Early detection of patients at high risk for gestational diabetes in the early second trimester in patients with significant risk factors

1997 ◽  
Vol 176 (1) ◽  
pp. S179
Author(s):  
S. Puza ◽  
N. Roth ◽  
M. Malee
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Early Detection ◽  
Gestational Diabetes ◽  
Significant Risk ◽  
Second Trimester

scholarly journals Problem-Orientated Antenatal Notekeeping: A Useful Primary Health Care Tool

Curationis ◽  
1978 ◽  
Vol 1 (3) ◽  
Author(s):  
J.V. Larsen
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Significant Risk ◽  
Obstetric Care ◽  
Antenatal Screening ◽  
Primary Health ◽  
Risk Patients

It has recently been demonstrated that about 56 percent of patients delivering in a rural obstetric unit had significant risk factors, and that 85 percent of these could have been detected by meticulous antenatal screening before the onset of labour. These figures show that the average rural obstetric unit in South Africa is dealing with a large percentage of high risk patients. In this work, it is hampered by: 1. Communications problems: i.e. bad roads, long distances. and unpredictable telephones. 2. A serious shortage of medical staff resulting in primary obstetric care being delivered by midwives with minimal medical supervision.

EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients

2008 ◽  
Vol 18 (2) ◽  
pp. 357-362 ◽  
Author(s):  
W.-G. Lu ◽  
F. Ye ◽  
Y.-M. Shen ◽  
Y.-F. Fu ◽  
H.-Z. Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
High Risk ◽  
Complete Remission ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Clinical Analysis ◽  
Secondary Malignancy ◽  
Primary Therapy ◽  
Gestational Trophoblastic Neoplasia

This study was designed to analyze the outcomes of chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) with EMA-CO regimen as primary and secondary protocol in China. Fifty-four patients with high-risk GTN received 292 EMA/CO treatment cycles between 1996 and 2005. Forty-five patients were primarily treated with EMA-CO, and nine were secondarily treated after failure to other combination chemotherapy. Adjuvant surgery and radiotherapy were used in the selected patients. Response, survival and related risk factors, as well as chemotherapy complications, were retrospectively analyzed. Thirty-five of forty-five patients (77.8%) receiving EMA-CO as first-line treatment achieved complete remission, and 77.8% (7/9) as secondary treatment. The overall survival rate was 87.0% in all high-risk GTN patients, with 93.3% (42/45) as primary therapy and 55.6% (5/9) as secondary therapy. The survival rates were significantly different between two groups (χ2= 6.434, P = 0.011). Univariate analysis showed that the metastatic site and the number of metastatic organs were significant risk factors, but binomial distribution logistic regression analysis revealed that only the number of metastatic organs was an independent risk factor for the survival rate. No life-threatening toxicity and secondary malignancy were found. EMA-EP regimen was used for ten patients who were resistant to EMA-CO and three who relapsed after EMA-CO. Of those, 11 patients (84.6%) achieved complete remission. We conclude that EMA-CO regimen is an effective and safe primary therapy for high-risk GTN, but not an appropriate second-line protocol. The number of metastatic organs is an independent prognostic factor for the patient with high-risk GTN. EMA-EP regimen is a highly effective salvage therapy for those failing to EMA-CO.

scholarly journals ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

2012 ◽  
Author(s):  
І. К. Чурпій
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Significant Risk ◽  
Female Gender ◽  
Electrolyte Composition ◽  
Terminal Phase ◽  
Phase Flow ◽  
History Of

<p>To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin &lt;35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.</p>

scholarly journals Reference Values of D-Dimers and Fibrinogen in the Course of Physiological Pregnancy: the Potential Impact of Selected Risk Factors—A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Aldona Siennicka ◽  
Magdalena Kłysz ◽  
Kornel Chełstowski ◽  
Aleksandra Tabaczniuk ◽  
Zuzanna Marcinowska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Reference Values ◽  
Venous Blood ◽  
Fibrinogen Concentration ◽  
Reference Ranges ◽  
Second Trimester ◽  
Increase Risk ◽  
Potential Impact ◽  
D Dimer

Pregnancy predisposes to thrombotic hemostasis, reflected in the laboratory as, e.g., increased levels of D-Dimers and fibrinogen, but in physiological pregnancy, the risk of venous thrombosis does not increase. Risk may increase if gestational diabetes mellitus (GDM) or nicotinism coexists. Study aims were to determine reference values ​​for D-Dimers and fibrinogen concentrations in each trimester of pregnancy, corrected for GDM and nicotinism. Subjects and Methods. The study involved 71 pregnant women aged 25-44 y. Venous blood was collected three times: in the first (11-14 weeks), second (20-22 weeks), and third (30-31 weeks) trimesters. D-Dimer concentrations were determined by an enzyme-linked fluorescence assay, fibrinogen concentrations by a coagulation method according to Clauss. Results. Significant increases in D-Dimers and fibrinogen concentrations were observed, increasing with successive trimesters (p ANOVA<0.0001). Furthermore, a positive correlation between D-Dimers and fibrinogen was detected in the second trimester of pregnancy (r=0.475; p<0.0001). In addition, a significantly higher fibrinogen concentration was found in women with GDM compared to without GDM (p=0.0449). Reference ranges for D-Dimers were established, in trimester order, as follows: 167-721 ng/mL, 298-1653 ng/mL, and 483-2256 ng/mL. After adjusting for risk factors, significantly higher D-Dimer values ​​(mainly second and third trimesters) were obtained: 165-638 ng/mL, 282-3474 ng/mL, and 483-4486 ng/mL, respectively. Reference ranges for fibrinogen were, in trimester order, 2.60-6.56 g/L, 3.40-8.53 g/L, and 3.63-9.14 g/L and, after adjustment for risk factors, 3.34-6.73 g/L, 3.40-8.84 g/L, and 3.12-9.91 g/L. Conclusions. We conclude that the increase in D-Dimers and fibrinogen levels in women with physiological pregnancy was compounded by gestational diabetes (GDM) and nicotinism. Therefore, D-Dimers and fibrinogen pregnancy reference values require correction for these risk factors.

scholarly journals Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening

2018 ◽  
Vol 7 (3) ◽  
pp. 801 ◽  
Author(s):  
Tulasa Basnet ◽  
Neelam Pradhan ◽  
Poonam Koirala ◽  
Kesang D. Bista
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Challenge Test ◽  
Perinatal Outcomes ◽  
High Risk Group ◽  
High Risk Women ◽  
Glucose Challenge

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.

scholarly journals Role of second trimester uterine artery doppler for the prediction of preeclampsia in high risk pregnancy

2019 ◽  
Vol 8 (3) ◽  
pp. 906
Author(s):  
Madhuri Thakur ◽  
Reeti Mehra
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Uterine Artery ◽  
High Risk Pregnancy ◽  
Second Trimester ◽  
Uterine Artery Doppler ◽  
Risk Pregnancy ◽  
Doppler Study ◽  
Doppler Indices

Background: The uterine artery Doppler has potentials for screening for complications of impaired placentation. The purpose of study was to assess the role of uterine artery color Doppler waveform analysis in second trimester for the prediction of preeclampsia in a high-risk pregnancy between 18-24 weeks of gestation.Methods: 100 women with moderate or high-risk factors for developing preeclampsia reporting to Obstetrics and Gynaecology department of Government Medical College and Hospital, Sector 32, Chandigarh were enrolled for present study. Transabdominal uterine artery doppler measurements was done at 18-24weeks of gestation in these patients. Doppler . The Doppler indices generated automatically from the machine , the Pulsatility Index (PI), Resistance Index (RI) , presence or absence of diastolic notch and S/D Ratio were recorded, and average was calculated.Results: Out of 100 patients there were 46 primigravidas with no additional risk factors, 22 pateints with two or more risk factors and there were no patients who had three or more risk factors in present study population. Preeclampsia is seen more commonly in primigravida and primigravida is considered as moderate risk factor for preeclampsia. It was found that an elevated second trimester uterine artery RI was significantly associated with developing preeclampsia later in pregnancy. The sensitivity and specificity of uterine artery Doppler velocimetry were found to be 84% and 55% respectively. Receiver operator characteristics (ROC) curves were created to demonstrate the prognostic value of RI and PI of uterine artery doppler indices at 18-24 weeks of gestation for the development preeclampsia. In addition, there were statistically significant positive correlations between mean RI of uterine artery doppler study and patients who developed preeclampsia. With a sensitivity of 84.21% it could identify 31% of the cases of preeclampsia at a false positive rate of 44.4%.Conclusions: Uterine artery doppler study can be used as a predictor of moderate strength for preeclampsia.

A PRELIMINARY STUDY OF RISK FACTORS OF BREAST CANCER AND THE USEFULNESS OF BREAST MRI AS AN ADDITION TO MAMMOGRAPHY IN DETECTING BREAST CANCER IN HIGH RISK WOMEN

2016 ◽  
Vol 78 (11-3) ◽  
Author(s):  
Noor Khairiah A. Karim ◽  
Rohayu Hami ◽  
Nur Hashamimi Hashim ◽  
Nizuwan Azman ◽  
Ibrahim Lutfi Shuaib
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Cancer Detection ◽  
Significant Risk ◽  
Breast Mri ◽  
Breast Cancer Detection ◽  
P Value ◽  
High Risk Women ◽  
History Of

The risk factors of breast cancer among women, such as genetic, family history and lifestyle factors, can be divided into high-, intermediate- and average-risk. Determining these risk factors may actually help in preventing breast cancer occurrence. Besides that, screening of breast cancer which include mammography, can be done in promoting early breast cancer detection. Breast magnetic resonance imaging (MRI) has been recommended as a supplemental screening tool in high risk women. The aim of this study was to identify the significant risk factor of breast cancer among women and also to determine the usefulness of breast MRI as an addition to mammography in detection of breast cancer in high risk women. This retrospective cohort study design was conducted using patients’ data taken from those who underwent mammography for screening or diagnostic purposes in Advanced Medical and Dental Institute, Universiti Sains Malaysia, from 2007 until 2015. Data from 289 subjects were successfully retrieved and analysed based on their risk factors of breast cancer. Meanwhile, data from 120 subjects who had high risks and underwent both mammography and breast MRI were further analysed. There were two significant risk factors of breast cancer seen among the study population: family history of breast cancer (p-value=0.012) and previous history of breast or ovarian cancer (p-value <0.001). Breast MRI demonstrated high sensitivity (90%) while mammography demonstrated high specificity (80%) in detection of breast cancer in all 120 subjects. The number of cases of breast cancer detection using breast MRI [46 (38.3%)] was higher compared to mammography [24 (20.0%)]. However, breast MRI was found to be non-significant as an adjunct tool to mammography in detecting breast cancer in high risk women (p-value=0.189). A comprehensive screening guideline and surveillance of women at high risk is indeed useful and should be implemented to increase cancer detection rate at early stage

scholarly journals Identification of Intermediate- to High-Risk Papillary Thyroid Carcinoma Patients Who May Be Safely Managed without the Performance of Delayed Stimulated Thyroglobulin Measurements following Total Thyroidectomy and Radioactive Iodine Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Kyung-Hee Kim ◽  
Min-Hee Kim ◽  
Ye-Jee Lim ◽  
Ihn Suk Lee ◽  
Ja-Seong Bae ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Significant Risk ◽  
Disease Status ◽  
Radioactive Iodine Therapy ◽  
Papillary Thyroid ◽  
Independent Risk Factors

Background. The measurement of stimulated thyroglobulin (sTg) after total thyroidectomy and remnant radioactive iodine (RAI) ablation is the gold standard for monitoring disease status in patients with papillary thyroid carcinomas (PTCs). The aim of this study was to determine whether sTg measurement during follow-up can be avoided in intermediate- and high-risk PTC patients.Methods. A total of 346 patients with PTCs with an intermediate or high risk of recurrence were analysed. All of the patients underwent total thyroidectomy as well as remnant RAI ablation and sTg measurements. Preoperative and postoperative parameters were included in the analysis.Results. Among the preoperative parameters, age below 45 years and preoperative Tg above 19.4 ng/mL were significant risk factors for predicting detectable sTg during follow-up. Among the postoperative parameters, thyroid capsular invasion, lymph node metastasis, and ablative Tg above 2.9 ng/mL were independently correlated with a detectable sTg range. The combination of ablative Tg less than 2.9 ng/mL with pre- and postoperative independent risk factors for detectable sTg increased the negative predictive value for detectable sTg up to 98.5%.Conclusions. Based on pre- and postoperative parameters, a substantial proportion of patients with PTCs in the intermediate- and high-risk classes could avoid aggressive follow-up measures.

scholarly journals First Trimester Biomarkers in the Prediction of Later Pregnancy Complications

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Stefan C. Kane ◽  
Fabricio da Silva Costa ◽  
Shaun Brennecke
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Preterm Birth ◽  
High Risk ◽  
Gestational Diabetes ◽  
First Trimester ◽  
Obstetric Outcomes ◽  
High Risk Population ◽  
Maternal History

Adverse obstetric outcomes, such as preeclampsia, preterm birth, gestational diabetes, and fetal growth restriction, are poorly predicted by maternal history and risk factors alone, especially in nulliparae. The ability to predict these outcomes from the first trimester would allow for the early initiation of prophylactic therapies, institution of an appropriate model and location of care, and recruitment of a truly “high risk” population to clinical trials of interventions to prevent or ameliorate these conditions. To this end, development of adequately sensitive and specific predictive tests for these outcomes has become a significant focus of perinatal research. This paper reviews the biomarkers involved in these multiparametric tests and also outlines the performance of these tests and issues regarding their introduction into clinical practice.

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