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Françoise Muller - One of the best experts on this subject based on the ideXlab platform.
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Management strategy in pregnancies with elevated second-trimester Maternal Serum alpha-fetoprotein based on a second assay
American Journal of Obstetrics and Gynecology, 2013Co-Authors: Emmanuel Spaggiari, Sophie Dreux, Isabelle Czerkiewicz, Marie Ruas, Anne-sylvie Valat, Fabien Guimiot, Thomas Schmitz, Anne-lise Delezoide, Françoise MullerAbstract:Objective To assess Maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester Maternal Serum alpha-fetoprotein. Study Design A retrospective cohort study in 658 patients with Maternal Serum alpha-fetoprotein ≥2.5 multiple of median, performed at routine Down syndrome screening. Maternal Serum alpha-fetoprotein was assayed a second time in 341 of them. Outcomes were recorded in all cases. Results The group with unexplained Maternal Serum alpha-fetoprotein persistently ≥2.5 multiple of median was associated with more pregnancy complications 37 of 92 (40.2%) as fetal death, preeclampsia, intrauterine growth restriction, and congenital nephrotic syndrome, compared with the group with Maternal Serum alpha-fetoprotein that returned to a normal level 37 of 226 (16.4%) ( P Conclusion When Maternal Serum alpha-fetoprotein returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat Maternal Serum alpha-fetoprotein assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. Alpha-fetoprotein should be monitored in pregnancies associated with unexplained high Maternal Serum alpha-fetoprotein. A management strategy based on ultrasound examination, second Maternal Serum alpha-fetoprotein assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it.
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Down syndrome Maternal Serum screening in patients with renal disease
American Journal of Obstetrics and Gynecology, 2010Co-Authors: Alexandra Benachi, Sophie Dreux, Sahar Kaddioui-maalej, Isabelle Czerkiewicz, Fadi Fakhouri, Eric Thervet, Françoise MullerAbstract:Objective The objective of the study was to determine the value of Maternal Serum Down syndrome screening in patients affected by renal disease. Study Design A study group of 54 pregnant women with renal diseases defined before pregnancy, was compared with a control group of 108 patients matched for Maternal age, Maternal weight, smoking status, and gestational age. Maternal Serum markers (free β-human chorionic gonadotropin [hCG], total hCG, alpha-fetoprotein) expressed in multiple of median and Maternal renal function markers (creatinine, β2-microglobulin, α1-microglobulin) were assayed. Results The percentage of patients in the Down syndrome at-risk group (>1:250) using free β-hCG was significantly higher ( P Conclusion Down syndrome screening using free β-hCG is not applicable in patients with renal disease whatever the Maternal Serum creatinine and can be used with caution when total hCG is used.
Mark I. Evans - One of the best experts on this subject based on the ideXlab platform.
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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, 1999Co-Authors: Yuval Yaron, Mordechai Hallak, Mark P. Johnson, Michele Cherry, Ralph L Kramer, Joseph E Obrien, Mark I. EvansAbstract: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.)
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2nd-Trimester Maternal Serum Marker Results Are Not Altered by Delayed Analysis
Fetal diagnosis and therapy, 1998Co-Authors: Baruch Feldman, Mark P. Johnson, Ralph L Kramer, Elena Dvorin, Tracy Phillips, Mark I. EvansAbstract:Objective: The goal of the study was to evaluate the significance of delayed laboratory analysis of Maternal Serum α-fetoprotein, β-subunit of human chorionic gonadotropin, and unconjugated estriol for prenatal screening. Methods: Biochemical analysis of 30 consecutive biochemical screening specimens of Maternal Serum α-fetoprotein, β-subunit of human chorionic gonadotropin, and unconjugated estriol was performed immediately upon arrival to the laboratory, 7 days later, and again 14 days after Maternal blood was drawn. Differences among the results of the three sets of biochemical studies were evaluated by one-way analysis of variance for repeated measures. Results: No significant differences were found among the results of immediate assays as compared with those at a 7- or a 14-day delay for all three biochemical markers. Conclusions: Our data suggest that up to a 14-day delay in the performance of the 2nd-trimester Maternal Serum biochemical screening assays will not alter the results significantly. The results of Maternal Serum screening are, thus, clinically valid even if the laboratory assays were performed several days after Maternal blood was drawn.
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Maternal Thyroid Function Does Not Alter Maternal Serum α-Fetoprotein Interpretation
The Journal of maternal-fetal medicine, 1997Co-Authors: Mordechai Hallak, Joseph E. O’brien, Nelson B. Isada, Mark P. Johnson, Arie Drugan, Mark I. EvansAbstract:Objective: Endocrine alterations of metabolism such as diabetes and obesity are known to affect Maternal Serum α-fetoprotein interpretation. Thyroid function has been questioned, e.g., because of binding globulins, but not adequately studied as to its impact upon Maternal Serum α-fetoprotein. The purpose of this study was to assess the possible effects of T4 and thyroid-stimulating hormone (TSH) on α-fetoprotein production, and to determine if thyroid function (hypothyroidism) alters Maternal Serum α-fetoprotein. Methods: We evaluated Maternal Serum α-fetoprotein, T4, and TSH records of 25,551 patients, between 14 and 20 weeks' gestation, on whom both studies had been ordered by the patient's primary obstetrician to rule out Maternal thyroid disease in pregnancy. Statistical analyses were performed by χ2 and regression analysis. Results: Patients were stratified according to thyroid function tests into two groups: hypothyroidism (T4 5.0 μU/mL), and normal or hyperthyroidism (T4 ≥ ...
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Risk of anomalies as a function of level of elevated Maternal Serum α-fetoprotein
American journal of obstetrics and gynecology, 1994Co-Authors: Avihai Reichler, Nelson B. Isada, Mark P. Johnson, Arie Drugan, Roderick F. Hume, Mordechai Bardicef, Mark I. EvansAbstract:Abstract Objective: Most neural tube defects risks, are not actual but mathematic extrapolations. We sought to evaluate this risk and to compare actual performance. Study Design: This was a retrospective study of a referral population with elevated Maternal Serum α-fetoprotein results between 1987 and 1992. Ultrasonography results, delivery records, and autopsy results were compared with entry levels of Maternal Serum α-fetoprotein, and the percentage of fetal anomalies detected in this study was evaluated. Results: A total of 773 patients with elevated Maternal Serum α-fetoprotein levels were evaluated. There was a progressive increase in the incidence of anomalies as a direct function of the level of the Maternal Serum AFP, varying from 3.4% at a level of 2.5 to 40.3% at a level>7.0. Conclusion: Data from this study support the correlation of Maternal Serum AFP levels with the risk of neural tube defect and ventral wall defects.
Krishnananda Prabhu - One of the best experts on this subject based on the ideXlab platform.
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role of Maternal Serum human placental lactogen in first trimester screening
Indian Journal of Clinical Biochemistry, 2019Co-Authors: Indranil Ghoshal, Varashree Bolar Suryakanth, Vijetha Shenoy Belle, Krishnananda PrabhuAbstract:The most preferred antenatal screening test is first trimester dual test which has a detection rate of 95% for foetal chromosomal anomaly. Maternal Serum free b human chorionic gonadotropin (free b hCG) and pregnancy associated plasma protein A are used in first trimester dual test along with Maternal demographic and foetal sonographic indices to calculate risk for foetal aneuploidy. Human placental lactogen is a placental hormone that is present in Maternal Serum only during pregnancy and its level rises in relation to the growth of the foetus and placenta. The objectives of this study was to measure and correlate Maternal Serum hPL with free b hCG, Maternal age, Maternal age related risk ratio and calculated risk ratio of first trimester screening. After obtaining permission from the Institutional Ethics Committee, hPL and free b hCG were measured from the Serum of 84 pregnant women aged 20–40 years in 11–13th weeks ? 6 days of gestation who underwent dual test during their antenatal check-up. Independent t test, Pearson’s correlation, Spearman’s correlation, Mann–Whitney U test, ANOVA were used wherever appropriate. A significant positive correlation between Maternal Serum hPL, Maternal age related aneuploidy risk ratio (p value\0.001) and aneuploidy risk ratio at the time of delivery (p value\0.001) was observed. Also Maternal age was negatively correlated with Maternal Serum hPL (p value\0.001) and positively correlated with Maternal Serum free b hCG (p value 0.023). A significant negative correlation between Maternal Serum hPL and free b hCG (p value\0.001) was found. To conclude low level of Maternal Serum hPL in advanced Maternal age may reflect decreased functional syncytiotrophoblast mass which may predispose to adverse pregnancy outcome. As chance of baby born with chromosomal anomaly is known to increase with advancing Maternal age, hPL may have role in first trimester screening.
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Role of Maternal Serum Human Placental Lactogen in First Trimester Screening.
Indian journal of clinical biochemistry : IJCB, 2018Co-Authors: Indranil Ghoshal, Varashree Bolar Suryakanth, Vijetha Shenoy Belle, Krishnananda PrabhuAbstract:The most preferred antenatal screening test is first trimester dual test which has a detection rate of 95% for foetal chromosomal anomaly. Maternal Serum free β human chorionic gonadotropin (free β hCG) and pregnancy associated plasma protein A are used in first trimester dual test along with Maternal demographic and foetal sonographic indices to calculate risk for foetal aneuploidy. Human placental lactogen is a placental hormone that is present in Maternal Serum only during pregnancy and its level rises in relation to the growth of the foetus and placenta. The objectives of this study was to measure and correlate Maternal Serum hPL with free β hCG, Maternal age, Maternal age related risk ratio and calculated risk ratio of first trimester screening. After obtaining permission from the Institutional Ethics Committee, hPL and free β hCG were measured from the Serum of 84 pregnant women aged 20–40 years in 11–13th weeks + 6 days of gestation who underwent dual test during their antenatal check-up. Independent t test, Pearson’s correlation, Spearman’s correlation, Mann–Whitney U test, ANOVA were used wherever appropriate. A significant positive correlation between Maternal Serum hPL, Maternal age related aneuploidy risk ratio (p value
W A Bennett - One of the best experts on this subject based on the ideXlab platform.
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Reduced placental perfusion causes an increase in Maternal Serum leptin.
Placenta, 2003Co-Authors: L E Moore, B T Alexander, W L May, B D Thigpen, Kedra Wallace, W A BennettAbstract:Abstract Objective: We tested the hypothesis that the inadequately perfused placenta increases production of leptin, which can be detected in Maternal Serum. Study design: Sprague–Dawley rats (n=13), on day 14 of gestation, had placement of clips on the aorta and the ovarian arteries providing 35 per cent occlusion of the vessels. Eight rats had sham surgery and 14 rats served as non-surgical controls. All animals were sacrificed on day 19 of gestation. Maternal Serum was obtained, and pups and placentae were weighed. Results: Both placental weights and pup weights were reduced due to reduced uterine perfusion and were negatively correlated with Maternal Serum leptin (P=0.018 and 0.028, respectively). Maternal Serum leptin was increased in the treatment group (2.21 ng/ml±64 ng/ml) compared to controls (1.66 ng/ml±38 ng/ml) (P=0.031). Conclusion: Our findings suggest that reduced placental perfusion results in an increase in Maternal Serum leptin. Further investigation is needed to determine if Maternal Serum leptin may be useful in identifying pregnancies with uteroplacental insufficiency.
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Reduced placental perfusion causes an increase in Maternal Serum leptin.
Placenta, 2003Co-Authors: L E Moore, K L Wallace, B T Alexander, W L May, B D Thigpen, W A BennettAbstract:We tested the hypothesis that the inadequately perfused placenta increases production of leptin, which can be detected in Maternal Serum. Sprague-Dawley rats (n=13), on day 14 of gestation, had placement of clips on the aorta and the ovarian arteries providing 35 per cent occlusion of the vessels. Eight rats had sham surgery and 14 rats served as non-surgical controls. All animals were sacrificed on day 19 of gestation. Maternal Serum was obtained, and pups and placentae were weighed. Both placental weights and pup weights were reduced due to reduced uterine perfusion and were negatively correlated with Maternal Serum leptin (P=0.018 and 0.028, respectively). Maternal Serum leptin was increased in the treatment group (2.21 ng/ml+/-64 ng/ml) compared to controls (1.66 ng/ml+/-38 ng/ml) (P=0.031). Our findings suggest that reduced placental perfusion results in an increase in Maternal Serum leptin. Further investigation is needed to determine if Maternal Serum leptin may be useful in identifying pregnancies with uteroplacental insufficiency.
George K - One of the best experts on this subject based on the ideXlab platform.
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Maternal Serum alpha-fetoprotein levels in chorioangiomas.
American Journal of Perinatology, 1994Co-Authors: Khong Ty, George KAbstract:: It has been suggested that chorioangiomas should be added to the list of causes of elevated Maternal Serum alpha-fetoprotein levels. We undertook a review of Maternal Serum alpha-fetoprotein levels in chorioangiomas histologically diagnosed in our department, and a review of the literature. Maternal Serum alpha-fetoprotein level was elevated in only 1 of our 11 cases of chorioangioma. To date, there have been 14 case reports of chorioangiomas in which Maternal Serum alpha-fetoprotein levels have been recorded; 12 of these were associated with elevated Maternal Serum alpha-fetoprotein levels. We consider that, although chorioangiomas may be a cause of elevated Maternal Serum alpha-fetoprotein levels, it is likely to be infrequently a cause of such elevations in our population.
