Robert K. Silverman

Constriction Rings and Congenital Amputations of the Fingers and Toes in a Mild Case of Amniotic Band Syndrome

Amniotic band syndrome (ABS) may result in fetal anomalies that vary in severity from minor to lethal. Although numerous conditions have been grouped with this diagnosis, a subset of this population will have no other intrauterine abnormalities other than isolated defects of the extremities. ABS may present as constriction rings and congenital amputation affecting the limbs and digits. Routine sonographic evaluation of the fetus in the second trimester can identify the major defects associated with ABS. Detailed evaluation of the fetal extremities, including views of the hands and feet, will increase the detection of minor defects.

Risk factors in premature rupture of membranes.

Objective: This retrospective study was undertaken to investigate risk factors in women who have preterm premature rupture of membranes. This information will aid the clinician in targeting at-risk women for intensified obstetric care and entry into prevention programs.Methods: 28,725 deliveries were analyzed over a 16-month time frame (January 1, 1995-April 30, 1996). These data were collected via a 14 county, 23 hospital population based Perinatal Data System. The associations between premature rupture of membranes and risk factors were analyzed using chi(2) and Fishers Exact test analyses. Odds ratios show the magnitude of these associations.Results: Risk factors included vaginal bleeding, tobacco usage, multiple births, polyhydramnios, maternal age <20 years and >34 years, congenital malformations, parity, race, in vitro fertilization, sexually transmitted disease, prior preterm delivery, and incompetent cervix. Premature rupture of membranes shows a significant association with prior preterm delivery, prior history of a low birth weight infant, incompetent cervix, tobacco use (12 pack per day), multiple births, parity, in vitro fertilization, sexually transmitted diseases, and viral diseases, P <.001 (for all of these risk factors), polyhydramnios and non-white race, P <.01.Conclusions: These associations help to develop a picture of the patient at risk for premature rupture of membranes. Strategies can be better developed to enter high-risk patients into prevention programs to maximize pregnancy outcomes.

It Takes At Least Two: Male Partner Factors, Racial/Ethnic Disparity, and Chlamydia trachomatis Among Pregnant Women

Chlamydia trachomatis (CT), the most prevalent sexually transmitted infection in the United States, disproportionately infects women and people of color. This study aimed to identify risk factors for racial and ethnic disparities for CT infection, re-infection, and persistent infection among pregnant women. We present a secondary analysis of births from a retrospective cohort study in Syracuse, NY from January 2000 through March 2002. African American women [OR 3.35 CI (2.29, 4.92)], Latin American women [OR 4.35 CI (2.52, 7.48)], unmarried women [OR 7.57 CI (4.38, 13.10)], and teen mothers [OR 3.87 CI (2.91, 5.16)] demonstrated statistically significant increased risk for infection. In multivariate analyses that included male partner variables, fathers race/ethnicity but not the mothers race/ethnicity remained statistically associated with CT. Despite near universal rates of screening pregnant women, challenges to CT control remain and reflect barriers to testing and treatment of male partners.

Exploring 3-Dimensional Imaging Techniques in the Prenatal Interrogation of Cebocephaly

Cebocephaly is a very rare craniofacial abnormality defined by a tubular nose with a single median nostril and ocular hypotelorism noted almost exclusively in association with alobar holoprosencephaly. Because of the additional presence of a median cleft lip, this case report may represent a transitional form of facial dysmorphism in the well-established spectrum of facial defects associated with holoprosencephaly. Three-dimensional (3D) sonographic evaluation of this condition allows for the opportunity to reconstruct the imaging planes not obtainable by traditional 2-dimensional (2D) scanning. Volume slicing is particularly useful in the interrogation and diagnosis of the intracranial and facial anomalies characteristic of cebocephaly. This technique allows for the manipulation of the slice depth and thickness to optimize depiction of the targeted intracranial and facial structures.

The effects of in vitro fertilization on subsequent pregnancy outcome.

Objective: The purpose of this study was to look at the effects of assisted reproductive technology on subsequent pregnancy outcome variables.Methods: This retrospective study was performed using the Regional Perinatal Data System, a population-based birth registry. The data system is used by all 23 hospitals in the 14-county region of Central New York. 42,656 births were analyzed from January 1, 1995 through December 31, 1996. The associations between in vitro fertilization and premature rupture of membranes (PROM), preterm delivery (PTD), age, gravidity, parity, and race were evaluated using chi(2) and Fishers two-tailed Exact analyses. Odds ratios represent the magnitude of the association.Results:Women undergoing in vitro fertilization were significantly more likely to experience PTD and PROM. They were significantly more likely to be nulliparous, primigravidas, or over the age of 34.Conclusions: This analysis shows a strong association between women who have undergone in vitro fertilization and adverse pregnancy outcomes including PROM and preterm delivery. This study suggests a need for intensified obstetric care and the assignment of high risk pregnancy status to those women who have undergone in vitro fertilization. This association has not been previously reported and underscores the need for a comprehensive data system to analyze adverse events within a region and develop strategies for prevention.

The effects of cigarette smoking on pulmonary function tests during pregnancy

Objective: The objective of this study was to determine what changes occur in pulmonary function testing in pregnant women who smoke versus nonsmokers.Methods: This was a prospective study. Pregnant women were recruited in all trimesters of pregnancy. A total of 34 women (15 smokers, 19 nonsmokers) were recruited. Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEVI), the ratio of FEVI to FVC, and maximum voluntary ventilation (MVV) were obtained.Results:Conclusions: This study confirms other studies that have seen no significant changes in FVC, FEVI, FEVI/FVC in pregnant smokers and nonsmokers. A significant worsening in MVV was seen in pregnant women who smoke. The pathophysiologic impact of this effect is unclear. However, since MVV is a measure of the bellows action of the chest, this may lead to a decrease in oxygenation during the active phase and the second stage of labor. This may lead to more abnormal fetal monitoring strips and possibly lower Apgar scores. Further investigation will be necessary to clarify the effects on pregnancy of lower MVV in patients who smoke.