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K H Nicolaides - One of the best experts on this subject based on the ideXlab platform.

Foteini E Bredaki - One of the best experts on this subject based on the ideXlab platform.

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Hye J. Heo - One of the best experts on this subject based on the ideXlab platform.

  • First-trimester maternal serum alpha Fetoprotein is associated with ischemic placental disease
    American journal of obstetrics and gynecology, 2019
    Co-Authors: Cheryl Dinglas, Nur Afsar, Elizabeth Cochrane, Jay Davis, Sara Kim, Meredith Akerman, Matthew Wells, Martin Chavez, Kimberly Herrera, Hye J. Heo
    Abstract:

    Background While elevated second-trimester maternal serum alpha Fetoprotein has been associated with adverse pregnancy outcomes, the utility of first-trimester maternal serum alpha Fetoprotein in predicting these outcomes is limited. Some laboratories have been including maternal serum alpha Fetoprotein as part of the first-trimester analyte screening for aneuploidy and preeclampsia, offering its potential utility in predicting pregnancy outcomes. Objective Our primary objective was to determine the association between elevated first-trimester maternal serum alpha Fetoprotein and preeclampsia as well as ischemic placental disease (a composite of preeclampsia, fetal growth restriction, and/or placental abruption). Secondary outcomes included early-onset preeclampsia requiring delivery at Study Design An institutional review board–approved multisite retrospective cohort study was performed including all patients with first-trimester maternal serum alpha Fetoprotein as part of routine first-trimester aneuploidy screening from April 2015 through January 2017. Pregnancies with multiple gestations, known structural or chromosomal abnormalities, known malignancy, and incomplete delivery records were excluded. Delivery records were reviewed for baseline characteristics and adverse pregnancy outcomes. The optimal cutoff point for first-trimester maternal serum alpha Fetoprotein to predict these outcomes was assessed, and an elevated maternal serum alpha Fetoprotein was considered >2.0 multiple of the median. A Fisher exact test and odds ratios were used to determine the association between elevated first-trimester maternal serum alpha Fetoprotein and adverse pregnancy outcomes. Spearman correlation coefficient assessed the relationship between first- and second-trimester maternal serum alpha Fetoprotein. Results Of 1478 patients with first-trimester maternal serum alpha Fetoprotein, 1280 had complete records available for review (86.6%). There was no association demonstrated between elevated first-trimester maternal serum alpha Fetoprotein (>2.0 multiple of the median) and the primary outcome, overall preeclampsia (5.8% vs 4.6%, odds ratio, 1.29, 95% confidence interval, 0.58–2.91). However, there was an increased incidence of ischemic placental disease, 15.8% vs 7.7% (odds ratio, 2.26, 95% confidence interval, 1.33–3.87) in those with an elevated alpha Fetoprotein. Also, elevated first-trimester maternal serum alpha Fetoprotein was associated with a higher incidence of fetal growth restriction (7.5% vs 2.3%, odds ratio, 3.40, 95% confidence interval, 1.56–7.42) and preterm birth (18.3% vs 10.3%, odds ratio, 1.95, 95% confidence interval, 1.18–3.21). Also, a positive correlation between first- and second-trimester maternal serum alpha Fetoprotein was demonstrated (rho = 0.46, P Conclusion Elevated first-trimester maternal serum alpha Fetoprotein is associated with ischemic placental disease, fetal growth restriction, and preterm birth. This suggests that elevated maternal serum alpha Fetoprotein may help to identify high risk pregnancies as early as the first trimester of pregnancy. Future studies are necessary to determine whether the addition of first-trimester maternal serum alpha Fetoprotein to existing algorithms can improve the early detection of ischemic placental disease.

Mark I. Evans - One of the best experts on this subject based on the ideXlab platform.

  • second trimester maternal serum marker screening maternal serum α Fetoprotein β human chorionic gonadotropin estriol and their various combinations as predictors of pregnancy outcome
    American Journal of Obstetrics and Gynecology, 1999
    Co-Authors: Yuval Yaron, Mordechai Hallak, Mark P. Johnson, Michele Cherry, Ralph L Kramer, Joseph E Obrien, Mark I. Evans
    Abstract:

    Objective: We evaluated the value of all 3 common biochemical serum markers, maternal serum α-Fetoprotein, β-human chorionic gonadotropin, and unconjugated estriol, and combinations thereof as predictors of pregnancy outcome. Study Design: A total of 60,040 patients underwent maternal serum screening. All patients had maternal serum α-Fetoprotein measurements; β-human chorionic gonadotropin was measured in 45,565 patients, and 24,504 patients had determination of all 3 markers, including unconjugated estriol. The incidences of various pregnancy outcomes were evaluated according to the serum marker levels by using clinically applied cutoff points. Results: In confirmation of previous observations, increased maternal serum α-Fetoprotein levels (>2.5 multiples of the median) were found to be significantly associated with pregnancy-induced hypertension, miscarriage, preterm delivery, intrauterine growth restriction, intrauterine fetal death, oligohydramnios, and abruptio placentae. Increased β-human chorionic gonadotropin levels (>2.5 multiples of the median [MoM]) were significantly associated with pregnancy-induced hypertension, miscarriage, preterm delivery, and intrauterine fetal death. Finally, decreased unconjugated estriol levels (<0.5 MoM) were found to be significantly associated with pregnancy-induced hypertension, miscarriage, intrauterine growth restriction, and intrauterine fetal death. As with increased second-trimester maternal serum α-Fetoprotein levels, increased serum β-human chorionic gonadotropin and low unconjugated estriol levels are significantly associated with adverse pregnancy outcomes. These are most likely attributed to placental dysfunction. Conclusion: Multiple-marker screening can be used not only for the detection of fetal anomalies and aneu-ploidy but also for detection of high-risk pregnancies. (Am J Obstet Gynecol 1999;181:968-74.)