|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
twinsFrom: Terrence.Jones@ncal.kaiperm.orgThu May 30 12:58:30 1996
Allen, would echo suggestions of Dr. Bui re: inc anomalies in twins. Tho Dr. Bombard sts this may be related in part to inc in age-related aneuploidy rate, this alone would not suffice. Dusting off the history books for a min., the Coll. Perinat. Project (60's nostalgia, sorry) revealed 2X the # of exp. anomalies in twins Vs singleton: Congenital Anomaly ~~~~~~~~~~~~~~~~~~ SINGLETON 3% TWINS 12% (would have expected 2 X 3 = 6%). Dr. Cunningham (from the Magnesium capital of the World), points out that many of these are CNS anomalies, and attributes them to VASCULAR causes related to placental-mediated mechanisms. Tho Dr. Edwards work (Ultras Obs Gyn (7/95) 6: 43-9), demonstrated a much lower anomaly rate (4.9%) compared to the above, in the 245 twin pairs studied, there WAS a very high sens. and spec. (and neg/pos pred value) in antepartum detection with sono. As always, this may be more related to who's holding the transducer & interpreting the films, than simply performing the test... For example, the study by Allen (AJOG 10/91, vol 165: 1056-60), examined 157 twin pairs (with a 9.5% anomaly rate, and 9% MAJOR anom rate), {He published 9.5%, but 33 twins demonstrated 40 malformations; and 33/314 seems closer to 10.5%?}. The most freq anomalies in this study were GU, but 50% would not influence perinatal mgmt. Number two were CV anomalies, none of which (n=8) were detected by 4-chambered view. He goes on to suggest eval of the arch and outflow tracts might improve sensitivity. (He also points out the CV anomaly more often seen in twins Vs Singleton is VSD, and NOT likely to influence perinatal mgmt.) Again, echoing the thoughts offered by others, the benefit of mid-trim anatomic scan is not solely for anomaly detection (regardless of varying sensitivities between different centers), but in establishing amnionicity and baseline growth msrmnts for later comparison). Terry Jones, Kaiser San Fran PS Regarding Magnesium, and the CNS, does anyone have any insights into the possible mechanisms by which MGSO4 might reduce CP in Preemies. Some cardiovascular studies point to prevention of reperfusion damage via endo- thelial-mediated action. Anyone using this outside the realm of tocolysis or seizure prophylaxis in severe early-onset preeclampsia? TJ.
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:18:27 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.