Nikki Koklanaris

Blind vaginal fetal fibronectin as a predictor of spontaneous preterm delivery.

OBJECTIVE: To assess the accuracy of vaginal fetal fibronectin sampling without use of a sterile speculum examination as a screening test for predicting spontaneous preterm birth. METHODS: A historical cohort of patients who were followed up with serial fetal fibronectin testing between 1998 and 2001 was identified. All patients were considered to be at high risk for preterm delivery and were screened with fetal fibronectin testing without using a speculum at 2- to 3-week intervals from 22 weeks to 32 weeks of gestation. Charts were reviewed for fetal fibronectin results and pregnancy outcome data. Groups were compared using χ2 analysis or Fisher exact test with significance defined as P < .05. RESULTS: A total of 1,396 fetal fibronectin tests from 416 pregnancies were performed via the “blind” sampling technique. Overall, 24.9% of pregnancies delivered spontaneously before 37 weeks; 9.1% delivered spontaneously before 34 weeks. For delivery before 34 weeks of gestation, the test had a sensitivity of 44.7%, a specificity of 88.4%, a positive predictive value of 27.9%, and a negative predictive value of 94.1%. For delivery within 14 and 21 days of a single fetal fibronectin assessment, the test had a sensitivity of 52% and 45.5%, a specificity of 94.5% and 94.9%, a positive predictive value of 14.6% and 22.5%, and a negative predictive value of 99.1% and 98.2%, respectively. CONCLUSION: “Blind” vaginal fetal fibronectin sampling has high negative predictive values and specificities in predicting spontaneous preterm birth. LEVEL OF EVIDENCE: II-2

Debate Preparation/Participation: An Active, Effective Learning Tool

Background: Passive educational techniques (such as lectures) are thought to be less productive than active learning. Purpose: We examined whether preparing for and participating in a debate would be an effective, active way to learn about a controversial topic. Methods: We compared quiz performance in residents who attended a lecture to residents who prepared for/participated in a debate. Twelve residents each participated in one lecture session and one debate session. Learning was evaluated via a quiz. Quizzes were given twice: before the debate/lecture and 1 week after the debate/lecture. Quiz scores were compared using repeated measures analysis of variance, with a p value of < .05 considered significant. A survey evaluating the usefulness of debating was given to all participants. Results: There was a statistically significant difference in the pretest mean quiz score between the debate and lecture groups: 78.3% and 52.5%, respectively ( p = .02). Similarly, on posttest quizzes, the average debater scored 85.8%, versus 61.7% for the lecture group ( p = .003). Although no one in the debate group scored lower on a follow-up quiz, 3 residents in the lecture group did worse on follow-up. Conclusions: When learning about a controversial topic, residents who prepared for/participated in a debate achieved higher quiz scores and were better at retaining information than those who attended a lecture. When faced with teaching a controversial topic, organizing a debate may be more effective than giving a lecture.

Isolated echogenic intracardiac foci in patients with low-risk triple screen results: assessing the risk of trisomy 21.

Abstract Objective: While an echogenic intracardiac focus (EIF) is associated with an increased risk of trisomy 21 (T21), the magnitude of that risk remains controversial, particularly in the setting of a low-risk triple screen (TS). The objective of this study is to define the risk of T21 in patients with a low-risk TS and an isolated EIF. Study design: A retrospective analysis was performed on patients presenting prior to 22 6/7 weeks of gestation. Patients met criteria for inclusion if an EIF was noted, a TS had been drawn, the anatomic survey was complete and was determined to be normal, and karyotyping or delivery occurred at Bellevue Hospital. A high-risk TS was defined as a risk of <1:500, assuming a 2-fold increased risk in the setting of an isolated EIF. A low-risk TS was defined as a risk of >1:500. Statistical analysis was performed using chi-square, with p values of <0.05 considered significant. Results: 7,318 anatomic surveys were performed. An EIF was identified in 584 patients (7.98%), of which 391 met the criteria for inclusion. Of the 391, 51% were Asian and 38% were Hispanic; 348 had a low-risk TS and 43 had a high-risk TS. Patients with an EIF and a low-risk TS had a significantly lower risk of having a T21 pregnancy compared to those with a high-risk TS and an EIF (0 vs. 2.3%; p=0.004). Conclusion: An isolated EIF with a low risk TS is not associated with an increased risk of T21.

Preoperative magnetic resonance imaging and antepartum myomectomy of a giant pedunculated leiomyoma.

BACKGROUND: Antepartum myomectomy is reserved for severe pain and prevention of fetal complications. Magnetic resonance imaging has been useful in nonpregnant women for preoperative management and patient counseling. CASE: A primigravida was admitted at 12 weeks of gestation in severe acute abdominal pain with a large abdominal mass, confirmed by magnetic resonance imaging to be a pedunculated 30×27×19–cm uterine leiomyoma. An uncomplicated abdominal myomectomy was performed, incorporating a flat cup vacuum device to mobilize the mass without disturbing the gravid uterus. The patient later had an uncomplicated term vaginal delivery and healthy newborn. CONCLUSION: Magnetic resonance imaging and a flat cup vacuum device were helpful in preoperative planning and performing an uncomplicated abdominal myomectomy during pregnancy, respectively.

Does raising the glucose challenge test threshold impact birthweight in Asian gravidas

Abstract Objective: Some authors suggest a glucose challenge test (GCT) threshold of 150 mg/dL in Asian gravidas. The impact of such a policy on outcomes is unknown. Study Design: A retrospective cohort of 1705 Asian gravidas. Subjects (n=95) had a GCT of 140–150 mg/dL and underwent a 3-h glucose tolerance test (GTT). Matched controls (n=190) had a GCT of <140 mg/dL. Birthweight was the primary outcome and the secondary outcomes were cesarean delivery (CD) rate and macrosomia. Results: Eight subjects (11.9%) had gestational diabetes mellitus (GDM); none had GTT fasting values of >90 mg/dL. Mean birthweight was 3282 g in the subjects and 3238 g in the controls (P=0.39). There were no significant differences in the secondary outcomes. Conclusion: Compared with controls, study patients did not deliver significantly larger infants. However, raising the GCT threshold would have missed 8 subjects (11.9%) with GDM. Raising the GCT threshold to 150 mg/dL in Asian gravidas may unacceptably lower the sensitivity of the screening test.