To determine whether the diagnosis of polycystic ovary syndrome (PCOS) independently predicts inc... more To determine whether the diagnosis of polycystic ovary syndrome (PCOS) independently predicts increased rates of pregnancy complications relative to control subjects, after adjusting for important confounders. Retrospective cohort. A single university-affiliated reproductive endocrinology unit. A review of all pregnancies after fresh IVF with or without intracytoplasmic sperm injection transfers from December 2006 to 2012 (n = 1,084) identified 394 eligible singleton births (71 women with PCOS; 323 controls without). None. Singleton births were assessed for selected adverse pregnancy and birth outcomes. Women with PCOS demonstrated a higher risk of developing the following pregnancy complications after adjusting for differences in age, parity, body mass index, and time to conception: gestational diabetes (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.35-7.33), hypertensive disorders of pregnancy (AOR 4.25, 95% CI 1.94-9.32), preterm birth <37 weeks (AOR 2.30, 95%...
Journal of Obstetrics and Gynaecology Canada Jogc Journal D Obstetrique Et Gynecologie Du Canada Jogc, Feb 1, 2012
OBJECTIVE: Abnormal serum screening markers have been associated with adverse pregnancy outcomes.... more OBJECTIVE: Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation.DATA SOURCES AND STUDY SELECTION: Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes.DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three relatively homogeneous studies on prediction of PET, and two on prediction of SGA were meta-analyzed. Several single studies demonstrated utility in combining markers to predict adverse outcome; however, this effect was not confirmed after meta-analysis. The most common combination of markers evaluated was alpha fetoprotein and human chorionic gonadotrophin for all outcomes. The highest positive likelihood ratios for predicting PET (5.68; 95% CI 0.73 to 43.97) and SGA (6.18; 95% CI 1.84 to 20.85) were seen with combined alpha fetoprotein and human chorionic gonadotrophin (> 2.5 multiples of the median).CONCLUSIONS: Currently, no identifiable combination of serum markers performs well as a screening test for preeclampsia, small for gestational age, and stillbirth beyond 24 weeks. Large cohort studies with standardized screening test parameters and outcomes are needed.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014
To evaluate the ability of sonographers to prospectively identify intracranial translucency and p... more To evaluate the ability of sonographers to prospectively identify intracranial translucency and posterior brain structures at 11 to 13 weeks and to evaluate measurement reproducibility of brain stem and brain stem-occipital bone diameters on stored images. After specific training for intracranial translucency visualization, 10 nonphysician sonographers prospectively identified intracranial translucency at the 11- to 13-week scan, noting whether intracranial translucency was present, absent, or uncertain. If absent/uncertain, they documented the reason as spina bifida or an inadequate image (with reasons for the inadequate image). Measurements of brain stem and brain stem-occipital bone diameters were performed on stored images. Fifty randomly selected cases were reviewed for intraobserver and interobserver variability. In 313 singleton pregnancies, the posterior brain including intracranial translucency was evaluated; 293 (93.6%) had known pregnancy outcomes. None had open spina bif...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013
To describe the current investigation and management of non-immune fetal hydrops, with a focus on... more To describe the current investigation and management of non-immune fetal hydrops, with a focus on treatable or recurring etiologies. To provide better counselling and management in cases of prenatally diagnosed non-immune hydrops. Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2011 using key words (non-immune hydrops fetalis, fetal hydrops, fetal therapy, fetal metabolism). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, observational studies, and significant case reports. Additional publications were identified from the bibliographies of these articles. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collecti...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010
To assess women's knowledge of and views on the evaluation and reporting of ultrasound soft m... more To assess women's knowledge of and views on the evaluation and reporting of ultrasound soft markers. A prospective survey of 263 women undergoing 18 to 20 week anatomy ultrasound examination at Mount Sinai Hospital, a level 3 perinatal referral centre for a multi-ethnic population of approximately 2.5 million. Prior to reading an information pamphlet provided in the context of this survey, 30% of women (79/263) reported having heard of the term soft marker and 59% of these women (47/79) had discussed soft markers with their caregiver. When asked their preferences about the reporting of ultrasound soft markers, 53% of women said that soft markers should be reported routinely, 20% said they should be reported when the caregiver thinks it necessary, and 23% preferred they be reported only when they have been discussed prior to the ultrasound examination. A minority of respondents (8%) had not participated in prenatal screening for aneuploidy. All of these women preferred that soft ...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012
Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought ... more Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation. Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes. Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three rela...
We report the prenatal findings in two cases of Beals syndrome. Both pregnancies presented with c... more We report the prenatal findings in two cases of Beals syndrome. Both pregnancies presented with clinical features of arthrogryposis multiplex congenita/fetal akinesia syndrome (AMC/FAS), including clenched fists and multiple joint contractures on repeat prenatal ultrasound examinations. The first case was diagnosed as having Beals syndrome on physical examination shortly after birth and the diagnosis was confirmed by DNA analysis, shown as a point mutation in the fibrillin 2 (FBN2) gene. The second case was diagnosed with Beals syndrome following microarray analysis on amniocytes, which showed a deletion of the FBN2 gene. Although most cases with AMC/FAS carry a poor prognosis, Beals syndrome is consistent with normal cognitive development and a better prognosis. Thus, making the correct diagnosis is crucial, both pre- and postnatally, for accurate counseling and management.
To determine the visualization rates of fetal anatomic structures by three-dimensional ultrasound... more To determine the visualization rates of fetal anatomic structures by three-dimensional ultrasound (3DUS) at 12-13 weeks of gestation. This was a prospective observational study of women presenting for nuchal translucency ultrasound. Five 3D volumes of the fetus were acquired transabdominally. Two investigators independently reviewed the stored volumes offline following a standardized protocol. One hundred singleton fetuses were examined. The mean time for 3D volumes acquisition was 4.8 min; and for 3D review 17 min. Anatomic structures were seen as follows: cranium, lateral cerebral ventricles and abdominal wall 100%; stomach, vertebrae, upper and lower limbs &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 94%; face 71%, bladder 58%, both kidneys 39%, skin overlying spine 26% and heart 18%. Agreement between two observers ranged from 100% (for head, abdominal wall and lower limbs) to 43% (for visualization of skin overlying spine). A complete basic anatomic survey was achieved in 11.4% of the 12-week fetuses and 33.3% of the 13-week fetuses (p-value = 0.038). First-trimester transabdominal 3DUS was adequate for assessment of the head, abdominal wall, stomach, limbs and vertebral alignment. It was less effective for evaluating the heart and intactness of the skin over the spine.
This study aimed to assess the quantitative impact of maternal weight discrepancy on the screen r... more This study aimed to assess the quantitative impact of maternal weight discrepancy on the screen result for Down syndrome when using Integrated Prenatal Screening and First Trimester Combined Screening. The study population consisted of 78,165 women undergoing prenatal screening in Ontario, Canada, and 158 pregnancies affected with Down syndrome at one Ontario center. The study assessed quantitative alterations of the multiple of the median values of first and second-trimester serum markers and the risks of Down syndrome at a set of theoretical weight discrepancies. Weight discrepancies have the greatest impact on screening results when the initial risk is close to the risk cut-off. When the weight discrepancy is 5 lb or greater and the denominator of the initial risk is within 50 of the risk cut-off, the chance that a screen result will change from positive to negative or from negative to positive is 47-55% for women undertaking Integrated Prenatal Screening. This chance is 33-43% for women undertaking First Trimester Combined Screening. A weight discrepancy of five or more pounds has a significant impact on the risk of Down syndrome; correction of maternal weight would improve the accuracy of the screening test.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012
Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought ... more Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation. Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes. Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three rela...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2004
(1) To elucidate the views of obstetricians with respect to the use of transvaginal ultrasound in... more (1) To elucidate the views of obstetricians with respect to the use of transvaginal ultrasound in general, and, specifically, for determining cervical length, and the conditions under which obstetricians would employ cervical cerclage based on a sonographically revealed shortened cervix; and (2) to determine the possibility of a randomized controlled trial on the use of cervical cerclage in this situation. A 7-item questionnaire in French and English was designed and pretested. Questionnaires were mailed to 1421 physicians identified in the Canadian Medical Directory as practising obstetricians/gynaecologists in Canada. Returned questionnaires were scanned into an Access database for simple descriptive analyses. Responses were received from 766 physicians. Of these 766 respondents, 604 physicians indicated they continued to practise obstetrics and supplied information that was usable in the analysis. The majority of the 604 respondents (85.6%) reported that they would recommend transvaginal ultrasound only in pregnant women with 1 or more risk factors for preterm birth. Respondents were most likely to recommend a cerclage, and least unsure of their decision to do so, if the gestational age was less than 23 weeks, the cervical length was less than 1 cm, and additional risk factors for preterm birth were present. As gestational age and cervical length increased, respondents were less likely to recommend cerclage and more unsure of their decision to do so. The pattern of responses was similar for singleton and multiple pregnancies. The McDonald technique was favoured over the Shirodkar technique by 70.4% of the respondents who performed cervical cerclage procedures. Adjunctive antibiotics were used with cerclage by 52.5% and adjunctive tocolytics were employed by 37.4%. The majority (68.8%) of the respondents who performed cervical cerclage procedures stated that they would participate in a randomized controlled trial on the effectiveness of cerclage for a sonographically revealed short cervix. In the case of a short cervix determined by ultrasound, there is significant uncertainty surrounding the decision whether to place a cerclage and considerable variation in the clinical practice on its placement. In the absence of good evidence to guide clinical practice, a randomized controlled trial is being planned.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2006
A shortened cervix is often considered to be equivalent to cervical insufficiency, and a cerclage... more A shortened cervix is often considered to be equivalent to cervical insufficiency, and a cerclage may be offered as an intervention to prolong pregnancy; however, we may not be differentiating between true cervical insufficiency and intrauterine causes of cervical shortening. A recent meta-analysis found no significant reduction in preterm birth < 35 weeks' gestation in women with cerclage compared with no cerclage in the total population of women studied. However, there was a potentially significant reduction in preterm birth < 35 weeks among women with a singleton pregnancy (relative risk [RR] 0.74; 95% confidence intervals [CI] 0.57-0.96), with a singleton pregnancy and a previous preterm birth (RR 0.61; 95% CI 0.40-0.92), and with a singleton pregnancy with a previous mid-trimester loss (RR 0.57; 95% CI 0.33-0.99). An increase was found in preterm birth among twin gestations with cerclage placed for a shortened cervix on transvaginal ultrasound (RR 2.15; 95% CI 1.15-4....
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2004
Significant fetomaternal hemorrhage (FMH) is an uncommon event that places the fetus at risk of s... more Significant fetomaternal hemorrhage (FMH) is an uncommon event that places the fetus at risk of severe morbidity and mortality. Symptoms and signs at presentation are subtle and, if promptly recognized, appropriate management may permit the fetus to escape serious injury. Four cases of significant FMH were diagnosed in the high-risk obstetrical unit at Mount Sinai Hospital, Toronto, during 2003. Three of the women complained of reduced fetal movements and were investigated initially with a non-stress test, a Kleihauer-Betke test, and ultrasound, including Doppler of the middle cerebral artery. These women all required emergency Caesarean section for non-reassuring fetal status. One fetus was treated by intravascular transfusion. Another identified case was transfused postnatally. One asymptomatic case was identified after spontaneous vaginal birth and also treated by neonatal transfusion. Neurological outcomes were good in all four cases. Reduced fetal movements may be the only comp...
To determine whether the diagnosis of polycystic ovary syndrome (PCOS) independently predicts inc... more To determine whether the diagnosis of polycystic ovary syndrome (PCOS) independently predicts increased rates of pregnancy complications relative to control subjects, after adjusting for important confounders. Retrospective cohort. A single university-affiliated reproductive endocrinology unit. A review of all pregnancies after fresh IVF with or without intracytoplasmic sperm injection transfers from December 2006 to 2012 (n = 1,084) identified 394 eligible singleton births (71 women with PCOS; 323 controls without). None. Singleton births were assessed for selected adverse pregnancy and birth outcomes. Women with PCOS demonstrated a higher risk of developing the following pregnancy complications after adjusting for differences in age, parity, body mass index, and time to conception: gestational diabetes (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.35-7.33), hypertensive disorders of pregnancy (AOR 4.25, 95% CI 1.94-9.32), preterm birth <37 weeks (AOR 2.30, 95%...
Journal of Obstetrics and Gynaecology Canada Jogc Journal D Obstetrique Et Gynecologie Du Canada Jogc, Feb 1, 2012
OBJECTIVE: Abnormal serum screening markers have been associated with adverse pregnancy outcomes.... more OBJECTIVE: Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation.DATA SOURCES AND STUDY SELECTION: Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes.DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three relatively homogeneous studies on prediction of PET, and two on prediction of SGA were meta-analyzed. Several single studies demonstrated utility in combining markers to predict adverse outcome; however, this effect was not confirmed after meta-analysis. The most common combination of markers evaluated was alpha fetoprotein and human chorionic gonadotrophin for all outcomes. The highest positive likelihood ratios for predicting PET (5.68; 95% CI 0.73 to 43.97) and SGA (6.18; 95% CI 1.84 to 20.85) were seen with combined alpha fetoprotein and human chorionic gonadotrophin (> 2.5 multiples of the median).CONCLUSIONS: Currently, no identifiable combination of serum markers performs well as a screening test for preeclampsia, small for gestational age, and stillbirth beyond 24 weeks. Large cohort studies with standardized screening test parameters and outcomes are needed.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014
To evaluate the ability of sonographers to prospectively identify intracranial translucency and p... more To evaluate the ability of sonographers to prospectively identify intracranial translucency and posterior brain structures at 11 to 13 weeks and to evaluate measurement reproducibility of brain stem and brain stem-occipital bone diameters on stored images. After specific training for intracranial translucency visualization, 10 nonphysician sonographers prospectively identified intracranial translucency at the 11- to 13-week scan, noting whether intracranial translucency was present, absent, or uncertain. If absent/uncertain, they documented the reason as spina bifida or an inadequate image (with reasons for the inadequate image). Measurements of brain stem and brain stem-occipital bone diameters were performed on stored images. Fifty randomly selected cases were reviewed for intraobserver and interobserver variability. In 313 singleton pregnancies, the posterior brain including intracranial translucency was evaluated; 293 (93.6%) had known pregnancy outcomes. None had open spina bif...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013
To describe the current investigation and management of non-immune fetal hydrops, with a focus on... more To describe the current investigation and management of non-immune fetal hydrops, with a focus on treatable or recurring etiologies. To provide better counselling and management in cases of prenatally diagnosed non-immune hydrops. Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2011 using key words (non-immune hydrops fetalis, fetal hydrops, fetal therapy, fetal metabolism). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, observational studies, and significant case reports. Additional publications were identified from the bibliographies of these articles. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collecti...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010
To assess women's knowledge of and views on the evaluation and reporting of ultrasound soft m... more To assess women's knowledge of and views on the evaluation and reporting of ultrasound soft markers. A prospective survey of 263 women undergoing 18 to 20 week anatomy ultrasound examination at Mount Sinai Hospital, a level 3 perinatal referral centre for a multi-ethnic population of approximately 2.5 million. Prior to reading an information pamphlet provided in the context of this survey, 30% of women (79/263) reported having heard of the term soft marker and 59% of these women (47/79) had discussed soft markers with their caregiver. When asked their preferences about the reporting of ultrasound soft markers, 53% of women said that soft markers should be reported routinely, 20% said they should be reported when the caregiver thinks it necessary, and 23% preferred they be reported only when they have been discussed prior to the ultrasound examination. A minority of respondents (8%) had not participated in prenatal screening for aneuploidy. All of these women preferred that soft ...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012
Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought ... more Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation. Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes. Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three rela...
We report the prenatal findings in two cases of Beals syndrome. Both pregnancies presented with c... more We report the prenatal findings in two cases of Beals syndrome. Both pregnancies presented with clinical features of arthrogryposis multiplex congenita/fetal akinesia syndrome (AMC/FAS), including clenched fists and multiple joint contractures on repeat prenatal ultrasound examinations. The first case was diagnosed as having Beals syndrome on physical examination shortly after birth and the diagnosis was confirmed by DNA analysis, shown as a point mutation in the fibrillin 2 (FBN2) gene. The second case was diagnosed with Beals syndrome following microarray analysis on amniocytes, which showed a deletion of the FBN2 gene. Although most cases with AMC/FAS carry a poor prognosis, Beals syndrome is consistent with normal cognitive development and a better prognosis. Thus, making the correct diagnosis is crucial, both pre- and postnatally, for accurate counseling and management.
To determine the visualization rates of fetal anatomic structures by three-dimensional ultrasound... more To determine the visualization rates of fetal anatomic structures by three-dimensional ultrasound (3DUS) at 12-13 weeks of gestation. This was a prospective observational study of women presenting for nuchal translucency ultrasound. Five 3D volumes of the fetus were acquired transabdominally. Two investigators independently reviewed the stored volumes offline following a standardized protocol. One hundred singleton fetuses were examined. The mean time for 3D volumes acquisition was 4.8 min; and for 3D review 17 min. Anatomic structures were seen as follows: cranium, lateral cerebral ventricles and abdominal wall 100%; stomach, vertebrae, upper and lower limbs &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 94%; face 71%, bladder 58%, both kidneys 39%, skin overlying spine 26% and heart 18%. Agreement between two observers ranged from 100% (for head, abdominal wall and lower limbs) to 43% (for visualization of skin overlying spine). A complete basic anatomic survey was achieved in 11.4% of the 12-week fetuses and 33.3% of the 13-week fetuses (p-value = 0.038). First-trimester transabdominal 3DUS was adequate for assessment of the head, abdominal wall, stomach, limbs and vertebral alignment. It was less effective for evaluating the heart and intactness of the skin over the spine.
This study aimed to assess the quantitative impact of maternal weight discrepancy on the screen r... more This study aimed to assess the quantitative impact of maternal weight discrepancy on the screen result for Down syndrome when using Integrated Prenatal Screening and First Trimester Combined Screening. The study population consisted of 78,165 women undergoing prenatal screening in Ontario, Canada, and 158 pregnancies affected with Down syndrome at one Ontario center. The study assessed quantitative alterations of the multiple of the median values of first and second-trimester serum markers and the risks of Down syndrome at a set of theoretical weight discrepancies. Weight discrepancies have the greatest impact on screening results when the initial risk is close to the risk cut-off. When the weight discrepancy is 5 lb or greater and the denominator of the initial risk is within 50 of the risk cut-off, the chance that a screen result will change from positive to negative or from negative to positive is 47-55% for women undertaking Integrated Prenatal Screening. This chance is 33-43% for women undertaking First Trimester Combined Screening. A weight discrepancy of five or more pounds has a significant impact on the risk of Down syndrome; correction of maternal weight would improve the accuracy of the screening test.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012
Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought ... more Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation. Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes. Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three rela...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2004
(1) To elucidate the views of obstetricians with respect to the use of transvaginal ultrasound in... more (1) To elucidate the views of obstetricians with respect to the use of transvaginal ultrasound in general, and, specifically, for determining cervical length, and the conditions under which obstetricians would employ cervical cerclage based on a sonographically revealed shortened cervix; and (2) to determine the possibility of a randomized controlled trial on the use of cervical cerclage in this situation. A 7-item questionnaire in French and English was designed and pretested. Questionnaires were mailed to 1421 physicians identified in the Canadian Medical Directory as practising obstetricians/gynaecologists in Canada. Returned questionnaires were scanned into an Access database for simple descriptive analyses. Responses were received from 766 physicians. Of these 766 respondents, 604 physicians indicated they continued to practise obstetrics and supplied information that was usable in the analysis. The majority of the 604 respondents (85.6%) reported that they would recommend transvaginal ultrasound only in pregnant women with 1 or more risk factors for preterm birth. Respondents were most likely to recommend a cerclage, and least unsure of their decision to do so, if the gestational age was less than 23 weeks, the cervical length was less than 1 cm, and additional risk factors for preterm birth were present. As gestational age and cervical length increased, respondents were less likely to recommend cerclage and more unsure of their decision to do so. The pattern of responses was similar for singleton and multiple pregnancies. The McDonald technique was favoured over the Shirodkar technique by 70.4% of the respondents who performed cervical cerclage procedures. Adjunctive antibiotics were used with cerclage by 52.5% and adjunctive tocolytics were employed by 37.4%. The majority (68.8%) of the respondents who performed cervical cerclage procedures stated that they would participate in a randomized controlled trial on the effectiveness of cerclage for a sonographically revealed short cervix. In the case of a short cervix determined by ultrasound, there is significant uncertainty surrounding the decision whether to place a cerclage and considerable variation in the clinical practice on its placement. In the absence of good evidence to guide clinical practice, a randomized controlled trial is being planned.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2006
A shortened cervix is often considered to be equivalent to cervical insufficiency, and a cerclage... more A shortened cervix is often considered to be equivalent to cervical insufficiency, and a cerclage may be offered as an intervention to prolong pregnancy; however, we may not be differentiating between true cervical insufficiency and intrauterine causes of cervical shortening. A recent meta-analysis found no significant reduction in preterm birth < 35 weeks' gestation in women with cerclage compared with no cerclage in the total population of women studied. However, there was a potentially significant reduction in preterm birth < 35 weeks among women with a singleton pregnancy (relative risk [RR] 0.74; 95% confidence intervals [CI] 0.57-0.96), with a singleton pregnancy and a previous preterm birth (RR 0.61; 95% CI 0.40-0.92), and with a singleton pregnancy with a previous mid-trimester loss (RR 0.57; 95% CI 0.33-0.99). An increase was found in preterm birth among twin gestations with cerclage placed for a shortened cervix on transvaginal ultrasound (RR 2.15; 95% CI 1.15-4....
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2004
Significant fetomaternal hemorrhage (FMH) is an uncommon event that places the fetus at risk of s... more Significant fetomaternal hemorrhage (FMH) is an uncommon event that places the fetus at risk of severe morbidity and mortality. Symptoms and signs at presentation are subtle and, if promptly recognized, appropriate management may permit the fetus to escape serious injury. Four cases of significant FMH were diagnosed in the high-risk obstetrical unit at Mount Sinai Hospital, Toronto, during 2003. Three of the women complained of reduced fetal movements and were investigated initially with a non-stress test, a Kleihauer-Betke test, and ultrasound, including Doppler of the middle cerebral artery. These women all required emergency Caesarean section for non-reassuring fetal status. One fetus was treated by intravascular transfusion. Another identified case was transfused postnatally. One asymptomatic case was identified after spontaneous vaginal birth and also treated by neonatal transfusion. Neurological outcomes were good in all four cases. Reduced fetal movements may be the only comp...
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