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Very preterm birth: a regional study. Part 2: the very preterm infant
310
Citations from the lirerature /International
Journal of Gynecology & Obstetrics 54 (1996) 307-316
preterm prelabor rupture of membranes (n = 148, 24.3%), idiopathic preterm labor (n = 19530.4%) and antepartum hemorrhage (n = 111,18.3%)were associatedwith 94.1%of deliveries. These proportions varied with plurality and period of gestation. Demographic details, use of antenatal steroids exposure to labor and cesarean section delivery differed between mothers depending on the primary complication. Overall, 322 (53.0%) received antenatal steroids and 297 (48.8%) were delivered by cesareansection. Factors associatedwith decreased use of steroids were gestational age of less than 27 weeks (O.R. 0.54, 95% C.I. 0.36-0.83), preterm prelabor rupture of the membranes(O.R. 0.48,95% C.I. 0.29-0.78) and idiopathic preterm labor (O.R. 056.95% C.I. 0.35-0.91). Factors associated with increased use of steroids were multiple pregnancy (O.R. 1.70,95%C.I. 1.02-2.81) and precclampsia (O.R. 1.8704, 95% C.I. 1.09-3.19). Conclusions. These very preterm deliveries account for only a small proportion of all deliveries. There are differencesin the mother’s demographic history, obstetric managementand delivery depending on the primary etiological factor. VerypretermMrUuamgIeaaIstudy.Part2:theverypretenn Idant Hagan R.; Bemiinger H.; Chiffings D.; Evans S.; French N. AUS BR J OBSTET GYNAECOL 1996 10313(239-245) Objective. To ascertain the growth characteristics, delivery room management and hospital mortality of very preterm liveborn infants (c 33 weeksof gestation) and to identify differencesbetween infants associatedwith the etiological factor related to their very preterm delivery. Design. Cohort analytical study. Setting. King Edward Memorial Hospital for Women, Western Australia. Main variables examined. Gestational age, birth weight, birth weight ratio, condition at birth and mortality. Results. Six hundred ninety-three livebom very preterm infants were born to 608 mothers between 1.190 and 31.12.91. This was 1.37% of all liveboms in Western Australia. Three hundred eighty-five (55.6%)were male. Growth characteristics (birth weight, birth weight ratio and proportion small for gestational age) differed between infants depending on the primary obstetric complication associatedwith the very preterm delivery. Overall, 217 (31%) infants were small for gestational age, 34 (4.9%)had a congenital anomaly and 102(14.7%)died. Corrected mortality, excluding major fatal congenital anomaly, was 86 (12.7%). The majority of infants died on the first day (n = 59, 57.8%).The only factors associatedwith an increased or decreased mortality were decreasing gestation (adjusted O.R. 1.7, 95% C.I. 1.50-1.93), decreasing birth weight ratio (small for gestational age) (adjusted O.R. 1.3, 95% C.I. 1.08-1.53), antepartum hemorrhage as primary complication (adjusted O.R. 3.1, 95% C.I. 1.25-7.69) and any antenatal steroids (adjusted O.R. 0.26, 95% C.I. 0.14-0.51). In comparison with other studies, survival in the extremely preterm group, defined as a gestational age of lessthan 28 weeks,is improving. Conclusions. Very preterm infants account for a large proportion of perinatal mortality. Further studies are required
to explore the differences between infants on the basis of the primary obstetric complication and to ensure that increased survival is not associatedwith an increase in disabilities.
ONCOLOGY &core fragmcmt@cnre/UCF/UGP), a tumor marker: a ‘I-year Cole L.A.; Tanaka A.; Goo Sang Kim; Park S.-Y.; Min Whan Koh; Schwartz P.E.; Chambers J.T.; Nam J.-H. USA
GYNECOL ONCOL 199660/2 (26-t-270) In 1988we published three papers describing immunoassay results for urine B-core fragment as a marker of gynecological cancers. Many other papers have been published since and three commercial immunoassayshave been established.&Core fragment is called &core, UGF or UGP by different commercial vendors. To avoid confusion we call it &co&IJGF/UGP here. In this ‘I-year report, we compare the three commercial assays,establish cut-off limits and use the Ciba-Coming kit for two large studies.The first was a retrospective study, measuring &co~GF/IJGP in gynecological cancer and control urines accumulated in our freexers (n = 486). The second is a first prospective study, testing over a I6-month period 6core/UGFAJGP levels in urines of all new patients attending the Gynecology Oncology Clinic (n = 548). In the retrospective study, elevated &coreAJGF/UGP levels (> 1.9 rig/ml) were detectedin 11%of urines from healthy individuals (n = 132),in 11%from women with benign gynecological disease(n = 196), in 44% from cervical cancer (n = 68), 56% from ovarian cancer (n = 54) and 47% from endometrial cancer (n = 38). Altogether, &core/IJGF/IJGP levels were elevated in 50% of 170 samples from gynecological cancers.Overall, sensitivity increased with advancing stageof malignancy. Sensitivity was 28% for stage-I, 50% for stage-II, 47% for stage-III and 68% for stage-IV malignancies.In the prospective study very similar results were recorded. Elevated core/UGFiUGP levels (> 1.9 rig/ml) were detected in 11% of urines from healthy individuals (n = W), 11% from individuals with benign gynecological disease (n = 196),7% from women with carcinoma in situ (n = 28), 42% of samples from cervical cancer (n = 69), 56% from ovarian cancer (n = 59) and 52% from endometrial cancer. Altogether, &corelUGF/UGP levels were elevated in 48% of 225 gynecologicalcancer samples.Overall sensitivity increasedwith advancing stageof malignancy. Sensitivity was 29% for stage-I, 66% for stage-II, 60% for stage-III and 77% for stage-IV malignancies. In both studies sensitivity for &coreAJGFIUGP increasedwith advancing stage of disease.Sensitivity for cervical and endometrial cancers was slightly lower than that for ovarian malignancies. This difference may be due to the preponderanceof advanced-stage-diseasepatients in the ovarian cancer group. &Core/UGF/UGP may be a general stagedependent marker for all gynecological cancers. The same false-positive results and very similar sensitivity values were found in a retrospective and a prospective study. They confirm each other and suggesta definitive false-positive rate and sensitivity of this tumor marker for gynecological cancers.
Citations from the lirerature /International
Journal of Gynecology & Obstetrics 54 (1996) 307-316
preterm prelabor rupture of membranes (n = 148, 24.3%), idiopathic preterm labor (n = 19530.4%) and antepartum hemorrhage (n = 111,18.3%)were associatedwith 94.1%of deliveries. These proportions varied with plurality and period of gestation. Demographic details, use of antenatal steroids exposure to labor and cesarean section delivery differed between mothers depending on the primary complication. Overall, 322 (53.0%) received antenatal steroids and 297 (48.8%) were delivered by cesareansection. Factors associatedwith decreased use of steroids were gestational age of less than 27 weeks (O.R. 0.54, 95% C.I. 0.36-0.83), preterm prelabor rupture of the membranes(O.R. 0.48,95% C.I. 0.29-0.78) and idiopathic preterm labor (O.R. 056.95% C.I. 0.35-0.91). Factors associated with increased use of steroids were multiple pregnancy (O.R. 1.70,95%C.I. 1.02-2.81) and precclampsia (O.R. 1.8704, 95% C.I. 1.09-3.19). Conclusions. These very preterm deliveries account for only a small proportion of all deliveries. There are differencesin the mother’s demographic history, obstetric managementand delivery depending on the primary etiological factor. VerypretermMrUuamgIeaaIstudy.Part2:theverypretenn Idant Hagan R.; Bemiinger H.; Chiffings D.; Evans S.; French N. AUS BR J OBSTET GYNAECOL 1996 10313(239-245) Objective. To ascertain the growth characteristics, delivery room management and hospital mortality of very preterm liveborn infants (c 33 weeksof gestation) and to identify differencesbetween infants associatedwith the etiological factor related to their very preterm delivery. Design. Cohort analytical study. Setting. King Edward Memorial Hospital for Women, Western Australia. Main variables examined. Gestational age, birth weight, birth weight ratio, condition at birth and mortality. Results. Six hundred ninety-three livebom very preterm infants were born to 608 mothers between 1.190 and 31.12.91. This was 1.37% of all liveboms in Western Australia. Three hundred eighty-five (55.6%)were male. Growth characteristics (birth weight, birth weight ratio and proportion small for gestational age) differed between infants depending on the primary obstetric complication associatedwith the very preterm delivery. Overall, 217 (31%) infants were small for gestational age, 34 (4.9%)had a congenital anomaly and 102(14.7%)died. Corrected mortality, excluding major fatal congenital anomaly, was 86 (12.7%). The majority of infants died on the first day (n = 59, 57.8%).The only factors associatedwith an increased or decreased mortality were decreasing gestation (adjusted O.R. 1.7, 95% C.I. 1.50-1.93), decreasing birth weight ratio (small for gestational age) (adjusted O.R. 1.3, 95% C.I. 1.08-1.53), antepartum hemorrhage as primary complication (adjusted O.R. 3.1, 95% C.I. 1.25-7.69) and any antenatal steroids (adjusted O.R. 0.26, 95% C.I. 0.14-0.51). In comparison with other studies, survival in the extremely preterm group, defined as a gestational age of lessthan 28 weeks,is improving. Conclusions. Very preterm infants account for a large proportion of perinatal mortality. Further studies are required
to explore the differences between infants on the basis of the primary obstetric complication and to ensure that increased survival is not associatedwith an increase in disabilities.
ONCOLOGY &core fragmcmt@cnre/UCF/UGP), a tumor marker: a ‘I-year Cole L.A.; Tanaka A.; Goo Sang Kim; Park S.-Y.; Min Whan Koh; Schwartz P.E.; Chambers J.T.; Nam J.-H. USA
GYNECOL ONCOL 199660/2 (26-t-270) In 1988we published three papers describing immunoassay results for urine B-core fragment as a marker of gynecological cancers. Many other papers have been published since and three commercial immunoassayshave been established.&Core fragment is called &core, UGF or UGP by different commercial vendors. To avoid confusion we call it &co&IJGF/UGP here. In this ‘I-year report, we compare the three commercial assays,establish cut-off limits and use the Ciba-Coming kit for two large studies.The first was a retrospective study, measuring &co~GF/IJGP in gynecological cancer and control urines accumulated in our freexers (n = 486). The second is a first prospective study, testing over a I6-month period 6core/UGFAJGP levels in urines of all new patients attending the Gynecology Oncology Clinic (n = 548). In the retrospective study, elevated &coreAJGF/UGP levels (> 1.9 rig/ml) were detectedin 11%of urines from healthy individuals (n = 132),in 11%from women with benign gynecological disease(n = 196), in 44% from cervical cancer (n = 68), 56% from ovarian cancer (n = 54) and 47% from endometrial cancer (n = 38). Altogether, &core/IJGF/IJGP levels were elevated in 50% of 170 samples from gynecological cancers.Overall, sensitivity increased with advancing stageof malignancy. Sensitivity was 28% for stage-I, 50% for stage-II, 47% for stage-III and 68% for stage-IV malignancies.In the prospective study very similar results were recorded. Elevated core/UGFiUGP levels (> 1.9 rig/ml) were detected in 11% of urines from healthy individuals (n = W), 11% from individuals with benign gynecological disease (n = 196),7% from women with carcinoma in situ (n = 28), 42% of samples from cervical cancer (n = 69), 56% from ovarian cancer (n = 59) and 52% from endometrial cancer. Altogether, &corelUGF/UGP levels were elevated in 48% of 225 gynecologicalcancer samples.Overall sensitivity increasedwith advancing stageof malignancy. Sensitivity was 29% for stage-I, 66% for stage-II, 60% for stage-III and 77% for stage-IV malignancies. In both studies sensitivity for &coreAJGFIUGP increasedwith advancing stage of disease.Sensitivity for cervical and endometrial cancers was slightly lower than that for ovarian malignancies. This difference may be due to the preponderanceof advanced-stage-diseasepatients in the ovarian cancer group. &Core/UGF/UGP may be a general stagedependent marker for all gynecological cancers. The same false-positive results and very similar sensitivity values were found in a retrospective and a prospective study. They confirm each other and suggesta definitive false-positive rate and sensitivity of this tumor marker for gynecological cancers.