Re: Does hypochorionic hemorrhage alters triplo-test results?'reply'
From: art fougner, md (evsono@pipeline.com)
Tue Apr 6 13:30:45 2004
ok - perhaps this may help -
Br J Obstet Gynaecol. 1994 Nov;101(11):948-53.
Taking account of vaginal bleeding in screening for Down's syndrome.
Cuckle H, van Oudgaarden ED, Mason G, Holding S.
Department of Clinical Medicine, University of Leeds, UK.
OBJECTIVE: To derive a method for revising the risk of Down's syndrome
in maternal serum marker screening when there is vaginal bleeding. The
effect on screening performance of routinely allowing for the presence
or absence of bleeding in all women is also assessed. DESIGN: Overview
of published studies on the rate of reported vaginal bleeding in
pregnancies with Down's syndrome, on the rate according to maternal age
and on the association of bleeding with alpha-fetoprotein (AFP) level.
The publications are supplemented with data on unconjugated oestriol
(uE3), human chorionic gonadotrophin (hCG) and AFP levels in a
consecutive series of screened women. SETTING: Routine Down's syndrome
screening tests carried out on women having antenatal care at the St
James's University Hospital, Leeds. SUBJECTS: Eight hundred and nine
screened women. RESULTS: In five studies the rate of vaginal bleeding
in Down's syndrome pregnancies was 1.7 times that in unaffected
pregnancies on average. In three studies, the vaginal bleeding rate
increased proportionally by 2.2% on average for each year of maternal
age. Three studies and our own data were consistent with a 10% increase
in the mean AFP level associated with vaginal bleeding, but it did not
appear to materially alter uE3 and hCG levels or the standard deviations
and correlation coefficients for any of the three analytes. An
individual woman's risk was calculated by multiplying her age-specific
odds of Down's syndrome by two likelihood ratios, one relating to the
vaginal bleeding itself and one from the marker levels. Routine
allowance for the presence or absence of vaginal bleeding was estimated
to increase the detection rate by less than 1%. CONCLUSION: Our method
is of clinical value in revising the risk when there is concern that
vaginal bleeding might be responsible for a negative maternal serum
Down's syndrome screening result. A policy of routinely incorporating
information on vaginal bleeding in risk estimation for all women would
have too small an effect on overall screening performance to recommend
it.
art
At Sat, 3 Apr 2004, art fougner, md wrote:
>
>along similar lines, i've noticed a trend in abnormal maternal serum
>screens, especially high afp's, associated with multifetal reduction
>procedures. anecdotal though, not evidence-based.
>
>art
>
>At Fri, 02 Apr 2004, Latha Natarajan wrote:
>>
>>Maternal Serum AFP levels go up with haemorrhage.
>>
>>LN.
>>
>>>>>----- Original Message -----
>>From: "art fougner, md" <evsono@pipeline.com>
>>To: "Multiple recipients of list ULTRASOUND" <ultrasound@dns.obgyn.net>
>>Sent: Friday, April 02, 2004 12:19 AM
>>Subject: Re: Does hypochorionic hemorrhage alters triplo-test
>>results?'reply'
>>
>>> But how were the maternal serum screens specifically affected by
>>> "threatened miscarriage"?
>>>
>>> art
>>>
>>> At Wed, 31 Mar 2004, AFPPLUS3@aol.com wrote:
>>> >
>>> >This may help you with regards to adjusting the patients risk...
>>> >
>>> >Threatened abortion: A risk factor for poor pregnancy outcome, a
>>> >population-based screening study
>>> >Joshua L. Weiss, MD,* Fergal D. Malone, MD, John Vidaver, MA, Robert H.
>>Bal ,
>>> >MD,
>>> >David A. Nyberg, MD, Christine H. Comstock, MD, Gary D. Hankins, MD,
>>Richar
>>> >L. Berkowitz, MD, Susan J. Gross, MD, Lorraine Dugoff, MD, Ilan E.
>>> >Timor-Tritsch, MD, Mary E. Dâ?TAlton, MD, for the FASTER Consortium
>>> >Columbia Presbyterian Medical Center, New York, NY
>>> >â?"
>>> >Objective: The purpose of this study was to determine whether patients
>>with
>>> >first-trimester threatened abortion are at increased risk for poor
>>pregnanc
>>> >outcome.
>>> >Study design: A large prospective multicenter database was studied.
>>Subject
>>> >were divided into three groups: (1) no bleeding, (2) light bleeding, and
>>(3
>>> >heavy bleeding. Univariate and multivariable logistic regression analyses
>>w re
>>> >used.
>>> >Results: The study comprised 16,506 patients: 14,160 patients without
>>> >bleeding, 2094 patients with light bleeding, and 252 patients with heavy
>>bl eding.
>>> >Patients with vaginal bleeding, light or heavy, were more likely to
>>experie ce a
>>> >spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2,
>>> >respectively) and cesarean delivery (odds ratio, 1.1 and 1.4,
>>respectively) Light
>>> >bleeding subjects were more likely to have preeclampsia (odds ratio,
>>1.5),
>>> >preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio,
>>1. ).
>>> >Heavy vaginal bleeding subjects were more likely to have intrauterine
>>growt
>>> >restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0),
>>preterm
>>> >premature rupture of membranes (odds ratio, 3.2), and placental abruption
>>( dds
>>> >ratio, 3.6).
>>> >Conclusion: First-trimester vaginal bleeding is an independent risk
>>factor
>>> >for adverse obstetric outcome that is directly proportional to the amount
>>o
>>> >bleeding.
>>> > 2004 Elsevier Inc. All rights reserved.
>>> >KEY WORDS
>>> >Threatened abortion
>>> >Spontaneous pregnancy
>>> >loss
>>> >Preterm delivery
>>> >Placental abruption
>>> >Preterm premature
>>> >rupture of membranes
>>> >â?"
>>> >First-trimester vaginal bleeding is a common complication that affects
>>16% o
>>> >25% of all pregnancies.1,2 When pregnant patients have bleeding, it may
>>cau e
>>> >stress and anxiety for the mother-to-be about the future outcome of the
>>> >pregnancy. In general, the incidence of
>>> >spontaneous abortion after first-trimester bleeding is quoted to be 50%
>>> >before sonographic evaluation for fetal viability.1,3 If a viable fetus
>>is oted at
>>> >ultrasound examination after first-trimester vaginal bleeding, 95% to 98%
>>o
>>> >such pregnancies will still continue beyond 20
>>> >weeks of gestation.1,4 Supported by grant No. RO1 HD 38652 from the
>>National
>>> >Institutes of Health and the National Institute of Child Health and Human
>>> >Development.
>>> >* Reprint requests: Joshua L. Weiss, MD, Columbia Presbyterian
>>> >Medical Center, 622 W 168th St, PH-16-66, New York, NY 10032.
>>> >E-mail: jw791@columbia.edu
>>> >http://www.elsevier.com/locate/ajog
>>> >
>>> >American Journal of Obstetrics and Gynecology (2004) 190, 745-50
>>> >
>>> >Leonard H. Kellner
>>> >Lenetix Medical Screening Laboratory, Inc.
>>> >
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>>> --
>>> art fougner, md
>>> ich bin ein New Yorker
>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
art fougner, md
ich bin ein New Yorker
