Objective-To test whethcr the introduction of Doppler wavcform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management. Design-A randomized controlled trial. Setting-Department of Ultrasound, King Edward Memorial Hospital, Perth, Westcrn Australia. Subjecrs-505 women with pregnancy abnormalities referred to an ultrasound department for fetal investigation during the third trimester. Zntervention-Continuous wave Doppler studies of umbilical and uteroplaccntal arterial circulations. Results were rcvealed to patients and clinicians. Main outcome measures-Principal end point was the duration of neonatal stay in hospital; other end points included the number and type of fetal heart rate monitoring studies, obstetric intervcntions, frequency of fetal distress, birthweight, Apgar scores and need for neonatal intensive care.Results-Thcre was no effect on the duration of neonatal stay in hospital. Small trends in obstetric management were observed with study group patients having fewcr contraction stress tests, less likelihood of antepartum fetal distress, and more likelihood of fetal distrcss after induction of labour leading to emergency cacsarean section. Depressed Apgar scores were more frequent in the study group. Conclusion-Introduction of Doppler waveform studies did not result in rcduced neonatal morbidity but did have a small effect on obstetric management. For each institution the role of Doppler studies in late pregnancy will be influenced by the usage of other tests of fetal welfare already entrenched in clinical practice.In recent years examination of umbilical and uteroplacental arterial waveforms by Doppler
Data from 3,953 consecutive second trimester genetic amniocenteses were analysed to determine pregnancy loss rates up to 6 weeks after the procedure. Information was prospectively collected on a cohort of 3,685 women in 3,896 singleton and 50 twin pregnancies, from 2 operating sites in Perth, Western Australia, using 9 operators over the 6-year period, 1989 to 1995. Complete information regarding pregnancy outcome was obtained for 3,643 of the 3,685 women (98.9%). There were 27 identified singletons and 1 set of twins lost within 6 weeks following amniocentesis. The overall pregnancy loss rate in this cohort was 29 of 3,911 (0.74%). The pregnancy loss rate associated with genetic amniocentesis is not excessive in comparison to the calculated background pregnancy loss rate of 1%, and it is suggested that each prenatal diagnostic team should determine their own complication rates for the purpose of counselling prior to amniocentesis.
Objective: To evaluate the accuracy and assess the indications of fetal echocardiography to diagnose structural heart disease in our high risk population, by an obstetric team. Methodology: Over a 4-year period, a transabdominal echocardiography was performed in 912 high risk pregnancies for congenital heart disease at 18-38 weeks of gestation. In the last 140 cases, an early examination combining either the transvaginal or the transabdominal route at 13-16 weeks was also carried out. Follow up was obtained from neonatal examinations and autopsies. The main indications for referral were: pregestational diabetes mellitus, family risk, increased nuchal translucency, suspected cardiac anomaly at screening ultrasound, women at high risk of chromosomal abnormality reluctant to invasive test, suspected arrhythmia, single umbilical artery, exposure to teratogens, and pregnancies affected by a chromosomal abnormality. Results: There were 79 (8.6%) major congenital heart defects, and most of them were yielded in the group of screening by ultrasound. Seventy of them (88.6%) were diagnosed correctly as abnormal prenatally. Atrioventricular septal defects (21 cases) and hypoplastic left ventricle syndrome (12 cases) were the most prevalent heart anomalies in the fetus. Isolated septal defects and coarctation of the aorta were the most difficult lesions to detect, being the ones with false positive and negative diagnosis. Another four cases of non-significant (<3 mm, no surgery nor medical treatment required) ventricular septal defects were overlooked during gestation, but closed by the sixth month of life. Fifteen apparently normal cases were lost to follow up. Conclusion: Our obstetric team results, in accordance with others previously published, show a good effectiveness to diagnose congenital heart anomalies. Most major detectable cardiac anomalies occur in the group without previously-known risk. Fetal echocardiography is optimized by a team strategy of imaging by obstetricians/high risk obstetric scanners (O) and fetal pediatric cardiologists (FPC). We retrospectively examined 1037 studies (1995)(1996)(1997)(1998)(1999), and identified 249 cases of major congenital heart disease. The O diagnosis was compared to the FPC diagnosis and postnatal diagnosis. The rate of complete accurate diagnosis for O and FPC diagnosis were 59% (17% false positive, 41% negative), respectively. Major differences in diagnosis or detail were found in 79 patients after FPC was completed and in 35/79 (44%) this was judged to have potential significant impact on management and prognosis counseling. The complementary roles of O and FPC remain important. FPC can contribute with additional detail in some cases which may significantly impact on counselling and planning. F03Factors influencing the prenatal detection of structural congenital heart diseases S.-F. Wong, F.-Y. Chan, R. Cincotta, A. Lee-Tannock & C. Ward Background: Congenital heart disease is the commonest congenital anomaly, but the reported antenatal detection rate varies widely from ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations鈥揷itations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright 漏 2024 scite LLC. All rights reserved.
Made with 馃挋 for researchers
Part of the Research Solutions Family.