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Frank A. Manning - One of the best experts on this subject based on the ideXlab platform.
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Fetal Biophysical Profile.
Obstetrics and Gynecology Clinics of North America, 1999Co-Authors: Frank A. ManningAbstract:This article begins with an outline of the theoretic basis of the Fetal Biophysical Profile, the method for the Biophysical Profile score (BPS), and the timing and frequency of testing. The article further discusses the clinical management based on test scores; modified methods of the BPS; and clinical application, predictive accuracy, and impact on outcome of BPS. The authors specifically examine the relationship between BPS and cerebral palsy. They conclude with a discussion of adult sequelae and Fetal adaptation to asphyxia.
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Acute oligohydramnios and deteriorating Fetal Biophysical Profile associated with severe preeclampsia
The Journal of Maternal-Fetal Medicine, 1999Co-Authors: David M. Sherer, Ashlesha K. Dayal, Benjamin M. Schwartz, Chukwuma I. Onyeije, Frank A. ManningAbstract:Acute changes in Fetal Biophysical Profile (BPP) status usually include rapid cessation of all nonessential acute Biophysical activities, yet not necessarily an acute decrease in the amniotic fluid volume, or oligohydramnios. A 36-year-old para 3 with early third-trimester severe preeclampsia, mild placental abruption, and Fetal growth restriction, with a reassuring BPP of 8/8, was managed expectantly with intravenous magnesium sulfate, hydralazine, and intramuscular corticosteroids. Within 20 h of admission a marked change in the BPP was noted, with a score of 0/8. Amniotic fluid index (AFI), which on admission had been 20.1, progressively became 0, despite a stable normovolemic maternal status. At immediate cesarean, a mildly acidotic and hypoxic fetus was delivered which subsequently did well. This case supports the concept that acute oligohydramnios may develop rapidly in the presence of acute Fetal hypoxemia.
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Fetal assessment based on Fetal Biophysical Profile scoring
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Frank A. Manning, Christopher Harman, Nabeel Bondaji, Oscar Casiro, Savas Menticoglou, Ian N. Morrison, David J. BerckAbstract:Abstract OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the Fetal Biophysical Profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last Fetal Biophysical Profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, –coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial Fetal Biophysical Profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded Biophysical Profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the Fetal Biophysical Profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test Fetal Biophysical Profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by Fetal Biophysical Profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy. (Am J Obstet Gynecol 1998;178:696-706.)
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Fetal Biophysical Profile: a critical appraisal
Fetal and Maternal Medicine Review, 1997Co-Authors: Frank A. ManningAbstract:In medicine, in general and Fetal medicine in particular, the conceptual development and emerging application of a new diagnostic modality is fuelled firstly by a general recognition of the increasing relative importance of a particular clinical problem and then by critical examination of the body of scientific observation, often disparate in origin, that provides the key insights into the pathophysiology, manifestation and natural history of the disease process. So it is with the evolution of the Fetal Biophysical Profile score. In general terms, until the 1950's the major goal of obstetric care was the prevention of maternal mortality and morbidity. As the result of a host of clinical advances including improved anaesthesia and surgical techniques and availability of blood and blood products, antibiotics and specific other drugs (oxytocin, anticonvulsants, antihypertensives, insulin etc.) maternal mortality declined to the low rates of the present day. Consequently, the focus of obstetric care shifted to the recognition and prevention of death or damage affecting the other patient in the obstetric dyad: the fetus. The first methods for evaluation of antepartum Fetal health care were based on measurements of biochemical variables in the maternal compartment (e.g. oestriol, placental lactogen, alkaline phosphatase and oxytocinase).
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Fetal assessment based on the Fetal Biophysical Profile score: relationship of last BPS result to subsequent cerebral palsy
Journal de gynecologie obstetrique et biologie de la reproduction, 1997Co-Authors: Frank A. Manning, Savas Menticoglou, C.r. Harman, Bondagji N, Casiro O, Morrison IAbstract:Evaluation antenatale par le profil biophysique foetal (PBF): relation entre le resultat du dernier PBF et la survenue d'une Infirmite motrice cerebrale. Introduction. Le profil biophysique foetal (PBF), ou score de Manning, consiste a coter de 0 a 2 quatre activites instantanees du foetus (mouvements respiratoires, mouvements globaux du corps, tonus, activite cardiaque) et une variable chronique (volume du liquide amniotique). Il a deja ete montre qu'il y a une relation etroite entre la valeur du dernier PBF etabli et une acidemie prenatale (mesuree par ponction du sang foetal dans la veine ombilicale), la mortalite peri-natale, les indicateurs principaux de morbidite perinatale (Apgar a 5 mm 8/10) a 250 %o en cas de dernier resultat nul (0/10). On notait toutefois que 18 fois sur 27 le dernier PBF obtenu etait normal. Parmi les 27 cas d'IMC, il s'agissait d'une quadriplegie dans 63 % des cas, d'une diplegie dans 22 % des cas, et d'une hemiplegie dans 15 % des cas; des convulsions etaient associees dans la moitie des cas (et plus souvent quand le dernier PBF etait < 6); I l'origine de l'atteinte cerebrale etait genetique dans 3 cas, antenatale dans 8 cas, perpartum dans 2 cas, neonatale dans 10 cas, postnatale dans 3 cas, et indeterminee dans 1 cas. Seuls les cas classes comme etant d'origine antenatale (7 sur 8) et neonatale (2 sur 10) avaient un dernier PBF anormal. Les complications liees a la prematurite rendaient compte de 37 % des cas d'IMC, l'asphyxie antepartum de 29 % des cas, et l'asphyxie intrapartum de 7,4 %. Conclusion. Le dernier resultat du PBF est un predicteur du risque d'lMC.
Ian N. Morrison - One of the best experts on this subject based on the ideXlab platform.
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Fetal assessment based on Fetal Biophysical Profile scoring
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Frank A. Manning, Christopher Harman, Nabeel Bondaji, Oscar Casiro, Savas Menticoglou, Ian N. Morrison, David J. BerckAbstract:Abstract OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the Fetal Biophysical Profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last Fetal Biophysical Profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, –coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial Fetal Biophysical Profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded Biophysical Profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the Fetal Biophysical Profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test Fetal Biophysical Profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by Fetal Biophysical Profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy. (Am J Obstet Gynecol 1998;178:696-706.)
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Fetal Biophysical Profile score vi correlation with antepartum umbilical venous Fetal ph
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Fetal Biophysical Profile score: VI. Correlation with antepartum umbilical venous Fetal pH*
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Fetal assessment based on Fetal Biophysical Profile scoring. III. Positive predictive accuracy of the very abnormal test (Biophysical Profile score = 0).
American Journal of Obstetrics and Gynecology, 1990Co-Authors: Frank A. Manning, Christopher Harman, Ian N. Morrison, Savas MenticoglouAbstract:The relationship between complete absence of all components of the Fetal Biophysical Profile score (Biophysical Profile score = 0) and adverse perinatal outcome was examined. Twenty-nine of 28,655 fetuses studied (0.092%) had a last Biophysical Profile score of 0; 48.3% of these perinates died (14 of 29 fetuses), the majority of whom (11 of 14) were stillborn, with death occurring as early as 30 minutes to as long as 11 days after the last test. Three asphyxia-related neonatal deaths occurred despite aggressive and immediate intervention. All survivors exhibited at least one of the five discrete markers used to assess perinatal morbidity. The positive predictive accuracy of a Biophysical Profile score of 0, with mortality and morbidity used as end points, was 100%. These data indicate the very abnormal Fetal Biophysical Profile score to be a perinatal emergency.
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The abnormal Fetal Biophysical Profile score. V: Predictive accuracy according to score composition
American Journal of Obstetrics and Gynecology, 1990Co-Authors: Frank A. Manning, Christopher Harman, Ian N. Morrison, Savas MenticoglouAbstract:The relationship between last abnormal Biophysical Profile score, in total and by variable composition, and a spectra of abnormal perinatal outcome end points was examined in 525 fetuses. Highly significant inverse relationships between last test score and outcome were observed; relationships were linear for most end points and exponential for perinatal mortality end points. For Biophysical Profile scores less than or equal to 6, 25 of the 26 possible variable combinations were observed, at varying frequencies. For a Biophysical Profile score of 6, the positive predictive accuracy for some end points was significantly higher with either nonreactive nonstress test/Fetal tone absent or nonreactive nonstress test/absent Fetal breathing movement, and significantly lower with absent Fetal breathing movement and decreased amniotic fluid volume. For a Biophysical Profile score of 4, the positive predictive accuracy for some end points was significantly higher with nonreactive nonstress test/absent Fetal breathing movement/decreased amniotic fluid and was significantly lower with absent Fetal movement/Fetal breathing movement/Fetal tone. No significant variation was observed for a Biophysical Profile score of 2. These data indicate that not all abnormal Biophysical Profile scores are equal.
Savas Menticoglou - One of the best experts on this subject based on the ideXlab platform.
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Fetal assessment based on Fetal Biophysical Profile scoring
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Frank A. Manning, Christopher Harman, Nabeel Bondaji, Oscar Casiro, Savas Menticoglou, Ian N. Morrison, David J. BerckAbstract:Abstract OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the Fetal Biophysical Profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last Fetal Biophysical Profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, –coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial Fetal Biophysical Profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded Biophysical Profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the Fetal Biophysical Profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test Fetal Biophysical Profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by Fetal Biophysical Profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy. (Am J Obstet Gynecol 1998;178:696-706.)
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Fetal assessment based on the Fetal Biophysical Profile score: relationship of last BPS result to subsequent cerebral palsy
Journal de gynecologie obstetrique et biologie de la reproduction, 1997Co-Authors: Frank A. Manning, Savas Menticoglou, C.r. Harman, Bondagji N, Casiro O, Morrison IAbstract:Evaluation antenatale par le profil biophysique foetal (PBF): relation entre le resultat du dernier PBF et la survenue d'une Infirmite motrice cerebrale. Introduction. Le profil biophysique foetal (PBF), ou score de Manning, consiste a coter de 0 a 2 quatre activites instantanees du foetus (mouvements respiratoires, mouvements globaux du corps, tonus, activite cardiaque) et une variable chronique (volume du liquide amniotique). Il a deja ete montre qu'il y a une relation etroite entre la valeur du dernier PBF etabli et une acidemie prenatale (mesuree par ponction du sang foetal dans la veine ombilicale), la mortalite peri-natale, les indicateurs principaux de morbidite perinatale (Apgar a 5 mm 8/10) a 250 %o en cas de dernier resultat nul (0/10). On notait toutefois que 18 fois sur 27 le dernier PBF obtenu etait normal. Parmi les 27 cas d'IMC, il s'agissait d'une quadriplegie dans 63 % des cas, d'une diplegie dans 22 % des cas, et d'une hemiplegie dans 15 % des cas; des convulsions etaient associees dans la moitie des cas (et plus souvent quand le dernier PBF etait < 6); I l'origine de l'atteinte cerebrale etait genetique dans 3 cas, antenatale dans 8 cas, perpartum dans 2 cas, neonatale dans 10 cas, postnatale dans 3 cas, et indeterminee dans 1 cas. Seuls les cas classes comme etant d'origine antenatale (7 sur 8) et neonatale (2 sur 10) avaient un dernier PBF anormal. Les complications liees a la prematurite rendaient compte de 37 % des cas d'IMC, l'asphyxie antepartum de 29 % des cas, et l'asphyxie intrapartum de 7,4 %. Conclusion. Le dernier resultat du PBF est un predicteur du risque d'lMC.
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Fetal Biophysical Profile score vi correlation with antepartum umbilical venous Fetal ph
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Fetal Biophysical Profile score: VI. Correlation with antepartum umbilical venous Fetal pH*
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Assessment of Fetal well-being with ultrasound.
Obstetrics and gynecology clinics of North America, 1991Co-Authors: Frank A. Manning, Savas Menticoglou, C.r. Harman, Morrison IAbstract:The practice of medicine is undergoing marked changes fueled by the infusion of vast amounts of new information concerning the etiology, the progressive pathophysiology, and the complexity of host response to disease states. It is only recently that we have begun to examine the present extent of Fetal disease and to determine the characteristics of its advancements. This information now permits new and rational approaches to the management of Fetal disease. Clinical significance, both real and potential, of this new wealth of information in reducing perinatal mortality and morbidity is difficult to overestimate. Cumulative experience with Fetal Biophysical scoring as a method for antepartum Fetal risk assessment is now extensive. The cumulative data indicate that the method is sensitive for recognizing both the normal and the compromised fetus. Moreover, the method appears to offer the advantage of grading various degrees of Fetal compromise. The additional information gained by real-time ultrasound scanning (gestational age determination, Fetal morphometrics, and Fetal anomaly screening), although not an integral part of the Fetal Biophysical Profile score, nevertheless remains a critical aspect of antepartum Fetal assessment. These data are collected simultaneously with Fetal Biophysical Profile scoring. It is impossible to separate cleanly the advantage of Fetal Biophysical Profile scoring in isolation of this additional information. It would, however, seem that such attempt at separation is artificial because the data in combination provide the key information that the physician needs to guide Fetal management. It seems more reasonable to expect that continued modification and improvement of the existing Fetal Biophysical Profile scoring method with inclusion of new testing techniques will be the steps that will occur to improve testing accuracy (Fig. 3). In medical schools in the 1960s, it was generally taught that the concept of "irreducible" perinatal mortality existed and that this figure was usually set at a perinatal mortality of around 8 per 1000. Now in the 1990s that perinatal mortality has already fallen below this irreducible level and continues to fall. We now observe perinatal mortality among tested fetuses of less than 7 per 1000 and corrected perinatal mortalities of less than 2 per 1000. These remarkable results strongly underscore the advantages obtained by ultrasound assessment of the fetus.
Christopher Harman - One of the best experts on this subject based on the ideXlab platform.
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Fetal assessment based on Fetal Biophysical Profile scoring
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Frank A. Manning, Christopher Harman, Nabeel Bondaji, Oscar Casiro, Savas Menticoglou, Ian N. Morrison, David J. BerckAbstract:Abstract OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the Fetal Biophysical Profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last Fetal Biophysical Profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, –coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial Fetal Biophysical Profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded Biophysical Profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the Fetal Biophysical Profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test Fetal Biophysical Profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by Fetal Biophysical Profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy. (Am J Obstet Gynecol 1998;178:696-706.)
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Fetal Biophysical Profile score vi correlation with antepartum umbilical venous Fetal ph
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Fetal Biophysical Profile score: VI. Correlation with antepartum umbilical venous Fetal pH*
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Fetal assessment based on Fetal Biophysical Profile scoring. III. Positive predictive accuracy of the very abnormal test (Biophysical Profile score = 0).
American Journal of Obstetrics and Gynecology, 1990Co-Authors: Frank A. Manning, Christopher Harman, Ian N. Morrison, Savas MenticoglouAbstract:The relationship between complete absence of all components of the Fetal Biophysical Profile score (Biophysical Profile score = 0) and adverse perinatal outcome was examined. Twenty-nine of 28,655 fetuses studied (0.092%) had a last Biophysical Profile score of 0; 48.3% of these perinates died (14 of 29 fetuses), the majority of whom (11 of 14) were stillborn, with death occurring as early as 30 minutes to as long as 11 days after the last test. Three asphyxia-related neonatal deaths occurred despite aggressive and immediate intervention. All survivors exhibited at least one of the five discrete markers used to assess perinatal morbidity. The positive predictive accuracy of a Biophysical Profile score of 0, with mortality and morbidity used as end points, was 100%. These data indicate the very abnormal Fetal Biophysical Profile score to be a perinatal emergency.
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The abnormal Fetal Biophysical Profile score. V: Predictive accuracy according to score composition
American Journal of Obstetrics and Gynecology, 1990Co-Authors: Frank A. Manning, Christopher Harman, Ian N. Morrison, Savas MenticoglouAbstract:The relationship between last abnormal Biophysical Profile score, in total and by variable composition, and a spectra of abnormal perinatal outcome end points was examined in 525 fetuses. Highly significant inverse relationships between last test score and outcome were observed; relationships were linear for most end points and exponential for perinatal mortality end points. For Biophysical Profile scores less than or equal to 6, 25 of the 26 possible variable combinations were observed, at varying frequencies. For a Biophysical Profile score of 6, the positive predictive accuracy for some end points was significantly higher with either nonreactive nonstress test/Fetal tone absent or nonreactive nonstress test/absent Fetal breathing movement, and significantly lower with absent Fetal breathing movement and decreased amniotic fluid volume. For a Biophysical Profile score of 4, the positive predictive accuracy for some end points was significantly higher with nonreactive nonstress test/absent Fetal breathing movement/decreased amniotic fluid and was significantly lower with absent Fetal movement/Fetal breathing movement/Fetal tone. No significant variation was observed for a Biophysical Profile score of 2. These data indicate that not all abnormal Biophysical Profile scores are equal.
R.j.m. Snijders - One of the best experts on this subject based on the ideXlab platform.
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Fetal Biophysical Profile score vi correlation with antepartum umbilical venous Fetal ph
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.
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Fetal Biophysical Profile score: VI. Correlation with antepartum umbilical venous Fetal pH*
American Journal of Obstetrics and Gynecology, 1993Co-Authors: Frank A. Manning, Christopher Harman, Savas Menticoglou, R.j.m. Snijders, Kypros H. Nicolaides, Ian N. MorrisonAbstract:OBJECTIVE:: Our objective was to determine the relationship, if any, between the Fetal Biophysical Profile score and antepartum umbilical venous pH. STUDY DESIGN: This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal Biophysical Profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of Biophysical Profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS: In both data sets there was a highly significant linear correlation between Biophysical Profile score and umbilical venous pH. Poor Biophysical Profile score performance (a score of 0 of 10) was always associated with a pH 7.20 when the Biophysical Profile score was 10 of 10. Sequenced sensitivity of short-term Biophysical variables in the detection of acidemia was observed. CONCLUSION: The Fetal Biophysical Profile score accurately predicts antepartum umbilical venous pH.