Quality of life in people with insomnia.

OBJECTIVE: To determine whether subjects with insomnia report greater reductions in quality of life (QoL) than subjects without insomnia when assessed with self-report instruments. METHODS: Questionnaires were completed by individuals recruited through media advertisements and screened with a structured telephone interview. Data obtained from 261 individuals with insomnia (INS group) were compared with those of 101 individuals with no sleep complaint, or controls (CTL group). RESULTS: Subjects in the INS group obtained lower mean sum scores on the Medical Outcomes Study Cognitive Scale than did subjects in the CTL group (25.34 +/- 0.34 vs 31.91 +/- 0.58, t = 9.53, p < 0.0001). The INS group also obtained lower mean scores on all subscales of the SF-36 Questionnaire compared with those in the CTL group (each, p < 0.0001 or lower), indicating impairments across multiple QoL domains. Psychiatric assessment revealed that subjects in the INS group obtained significantly higher mean item scores than subjects in the control group on the Zung Depression Scale (2.22 +/- 0.03 vs. 1.52 +/- 0.03, p < 0.0001) and the Zung Anxiety Scale (1.96 +/- 0.02 vs. 1.40 +/- 0.04, p < 0.0001). In addition, subjects in the INS group reported significantly greater impairments in specific QoL domains on the QoL inventory, and the Work and Daily Activities Inventory. No differences were observed between subjects in the INS group who were receiving treatment for insomnia versus those who were untreated. CONCLUSIONS: The results of this study indicate that significant QoL impairments are associated with insomnia.

The effect of oligohydramnios on detection of fetal anomalies with sonography.

OBJECTIVE: The sonographic examination of fetuses is generally thought to be compromised when oligohydramnios is present because of the subjective impression of less adequate visualization of fetal anatomy. The aim of this study was to evaluate the extent to which oligohydramnios limits our ability to detect major anomalies on sonograms. MATERIALS AND METHODS: Records from the University of California, San Francisco from March 4, 1989 through January 4, 1994, were reviewed to identify all cases of premature rupture of the membranes in patients who then underwent nontargeted sonography. Sonographic results in pregnancies with oligohydramnios and without oligohydramnios (control population) were compared. Follow-up was obtained from a perinatal database, autopsy reports, and medical records. RESULTS: We found 345 patients with a history of premature rupture of the membranes (175 with oligohydramnios, 170 without oligohydramnios). Gestational age of fetuses was 16-38 weeks. Major congenital anomalies, including hydronephrosis, ventriculomegaly, intestinal atresias, hydrops, congenital diaphragmatic hernia, skeletal dysplasias, cloacal malformations, and gastroschisis, were revealed on sonography in 13 of 175 pregnancies with oligohydramnios and in 17 of the 170 pregnancies in the control group. Major anomalies missed in the oligohydramnios group included cardiac anomalies, club foot, small ventral hernia, limb reduction defect, and anal atresia. Major anomalies missed in the control group were club foot, anal atresia, and tracheoesophageal fistula. All of the major anomalies missed in both groups were of the type that are known to be difficult to diagnose before birth and that are frequently missed on sonography. CONCLUSION: Although oligohydramnios subjectively degrades image resolution, sonography still reveals important fetal anatomic landmarks. Major anomalies can be detected on sonography even when the pregnancy has less than the normal amount of amniotic fluid.

Dolichocephaly and oligohydramnios in preterm premature rupture of the membranes.

This study evaluates the association between dolichocephaly and fetal outcome after preterm premature rupture of membranes. Dolichocephaly was more common in preterm fetuses in the breech presentation than those in the cephalic presentation and was more common in fetuses with oligohydramnios of long duration. Of fetuses in the cephalic presentation, 10 of 12 (83%) surviving dolichocephalic fetuses had respiratory distress syndrome compared with 31 of 73 (42%) normocephalic fetuses. However, other outcome parameters did not differ significantly. We conclude that the finding of dolichocephaly is associated with oligohydramnios of long duration. In fetuses with preterm premature rupture of membranes it is associated with respiratory distress syndrome, but not otherwise with a poor neonatal prognosis.

Imaging the fetal abdomen: how efficacious are the AIUM/ACR guidelines?

This study was performed to evaluate the efficacy of the American Institute of Ultrasound in Medicine/American College of Radiology guidelines for the detection of fetal abdominal abnormalities. In Part 1 of the study, images from 100 fetuses with sonographically diagnosed abdominal anomalies were masked except for one view of the abdominal circumference, stomach, renal area, bladder, and cord insertion. Ninety-six cases were recognized as abnormal by two sonologists. In Part 2, sonograms of 70 normal fetuses and 30 abnormal fetuses were similarly masked and shown to a sonographer and a fourth year radiology resident. Each identified 29 of 30 abnormal cases. Among fetuses with abdominal anomalies detectable at a prenatal diagnostic center, the majority of abnormal fetuses could be identified by evaluation of the five AIUM/ACR recommended views.

Prevalence of ventriculomegaly in association with myelomeningocele: correlation with gestational age and severity of posterior fossa deformity.

PURPOSE: To investigate the relationship of ventriculomegaly (VM) with gestational age (GA) and the severity of the associated Chiari II malformation. MATERIALS AND METHODS: The sonograms of 51 fetuses with myelomeningoceles were retrospectively reviewed. VM was judged to be present when the transverse ventricular atrial diameter was greater than 10 mm. The severity of the posterior fossa (PF) deformity was subjectively graded as mild, moderate, or severe. Thirty-four fetuses were scanned at < or = 24 weeks GA, and 17 were scanned at > 24 weeks GA. RESULTS: The prevalence of VM was 61%. However, only 44% of fetuses < or = 24 weeks GA had VM, whereas 94% of fetuses > 24 weeks GA had VM. When compared with fetuses with mild PF deformities, fetuses with moderate or severe deformities had a higher prevalence of VM and the largest ventricles. CONCLUSION: The prevalence of VM in fetuses with myelomeningoceles varies with both GA and the severity of the associated PF deformity. These observations may provide additional prognostic information once a myelomeningocele is detected at sonography.

Sonographic diagnosis of ectopic pregnancy with endovaginal probes: what really has changed?

To evaluate the impact of endovaginal (EV) sonography in the diagnosis of ectopic pregnancy, a 2 year retrospective study was performed identifying 123 at-risk patients. Of these 123 women, 19 (15.4%) had a surgically proved ectopic pregnancy, only three (15.8%) of which were visualized directly at sonography. A confident diagnosis of an intrauterine pregnancy (IUP) was made at the initial scan in 74%, which contrasts with 58% diagnosed at the first transabdominal (TA) scan in an earlier study from this laboratory, thus confirming an improvement in diagnostic ability with EV transducers. This study has failed to confirm some findings of other workers, particularly that adnexal ring-like structures are visualized frequently in the presence of an ectopic pregnancy. No adnexal rings were observed in our 19 cases. The combination of an adnexal mass and free pelvic fluid was found to correlate best with the presence of an ectopic pregnancy. This study further emphasizes that a significant proportion (26.3%) of ectopic pregnancies have a normal EV sonogram at presentation. The group failing to demonstrate an IUP and showing no evidence of an adnexal mass or pelvic fluid (i.e., a normal pelvic sonogram) carried a 1:3 risk for the presence of an ectopic pregnancy, a result that is very similar to our data published before the introduction of EV technology. We conclude that, although it provides a significant improvement and refinement in the recognition of intrauterine pregnancies, EV scanning does not permit a confident diagnosis of ectopic pregnancy in many cases.

Frequency of fetal anomalies in sonographically detected polyhydramnios.

One hundred and five patients who met the criterion of having an amniotic fluid pocket depth greater than 8.0 cm were categorized as polyhydramniotic. Of these cases, 82% were singleton pregnancies and 18% were twin pregnancies. The degree of polyhydramnios correlated directly with the probability that an anomaly would be detected. For the lowest rank group (pocket depth of 8 to 9.5 cm), 50% of fetuses manifested an anomaly, whereas the highest rank (16.0 cm or greater pocket depth) carried an 88% risk for an anomaly. Overall, 63% of pregnancies with polyhydramnios revealed anomalies. Sonography found all to be anomalous. There were three false diagnoses of potential anomalies. Monochorionic anomalies of twinning (twin transfusion syndrome and acardiac twin) and gastrointestinal anomalies among singletons were the most commonly seen abnormalities. However, a broad spectrum of anomalies was represented in the study group. Only five diabetic mothers were seen in our study cohort, and in each of them the pregnancy was further complicated by an associated fetal anomaly.