≥ 4000 g, the aEFW had no predictive power (AUC = 0.548), and the model performed significantly better (0.775, P = 0.0002). A risk-score threshold of 0.5 stratified 42.9% of deliveries to the high-risk group, which included 90.9% of ShD cases and all cases accompanied by maternal or newborn complications. A more specific threshold of 0.7 stratified only 27.5% of the deliveries to the high-risk group, which included 63.6% of ShD cases and all those accompanied by newborn complications. CONCLUSION We developed a ML model for prediction of ShD and, in a different cohort, externally validated its performance. The model predicted ShD better than did estimated fetal weight either alone or combined with maternal diabetes, and was able to stratify the risk of ShD and neonatal injury in the context of suspected macrosomia. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A Tsur
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel
| | - L Batsry
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel
| | - S Toussia-Cohen
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel
| | - M G Rosenstein
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of California, San Francisco, CA, USA
| | - O Barak
- Department of Obstetrics and Gynecology, The Kaplan Medical Center, Rehovot, Israel
| | - Y Brezinov
- Department of Obstetrics and Gynecology, The Kaplan Medical Center, Rehovot, Israel
| | - R Yoeli-Ullman
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel
| | - E Sivan
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel
| | - M Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - M L Druzin
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - D K Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Y J Blumenfeld
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - D Aran
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| |
Collapse
|
3
|
Blumenfeld YJ. Benefits of and variability within a nationwide CHD screening programme. BJOG 2019; 126:874. [PMID: 30697900 DOI: 10.1111/1471-0528.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y J Blumenfeld
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
4
|
Blumenfeld YJ. Evidenced-based care of pregnant women with symptomatic adrenal masses - accepting imperfect data. BJOG 2017; 125:728. [PMID: 29090509 DOI: 10.1111/1471-0528.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y J Blumenfeld
- Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
5
|
Blumenfeld YJ, Do S, Girsen AI, Davis AS, Hintz SR, Desai AK, Mansour T, Merritt TA, Oshiro BT, El-Sayed YY, Shamshirsaz AA, Lee HC. Utility of third trimester sonographic measurements for predicting SGA in cases of fetal gastroschisis. J Perinatol 2017; 37:498-501. [PMID: 28125100 DOI: 10.1038/jp.2016.275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/26/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the accuracy of different sonographic estimated fetal weight (EFW) cutoffs, and combinations of EFW and biometric measurements for predicting small for gestational age (SGA) in fetal gastroschisis. STUDY DESIGN Gastroschisis cases from two centers were included. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for different EFW cutoffs, as well as EFW and biometric measurement combinations. RESULTS Seventy gastroschisis cases were analyzed. An EFW<10% had 94% sensitivity, 43% specificity, 33% PPV and 96% NPV for SGA at delivery. Using an EFW cutoff of <5% improved the specificity to 63% and PPV to 41%, but decreased the sensitivity to 88%. Combining an abdominal circumference (AC) or femur length (FL) z-score less than -2 with the total EFW improved the specificity and PPV but decreased the sensitivity. CONCLUSION A combination of a small AC or FL along with EFW increases the specificity and PPV, but decreases the sensitivity of predicting SGA.
Collapse
Affiliation(s)
- Y J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.,The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - S Do
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - A I Girsen
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - A S Davis
- The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S R Hintz
- The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - A K Desai
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T Mansour
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T A Merritt
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - B T Oshiro
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Y Y El-Sayed
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.,The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - A A Shamshirsaz
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - H C Lee
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
6
|
Blumenfeld YJ, E Milan K, Rubesova E, Sylvester KG, Davis AS, Chock VY, Hintz SR. HDlive imaging of a giant omphalocele. Ultrasound Obstet Gynecol 2016; 48:407-408. [PMID: 27299988 DOI: 10.1002/uog.15993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/01/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Y J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - K E Milan
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - E Rubesova
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - K G Sylvester
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - A S Davis
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - V Y Chock
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - S R Hintz
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
7
|
Grande M, Jansen FAR, Blumenfeld YJ, Fisher A, Odibo AO, Haak MC, Borrell A. Genomic microarray in fetuses with increased nuchal translucency and normal karyotype: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 46:650-658. [PMID: 25900824 DOI: 10.1002/uog.14880] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [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: 12/23/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To estimate the incremental yield of detecting copy number variants (CNVs) by genomic microarray over karyotyping in fetuses with increased nuchal translucency (NT) diagnosed by first-trimester ultrasound. METHODS This was a systematic review conducted in accordance with PRISMA criteria. We searched PubMed, Ovid MEDLINE and Web of Science for studies published between January 2009 and January 2015 that described CNVs in fetuses with increased NT, usually defined as ≥ 3.5 mm, and normal karyotype. Search terms included: fetal or prenatal, nuchal translucency or cystic hygroma or ultrasound anomaly, array comparative genomic hybridization or copy number variants, with related search terms. Risk differences were pooled to estimate the overall and stratified microarray incremental yield using RevMan. Quality assessment of included studies was performed using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. RESULTS Seventeen studies met the inclusion criteria for analysis. Meta-analysis indicated an incremental yield of 5.0% (95% CI, 2.0-8.0%) for the detection of CNVs using microarray when pooling results. Stratified analysis of microarray results demonstrated a 4.0% (95% CI, 2.0-7.0%) incremental yield in cases of isolated NT and 7.0% (95% CI, 2.0-12.0%) when other malformations were present. The most common pathogenic CNVs reported were 22q11.2 deletion, 22q11.2 duplication, 10q26.12q26.3 deletion and 12q21q22 deletion. The pooled prevalence for variants of uncertain significance was 1%. CONCLUSION The use of genomic microarray provides a 5.0% incremental yield of detecting CNVs in fetuses with increased NT and normal karyotype.
Collapse
Affiliation(s)
- M Grande
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Catalonia, Spain
| | - F A R Jansen
- Leiden University Medical Center, Department of Obstetrics and Fetal Medicine, Leiden, The Netherlands
| | - Y J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - A Fisher
- Elliot Health System, Manchester, NH, USA
| | - A O Odibo
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - M C Haak
- Leiden University Medical Center, Department of Obstetrics and Fetal Medicine, Leiden, The Netherlands
| | - A Borrell
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Catalonia, Spain
| |
Collapse
|
8
|
Jelliffe-Pawlowski LL, Baer RJ, Blumenfeld YJ, Ryckman KK, O'Brodovich HM, Gould JB, Druzin ML, El-Sayed YY, Lyell DJ, Stevenson DK, Shaw GM, Currier RJ. Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth. BJOG 2015; 122:1484-93. [PMID: 26111589 DOI: 10.1111/1471-0528.13495] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [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: 04/20/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the relationship between maternal characteristics, serum biomarkers and preterm birth (PTB) by spontaneous and medically indicated subtypes. DESIGN Population-based cohort. SETTING California, United States of America. POPULATION From a total population of 1 004 039 live singleton births in 2009 and 2010, 841 665 pregnancies with linked birth certificate and hospital discharge records were included. METHODS Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models and 95% confidence intervals. First-trimester and second-trimester serum marker levels were analysed in a subset of 125 202 pregnancies with available first-trimester and second-trimester serum biomarker results. MAIN OUTCOME MEASURE PTB by subtype. RESULTS In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, pre-existing hypertension with and without pre-eclampsia, gestational hypertension with pre-eclampsia, pre-existing diabetes, anaemia, previous PTB, one or two or more previous caesarean section(s), interpregnancy interval ≥ 60 months, low first-trimester pregnancy-associated plasma protein A, high second-trimester α-fetoprotein, and high second-trimester dimeric inhibin A). These risks occurred in 51.6-86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically indicated PTB <32 weeks in women with pre-existing hypertension and pre-eclampsia (adjusted odds ratio 89.7, 95% CI 27.3-111.2). CONCLUSIONS Our findings suggest a shared aetiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies. TWEETABLE ABSTRACT Findings suggest a shared aetiology across preterm birth subtypes. Patterns may inform risk reduction efforts.
Collapse
Affiliation(s)
- L L Jelliffe-Pawlowski
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, USA.,Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - R J Baer
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, USA
| | - Y J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - K K Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - H M O'Brodovich
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - J B Gould
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - M L Druzin
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Y Y El-Sayed
- Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - D J Lyell
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - D K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - G M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - R J Currier
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, USA
| |
Collapse
|
9
|
Butwick AJ, El-Sayed YY, Blumenfeld YJ, Osmundson SS, Weiniger CF. Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry. Br J Anaesth 2015; 115:267-74. [PMID: 25956901 DOI: 10.1093/bja/aev108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. METHODS Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. RESULTS Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. CONCLUSIONS In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.
Collapse
Affiliation(s)
- A J Butwick
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Y Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Y J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - S S Osmundson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - C F Weiniger
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
10
|
Jansen FAR, Blumenfeld YJ, Fisher A, Cobben JM, Odibo AO, Borrell A, Haak MC. Array comparative genomic hybridization and fetal congenital heart defects: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 45:27-35. [PMID: 25319878 DOI: 10.1002/uog.14695] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [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: 09/15/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Array comparative genomic hybridization (aCGH) is a molecular cytogenetic technique that is able to detect the presence of copy number variants (CNVs) within the genome. The detection rate of imbalances by aCGH compared to standard karyotyping and 22q11 microdeletion analysis by fluorescence in-situ hybridization (FISH), in the setting of prenatally-diagnosed cardiac malformations, has been reported in several studies. The objective of our study was to perform a systematic literature review and meta-analysis to document the additional diagnostic gain of using aCGH in cases of congenital heart disease (CHD) diagnosed by prenatal ultrasound examination, with the aim of assisting clinicians to determine whether aCGH analysis is warranted when an ultrasonographic diagnosis of CHD is made, and to guide counseling in this setting. METHODS Articles in PubMed, EMBASE and Web of Science databases from January 2007 to September 2014 describing CNVs in prenatal cases of CHD were included. Search terms were: 'array comparative genomic hybridization', 'copy number variants' and 'fetal congenital heart defects'. Articles regarding karyotyping or 22q11 deletion only were excluded. RESULTS Thirteen publications (including 1131 cases of CHD) met the inclusion criteria for the analysis. Meta-analysis indicated an incremental yield of 7.0% (95% CI, 5.3-8.6%) for the detection of CNVs using aCGH, excluding aneuploidy and 22q11 microdeletion cases. Subgroup results showed a 3.4% (95% CI, 0.3-6.6%) incremental yield in isolated CHD cases, and 9.3% (95% CI, 6.6-12%) when extracardiac malformations were present. Overall, an incremental yield of 12% (95% CI, 7.6-16%) was found when 22q11 deletion cases were included. There was an additional yield of 3.4% (95% CI, 2.1-4.6%) for detecting variants of unknown significance (VOUS). CONCLUSIONS In this review we provide an overview of published data and discuss the benefits and limitations of using aCGH. If karyotyping and 22q11 microdeletion analysis by FISH are normal, using aCGH has additional value, detecting pathogenic CNVs in 7.0% of prenatally diagnosed CHD, with a 3.4% additional yield of detecting VOUS.
Collapse
Affiliation(s)
- F A R Jansen
- Leiden University Medical Center, Department of Obstetrics and Fetal Medicine, Leiden, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
11
|
Blumenfeld YJ, Caughey AB, El-Sayed YY, Daniels K, Lyell DJ. Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions. BJOG 2010; 117:690-4. [PMID: 20236104 DOI: 10.1111/j.1471-0528.2010.02529.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary caesarean delivery and subsequent adhesion formation. DESIGN A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. SETTING Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. POPULATION One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. METHODS Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher's exact tests and multivariable logistic regression. MAIN OUTCOME MEASURE Prevalence rate of pelvic and abdominal adhesions. RESULTS Of the 127 women, primary hysterotomy closure was single layer in 56 and double layer in 71. Single-layer hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72-28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions. CONCLUSIONS Primary single-layer hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.
Collapse
Affiliation(s)
- Y J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA 94305, USA.
| | | | | | | | | |
Collapse
|