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Prenatal diagnosis in twin gestations: A comparison between second-trimester amniocentesis and first-trimester chorionic villus sampling
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Citations from the Literature
Pretreatmentplasma levels of fibrinopeptide-A(FPA), Ddlmer (DD), and van WillebrandFactor (vWF) in patients with operable cervical cancer: Influence of surgical-pathological stage, tumor she, bistologlc type, aad lymph node status Gadducci A.; Baicchi U.; Marrai R.; Facchini V.; Del Bravo B.; Fosella P.V.; Fioretti P. ITA
GYNECOL ONCOL 1993 49/3 (354-358) The preoperative plasma levels of tibrinopeptide A (FPA), D-dimer (DD), and von Willebrand Factor (vWF) were measured in 38 patients with cervical cancer undergoing radical hysterectomy with pelvic lymphadenectomy. The surgicalpathological stage of disease was Ib in 17 patients. Ila in 9 patients, and Ilb in 12 patients. The tumor size was 54 cm in 20 patients and >4 cm in 18 patients. The histologic type was squamous cell carcinoma in 32 patients and adenocarcinoma in 6 patients. Positive pelvic lymph nodes were found in 10 patients. When compared to controls, FPA, DD, and vWF levels were significantly raised in patients with surgical-pathological stage IIb disease but not in patients with stage Ib or Ila disease. The values of FPA, DD, and vWF were related to surgicalpathological stage (stage IIb vs. stage lb-IIa: P < 0.005, P < 0.001, and P < 0.001, respectively) and tumor size (>4 cm vs $4 cm: P < 0.05, P < 0.005, and P < 0.02, respectively), but not to histologic type. vWF values were also related to lymph node status (positive vs negative lymph nodes: P < 0.02). FPA and DD levels were higher in patients with positive lymph nodes than in patients with negative lymph nodes, but the difference did not reach the statistical significance even due to the small number of patients involved. In conclusion, increased fibrin production and degradation seem to occur in patients with stage IIb cervical cancer. The biological meaning of this hemostasis activation deserves further investigation. Endometvialchanges in postmenopausalwomen treated with tamoxifen for breast cancer Cohen I.; Rosen D.J.D.; Shapira J.; Cordoba M.; Gilboa S.; Altaras M.M.; Yigael D.; Beyth Y. ISR
BR J OBSTET GYNAECOL 1993 10016(567-570) Objective - To evaluate whether risk factors, other than tamoxifen, can be identified for the development of endometrial pathologies in postmenopausal breast cancer patients treated with tamoxifen. Design. A cross-sectional study. Setting. Department of Obstetrics and Gynaecology and Oncology Clinic, Sapir Medical Center, Kfar Saba, Israel. Subjects. 77 asymptomatic postmenopausal women, treated with tamoxifen for breast cancer. Of these, 55 had no endometrial tissue and 22 had endometrial tissue obtained by biopsy. Main outcome measures. Demographic characteristics, health habits, risk factors, vaginal ultrasonographic evaluations of endometrial thickness and texture, and histologic evaluations of endometrial biopsies. Results. Overall, there was a high rate (29%) of endometrial pathological change among the 77 asymp tomatic postmenopausal women. There were no significant statistical differences in the features tested between the two groups. Conclusion. It is impossible to predict which
Int J Gynecol Obstet 45
postmenopausal women will develop pathological endometrial changes after treatment with tamoxifen and thus a routine periodic endometrial sampling-follow up is suggested for all postmenopausal women beingtreated with this agent.
PERINATOLOGY, LIVERY
PREGNANCY
AND
DE
Prenatal diagnosis la twin gestations: A comparison between second-trimester amniocentesis and fust-trimester chorionic villus samplii Wapner R.J.; Johnson A.; Davis .G.; Urban A.; Morgan P.; Jackson L. USA
OBSTET GYNECOL 1993 82/l (49-56) Objective - To evaluate prospectively the relative risks and accuracy of first-trimester chorionic villus sampling (CVS) and second-trimester amniocentesis in the genetic evaluation of twin gestations. Methods - Between March 1984 and August 1990, patients presenting for prenatal diagnosis of a twin gestation of less than 12 weeks were offered sampling by either first trimester CVS or amniocentesis at 16-18 weeks’ gestation. Selection was based solely on patient preference and was obtained before ultrasound identification of placental position. Women presenting beyond I2 weeks’gestation were sampled by amniocentesis. Clinical and laboratory outcomes were evaluated. Results - Eighty-one women had amniocentesis (nine of whom also had CVS), and 161 women had CVS. All fetuses in both groups were successfully sampled and karyotyped; 85.3% of the amniocentesis patients and 75.8% of the CVS patients were sampled in two or fewer passes (P = not significant). There were three cases of twin-twin villus contamination following CVS; one of these led to incorrect gender assignment because of erroneous laboratory interpretation. Loss of the entire pregnancy from the time of sampling until the 28th week of gestation followed amniocentesis in 2.9% of the cases and CVS in 3.2%. The total fetal loss rates were 9.3% for amniocentesis and 4.9% for CVS (P = not significant). When pregnancies having mosaic or abnormal karyotype results are excluded, the total amniocentesis loss rate remained 9.3% and the CVS loss rate became 3.9% (P c.05). Conclusion - In the hands of experienced operators, CVS is at least as safe and effective as amniocentesis for the prenatal diagnosis of twin gestations. Perinatal lethal conditions: The effect of diagnosis on decision making Hassed S.J.; Miller C.H.; Pope SK.; Murphy P.; Quirk J.G. Jr.; Cunniff C. USA
OBSTET GYNECOL 1993 82/l (37-42) Objective - To identify factors influencing pregnancy management decisions following identification of a perinatal lethal condition. Methods - One hundred thirty pregnancies with perinatal lethal conditions diagnosed before 24 weeks’ gestation were examined. Information collected included demographic data, estimated gestational age at presentation, referral indication, nature of the defect, and performance of autopsy.
Citations from the Literature
Pretreatmentplasma levels of fibrinopeptide-A(FPA), Ddlmer (DD), and van WillebrandFactor (vWF) in patients with operable cervical cancer: Influence of surgical-pathological stage, tumor she, bistologlc type, aad lymph node status Gadducci A.; Baicchi U.; Marrai R.; Facchini V.; Del Bravo B.; Fosella P.V.; Fioretti P. ITA
GYNECOL ONCOL 1993 49/3 (354-358) The preoperative plasma levels of tibrinopeptide A (FPA), D-dimer (DD), and von Willebrand Factor (vWF) were measured in 38 patients with cervical cancer undergoing radical hysterectomy with pelvic lymphadenectomy. The surgicalpathological stage of disease was Ib in 17 patients. Ila in 9 patients, and Ilb in 12 patients. The tumor size was 54 cm in 20 patients and >4 cm in 18 patients. The histologic type was squamous cell carcinoma in 32 patients and adenocarcinoma in 6 patients. Positive pelvic lymph nodes were found in 10 patients. When compared to controls, FPA, DD, and vWF levels were significantly raised in patients with surgical-pathological stage IIb disease but not in patients with stage Ib or Ila disease. The values of FPA, DD, and vWF were related to surgicalpathological stage (stage IIb vs. stage lb-IIa: P < 0.005, P < 0.001, and P < 0.001, respectively) and tumor size (>4 cm vs $4 cm: P < 0.05, P < 0.005, and P < 0.02, respectively), but not to histologic type. vWF values were also related to lymph node status (positive vs negative lymph nodes: P < 0.02). FPA and DD levels were higher in patients with positive lymph nodes than in patients with negative lymph nodes, but the difference did not reach the statistical significance even due to the small number of patients involved. In conclusion, increased fibrin production and degradation seem to occur in patients with stage IIb cervical cancer. The biological meaning of this hemostasis activation deserves further investigation. Endometvialchanges in postmenopausalwomen treated with tamoxifen for breast cancer Cohen I.; Rosen D.J.D.; Shapira J.; Cordoba M.; Gilboa S.; Altaras M.M.; Yigael D.; Beyth Y. ISR
BR J OBSTET GYNAECOL 1993 10016(567-570) Objective - To evaluate whether risk factors, other than tamoxifen, can be identified for the development of endometrial pathologies in postmenopausal breast cancer patients treated with tamoxifen. Design. A cross-sectional study. Setting. Department of Obstetrics and Gynaecology and Oncology Clinic, Sapir Medical Center, Kfar Saba, Israel. Subjects. 77 asymptomatic postmenopausal women, treated with tamoxifen for breast cancer. Of these, 55 had no endometrial tissue and 22 had endometrial tissue obtained by biopsy. Main outcome measures. Demographic characteristics, health habits, risk factors, vaginal ultrasonographic evaluations of endometrial thickness and texture, and histologic evaluations of endometrial biopsies. Results. Overall, there was a high rate (29%) of endometrial pathological change among the 77 asymp tomatic postmenopausal women. There were no significant statistical differences in the features tested between the two groups. Conclusion. It is impossible to predict which
Int J Gynecol Obstet 45
postmenopausal women will develop pathological endometrial changes after treatment with tamoxifen and thus a routine periodic endometrial sampling-follow up is suggested for all postmenopausal women beingtreated with this agent.
PERINATOLOGY, LIVERY
PREGNANCY
AND
DE
Prenatal diagnosis la twin gestations: A comparison between second-trimester amniocentesis and fust-trimester chorionic villus samplii Wapner R.J.; Johnson A.; Davis .G.; Urban A.; Morgan P.; Jackson L. USA
OBSTET GYNECOL 1993 82/l (49-56) Objective - To evaluate prospectively the relative risks and accuracy of first-trimester chorionic villus sampling (CVS) and second-trimester amniocentesis in the genetic evaluation of twin gestations. Methods - Between March 1984 and August 1990, patients presenting for prenatal diagnosis of a twin gestation of less than 12 weeks were offered sampling by either first trimester CVS or amniocentesis at 16-18 weeks’ gestation. Selection was based solely on patient preference and was obtained before ultrasound identification of placental position. Women presenting beyond I2 weeks’gestation were sampled by amniocentesis. Clinical and laboratory outcomes were evaluated. Results - Eighty-one women had amniocentesis (nine of whom also had CVS), and 161 women had CVS. All fetuses in both groups were successfully sampled and karyotyped; 85.3% of the amniocentesis patients and 75.8% of the CVS patients were sampled in two or fewer passes (P = not significant). There were three cases of twin-twin villus contamination following CVS; one of these led to incorrect gender assignment because of erroneous laboratory interpretation. Loss of the entire pregnancy from the time of sampling until the 28th week of gestation followed amniocentesis in 2.9% of the cases and CVS in 3.2%. The total fetal loss rates were 9.3% for amniocentesis and 4.9% for CVS (P = not significant). When pregnancies having mosaic or abnormal karyotype results are excluded, the total amniocentesis loss rate remained 9.3% and the CVS loss rate became 3.9% (P c.05). Conclusion - In the hands of experienced operators, CVS is at least as safe and effective as amniocentesis for the prenatal diagnosis of twin gestations. Perinatal lethal conditions: The effect of diagnosis on decision making Hassed S.J.; Miller C.H.; Pope SK.; Murphy P.; Quirk J.G. Jr.; Cunniff C. USA
OBSTET GYNECOL 1993 82/l (37-42) Objective - To identify factors influencing pregnancy management decisions following identification of a perinatal lethal condition. Methods - One hundred thirty pregnancies with perinatal lethal conditions diagnosed before 24 weeks’ gestation were examined. Information collected included demographic data, estimated gestational age at presentation, referral indication, nature of the defect, and performance of autopsy.