Melvin V. Gerbie

Amniocentesis in genetic counseling: Safety and reliability in early pregnancy☆☆☆

Abstract Amniotic fluid obtained early in pregnancy has been utilized successfully to detect genetic defects of the fetus. Reliable cytologic, cytogenetic, and biochemical techniques have been developed. However, before such techniques can be utilized for patient management, the safety of transabdominal amniocentesis performed early in the second trimester of pregnancy must be established and the reliability further substantiated. Two hundred and thirty-eight pregnancies have been monitored utilizing amniotic fluid obtained by transabdominal amniocentesis between the thirteenth and eighteenth weeks of gestation. There was no evidence of maternal or fetal complications. These data and the experience of others suggest that transabdominal amniocentesis, performed early in pregnancy, carries a very low risk of either fetal or maternal complications. On the other hand, analysis of this fluid may eliminate the uncertainty in genetic counseling by identifying a fetus with a serious genetic defect.

Diagnosis of fetal maturity by amniotic fluid phospholipids

Abstract A lecithin/sphingomyelin (L/S) ratio of >1.75 indicates pulmonary maturity. With the use of thin-layer chromatography, the L/S ratio can be determined in about 1½ hours. The L/S ratio should be determined in those patients in whom there is doubt of fetal maturity and where elective termination of pregnancy is warranted. Creatinine determination is less helpful in our laboratory because of the wide range of values.

Pertussis disease in new mothers: Effect on young infants and strategies for prevention

Pertussis, or whooping cough, is a major public health problem in the United States, with the incidence of disease and its associated complications having significantly increased in the adolescent and adult populations. These populations serve as the major transmission source of the disease to young infants, a group that is at the highest risk of severe morbidity and mortality from the disease. Studies have shown that new parents, especially mothers, are the source of disease transmission in more than 50% of the cases. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis booster vaccines (Tdap) are licensed for use in adolescent and adult populations. The Centers for Disease Control and Prevention (CDC) recommends that the Tdap vaccine be given to postpartum women as soon as possible after delivery and before hospital discharge to protect them and their newborns against pertussis disease. The American College of Obstetricians and Gynecologists recommends that its membership follow the CDC recommendations. This article includes a further discussion of the rationale for this recommendation and provides possible strategies for vaccine implementation.

Cryosurgical treatment of cervical intraepithelial neoplasia: Four-year experience

Cryosurgical therapy was used to treat 393 patients with cervical intraepithelial neoplasia. Therapeutic success was evaluated in relation to lesion size, grade, and endocervical extension. The overall cure rate with cryosurgical therapy was 84%. Size alone was found to be the major determinant of cryosurgical success. For one-quadrant lesions, there was a 99% cure rate. For two-quadrant lesions, the cure rate was 93%. For three- or four-quadrant lesions, the success rate was only 61%. Lesion size was found to be positively correlated with grade of dysplasia. As the grade of cervical intraepithelial neoplasia progressed, lesion size tended to increase. When this association was controlled for, grade of dysplasia was not a significant determinant of success rate. When endocervical extension occurred, although the upper limits of the lesion were seen, there was a significantly reduced success rate of 64%. Patients with large lesions or endocervical extension are at a much higher risk for failure with cryosurgical treatment. If cryotherapy is chosen for these patients, careful, long-term follow-up is essential to ensure adequate treatment of disease.

Pertussis, a disease whose time has come: what can be done to control the problem?

In the United States, major epidemics of pertussis or whooping cough have occurred in the last 5 years making this disease a major public health issue. The adolescent and adult populations are the major transmitters of disease to the community. However, these epidemics have had the greatest effect on the young infant population resulting in high rates of hospitalizations and complications and accounting for 100% of the mortality. Optimization of vaccine recommendations is a strategy that is critically important as a method to control the disease burden and decrease the transmission of disease to the young infant population. Immunization that is focused on the close contacts of these young infants (the cocoon strategy) is felt to be one of the main cornerstones to vaccine optimization with the immunization of pregnant women being critical. Transmission studies have shown that adolescent and adult close contacts, especially new mothers, are the source of disease transmission to their young infants in more than 50% of the cases. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists strongly recommend that the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis booster vaccine be given to pregnant women during each pregnancy between 27 weeks and 36 weeks of gestation to protect their infant against pertussis disease.

Perception, Awareness, and Acceptance of Human Papillomavirus Disease and Vaccine among Parents of Boys Aged 9 to 18 Years

Male human papillomavirus (HPV) vaccination rates remain very low. The study objective was to gain an understanding of the perceptions of HPV disease and acceptance/barriers to HPV vaccine by parents of boys aged 9 to 18 years. An anonymous, written survey was administered from January 1, 2011 to September 30, 2013 in private pediatric offices (PPOs) and public health clinics (PHCs) in Chicago, Illinois. A total of 230 PPO parents (PPOPs) and 286 PHC parents (PHCPs) completed the survey. Despite significant differences (P < .0001) in education level, socioeconomic status, and HPV disease and vaccine knowledge/awareness between the PPOP and PHCP, there was no difference between PPOP and PHCP who would vaccinate their sons with HPV vaccine. For both groups, health care provider recommendation was the primary influence for vaccination. The major barrier to vaccination was lack of information on HPV disease/vaccine. Health care providers need to proactively discuss and use HPV vaccine in male patients.

Knowledge and Utilization of Recommended Preventative Vaccines among Young Adults

Background: Outbreaks of vaccine preventable diseases continue to be a problem, with recent epidemics of measles, pertussis and influenza causing notable morbidity and mortality. Recommended routine vaccination of the adult population has been low and sporadic. Objectives: To examine the awareness, perception of risk, and knowledge of common vaccine preventable diseases in young adults. To assess utilization of vaccines (e.g. HPV, T dap and influenza), primary care provider recommendation of vaccines, and preventive healthcare trends in order to identify potential barriers to vaccination. Methods: An anonymous, prospective survey of graduate students in Chicago. Results: Survey was completed by 2,582 students; 53.3% were female. Seventy-eight percent were 18-26 years of age; 23% of sexually active students did not use condoms. Ninety-five percent reported having health insurance, but 26% of males and 12% of females rarely or never sought routine medical care. Average knowledge scores were significantly higher for HPV than pertussis and influenza. Over 80% of students would be willing to ask their physician about vaccines. Fourteen percent of women and 9.4% of students had been vaccinated against HPV and pertussis respectively. Primary obstacles to vaccination were perception of not being at risk for disease, vaccine cost, and lack of time. Conclusions: Despite media attention about various vaccine preventable diseases, a general awareness and openness towards vaccination, and adequate access to healthcare, the majority of young adults are not being offered or receiving recommended vaccinations. Personal risk perception and cost are major obstacles. New and creative interventions to reduce barriers to young adult vaccination are necessary.

Elevated maternal serum α-fetoprotein associated with placenta accreta

Alpha-fetoprotein (AFP) was first detected by Bergstrand and Czar in the human fetus in 1956 (1). The work of Macri et al. (2) and the United Kingdom Collaborative Study on AFP in Relation to NeuralTube Defects (3) led to the 1986 recommendation of the American College of Obstetrics and Gynecology that maternal screening for AFP be made available to all pregnant women (4). Although the function of AFP is still not well understood, multiple associations have been made in the presence of elevated levels of maternal serum AFP (MSAFP). Elevations in MSAFP may signify a variety of other pregnancy complications in addition to neural-tube defects (5). In this report we describe an additional association, that of an elevated MSAFP with placenta accreta.