Morbidity, Mortality, and Placental Pathology in Excessively Long Umbilical Cords: Retrospective Study

2001 ◽  
Vol 4 (2) ◽  
pp. 144-153 ◽  
Author(s):  
Rebecca N. Baergen ◽  
Denise Malicki ◽  
Cynthia Behling ◽  
Kurt Benirschke
Keyword(s):  
Retrospective Chart Review ◽  
Neonatal Morbidity ◽  
Maternal Factors ◽  
Normal Length ◽  
Nucleated Red Blood Cells ◽  
Increased Risk ◽  
History Of ◽  
Altered Blood ◽  
Vertex Presentation ◽  
Umbilical Cords

The purpose of this study was to compare specific fetal, maternal, and placental factors, including neonatal morbidity and mortality, in infants with umbilical cords (UCs) of normal length to the same factors in infants with excessively long umbilical cords (ELUCs). We performed an 18-year retrospective chart review of the medical records of mothers and infants with ELUCs (926 cases) and normal-length UCs (200 cases) and recorded maternal factors, fetal factors, and neonatal outcomes. Corresponding placental pathologic reports and slides were reviewed. Statistical analysis comparing the two groups included univariate and multivariate analyses. ELUCs were significantly associated with certain maternal factors (systemic diseases, delivery complications, increased maternal age), fetal factors (non-reassuring fetal status, respiratory distress, vertex presentation, cord entanglement, fetal anomalies, male sex, increased birth weight), gross placental features (increased placental weight, right-twisted cords, markedly twisted cords, true knots, congestion), and microscopic placental features (nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increased syncytial knots, single umbilical artery). Some of these histopathologic features have previously been associated with fetal hypoxia and/or altered blood flow in the placenta. Infants with ELUCs were found to be at a significantly increased risk of brain imaging abnormalities and/or abnormal neurological follow-up. In addition, mothers with a history of an ELUC are at increased risk of a second long cord.

Examining ethnic differences for bevacizumab-induced hypertension and proteinuria

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21168-21168 ◽  
Author(s):  
Y. M. Choi ◽  
S. Shord ◽  
S. Cuellar ◽  
J. Villano
Keyword(s):  
Clinical Benefit ◽  
Previous History ◽  
Retrospective Chart Review ◽  
Increased Risk ◽  
High Prevalence ◽  
Induced Hypertension ◽  
History Of ◽  
Grade 3 ◽  
The University ◽  
Ethnic Variations

21168 Background: Bevacizumab is an increasingly used anti-cancer treatment with common side effects including hypertension (htn) and proteinuria which occur in approximately 10% and 20% of the patients, respectively. Little is known regarding ethnic variations of bevacizumab induced htn and proteinuria, particularly in African-Americans (AA) who have a high prevalence of htn and susceptibility to kidney disease. Methods: We conducted a retrospective chart review of patients who completed bevacizumab alone or as a chemotherapy regimen at the University of Illinois at Chicago for an 18-month study period. We collected blood pressure (BP) measurements and urinanalyses before starting bevacizumab, during bevacizumab and after stopping bevacizumab, in addition to concurrent medications, past medical history and demographics. Htn and proteinuria were graded by CTC v3.0. Patients with less than two successive doses of bevacizumab or unreliable ethnicity were excluded. Results: 27 subjects were eligible. Eighteen AA (67%) and 9 (33%) non-AA were included. Twenty-two (81%) had colorectal cancer. AA received a median of 10 cycles and non-AA received a median of 6 cycles. Six subjects (22%) developed any grade htn toxicity; maximum grade: grade 2=4 (15%), grade 3=2 (7%). Htn toxicity occurred in 28% AA and 11% non-AA (p=NS). Previous history of hypertension was found in 15 subjects (55%): AA=14 vs. non-AA=1 (p=0.002) and was not correlated with hypertensive toxicity. Twelve subjects (44%) developed any grade proteinuria; maximum grade: grade 1=9 (33%), grade 2=3 (11%). Proteinuria toxicity occurred in 50% AA and 33% non-AA (p=NS). Presence of hypertensive toxicity was associated with increased risk of proteinuria. Clinical benefit (PR, SD) was seen in 15 subjects (55%). Rate of clinical benefit was 67% in AA and 33% in non-AA (p=NS). Clinical benefit did not correlate with hypertensive or proteinuria toxicities. Conclusions: AA were more prone than non-AA to bevacizumab induced hypertension and proteinuria toxicity in this retrospective study. Higher clinical benefit was seen in AA. No significant financial relationships to disclose.

scholarly journals Effect of Prior History of Dementia and a Diagnosis of COVID-19 on Delirium in the ICU

2020 ◽  
Vol 3 ◽  
Author(s):  
Amira Kupty ◽  
Fen-Lei Chang
Keyword(s):  
Retrospective Chart Review ◽  
Multiple Organ ◽  
Prior History ◽  
Organ Systems ◽  
Increased Risk ◽  
History Of ◽  
Recent Diagnosis ◽  
Potential Factors ◽  
Icu Delirium ◽  
Severity Of Dementia

Background: Delirium occurred in nearly two out of every three patients in the ICU from prior studies. It is associated with poor health outcomes, including long-term cognitive and motor decline, increased risk of dementia, and increased mortality. In the context of COVID-19, patients are more likely to develop delirium due to the severity of the illness involving multiple organ systems. Our study evaluates factors contributing to the occurrence of delirium in the ICU for patients with or without a history of dementia and with or without a recent diagnosis of COVID-19.  Methods: We performed a retrospective chart review of ICU patients in Fort Wayne, IN from January through the end of June of 2020. Patients were grouped by whether they developed delirium or not and whether they had pre-existing dementia. We recorded age, sex, race, BMI, level of education, high risk medications, comorbidities, enteric/NPO feeding, mechanical ventilation, mobility, and lab results including CBC and BMP at the onset of delirium. Additionally, we included severity of delirium, length of stay, functional status at time of discharge, and COVID-19 status.   Results: We were unable to collect data at the time. However, we hypothesized that the incidence and severity of ICU delirium is associated with the severity of dementia and COVID status, among other factors.  Potential Impact: This study can shed light on the contribution of dementia history to ICU delirium and potential factors contributing to delirium incidence and severity. The COVID pandemic offers opportunities to differentiate effects of neurological (dementia) versus non-neurological factors (respiratory, renal, cardiovascular, and metabolic) on ICU delirium. 

scholarly journals Haemorrhagic complications of peripartum anticoagulation: A retrospective chart review

2014 ◽  
Vol 7 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Erica HZ Wang ◽  
Catherine A Marnoch ◽  
Rshmi Khurana ◽  
Winnie Sia ◽  
Nesé Yuksel
Keyword(s):  
Heart Valves ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Low Molecular Weight ◽  
Index Pregnancy ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
History Of ◽  
Academic Teaching Hospital ◽  
Therapeutic Doses

Background Women with venous thromboembolism (VTE), thrombophilias or mechanical heart valves may require anticoagulation during pregnancy and postpartum. The incidence of postpartum hemorrhage (PPH) in the literature is 2.9–6%, but the rate while on anticoagulation is not well documented. Aims To determine the incidence of haemorrhagic complications associated with the use of peripartum anticoagulation, and the types and risk factors for haemorrhagic complications. Methods A retrospective chart review was conducted on women who delivered at an academic teaching hospital and received peripartum anticoagulation between January 2000 and August 2009. Women with known bleeding disorders were excluded. Results In total, 195 cases were identified with mean age 31.3 years and gestational age of 37.7 weeks. Of these, 49% had a history of VTE, 21% had active VTE in the index pregnancy, and 63% had vaginal delivery. Types of anticoagulation used antepartum were unfractionated heparin (UFH) (43%) and low molecular weight heparin (LMWH) (36%), with 26% receiving therapeutic doses. The rate of haemorrhagic complications was 12.8%, with majority being PPH (80%). Sixty percent of the PPH occurred before reintroduction of anticoagulation postpartum. Use of therapeutic UFH antepartum was associated with increased risk of haemorrhagic complications compared to LMWH (OR 3.08, 95% CI 0.663 – 15.03, p = 0.183). Conclusion The rate of haemorrhagic complications is higher in women on peripartum anticoagulation compared with published incidence in unselected obstetric populations; however, this rate is similar to our institution’s reported rates. Our findings inform clinicians about competing risks of thrombotic and haemorrhagic complications in this population.

Incidence and management of bevacizumab associated hypertension in outpatient oncology clinic

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20677-e20677
Author(s):  
C. Jee ◽  
B. Brockstein ◽  
W. Hui ◽  
J. Lawton ◽  
A. Harper ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Retrospective Chart Review ◽  
Vascular Endothelial ◽  
Vegf Inhibitor ◽  
Number Of Patients ◽  
Increased Risk ◽  
Wide Range ◽  
History Of ◽  
Grade 3 ◽  
Endothelial Growth Factor

e20677 Background: Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor is utilized to treat a wide range of cancers. However, clinical trials of bevacizumab reported the incidence of hypertension (HTN) up to 36%. A national guideline has not been established to manage bevacizumab-induced HTN. The incidence and management of bevacizumab associated HTN were evaluated in an outpatient oncology clinic. Methods: A randomized, retrospective chart review of 100 patients who received at least one dose of bevacizumab from 1/1/07 to 12/31/07 was conducted. The overall incidence and management of hypertension were evaluated. Other bevacizumab associated toxicities were compared in patients with or without hypertension. Results: The overall incidence of bevacizumab-induced HTN was 31% (95%CI: 22%-40%) with CTC (v 3.0) grade 3 HTN rate of 10%. The number of patients with a history of HTN or uncontrolled BP prior to bevacizumab therapy was significantly different across the four HTN grade groups (p= 0.0019). Out of 31 patients who had grade 1–3 HTN, 8 patients (26%) were managed by the oncologists, 8 patients (26%) by the primary care physicians, and 15 patients (48%) had no management. Bevacizumab was held in 3 patients due to high blood pressure (BP) resulting in one patient discontinuing bevacizumab therapy. The odds of other bevacizumab associated adverse events in patients with grades 1–3 HTN was 2.776 times than that of patients with grade 0 HTN (p=0.0201). Conclusions: Bevacizumab was associated with HTN in 31% of patients. Patients with history of HTN or uncontrolled BP prior to initiating bevacizumab were at an increased risk to develop a higher grade of HTN. Management of bevacizumab-induced HTN could be improved since BP of 63% of patients with grades 2 and 3 HTN was not adequately controlled. No significant financial relationships to disclose.

Real-world outcomes of genetic testing in a GU genetics clinic and evaluation of current guidelines.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 668-668
Author(s):  
Annelise Pace ◽  
Ashley Henriksen Woodson ◽  
Rebecca Slack-Tidwell ◽  
Molly S. Daniels ◽  
Patrick Glen Pilie ◽  
...  
Keyword(s):  
At Risk ◽  
Genetic Testing ◽  
Retrospective Chart Review ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Clinical Criteria ◽  
Increased Risk ◽  
Genetic Test Results ◽  
History Of ◽  
Cancer Syndromes

668 Background: Several known hereditary cancer syndromes confer an increased risk for genitourinary (GU)-related malignancies. Various guidelines indicate when to refer patients to genetic counseling for GU cancers, but there are limited data on the performance of these guidelines in clinical practice, and the association between testing outcome and clinical and familial features that may delineate a heritable syndrome. The purpose of this study is to determine the most common indications for ordering genetic testing in a GU Genetics Clinic and evaluate the relationship between the indication for germline testing and outcome. Methods: An IRB-approved retrospective chart review was performed for 350 patients seen in a GU Genetics Clinic at a single comprehensive cancer center from 2014-2018. Subgroups of patients were formed based on their indication for genetic testing. Exact binomial tests were used to compare the proportion of patients with a positive (pathogenic or likely pathogenic) germline variant for those with vs. without each indication. Results: All patients had a genetic evaluation due to a personal or family history of GU cancer. The majority (324 of 350, 92.5%) were evaluated for either renal cell carcinoma (RCC) or prostate cancer (PrCa). Among patients seen for RCC-related evaluation (n = 159), 23 patients (14.5%) tested positive. Meeting published clinical criteria for a hereditary RCC syndrome significantly predicted positive testing ( P< 0.001). No other indication for testing, including RCC diagnosis ≤ 46 years, predicted for positive germline genetic test results. No positive patients were identified by age of RCC onset alone. Among patients seen for PrCa-related evaluation (n = 173), 13 (7.5%) individuals tested positive; all positive variants were in ATM or BRCA2. A single patient (1/13) was identified by metastatic PrCa status alone. Conclusions: Our data suggest current algorithms lack specificity for selecting individuals with RCC or PrCa at risk for germline mutations, and need to be revised. Evaluation of pedigrees and identifying presence of syndromic features are essential and increase the probability of identifying individuals at risk for harboring a germline mutation.

Cigarette smoking as a risk factor for recurrence of aneurysms treated by endosaccular occlusion

2008 ◽  
Vol 108 (4) ◽  
pp. 672-675 ◽  
Author(s):  
Rafael Ortiz ◽  
Michael Stefanski ◽  
Robert Rosenwasser ◽  
Erol Veznedaroglu
Keyword(s):  
Cigarette Smoking ◽  
Coil Embolization ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Smoking History ◽  
Low Grade ◽  
Entire Cohort ◽  
Published Evidence ◽  
Increased Risk ◽  
History Of

Object Aneurysms treated by endovascular coil embolization have been associated with coil compaction, and the rate of recanalization has been reported to be as high as 40%. The authors report the first published evidence of a correlation between aneurysm recanalization correlated with a history of cigarette smoking. Methods The authors conducted a retrospective chart review of all cases involving patients admitted to their institution from January 1, 2003, to December 31, 2003, for treatment of a cerebral aneurysm. Cases in which patients were treated with coil embolization were reviewed for inclusion. Coil compaction was defined as change in the shape of the coil mass. Aneurysm recanalization was defined as an increase in inflow to the aneurysm in comparison with baseline. The incidence of coil compaction and the relationship with cigarette smoking history were compared in patients with and without recurrence. Results A total of 110 patients qualified for inclusion. The odds ratio (OR) for aneurysm recanalization after endosaccular occlusion with respect to history of cigarette smoking was significant for the entire cohort (OR 4.53, 95% confidence interval [CI] 1.95–10.52) and especially for the female cohort (OR 3.72, 95% CI 1.45–9.54). The male cohort demonstrated a trend toward a direct correlation, but the sample size was not large enough for statistical significance (OR 7.50, 95% CI 1.02–55.00). Conclusions There was an increased risk of recanalization especially in patients with low-grade subarachnoid hemorrhage who had a history of cigarette smoking. These data suggest a correlation between cigarette smoking and aneurysm recurrence.

scholarly journals Caesarean Section of Multifetal Pregnancy

2020 ◽  
Vol 06 (S 02) ◽  
pp. S92-S97
Author(s):  
Shinji Tanigaki ◽  
Satoshi Takemori ◽  
Makoto Osaka ◽  
Momoe Watanabe ◽  
Aya Kitamura ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Neonatal Morbidity ◽  
Lateral Wall ◽  
Gestational Period ◽  
Uterine Incision ◽  
Increased Risk ◽  
Vertex Presentation ◽  
The Right ◽  
Multifetal Pregnancy ◽  
Second Twin

AbstractPlanned caesarean delivery (CD) did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity in twin pregnancy between 32 0/7 and 38 6/7 weeks of gestation, with the first twin in the vertex presentation. As prevalence rises for the second twin, emergency CD is necessary for delivery of the second twin after vaginal delivery of the first twin. Waiting after 38 weeks' gestation essentially requires close fetal and maternal surveillance to identify if those pregnancies may benefit to extend a gestational period. It is important to construct a system in which an emergency CD can be performed anytime. The caesarean section does not change in even multifetal pregnancy. Each step after laparotomy has few tips: (1) because the uterus strongly leans to the right, image the uterine rotation. To avoid thick vessels on the uterine lateral wall, perform long U-shaped incision using a scissor. 2) Ensure not to rupture the membrane of the second twin before delivery of the first twin. (3) Check the presentation of the second twin before rupture of that fetus's membrane. The second twin tends to change the presentation. If the upper uterine segment will clamp down and entrap the second twin, a vertical uterine incision is performed without hesitation. Women with multifetal pregnancy are at increased risk of postpartum hemorrhage (PPH). Mainly PPH is caused by uterine atony. Oxytocin should be prepared before starting the CD. All bleeding may not be recognized in the operation field. Do not lose the timing of blood transfusion.

Anencephaly and obstetric outcome beyond the age of viability

2018 ◽  
Vol 46 (8) ◽  
pp. 885-888 ◽  
Author(s):  
Sawsan Al-Obaidly ◽  
Jis Thomas ◽  
Mahmoud Abu Jubara ◽  
Abdullah Al Ibrahim ◽  
Mariam Al-Belushi ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Mode Of Delivery ◽  
Retrospective Chart Review ◽  
Shoulder Dystocia ◽  
Obstetric Outcomes ◽  
Average Birth Weight ◽  
Increased Risk ◽  
History Of ◽  
Uterine Scar

AbstractObjectiveTo review the obstetric impact and natural history of anencephalic pregnancies beyond the age of viability.Study designA retrospective chart review of all cases with a prenatal diagnosis of anencephaly who delivered after 24 weeks’ gestation during the period 1990 until 2016. Obstetric outcomes including mode of delivery, live births, shoulder dystocia, antepartum haemorrhage (APH), postpartum haemorrhage (PPH) and uterine rupture were studied.ResultsA total of 42 cases were studied. The average gestational age at diagnosis was 22 weeks (range 10–41). The average gestational age at birth was 36 weeks (range 25–44 weeks). Induction of labour was performed in 55% (23/42) of the cases. Livebirths were documented in 40% (17/42) of the cases. The average birth weight was 1597±746 g. The rate of vaginal birth was 69% (29/42), the overall rate of caesarean section was 31% (13/42), with a primary caesarean section in 31% (4/13) and a repeat caesarean section in 69% (9/13) of the patients. There were two cases of shoulder dystocia. No other complications were encountered.ConclusionOverall, anencephaly is not associated with an increased risk of obstetric complications; however, there is a tendency towards delivery via repeated caesarean section in women with a previous uterine scar and anencephaly. The prenatal counselling of potential obstetric outcomes could be of robust value for parents who opt to continue with anencephalic pregnancies.

Maternal characteristics and the distribution of birthweight standardized for gestational age

1987 ◽  
Vol 19 (1) ◽  
pp. 17-26 ◽  
Author(s):  
R. M. Pickering
Keyword(s):  
Gestational Age ◽  
Perinatal Death ◽  
Large For Gestational Age ◽  
Maternal Factors ◽  
Maternal Characteristics ◽  
Live Births ◽  
Class A ◽  
Routinely Collected Data ◽  
Increased Risk ◽  
History Of

SummaryUsing routinely collected data for 184,000 Scottish singleton live births in 1980–82, nine maternal factors were related to changes in the distribution of birthweight for given gestational age. Maternal height and marital status were associated with overall shifts in the distribution. In contrast, social class, a previous perinatal death or two or more previous spontaneous abortions in multiparae were primarily associated with increased risk of a small-for-gestational-age infant. A history of caesarean section or three or more previous live births was associated with increased risk of a large-for-gestational-age infant. The results of this population study were generally consistent with reported hospital-based findings.

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

2021 ◽  
pp. 112067212110066
Author(s):  
Allisa J Song ◽  
Cheryl L Khanna ◽  
Sepideh Jamali ◽  
Gavin W Roddy ◽  
Lilly H Wagner
Keyword(s):  
Revision Surgery ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Glaucoma Drainage Device ◽  
Control Group ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
History Of ◽  
Surgery Outcomes ◽  
Ptosis Surgery

Purpose: There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. Methods: A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. Results: Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. Conclusions: Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.

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