Maternal obesity: do patients understand the risks?

OBJECTIVE: To evaluate patient knowledge of the risks of maternal obesity and compare knowledge between non-obese and obese women. STUDY DESIGN: A face-to-face survey was administered to 105 women at their first prenatal visit. The survey assessed their knowledge of obesity-related risks during pregnancy, weight history and goals and health behaviors. Descriptive statistics described the entire sample. Student's t-test and chi(2) tests compared knowledge between non-obese (body mass index (BMI) of <30 kg m(-2)) and obese (BMI of > or =30 kg m(-2)) gravidas. RESULT: There were 56 (54%) non-obese and 47 (46%) obese participants. There were no significant differences between the weight groups with respect to age, race, insurance, education, tobacco use and primigravity. Overall, 49% participants knew that obesity increases risks in pregnancy. The knowledge of specific risks was similar in the non-obese (60% correct) and obese (64% correct) groups (P=0.76). Obese patients were more aware of the risk for diabetes (68 vs 96%, P<0.001). Obese gravidas expressed more interest in weight loss before another pregnancy (61 vs 81%, P=0.03), although the desired BMIs (22.1+/-2.3 vs 26.2+/-3.0 kg m(-2), P<0.001) were different for non-obese and obese women, respectively. Of all participants, 9% discussed the risks of maternal obesity with a provider before study participation and 75% wanted to participate in a study on weight loss before pregnancy to determine whether it leads to healthier pregnancies. CONCLUSION: Regardless of BMI category, patients required more knowledge about the risks of obesity in pregnancy, requested additional information and were motivated to lose weight before future pregnancies. Because obese women underestimated their optimal weight loss goals, it is necessary to target this group for further education.

In utero progression of mild fetal ventriculomegaly.

OBJECTIVE: To evaluate the progression in utero of mild isolated fetal ventriculomegaly (defined as a transverse diameter of the atrium of the lateral ventricle measuring between 10 and 15 mm), and to estimate the proportion of fetuses that normalize (diameter decreasing to less than 10mm), stabilize (remaining between 10 and 15 mm), or progress to more severe ventriculomegaly (becoming greater than 15 mm). METHODS: The obstetric databases of 3 institutions were queried for any studies mentioning ventriculomegaly or hydrocephalus. Reports and original images were reviewed to verify cases of isolated mild ventriculomegaly, with no other anomalies on comprehensive ultrasonographic examination. Fetuses that had 2 or more evaluations more than 3 weeks apart were included. RESULTS: A total of 63 fetuses met the criteria for isolated mild ventriculomegaly. The mean gestational age and ventricular measurements were 24.7+/-3.7 weeks and 11.8+/-1.1mm, respectively, at the initial scan and 34+/-2.9 weeks and 12.1 +/-3.8mm, respectively, at the final scan. The mean number of scans was 3.75 per fetus (range, 2-6). Amniocentesis revealed the deletion of 5p, which causes the cri du chat, in 1 of 21 fetuses; 26 fetuses (41%) showed normalization of the lateral ventricles; 10 fetuses (16%) showed progression; and 27 (43%) appeared stable. shows the statistics of the individual groups. Three of the fetuses that "stabilized" improved from 15 mm to 11, 11.5, and 11.7 mm, respectively. Two worsened from 10.2 to 14 mm and from 11.4 to 13 mm. CONCLUSIONS: More than 40% of the cases of mild isolated fetal ventriculomegaly resolved in utero. The significant overlap in measurements for the different groups precludes prediction in individual cases. However, of the 13 cases where the transverse diameter measured 13 mm or more, only 1 normalized, while 9 of the remaining 12 cases stabilized and 3 progressed.

Transabdominal three-dimensional volume imaging of the fetal brain at 18--24 weeks' gestation.

OBJECTIVE: This study was undertaken to determine the quality of the visualization of fetal neuroanatomical structures at 18--24 weeks gestation using three-dimensional transabdominal ultrasound. METHODS: A retrospective study of 40 stored fetal head volumes obtained from 1 November 1999 to 30 June 2000 was undertaken as part of an institutional review board-approved study. The quality of stored images for three axial planes, the midline sagital plane and three coronal planes was graded using a three tier system (optimal, suboptimal and poor). RESULTS: Optimal visualization for the seven anatomic planes under study ranged from 38% to 55%. CONCLUSION: Three-dimensional trans abdominal volume studies of the fetal brain show promise for the diagnosis of structural anomalies of the developing brain. However, technological improvements in the quality of resolution will be required for this technique to be incorporated into routine clinical practice.

Reliability and validity of three-dimensional fetal brain volumes.

OBJECTIVE: To determine the intraobserver and interobserver variability in calculating three-dimensional fetal brain volumes and to examine the relationship between these volumes and biparietal diameter and head circumference measurements and estimated gestational age. METHODS: Eighty-five subjects between 16 and 40 completed weeks' gestation participated in the Institutional Review Board-approved study. Fetal head images were obtained axially and stored on a magnetic optical disk. The fetal brain volumes were calculated in triplicate by each of 2 observers using 8 to 10 coronal cuts. The coefficient of variation was determined for both physicians. Pearson correlations and linear regression were used to evaluate the relationship between three-dimensional head volume and standard biparietal diameter and head circumference measurements and estimated gestational age. RESULTS: The coefficients of variation were low for both investigators, at 2.04% and 2.44%. The correlations between fetal brain volumes and biparietal diameter, head circumference, and estimated gestational age were all highly significant (P < .001). The linear regression of brain volumes with estimated gestational age was also highly significant (P < .001). CONCLUSIONS: Three-dimensional fetal brain volume measurements had excellent intraobserver and interobserver reliability. The volumes correlated very well with standard biparietal diameter and head circumference measurements. These volumes can also be used to determine estimated gestational age.

Spontaneous second trimester uterine rupture after classical cesarean.

BACKGROUND: Several cases of spontaneous second trimester uterine rupture have been reported, but none as early as 15 weeks' gestation after classical cesarean and with placenta percreta. CASE: A 23-year-old woman, gravida 5, para 3, at 15 37 weeks' gestation with a history of classical cesarean incision presented to the emergency department with abdominal pain, hypotension, and tachycardia. Ultrasound showed a normal intrauterine pregnancy. She developed worsening pain, abdominal rebound, and abdominal distention. On exploratory laparotomy, a large uterine rupture was found and hysterectomy was done. CONCLUSION: Spontaneous uterine rupture after classical cesarean can occur as early as 15 weeks' gestation. Uterine rupture must be considered in differential diagnoses of severe abdominal pain even in the early second trimester.

Experience with self-administered emergency contraception in a low-income, inner-city family planning program.

OBJECTIVE: To evaluate women's use, knowledge of and attitudes toward self-administered emergency contraceptive pills (ECP) at the University of Pennsylvania family planning clinic (FPC). STUDY DESIGN: The University of Pennsylvania FPC is a Title X, publicly funded clinic serving urban, low-income women. All women attending the clinic were offered ECP packets. Exclusion criteria for ECP were current pregnancy or newly diagnosed hypertension. Women signed consent forms and were given specific instructions on using ECP with the standard Yuzpe method. Women were contacted for a phone interview after they had the ECP packets at home for six to eight months. RESULTS: One hundred ninety-two women received the ECP packets. Forty-eight were contacted and completed the survey. One hundred forty-four women had moved, no longer had phone service or were unreachable after three or more attempts. Eleven of the 48 women (22.9%) used the ECP, but only 2 of 11 (18.2%) took the pills correctly. One of these two women became pregnant. Of the women who had not used the ECP packets, only 25 of 37 (67.6%) could locate them, and only 9 of 37 (24%) could recall how to use them correctly. Four of 37 (10.8%) experienced an unplanned pregnancy. CONCLUSION: Emergency contraception utilization was far lower than anticipated, suggesting that ready access is not the only issue. Many of the women did not administer ECP correctly or could not state how they would use it in the future despite extensive instruction. Patients will require new and creative approaches to encourage their appropriate use of emergency contraception.

Alteration of Hormonal Levels in a Rootless Epiphytic Bromeliad in Different Phenological Phases.

Major changes in indole-3-acetic acid (IAA) and cytokinin (CK) levels occur at different phenological phases of Tillandsia recurvata shoots. This epiphytic rootless bromeliad was chosen as suitable material for hormonal analysis because CK synthesis is restricted to the shoots, thus avoiding problems in the interpretation of results caused by translocation and interconversion of CK forms between roots and leaves encountered in plants with both organs. Young plants of T. recurvata have weak apical dominance because side shoots appeared early in development, and branch growth was correlated with a strong increase in the level of zeatin. The flowering phase was characterized by a significant increase in free base CKs, zeatin, and isopentenyladenine compared with the levels found in adult vegetative shoots. In contrast, both free-base CKs declined in the fruiting phenological phase, and the IAA level increased dramatically. It was concluded that in phases characterized by intense organ formation, such as in the juvenile and flowering stages, there was an enhancement of CK content, mainly caused by zeatin, leading to a lower IAA/CK ratio. Higher ratios were correlated with phases that showed no organogenesis, such as adult and fruiting phenologies.

Meta-interpretive reliability of computer-based test interpretations: the Karson Clinical Report.

Meta-interpretive reliability is a new method to evaluate the accuracy with which personality trait scores are communicated via interpretive statements in a computer-based test interpretation (CBTI). The prototypic experimental design is based on a two-way repeated measures analysis of variance (ANOVA); the two effects are personality traits and randomly chosen CBTI protocols. In this application, 101 psychologists read four examples of the Karson Clinical Report (KCR, Karson & O'Dell, 1975) and estimated the original trait scores from the Sixteen Personality Factor Questionnaire (16PF; Cattell, Eber, & Tatsuoka, 1970) on which the KCR is based. Estimated trait score variance was significantly related to the Trait x Protocol interaction and the main effects for personality trait and differences among protocols (omega 2 = .55). The total effect size corresponded to a multiple correlation of .74, suggesting that the KCR had acceptable meta-interpretive reliability. The protocol effect denoted a context effect created by the juxtaposition of several interpretive statements. Additional analyses showed that individual differences among raters contributed to less than 1% of the estimated standard ten (sten) score variance. Meta-interpretive reliability is proposed as an index of the upper limit of validity for CBTIs.