Serdar Ural

The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity

Objective: Our hypothesis was that the degree of antenatally diagnosed cerebral ventriculomegaly is related to aneuploidy, perinatal mortality and long-term neurological morbidity. Methods: Ninety-one cases of ventriculomegaly identified from 1 June 1994 to 1 July 1999 were examined for prenatal, intrapartum and neonatal complications. Pediatric follow-up was reviewed for infants with ventriculomegaly from birth up to as long as 4 years. Minor neurological morbidity was defined as a score of 70-80 on the clinical adaptive test/clinical linguistic and auditory milestone scale and included mild motor or language delay. Major morbidity included a score of < 70, evidence of cerebral palsy, or seizure disorder. The incidence of neurological complications was compared, on the basis of the degree of ventriculomegaly, with group 1 being > 10-15 mm and group 2 being > 15 mm. Results: Twenty-seven cases (18 with neural tube defects and nine with holoprosencephaly) were excluded. Among the remaining 64 patients, 39 had a ventricular diameter of > 10-15 mm and comprised group 1. Five of the 39 cases (12.8%), all with other ultrasound anomalies, elected to terminate. The incidence of aneuploidy in group 1 was 14.2%. Among the 19 cases with isolated ventriculomegaly, 17 (89%) were normal and two (11%) had minor neurological morbidity. In group 1 there were two cases associated with cytomegalovirus (CMV) infection. Of the 25 cases in group 2, eight (32%), all with other ultrasound anomalies, elected to terminate. The incidence of aneuploidy in group 2 was 17.4%. For the nine cases with isolated ventriculomegaly of > 15 mm, one (11%) was normal ( p < 0.001), five (56%) had minor neurological morbidity requiring a ventriculoperitoneal shunt ( p = 0.035), and three (33%) had major neurological morbidity ( p = 0.045) when compared to cases of isolated ventriculomegaly in group 1. There was one case of CMV infection in group 2. All perinatal deaths in both groups were associated with other anomalies. Conclusions: Amniocentesis to determine karyotype and the presence of CMV is warranted for all cases of ventriculomegaly of > 10 mm. The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity and, when it is > 15 mm, it is associated with an increase in abnormal neurological development.

Prevention of preterm birth by cervical cerclage compared with expectant management: a systematic review.

Our objective was to review the evidence on the use of cervical cerclage to prevent preterm births compared with expectant management. An OVID, MEDLINE, Cochrane Database, and Science Citation Index search using the medical subject headings and terms “cervical cerclage,” “cervical incompetence” and “preterm delivery” was conducted for the period 1966 to 2002. We included all randomized trials that evaluated the effectiveness of cervical cerclage in preventing preterm birth. Using a standardized data collection instrument, we reviewed trial designs, inclusion and exclusion criteria, and maternal and neonatal outcome. Fixed or random effects model were used to pool both dichotomous and continuous outcomes where appropriate. Seven trials were identified; six met our inclusion criteria. A total of 2190 women enrolled into the trials were identified with 1110 receiving cerclage and 1080 managed expectantly. There were a total of 278 of 2190 (12.7%) deliveries before 34 weeks of gestation. The meta-analysis demonstrated a trend toward cervical cerclage preventing preterm delivery at less than 34 weeks (OR 0.77, 95% CI, 0.59, 0.99; P = .049). However, there was no demonstrable improvement in neonatal mortality (OR of 0.0.86, 95% CI, 0.56, 1.33; P = .50). There is a trend toward cervical cerclage reducing preterm births before 34 weeks. The use of cerclage is, however, associated with an increased risk of postpartum fever. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to compare the evidence on the use of cervical cerclage with preventing preterm births and to criticize the various articles evaluating the use of cervical cerclage.

Screening for Aneuploidy in Twin Pregnancies: Maternal Age- and Race-specific Risk Assessment between 9-14 Weeks

The aim of this study was to calculate the risk for aneuploidy in twin pregnancies between 9-14 weeks utilizing maternal age, race and dizygotic twinning rates. Using previously published risks for aneuploidy in singletons and twins at the time of amniocentesis and at term, we calculated new risk estimates for twins at 9-14 weeks gestation or at the time of chorionic villus sampling. Using these tables, the risk for trisomy 21 in at least one fetus of a twin gestation in a 32-year-old at 9-14 weeks is 1/285 for Whites and for African-Americans. This is equivalent to the risk for trisomy 21 (1/265) in a 35-year-old woman with a singleton at the same gestational age. The risks for trisomies 18 and 13 also follow similar trends. In counseling women with twin pregnancies at the time of first trimester nuchal translucency screening or chorionic villus sampling, it should be noted that the maternal age-related risk for aneuploidy for a 32-year-old is equivalent to that of a 35-year-old woman with a singleton gestation.

Complete trisomy 9 in a term fetus: A case report

Complete trisomy 9 was diagnosed in a 35-week fetus by amniocentesis. Several sonograms had revealed only a two-vessel cord and intrauterine growth restriction. No other abnormalities were noted. A stillborn infant was delivered at 37 weeks gestation after induction of labor.

Perceived risk of preterm and low-birthweight birth in the Central Pennsylvania Women's Health Study

OBJECTIVE Engaging women in preconception prevention may be challenging if at-risk women do not perceive increased risk. This study examined predictors of perceiving increased risk for preterm/low birthweight birth. STUDY DESIGN Using the Central Pennsylvania Womens Health Study, a population-based sample of reproductive-age women, we analyzed whether sociodemographics, health and pregnancy history, health behaviors, attitudes, or health care utilization predicted risk perception of preterm/low-birthweight birth. RESULTS Of the 645 women analyzed, 157 (24%) estimated their risk of preterm/low-birthweight birth to be very or somewhat likely. Higher perceived risk was associated with being underweight, previous preterm/low-birthweight birth, having a mother with previous preterm/low-birthweight birth, lower perceived severity of preterm/low birthweight, and smoking. CONCLUSIONS Several factors known to predict preterm/low birthweight did influence risk perception in this study, whereas others did not. Further research on how these factors have an impact on participation in preconception care programs is warranted.

Intrapartum fever, epidural analgesia and histologic chorioamnionitis

OBJECTIVE:Our objective was to determine whether epidural analgesia and histologic chorioamnionitis were independent predictors of intrapartum fever.Study Design:This secondary analysis, retrospective cohort study included term parturients with placental examination during 2005. Logistic regression used fever (⩾38 °C) as the dependent variable. Significance was defined as P⩽0.05.Result:There were 488 (76%) of 641 term parturients with placental examination and epidural. Independent predictors of intrapartum fever were epidural odds ratio (OR)=3.4, confidence interval (CI): 1.70, 6.81, histologic chorioamnionitis OR=3.18, 95% CI: 2.04, 4.95, birthweight OR=2.07, 95%CI: 1.38, 3.12, vaginal exams OR=1.15, 95% CI:1.06, 1.24, duration ruptured membranes OR=1.03, 95% CI: 1.01,1.05, parity⩾1 OR=0.44: 0.29, 0.66 and thick meconium OR=0.35: 95%CI: 0.24, 0.85.Conclusion:Epidural analgesia and histologic chorioamnionitis were independent predictors of intrapartum fever. Modification of labor management may reduce the incidence of intrapartum fever.

The association between the regular use of preventive labour induction and improved term birth outcomes: findings of a systematic review and meta‐analysis

Despite a lack of high‐quality evidence, the use of ‘non‐indicated’ term labour induction is increasingly restricted throughout the world.

Minimally invasive hysterectomy at a university teaching hospital

Background and Objectives: To evaluate the feasibility of a minimally invasive approach for hysterectomy for benign disease at a university teaching hospital. Methods: Five hundred thirty-seven consecutive patients underwent hysterectomy for benign disease at Penn State Milton S. Hershey Medical Center in 2010. No cases were excluded. Minimally invasive approaches included total vaginal hysterectomy, laparoscopy-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and laparoscopic supracervical hysterectomy. All surgeries were completed with the resident as the primary surgeon or first assistant. Results: The median age was 45 years, the median body mass index was 30 kg/m2, the median estimated uterine size was 11 cm, and 22% of patients had a prior cesarean section. Of the 537 hysterectomies, 526 (98%) were started with a minimally invasive approach and 517 (96%) were completed in that fashion; thus only 9 conversions (2%) were required. Of the cases in which a minimally invasive approach was used, 16% were vaginal and 84% were laparoscopic. The median operative time was 86 minutes, the median blood loss was 95 mL, the median hospital stay was 1 day, and the median uterine weight was 199 g. For the minimally invasive hysterectomies, there was a 5% major complication rate. Conclusion: Our residency training institution completed 96% of 537 hysterectomies using a minimally invasive approach while maintaining an acceptable operative time, amount of blood loss, hospital stay, and complication rate. Thus our study supports that a minimally invasive approach for hysterectomy for benign disease at an academic resident teaching facility is feasible.

Fourth‐degree lacerations and epidural anesthesia

Epidural analgesia is associated with an increase in fourth-degree lacerations in nullipara, when operative vaginal deliveries and epiw x siotomies occur 1,2 . This study investigates the association in both nullipara and multipara. Of 11 038 vaginal births, 224 had fourth-degree lacerations for an incidence of 2.0%. Three controls were selected for each case, matched for birth weight within 100 g, parity and year of delivery. The cases were 79.0% nullipara which differs significantly from the 40.1% incidence of Ž nulliparity among all vaginal births reviewed P. 0.001 by Fisher’s exact test . Patient demographics are represented in Tables 1]3. Because of the similarity between the parity groups, logistic regression analysis was performed with the parity groups combined. Forceps posed a greater risk for fourth-degree

Penn state hershey - Center for pediatric cardiovascular research: Guest editorial

With the creation of the Penn State Hershey - Center for Pediatric Cardiovascular Research, we strive to become one of the leading centers for the innovation and development of novel devices and treatments for congenital heart surgery. We also seek to educate more bioengineers, medical students, residents, post-doctoral fellows, and junior faculty members in pediatric cardiovascular research. Finally, we seek to continue the growth of our conference (The International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion - http://www.hmc.psu.edu/childrens/pedscpb/), in order to provide a scientific venue for the pioneering research being performed in pediatric mechanical circulatory support and cardiopulmonary perfusion. Our website (http://www.pennstatehershey.org/web/childrensheartgroup/research/overview) includes an overview of all of our current projects (clinical, basic science, and bioengineering), publications, presentations, as well as national and international collaborators affiliated with our center. Investigators interested in collaborating with us on current or new projects should send an e-mail to ude.usp@radnua. Special thanks go to all those who support our collaborative efforts, both intellectually and financially each year. This includes significant financial support from the Penn State Hershey Children’s Hospital and Penn State Hershey College of Medicine, the National Heart Lung and Blood Institute, and the National Institute of Health Office of Rare Diseases. Furthermore, we are most grateful to our dedicated students, sponsors, faculty, and national and international collaborators which make the formation of such an establishment possible.