Speciality
Spotlight

 




 

Obstetric & Gynaecology

 

 




Ultrasound

   

  • Aaron B Caughey, Deirdre J Lyell, Roy A Filly et al (San Francisco and Stanford, Calif)

    The impact of the use of the isolated echogenic intracardiac focus as a screen for Down Syndrome in women under the age of 35 years.

    Am J Obstet & Gynecol, Nov.2001, 185(5):pg.1021-7

      

    Objective: The purpose of this study was to determine the public health impact of the routine offering of amniocentesis to women under the age of 35 years who have an isolated fetal echogenic intracardiac focus on second trimester ultrasound scan.

      

    Study Design: A decision analytic model was designed that compared the accepted standard of second trimester triple marker screen for Down syndrome to a policy in which amniocentesis with an isolated echogenic intracardiac focus on ultrasound in addition to the triple marker screen is offered to all women in the United States who are <35 years of age. A sensitivity of 20%, an echogenic intracardiac foucs screen positive rate of 5%, and a risk of Down syndrome of 1:1000 were assumed. A sensitivity analysis was performed that varied the screen positive rate, the sensivity of echogenic intracardiac focus for Down syndrome, and the prescreen risk for Down syndrome in the population.

      

    Conclusion: Although the echogenic intracardiac focus appears to be associated with a small increased risk of Down syndrome, its use as a screening tool in low-risk populations would lead to a large number of amniocenteses and miscarriages to identify a small number of Down syndrome fetuses.

           

  • James F X Egan, Lillian Malakh,et al (Farmington and Hartford, Conn, and Springfield, Mass)

    Role of ultrasound for Down syndrome screening in advanced maternal age.

    Am J Obstet Gynecol, Nov.2001, Vol.185(5), pg.1028-31.

      

    Objective: To determine the sensitivity and false-positive rate of Down syndrome screening by use of maternal serum and the genetic sonogram in women ³35 years of age.

      

    Study Design: Authors searched perinatal databases retrospectively from January 1992 to January 2000 for the following criteria: known Down syndrome fetus or newborn, advanced maternal age, and genetic sonogram from 14-24 weeks’ gestation. The a priori maternal age or maternal serum screen risk was modified by likelihood ratios for ultrasound markers. Without markers the risk was reduced by 50%. The cut-off was 1:270.

      

    Results: Age and maternal serum had a sensitivity of 90.5% and a false-positive rate of 27.1%. Age and ultrasound had a 95.2% sensitivity and 43.5% false-positive rate, whereas the combination of age, maternal serum screen, and ultrasound had a 97.6% sensitivity and a 22.0% false positive rate.

      

    Conclusion: The combination of age, maternal serum screen, and ultrasound improves the sensitivity for Down syndrome detection in the advanced maternal age population.

       

  • Huda B Al-Koualty, Stephen T Chasen, et al (New York, NY)

    The clinical significance of fetal echogenic bowel

    Am J Obstet Gynecol, Nov.2001, 185: 1035-8

      

    Objective: The purpose of this study was to determine the incidence of cystic fibrosis, aneuploidy, and intrauterine infection with toxoplasmosis and cytomegalovirus in second-trimester fetuses with the sonogrpahic finding of echogenic bowel.

      

    Study Design: All cases of echogenic bowel that were diagnosed in ultrasound unit from 1993 to 2000 were identified. Only cases in which bowel echogenicity was as bright as bone with no associated major fetal anomalies were included. Patients who were referred from other hospitals were excluded. Echogenicity was classified as focal or multifocal. Fetal karyotypes, cystic fibrosis carrier testing, and maternal serologic test results were determined.

      

    Results: One hundred seventy-five fetuses in 171 pregnancies met inclusion criteria. Cystic fibrosis mutations were identified in 7 of 138 mothers (5%) and 9 of 86 fathers (10.5%) who were tested. Five fetuses were affected with cystic fibrosis. Fetal karyotype was obtained in 139 cases, and autosomal trisomy was diagnosed in 5 cases (3.6%). One hundred sixty-six patients were tested for toxoplasmosis, and 111 patients were tested for cytomegalovirus. There were no cases of congenial toxoplasmosis. There was maternal serologic and fetal pathologic evidence of cytomegalovirus infection in 1 case. In all cases of cystic fibrosis and aneuploidy, echogenicity was multifocal; in the case of cytomegalovirus, echogenicity was focal.

      

    Conclusion: Mid-trimester fetal echogenic bowel was associated with a high prevalence of cystic fibrosis, aneuploidy, and cytomegalovirus (11/175 fetuses {6.3%}). This information should be considered when counseling patients after mid-trimester echogenic bowel is diagnosed.

        

  • Huda B Al-Koualty, Stephen T Chasen, et al (New York)

    Factors associated with fetal demise in fetal echogenic bowel.

    Am J Obstet Gynecol, Nov.2001; vol.185: 1039-43

      

    Objective: The purpose of this study was to determine risk factors associated with intrauterine fetal demise in fetuses with unexplained echogenic bowel that is diagnosed in the second trimester.

      

    Study Design: A retrospective case-control study compared fetuses with echogenci bowel and fetal demise with fetuses with echogenic bowel who were live born. Fetuses affected with cystic fibrosis, aneuploidy, or congenital infection and fetuses diagnosed with major anomalies were excluded. Variables examined in the determination of risk factors for intrauterine fetal demise included intrauterine growth restriction, oligohydramnios, elevated maternal serum alpha-fetoprotein levels, and elevated maternal serum b-hCG levels. Statistical analysis was performed with the Fisher exact test, Student t test, and logistic regression analysis.

       

    Results: One hundred fifty-six fetuses met the inclusion criteria. There were 9 cases of intrauterine fetal demise and 147 live born control fetuses. The median gestational age of intrauterine fetal demise was 22.0 weeks (range, 17-39 weeks). Intrauterine growth restriction occurred more frequently in cases of intrauterine fetal demise than in live born infants (22.2% vs 0.7%); P=.009), as did oligohydramnios (44.4% vs 2.0%; P <.001) and elevated maternal serum alpha-fetoprotein levels (80.0%vs 7.7%; P=.001). With the use of logistic regression analysis, elevated maternal serum alpha-fetoprotein was the strongest independent risk factor that was associated with intrauterine fetal demise (odds ratio, 39.48; 95% Cl, 11.04%-141.25%).

      

    Conclusion: There was a 5.8% incidence of intrauterine fetal demise in fetuses with unexplained echogenic bowel. Elevated maternal serum alpha-fetoprotein is the strongest predictor of fetal demise in fetal echogenic bowel.

         

      



 

 

Speciality Spotlight

 

 

Ultrasound
   

  • Aaron B Caughey, Deirdre J Lyell, Roy A Filly et al (San Francisco and Stanford, Calif)
    The impact of the use of the isolated echogenic intracardiac focus as a screen for Down Syndrome in women under the age of 35 years.
    Am J Obstet & Gynecol, Nov.2001, 185(5):pg.1021-7
      
    Objective: The purpose of this study was to determine the public health impact of the routine offering of amniocentesis to women under the age of 35 years who have an isolated fetal echogenic intracardiac focus on second trimester ultrasound scan.
      
    Study Design: A decision analytic model was designed that compared the accepted standard of second trimester triple marker screen for Down syndrome to a policy in which amniocentesis with an isolated echogenic intracardiac focus on ultrasound in addition to the triple marker screen is offered to all women in the United States who are <35 years of age. A sensitivity of 20%, an echogenic intracardiac foucs screen positive rate of 5%, and a risk of Down syndrome of 1:1000 were assumed. A sensitivity analysis was performed that varied the screen positive rate, the sensivity of echogenic intracardiac focus for Down syndrome, and the prescreen risk for Down syndrome in the population.
      
    Conclusion: Although the echogenic intracardiac focus appears to be associated with a small increased risk of Down syndrome, its use as a screening tool in low-risk populations would lead to a large number of amniocenteses and miscarriages to identify a small number of Down syndrome fetuses.
           

  • James F X Egan, Lillian Malakh,et al (Farmington and Hartford, Conn, and Springfield, Mass)
    Role of ultrasound for Down syndrome screening in advanced maternal age.
    Am J Obstet Gynecol, Nov.2001, Vol.185(5), pg.1028-31.
      
    Objective: To determine the sensitivity and false-positive rate of Down syndrome screening by use of maternal serum and the genetic sonogram in women ³35 years of age.
      
    Study Design: Authors searched perinatal databases retrospectively from January 1992 to January 2000 for the following criteria: known Down syndrome fetus or newborn, advanced maternal age, and genetic sonogram from 14-24 weeks’ gestation. The a priori maternal age or maternal serum screen risk was modified by likelihood ratios for ultrasound markers. Without markers the risk was reduced by 50%. The cut-off was 1:270.
      
    Results: Age and maternal serum had a sensitivity of 90.5% and a false-positive rate of 27.1%. Age and ultrasound had a 95.2% sensitivity and 43.5% false-positive rate, whereas the combination of age, maternal serum screen, and ultrasound had a 97.6% sensitivity and a 22.0% false positive rate.
      
    Conclusion: The combination of age, maternal serum screen, and ultrasound improves the sensitivity for Down syndrome detection in the advanced maternal age population.
       

  • Huda B Al-Koualty, Stephen T Chasen, et al (New York, NY)
    The clinical significance of fetal echogenic bowel
    Am J Obstet Gynecol, Nov.2001, 185: 1035-8
      
    Objective: The purpose of this study was to determine the incidence of cystic fibrosis, aneuploidy, and intrauterine infection with toxoplasmosis and cytomegalovirus in second-trimester fetuses with the sonogrpahic finding of echogenic bowel.
      
    Study Design: All cases of echogenic bowel that were diagnosed in ultrasound unit from 1993 to 2000 were identified. Only cases in which bowel echogenicity was as bright as bone with no associated major fetal anomalies were included. Patients who were referred from other hospitals were excluded. Echogenicity was classified as focal or multifocal. Fetal karyotypes, cystic fibrosis carrier testing, and maternal serologic test results were determined.
      
    Results: One hundred seventy-five fetuses in 171 pregnancies met inclusion criteria. Cystic fibrosis mutations were identified in 7 of 138 mothers (5%) and 9 of 86 fathers (10.5%) who were tested. Five fetuses were affected with cystic fibrosis. Fetal karyotype was obtained in 139 cases, and autosomal trisomy was diagnosed in 5 cases (3.6%). One hundred sixty-six patients were tested for toxoplasmosis, and 111 patients were tested for cytomegalovirus. There were no cases of congenial toxoplasmosis. There was maternal serologic and fetal pathologic evidence of cytomegalovirus infection in 1 case. In all cases of cystic fibrosis and aneuploidy, echogenicity was multifocal; in the case of cytomegalovirus, echogenicity was focal.
      
    Conclusion: Mid-trimester fetal echogenic bowel was associated with a high prevalence of cystic fibrosis, aneuploidy, and cytomegalovirus (11/175 fetuses {6.3%}). This information should be considered when counseling patients after mid-trimester echogenic bowel is diagnosed.
        

  • Huda B Al-Koualty, Stephen T Chasen, et al (New York)
    Factors associated with fetal demise in fetal echogenic bowel.
    Am J Obstet Gynecol, Nov.2001; vol.185: 1039-43
      
    Objective: The purpose of this study was to determine risk factors associated with intrauterine fetal demise in fetuses with unexplained echogenic bowel that is diagnosed in the second trimester.
      
    Study Design: A retrospective case-control study compared fetuses with echogenci bowel and fetal demise with fetuses with echogenic bowel who were live born. Fetuses affected with cystic fibrosis, aneuploidy, or congenital infection and fetuses diagnosed with major anomalies were excluded. Variables examined in the determination of risk factors for intrauterine fetal demise included intrauterine growth restriction, oligohydramnios, elevated maternal serum alpha-fetoprotein levels, and elevated maternal serum b-hCG levels. Statistical analysis was performed with the Fisher exact test, Student t test, and logistic regression analysis.
       
    Results: One hundred fifty-six fetuses met the inclusion criteria. There were 9 cases of intrauterine fetal demise and 147 live born control fetuses. The median gestational age of intrauterine fetal demise was 22.0 weeks (range, 17-39 weeks). Intrauterine growth restriction occurred more frequently in cases of intrauterine fetal demise than in live born infants (22.2% vs 0.7%); P=.009), as did oligohydramnios (44.4% vs 2.0%; P <.001) and elevated maternal serum alpha-fetoprotein levels (80.0%vs 7.7%; P=.001). With the use of logistic regression analysis, elevated maternal serum alpha-fetoprotein was the strongest independent risk factor that was associated with intrauterine fetal demise (odds ratio, 39.48; 95% Cl, 11.04%-141.25%).
      
    Conclusion: There was a 5.8% incidence of intrauterine fetal demise in fetuses with unexplained echogenic bowel. Elevated maternal serum alpha-fetoprotein is the strongest predictor of fetal demise in fetal echogenic bowel.
         

      

 

By |2022-07-20T16:44:29+00:00July 20, 2022|Uncategorized|Comments Off on Ultrasound

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