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The nonreactive nonstress test: Predictive value for neonatal anemia in the isoimmunized pregnancy
Citations from the literature /International
Journal of Gynecology & Obstetrics 56 (1997) W-109
were studied prospectively: 11 with a central nervous system anomaly (neural tube defect [n = 41, encephalocele [n = 21, hydrocephalus [n = 41, and anencephaly [n = 111, 13 fetuses with a family history or suspicion of cleft tip or palate, and one with a cloverleaf skull malformation. A volume scan was performed after the two-dimensional examination was complete. The mechanical transducer scans up to 40” in less than 4 s, acquiring the data for a pyramid-shaped tissue volume. Three matched and dynamically linked images representing the X, Y, and 2 planes arc displayed simultaneously. When one image is manipulated, the remaining images are updated automatically to maintain a 90” difference. After the ideal three orthogonal planes are identified, a 3-D image can be reconstructed. A variable number of scan images are possible, depending on the volume size and the data acquisition time. Processing time for the reconstruction depends on volume size, the number of scan images included, and the degrees of rotation of the final image. Results: The three orthogonal planes proved most helpful delineating the exact nature and anatomic level of the defect. No examination was delayed or required repetition because of suboptimal fetal positioning. The enhanced confidence achieved by our being able to delineate the precise anatomic level and extent of the defect improved patient counseling. The 3-D reconstructions clarified and documented the true magnitude of the defects and on occasion allowed a diagnosis not possible by either two-dimensional or nonreconstructed 3-D imaging. Conclusion: Our experience with 3-D ultrasound suggests that it is an advance in high-quality ultrasound. Its greatest advantage is that it allows the user to view simultaneously the three orthogonal planes. Clinical and ultrasound prediction of macrosomia in diabetic pregnancy Johnstone F.D.; Prescott R.J.; Steel J.M.; Mao J.H.; Chambers S.; Muir N. GBR BR. J. OBSTET. GYNECOL. 1996 103/S (747-754) Objective: To study prospectively the prediction power, at different gestations, of clinical and ultrasound measurements for fetal size in diabetic pregnancy. Setting A large combined obstetric diabetic clinic in a teaching hospital. Participants: One hundred eighty-one pregnancies in which women had scans at least two of three specific time points and who were delivered of singletons after 34 weeks: 73% were pre-gestational insulin-dependent diabetics, the others were pre-gestational White class A or gestational diabetics. Interventions: Clinical estimates of fundal height and fetal size and ultrasound estimates of abdominal circumference and head circumference were routinely carried out at gestational ages of 28, 34 and 38 weeks or before delivery. Main outcome measures: Standardised birthweight, corrected for gestation and parity. The relation with clinical and ultrasound measurements was investigated using multiple linear regression and the capability of the measurements to predict macrosomic births ( > 95th centile of normals) using receiver-operator characteristic curves. Results: All measurements are poor predictors of eventual standardised birthweight. Prediction
101
improves with closeness to delivery. Prediction is significantly improved by adding ultrasound to clinical information, but at 34 weeks or later this only contributes 8% of the variance. There is no difference in the prediction power for macrosomia between clinical and ultrasound measurements. Conclusions: Even regular serial scanning and clinical examination will not always diagnose the macrosomic fetus in diabetic pregnancy. In our hands, clinical examination is as predictive as ultrasound measurements. Ultrasound does add to clinical prediction power but only to a small extent. Ultrasound should be used in a selected way, as defined by clinical findings, and with recognition and understanding of the errors and biases involved. The nonreactive nonstress test: Predictive value for neonatal anemia in the isoimmunized pregnancy Ouzounian J.G.; Alsulyman O.M.; Monteiro H.A.; Songster G.S. USA OBSTET. GYNECOL. 1996 88/3 (364-367) Objective: To assess the value of the fetal nonstress test (NST) in predicting neonatal transfusion in pregnancies complicated by red cell isoimmunization. Methods: We retrospectively reviewed the records of all patients evaluated for isoimmunization in pregnancy for the period January 1992 to December 1994. In addition to prenatal care, serial ultrasonography, and invasive testing when indicated. patients had NSTs two times per week. Nonstress tests were interpreted as either reactive or nonreactive using standard criteria. Results of the last NST before delivery were analyzed. Neonatal outcome data were obtained prospectively and by chart review. Results: Sixty patients with isoimmunization were identified during the study period. Fifty-one patients (85%) had reactive NSTs until delivery, and nine (15%) had nonreactive NSTs that prompted delivery. Twelve of 51 (23.5%) patients with reactive NSTs and seven of nine (77.8%) patients with nonreactive NSTs required neonatal transfusion (P = 0.003, odds ratio 11.4 195% confidence interval (CI) 1.7-120.21). The mean (standard error of the mean; range) hcmatocrit (%) at birth was 38.9 (3.0; 21.3-52.0) in patients with reactive NSTs and 28.3 (3.8; 14.5-45.0) in those with nonreactive NSTs (P < 0.05). A nonreactive NST had a 77.8% positive predictive value (95% CI 49.0-100) in identifying the need for neonatal transfusion. Conclusion: These findings indicate that a nonreactive NST is predictive of subsequent neonatal transfusion in patients with isoimmunization. The antepartum fetal NST is a useful adjunct in the management of isoimmunized pregnancies. Soluble tumor necrosis factor receptors and interleukin-6 levels in patients with severe preeclampsia Kupferminc M.J.; Peaceman A.M.; Aderka D.; Wallach D.; Socol M.L. USA OBSTET. GYNECOL. 1996 X8/3 (420-427) Objective: To investigate whether serum and amniotic fluid (AF) levels of soluble tumor necrosis factor receptors and interleukin-6, markers of immune activation and endothelial
Journal of Gynecology & Obstetrics 56 (1997) W-109
were studied prospectively: 11 with a central nervous system anomaly (neural tube defect [n = 41, encephalocele [n = 21, hydrocephalus [n = 41, and anencephaly [n = 111, 13 fetuses with a family history or suspicion of cleft tip or palate, and one with a cloverleaf skull malformation. A volume scan was performed after the two-dimensional examination was complete. The mechanical transducer scans up to 40” in less than 4 s, acquiring the data for a pyramid-shaped tissue volume. Three matched and dynamically linked images representing the X, Y, and 2 planes arc displayed simultaneously. When one image is manipulated, the remaining images are updated automatically to maintain a 90” difference. After the ideal three orthogonal planes are identified, a 3-D image can be reconstructed. A variable number of scan images are possible, depending on the volume size and the data acquisition time. Processing time for the reconstruction depends on volume size, the number of scan images included, and the degrees of rotation of the final image. Results: The three orthogonal planes proved most helpful delineating the exact nature and anatomic level of the defect. No examination was delayed or required repetition because of suboptimal fetal positioning. The enhanced confidence achieved by our being able to delineate the precise anatomic level and extent of the defect improved patient counseling. The 3-D reconstructions clarified and documented the true magnitude of the defects and on occasion allowed a diagnosis not possible by either two-dimensional or nonreconstructed 3-D imaging. Conclusion: Our experience with 3-D ultrasound suggests that it is an advance in high-quality ultrasound. Its greatest advantage is that it allows the user to view simultaneously the three orthogonal planes. Clinical and ultrasound prediction of macrosomia in diabetic pregnancy Johnstone F.D.; Prescott R.J.; Steel J.M.; Mao J.H.; Chambers S.; Muir N. GBR BR. J. OBSTET. GYNECOL. 1996 103/S (747-754) Objective: To study prospectively the prediction power, at different gestations, of clinical and ultrasound measurements for fetal size in diabetic pregnancy. Setting A large combined obstetric diabetic clinic in a teaching hospital. Participants: One hundred eighty-one pregnancies in which women had scans at least two of three specific time points and who were delivered of singletons after 34 weeks: 73% were pre-gestational insulin-dependent diabetics, the others were pre-gestational White class A or gestational diabetics. Interventions: Clinical estimates of fundal height and fetal size and ultrasound estimates of abdominal circumference and head circumference were routinely carried out at gestational ages of 28, 34 and 38 weeks or before delivery. Main outcome measures: Standardised birthweight, corrected for gestation and parity. The relation with clinical and ultrasound measurements was investigated using multiple linear regression and the capability of the measurements to predict macrosomic births ( > 95th centile of normals) using receiver-operator characteristic curves. Results: All measurements are poor predictors of eventual standardised birthweight. Prediction
101
improves with closeness to delivery. Prediction is significantly improved by adding ultrasound to clinical information, but at 34 weeks or later this only contributes 8% of the variance. There is no difference in the prediction power for macrosomia between clinical and ultrasound measurements. Conclusions: Even regular serial scanning and clinical examination will not always diagnose the macrosomic fetus in diabetic pregnancy. In our hands, clinical examination is as predictive as ultrasound measurements. Ultrasound does add to clinical prediction power but only to a small extent. Ultrasound should be used in a selected way, as defined by clinical findings, and with recognition and understanding of the errors and biases involved. The nonreactive nonstress test: Predictive value for neonatal anemia in the isoimmunized pregnancy Ouzounian J.G.; Alsulyman O.M.; Monteiro H.A.; Songster G.S. USA OBSTET. GYNECOL. 1996 88/3 (364-367) Objective: To assess the value of the fetal nonstress test (NST) in predicting neonatal transfusion in pregnancies complicated by red cell isoimmunization. Methods: We retrospectively reviewed the records of all patients evaluated for isoimmunization in pregnancy for the period January 1992 to December 1994. In addition to prenatal care, serial ultrasonography, and invasive testing when indicated. patients had NSTs two times per week. Nonstress tests were interpreted as either reactive or nonreactive using standard criteria. Results of the last NST before delivery were analyzed. Neonatal outcome data were obtained prospectively and by chart review. Results: Sixty patients with isoimmunization were identified during the study period. Fifty-one patients (85%) had reactive NSTs until delivery, and nine (15%) had nonreactive NSTs that prompted delivery. Twelve of 51 (23.5%) patients with reactive NSTs and seven of nine (77.8%) patients with nonreactive NSTs required neonatal transfusion (P = 0.003, odds ratio 11.4 195% confidence interval (CI) 1.7-120.21). The mean (standard error of the mean; range) hcmatocrit (%) at birth was 38.9 (3.0; 21.3-52.0) in patients with reactive NSTs and 28.3 (3.8; 14.5-45.0) in those with nonreactive NSTs (P < 0.05). A nonreactive NST had a 77.8% positive predictive value (95% CI 49.0-100) in identifying the need for neonatal transfusion. Conclusion: These findings indicate that a nonreactive NST is predictive of subsequent neonatal transfusion in patients with isoimmunization. The antepartum fetal NST is a useful adjunct in the management of isoimmunized pregnancies. Soluble tumor necrosis factor receptors and interleukin-6 levels in patients with severe preeclampsia Kupferminc M.J.; Peaceman A.M.; Aderka D.; Wallach D.; Socol M.L. USA OBSTET. GYNECOL. 1996 X8/3 (420-427) Objective: To investigate whether serum and amniotic fluid (AF) levels of soluble tumor necrosis factor receptors and interleukin-6, markers of immune activation and endothelial