Papers by Karen Russo-Stieglitz
Condensation: Injections of 17P for the prevention of recurrent preterm delivery increases the in... more Condensation: Injections of 17P for the prevention of recurrent preterm delivery increases the incidence of gestational diabetes.
Obstetrics & Gynecology, 2009
To estimate whether body mass index (BMI) affects the evaluation of nuchal translucency or the na... more To estimate whether body mass index (BMI) affects the evaluation of nuchal translucency or the nasal bone during first-trimester ultrasound examination for aneuploidy risk assessment. Six hundred ninety-four women with singleton gestations undergoing first-trimester aneuploidy risk-assessment ultrasound examinations were identified. Weight categories were defined as normal (body mass index [BMI] less than 25), overweight (25-29.9), and obese (at or above 30). chi, chi for trend, Student t test, one-way analysis of variance, and Pearson correlation were used for statistical analysis where appropriate to estimate the effect of BMI on first-trimester ultrasound examination. P<.05 was considered statistically significant. Increasing BMI was significantly associated with an inadequate nasal-bone assessment (3% compared with 12.7%, P<.001), increased ultrasound examination time (15.23+/-8.09 minutes compared with 17.01+/-7.97 minutes, P=.028), and an increased need to perform a transvaginal ultrasound examination (23% compared with 41.8%, P<.001). Prior abdominal surgery was not significantly associated with nasal-bone assessment inadequacy (7.8% compared with 4.4%, P=.125), the need to perform transvaginal ultrasound examination (33.6% compared with 28.6%, P=.279), or longer examination time (16.22+/-8.6 minutes compared with 15.92+/-7.8 minutes, P=.704). In singleton pregnancies, increased BMI is not associated with suboptimal visualization of nuchal translucency, but it is associated with a longer time to perform the first-trimester ultrasound examination for aneuploidy risk assessment, increased need for transvaginal ultrasound examination for nuchal-translucency visualization, and a lower likelihood of obtaining an adequate nasal-bone image. Previous abdominal surgery did not affect the ability to visualize the nasal bone. II.
American Journal of Perinatology, 2008
Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in pa... more Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in patients with cervical cerclage treated with weekly 17 alpha-hydroxyprogesterone caproate (17P) injections versus daily outpatient nursing surveillance (ONS) without 17P. Included in this retrospective cohort study were singleton gestations with cerclage placed at the discretion of the provider due to prior SPTD, delivering between January 1, 2004 and May 1, 2006. The study group (n = 232) consisted of women receiving once-weekly nursing visit and 17P injection. The control group (n = 1650) consisted of women enrolled for ONS (twice-daily electronic uterine contraction monitoring and nursing assessment). Data were further stratified by the number of prior preterm deliveries (1, > 1). Primary study outcome was the incidence of SPTD. No difference in rates of recurrent SPTD at < 37 or < 35 weeks were observed between the study and control groups. Study patients were less likely to be diagnosed with preterm labor (PTL) than controls (45.7% versus 70.8%, respectively; P < 0.001). The incidence of preterm premature rupture of membranes was similar between the groups (8.6% versus 8.1%; P = 0.770). We concluded that the incidence of recurrent SPTD was similar in women with cerclage treated with 17P or ONS, although women receiving 17P had a lower incidence of PTL. This benefit of 17P should be considered when managing patients with prior SPTD and cerclage.
American Journal of Obstetrics and Gynecology, 2005
Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnanc... more Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies; this further increases their risk of perinatal and infant morality. This study was designed to determine if an increased interval between twin deliveries increases the survival rate of the second twin. STUDY DESIGN: We identified 325,516 sets of twins using the ''U.S. Matched Multiple Birth'' file that links birth and death certificates of multiple births from 1995-2000. We included twin pairs for which the first-born twin was 17-29 weeks gestation at delivery, was delivered vaginally, and born alive. Our study population included 496 sets of delayed delivery twins and 5622 sets of non-delayed delivered twins. We stratified the data by delayed delivery (in weeks) and gestational age to obtain rates and risk ratios for infant mortality of second-born twins. The three groups (for delivery of the first twin) were 17-23 weeks, 24-26 weeks and 27-29 weeks gestation. RESULTS: 8.8% of twins had a delayed delivery of one or more weeks. Second-born twins in the 17-23 week group whose delivery was delayed for at least 1 week, were 17% less likely to die by one year of life compared to nondelayed twins (P!0.05). However, delayed delivery of second-born twins in the 27-29 week group had a twofold increased risk of mortality compared to non-delayed second-born twins (P!0.05). CONCLUSION: Our results support delaying the birth of the second twin when the first twin is born vaginally and very premature (23 weeks). After 23 weeks gestation, there is no improvement in survivability of the second twin and appears detrimental for twins in the 27-29 week group.
American Journal of Obstetrics and Gynecology, 2008
Fetal urinary tract obstruction can result in renal dysplasia, oligohydramnios, and pulmonary hyp... more Fetal urinary tract obstruction can result in renal dysplasia, oligohydramnios, and pulmonary hypoplasia. Various surgical approaches have been used to create a complete obstructive uropathy though with variable success particularly in female fetuses and significant mortality in both males and females. Our objective was to create an improved ovine obstructive uropathy model in both male and female fetuses during the second trimester to study lung hypoplasia and renal function. STUDY DESIGN: Ewes (nϭ11) at 90-100 days gestation (termϭ140-145 days) underwent hysterotomy. 64% singletons, 36% twins. One fetus per ewe underwent creation of obstructive uropathy (7 males and 4 females). In the male fetus, a paramedian incision is made below the umbilical cord and the urachus and distal urethra are ligated. Females require two incisions. One midline incision made at the pubic symphysis to ligate the proximal urethra and a second in the midline below the umbilical cord to ligate the urachus. Serial ultrasounds are performed and fetuses are sacrificed between 130-135 gestational days. RESULTS: Ultrasounds confirmed bladder distention, hydronephrosis, and fetal viability. Mortality occurred in 4/11 (36%) from fetal demise. Successful completion of the model at necropsy demonstrates a grossly dilated bladder and multicystic kidneys (Figure 1,2). CONCLUSION: We demonstrate a successful complete obstructive uropathy model in male and female fetal lambs. Differing techniques are needed due to anatomic differences and allow for minimal fetal trauma. This refined ovine model has utility in studying potential fetal interventions in decreasing the mortality from renal dysplasia and pulmonary hypoplasia.
Uploads
Papers by Karen Russo-Stieglitz