The projected timing of climate departure from recent variability.

Ecological and societal disruptions by modern climate change are critically determined by the time frame over which climates shift beyond historical analogues. Here we present a new index of the year when the projected mean climate of a given location moves to a state continuously outside the bounds of historical variability under alternative greenhouse gas emissions scenarios. Using 1860 to 2005 as the historical period, this index has a global mean of 2069 (±18 years s.d.) for near-surface air temperature under an emissions stabilization scenario and 2047 (±14 years s.d.) under a 'business-as-usual' scenario. Unprecedented climates will occur earliest in the tropics and among low-income countries, highlighting the vulnerability of global biodiversity and the limited governmental capacity to respond to the impacts of climate change. Our findings shed light on the urgency of mitigating greenhouse gas emissions if climates potentially harmful to biodiversity and society are to be prevented.

FMR1 premutation frequency in a large, ethnically diverse population referred for carrier testing.

Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and is caused by an expansion of cytosine-guanine-guanine (CGG) repeats in the FMR1 gene. Female premutation allele carriers (55-200 CGG repeats) are at risk to have an affected child. Currently, specific population-based carrier screening for FXS is not recommended. Previous studies exploring female premutation carrier frequency have been limited by size or ethnicity. This retrospective study provides a pan-ethnic estimate of the Fragile X premutation carrier frequency in a large, ethnically diverse population of women referred for routine carrier screening during a specified time period at Progenity, Inc. Patient ethnicity was self-reported and categorized as: African American, Ashkenazi Jewish, Asian, Caucasian, Hispanic, Native American, Other/Mixed/Unknown, or Sephardic Jewish. FXS test results were stratified by ethnicity and repeat allele category. Total premutation carrier frequency was calculated and compared against each ethnic group. A total of 134,933 samples were included. The pan-ethnic premutation carrier frequency was 1 in 201. Only the Asian group differed significantly from this frequency. Using the carrier frequency of 1 in 201, a conservative pan-ethnic risk estimate for a male fetus to have FXS can be calculated as 1 in 2,412. This risk is similar to the highest ethnic-based fetal risks for cystic fibrosis and spinal muscular atrophy, for which population-wide screening is currently recommended. This study adds to the literature and supports further evaluation into specific population-wide screening recommendations for FXS.

Clinical experience with multigene carrier panels in the reproductive setting.

OBJECTIVES: Expanded carrier testing is acknowledged as an acceptable strategy for carrier testing by the American College of Obstetrics and Gynecology. Limited studies have investigated positivity rates of expanded carrier panels. We describe our experience with 3 commercial laboratory panels varying in size from 3 to 218 disorders. METHODS: We reviewed outcomes for 3 multigene carrier screening panels: trio (3 diseases), standard (23 diseases), and global (218 diseases). All panels used targeted genotype analysis of preselected mutations via next-generation sequencing. We calculated positivity rates for each panel. RESULTS: Positivity rates were 7.2% for Preparent Trio, 13.2% for Preparent Standard, and 35.8% for Preparent Global. The most frequent positive results in the global panel were (in descending order): abnormal hemoglobin electrophoresis, familial Mediterranean fever, cystic fibrosis, fragile X, glucose-6-phosphate dehydrogenase deficiency, alpha-thalassemia, and nonsyndromic hearing loss. CONCLUSIONS: While genetic diseases are individually rare, they are cumulatively common. Our experience illustrates that, with a panel of 218 diseases, the likelihood of identifying a carrier can be as high as 36%. Understanding panel positivity rates is one important factor for providers when choosing the right test for their practice, setting appropriate expectations for patients, and planning for follow-up counseling.

Anesthetic Considerations for the Parturient After Solid Organ Transplantation.

Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents. These women are at an increased risk of comorbidities and obstetric complications. Anesthetic management should consider the important task of protecting graft function. Optimal care of a woman with a transplanted solid organ involves management by a multidisciplinary team. In this focused review article, we review the anesthetic management of pregnant patients with solid organ transplants of the kidney, liver, heart, or lung.

Utility of magnetic resonance imaging for suspected appendicitis in pregnant women.

OBJECTIVE: The purpose of this study was to estimate the rate and risk of appendix nonvisualization and alternative diagnoses made with magnetic resonance imaging (MRI) for suspected appendicitis in pregnant women. STUDY DESIGN: We performed a retrospective cohort study of consecutive pregnant women who underwent MRI for suspected appendicitis at a single center from 2007-2012. Data on clinical presentation, imaging, and surgical pathologic evidence were extracted from electronic medical records. Odds ratios estimated risk factors for nondiagnosis. Radiologic diagnoses were identified, and rates of diagnoses were calculated. Subgroup analysis was performed among women who underwent initial imaging with ultrasound scanning. RESULTS: Over the 5-year period, 171 pregnant women underwent MRI for suspected appendicitis. The rate of nonvisualization was 30.9% (n = 53). Of the remaining 118 women with a visualized appendix, 18 women had imaging findings that were consistent with appendicitis and underwent appendectomy. Twelve cases of appendicitis were confirmed on pathologic evaluation (66.7%). Women with nonvisualization of the appendix on MRI were more likely to be beyond the first trimester (odds ratio, 2.1; 95% confidence interval, 1.0-4.5). Seventy-four women had disease diagnosed on MRI (43.3%). In the group of 43 women who had a nondiagnostic ultrasound scanning before the MRI, the rate of subsequent diagnostic MRI was 65% (n = 28). CONCLUSION: MRI yields a high diagnostic rate and accuracy in pregnant women with suspected appendicitis and provides alternative diagnoses to guide further management. Given the high rate of appendix nonvisualization on ultrasound scanning that has been reported in the literature, we recommend MRI as the imaging modality of choice for this population in settings in which MRI is readily available.

An economic analysis of prenatal cytogenetic technologies for sonographically detected fetal anomalies.

When congenital anomalies are diagnosed on prenatal ultrasound, the current standard of care is to perform G-banded karyotyping on cultured amniotic cells. Chromosomal microarray (CMA) can detect smaller genomic deletions and duplications than traditional karyotype analysis. CMA is the first-tier test in the postnatal evaluation of children with multiple congenital anomalies. Recent studies have demonstrated the utility of CMA in the prenatal setting and have advocated for widespread implementation of this technology as the preferred test in prenatal diagnosis. However, CMA remains significantly more expensive than karyotype. In this study, we performed an economic analysis of cytogenetic technologies in the prenatal diagnosis of sonographically detected fetal anomalies comparing four strategies: (i) karyotype alone, (ii) CMA alone, (iii) karyotype and CMA, and (iv) karyotype followed by CMA if the karyotype was normal. In a theoretical cohort of 1,000 patients, CMA alone and karyotype followed by CMA if the karyotype was normal identified a similar number of chromosomal abnormalities. In this model, CMA alone was the most cost-effective strategy, although karyotype alone and CMA following a normal karyotype are both acceptable alternatives. This study supports the clinical utility of CMA in the prenatal diagnosis of sonographically detected fetal anomalies.

Infectious morbidity is higher after second-stage compared with first-stage cesareans.

OBJECTIVE: The objective of the study was to compare maternal and neonatal infectious morbidity following cesareans performed in the second and first stages of labor. STUDY DESIGN: We conducted a retropective cohort study of all consecutive, singleton, term, cesarean deliveries in laboring women in a single institution from 2005 to 2012. Second-stage cesareans were defined as those performed at complete cervical dilation (10 cm), and first-stage cesareans were those performed before 10 cm cervical dilation. The primary outcome was endometritis. Rates of infectious morbidity were compared in the 2 groups. Multivariable logistic regression was used to calculate adjusted risk estimates. RESULTS: Of 2505 cesareans meeting inclusion criteria, 400 (16.0%) were performed in the second stage, whereas 2105 (84.0%) were performed in the first stage of labor. The risk of endometritis was nearly 3-fold higher in second- compared with first-stage cesareans (4.25% vs 1.52%; crude odds ratio, 2.88; 95% confidence interval, 1.58-5.23). The risk remained significantly higher after controlling for confounders (adjusted odds ratio, 2.78; 95% confidence interval, 1.51-5.09). CONCLUSION: Second-stage cesarean is associated with an increased risk of endometritis compared with first-stage cesarean. Further studies will determine whether different infection preventive strategies are needed at second-stage cesareans to reduce endometritis.

Moisture status during a strong El Niño explains a tropical montane cloud forest's upper limit.

Growing evidence suggests short-duration climate events may drive community structure and composition more directly than long-term climate means, particularly at ecotones where taxa are close to their physiological limits. Here we use an empirical habitat model to evaluate the role of microclimate during a strong El Niño in structuring a tropical montane cloud forest's upper limit and composition in Hawai'i. We interpolate climate surfaces, derived from a high-density network of climate stations, to permanent vegetation plots. Climatic predictor variables include (1) total rainfall, (2) mean relative humidity, and (3) mean temperature representing non-El Niño periods and a strong El Niño drought. Habitat models explained species composition within the cloud forest with non-El Niño rainfall; however, the ecotone at the cloud forest's upper limit was modeled with relative humidity during a strong El Niño drought and secondarily with non-El Niño rainfall. This forest ecotone may be particularly responsive to strong, short-duration climate variability because taxa here, particularly the isohydric dominant Metrosideros polymorpha, are near their physiological limits. Overall, this study demonstrates moisture's overarching influence on a tropical montane ecosystem, and suggests that short-term climate events affecting moisture status are particularly relevant at tropical ecotones. This study further suggests that predicting the consequences of climate change here, and perhaps in other tropical montane settings, will rely on the skill and certainty around future climate models of regional rainfall, relative humidity, and El Niño.

Fibroid tumors are not a risk factor for adverse outcomes in twin pregnancies.

OBJECTIVE: Uterine fibroid tumors have been associated with adverse outcomes in singleton pregnancies. We aimed to estimate risk for adverse obstetric outcomes that are associated with fibroid tumors in twin pregnancies. STUDY DESIGN: A retrospective cohort study of twin pregnancies with ≥1 fibroid tumor on second trimester ultrasound examination. Outcomes included small-for-gestational-age fetal growth, preterm delivery, preterm rupture of membranes, abruption, preeclampsia, and intrauterine fetal death. Univariable and multivariable analyses were used to evaluate the impact of fibroid tumors on outcomes in twin pregnancies compared with twin pregnancies without fibroid tumors. RESULTS: Of 2378 nonanomalous twin pregnancies, 2.3% had fibroid tumors. Twin pregnancies with fibroid tumors were no more likely to have small-for-gestational-age growth (40.0% vs. 36.0%; adjusted odds ratio, 1.1; 95% confidence interval, 0.7-2.0) or preterm delivery at <34 weeks' gestation (25.0% vs. 24.0%; adjusted odds ratio, 1.0; 95% confidence interval, 0.5-1.9) than twin pregnancies without fibroid tumors. Other adverse outcomes were no more likely to occur in twin pregnancies with fibroid tumors than in twin pregnancies without fibroid tumors. Post hoc power calculations suggested >97% power to detect 2-fold differences in small for gestational age and preterm delivery at <34 weeks' gestation. CONCLUSION: In contrast to data that suggest an increased risk for adverse outcomes in singleton pregnancies with fibroid tumors, twin pregnancies with fibroid tumors do not appear to be at increased risk for complications compared with those pregnancies without fibroid tumors.

Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery.

OBJECTIVE: The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. STUDY DESIGN: We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m(2) (n = 668 women), 30-39.9 kg/m(2) (n = 1002 women), 40-49.9 kg/m(2) (n = 403 women), or ≥50 kg/m(2) (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. RESULTS: Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m(2), 11.0 ± 6.8 for 30-39.9 kg/m(2), 13.0 ± 8.0 for 40-49.9 kg/m(2), and 16.0 ± 11.3 for ≥50 kg/m(2) (P < .01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m(2), 25% for 30-39.9 kg/m(2), 29.8% for 40-49.9 kg/m(2), and 32.1% for ≥50 kg/m(2) (P = .02). CONCLUSION: Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.

The incidence of isolated single umbilical artery in twins and adverse pregnancy outcomes.

OBJECTIVES: The aim of this study was to estimate the incidence of single umbilical artery (SUA) in twin pregnancies and to investigate whether SUA in twin gestations is associated with adverse obstetric outcomes. METHODS: We performed a retrospective cohort study of consecutive twin pregnancies over 17 years at a tertiary care hospital. Primary exposure was SUA in one or both twins documented at routine second trimester anatomic survey. Adverse obstetric outcomes included small for gestational age (SGA), placental abruption, and preterm birth, evaluated in univariable and multivariable analyses. Analysis was performed both at the pregnancy level and at the fetal level using paired analyses to account for the non-independence of twin pairs. RESULTS: Of the 2378 twin pregnancies without major anatomic abnormalities, 1.7% (n = 40) had SUA. Only one pregnancy (one monochorionic twin pair) was complicated by both twins having SUA. Twin fetuses with SUA are at increased risk for SGA (aOR = 2.1 (1.2-4.1), p = 0.03) after adjusting for pertinent confounding factors, similar to the findings of previous studies in singleton pregnancies. In addition, twins with SUA may be at increased risk for preterm delivery before 28 weeks compared with twin pregnancies with normal three-vessel umbilical cords (adjusted odds ratio (aOR) 3.2 (1.3-7.89.4), p = 0.01). CONCLUSIONS: The incidence of SUA in twin gestations in this cohort is significantly less than the recently published data. Similar to reports in singleton gestations, SUA appears to be associated with an increased risk for SGA in twins.

Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort.

Importance: Ultrasonography-based risk models can help nonexpert clinicians evaluate adnexal lesions and reduce surgical interventions for benign tumors. Yet, these models have limited uptake in the US, and studies comparing their diagnostic accuracy are lacking. Objective: To evaluate, in a US cohort, the diagnostic performance of 3 ultrasonography-based risk models for differentiating between benign and malignant adnexal lesions: International Ovarian Tumor Analysis (IOTA) Simple Rules with inconclusive cases reclassified as malignant or reevaluated by an expert, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX), and Ovarian-Adnexal Reporting and Data System (O-RADS). Design, Setting, and Participants: This retrospective diagnostic study was conducted at a single US academic medical center and included consecutive patients aged 18 to 89 years with adnexal masses that were managed surgically or conservatively between January 2017 and October 2022. Exposure: Evaluation of adnexal lesions using the Simple Rules, ADNEX, and O-RADS. Main Outcomes and Measures: The main outcome was diagnostic performance, including area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Surgery or follow-up were reference standards. Secondary analyses evaluated the models' performances stratified by menopause status and race. Results: The cohort included 511 female patients with a 15.9% malignant tumor prevalence (81 patients). Mean (SD) ages of patients with benign and malignant adnexal lesions were 44.1 (14.4) and 52.5 (15.2) years, respectively, and 200 (39.1%) were postmenopausal. In the ROC analysis, the AUCs for discriminative performance of the ADNEX and O-RADS models were 0.96 (95% CI, 0.93-0.98) and 0.92 (95% CI, 0.90-0.95), respectively. After converting the ADNEX continuous individualized risk into the discrete ordinal categories of O-RADS, the ADNEX performance was reduced to an AUC of 0.93 (95% CI, 0.90-0.96), which was similar to that for O-RADS. The Simple Rules combined with expert reevaluation had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 91.9% specificity (95% CI, 88.9%-94.3%), and the Simple Rules combined with malignant classification had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 88.1% specificity (95% CI, 84.7%-91.0%). At a 10% risk threshold, ADNEX had 91.4% sensitivity (95% CI, 83.0%-96.5%) and 86.3% specificity (95% CI, 82.7%-89.4%) and O-RADS had 98.8% sensitivity (95% CI, 93.3%-100%) and 74.4% specificity (95% CI, 70.0%-78.5%). The specificities of all models were significantly lower in the postmenopausal group. Subgroup analysis revealed high performances independent of race. Conclusions and Relevance: In this diagnostic study of a US cohort, the Simple Rules, ADNEX, and O-RADS models performed well in differentiating between benign and malignant adnexal lesions; this outcome has been previously reported primarily in European populations. Risk stratification models can lead to more accurate and consistent evaluations of adnexal masses, especially when used by nonexpert clinicians, and may reduce unnecessary surgeries.

Genome-wide association study for carcass weight in pasture-finished beef cattle in Hawai'i.

Introduction: Genome-wide association studies (GWAS) have identified genetic markers for cattle production and reproduction traits. Several publications have reported Single Nucleotide Polymorphisms (SNPs) for carcass-related traits in cattle, but these studies were rarely conducted in pasture-finished beef cattle. Hawai'i, however, has a diverse climate, and 100% of its beef cattle are pasture-fed. Methods: Blood samples were collected from 400 cattle raised in Hawai'i islands at the commercial harvest facility. Genomic DNA was isolated, and 352 high-quality samples were genotyped using the Neogen GGP Bovine 100 K BeadChip. SNPs that did not meet the quality control standards were removed using PLINK 1.9, and 85 k high-quality SNPs from 351 cattle were used for association mapping with carcass weight using GAPIT (Version 3.0) in R 4.2. Four models were used for the GWAS analysis: General Linear Model (GLM), the Mixed Linear Model (MLM), the Fixed and Random Model Circulating Probability Unification (FarmCPU), the Bayesian-Information and Linkage-Disequilibrium Iteratively Nested Keyway (BLINK). Results and Discussion: Our results indicated that the two multi-locus models, FarmCPU and BLINK, outperformed single-locus models, GLM and MLM, in beef herds in this study. Specifically, five significant SNPs were identified using FarmCPU, while BLINK and GLM each identified the other three. Also, three of these eleven SNPs ("BTA-40510-no-rs", "BovineHD1400006853", and "BovineHD2100020346") were shared by multiple models. The significant SNPs were mapped to genes such as EIF5, RGS20, TCEA1, LYPLA1, and MRPL15, which were previously reported to be associated with carcass-related traits, growth, and feed intake in several tropical cattle breeds. This confirms that the genes identified in this study could be candidate genes for carcass weight in pasture-fed beef cattle and can be selected for further breeding programs to improve the carcass yield and productivity of pasture-finished beef cattle in Hawai'i and beyond.

Risk of preterm delivery and growth restriction in twins discordant for structural anomalies.

OBJECTIVE: We sought to determine whether twin gestations with an anomalous fetus are at increased risk of preterm delivery or intrauterine growth restriction (IUGR) compared to twins with 2 normal fetuses. STUDY DESIGN: This was a retrospective cohort of twins undergoing ultrasound 15-22 weeks' gestation. Groups were defined by the presence of 1 twin with a major anomaly (discordant) or by twins with no major anomalies (normal). The primary outcomes were preterm delivery (<37 weeks) and IUGR (<10th percentile). RESULTS: Of 1977 twin pregnancies, 66 had a twin with a major anomaly. Preterm delivery occurred in 42 (63.6%) discordant twins, compared to 1271 (66.5%) normal twins (risk ratio, 1.0; 95% confidence interval, 0.8-1.2). IUGR was diagnosed in 15 (22.7%) normal co-twins, compared to 406 (21.3%) presenting twins in normal twins (risk ratio, 1.1; 95% confidence interval, 0.7-1.7). CONCLUSION: Twins discordant for major anomalies are not at increased risk of preterm delivery or IUGR compared to twins with no major anomalies.

Neural tube defects and associated low birth weight.

OBJECTIVE: To estimate the association between neural tube defects (NTDs) and low birth weight. STUDY DESIGN: This was a retrospective cohort study of women undergoing ultrasound from 17 to 22 weeks from 1990 to 2008. Presence or absence of fetal NTD defined the two study groups. The primary outcomes were intrauterine growth restriction (IUGR), birth weight <10th percentile, and severe IUGR <5th percentile. Subgroup analysis was performed to observe if the association with IUGR persisted. RESULTS: Of 66,956 women, 170 were found to have fetal NTD. Only the rate of advanced maternal age differed between the study groups. Fetuses with an NTD were at significantly increased risk for IUGR <10th percentile (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.8 to 3.9) and <5th percentile (aOR 2.8, 95% CI 1.9 to 4.3). The association persisted in subgroup analyses. CONCLUSION: Fetuses with NTD are at increased risk for IUGR, suggesting that a policy of serial growth scans in cases with isolated NTD is justified.

Climate change impacts shifting landscape of the dairy industry in Hawai'i.

Proper knowledge and understanding of climatic variability across different seasons are important in farm management. To learn more about the potential effects of climate change on dairying in Hawaii, we conducted a study on site-specific climate characterization using several variables including rainfall, wind speed (WS), solar radiation, and temperature, at two dairy farms located on Hawai`i Island, Hawai`i, in Ookala named "OK DAIRY" and in Upolu Point named "UP DAIRY." Temperature-humidity index (THI) and WS variations in the hottest four months (June to September) were analyzed to determine when critical thresholds that affect animal health are exceeded. Rainfall data were used to estimate the capacity of forage production in 6-mo wet (November to April) and dry (May to October) seasons. Future projections of temperature and rainfall were assessed using mid- and end-century gridded data products for low (RCP 4.5) and high emissions (RCP 8.5) scenarios. Our results showed that the "OK DAIRY" site received higher rainfall than the "UP DAIRY" site, favoring grass growth and forage availability. In addition, the "UP DAIRY" site was more stressful for animals during the summer (THI 69 to 73) than the "OK DAIRY" site (THI 67 to 70) as the THI exceeded the critical threshold of 68, which is conducive for high-lactating cattle. On the "UP DAIRY" site, the THI did not drop below 68 during the summer nights, which created fewer opportunities for cattle to recover from heat stress. Future projections indicated that air temperature would increase 1.3 to 1.8 °C by mid-century and 1.6 to 3.2 °C by the end-century at both farms, and rainfall will increase at the "OK DAIRY" site and decrease at the "UP DAIRY" site by the end-century. The agriculture and livestock industries, particularly the dairy and beef subsectors in Hawai`i, are vulnerable to climate changes as higher temperatures and less rainfall will have adverse effects on cattle. The findings in this study demonstrated how both observed and projected changes in climate support the development of long-term strategies for breeding and holistic livestock management practices to adapt to changing climate conditions.

Congenital uterine anomalies and adverse pregnancy outcomes.

OBJECTIVE: We sought to estimate whether the presence of a maternal uterine anomaly is associated with adverse pregnancy outcomes. STUDY DESIGN: This retrospective cohort study included singleton pregnancies undergoing routine anatomic survey from 1990 through 2008 at a major tertiary care medical center. Pregnancies with a diagnosis of uterine anomaly (uterine septum, unicornuate uterus, bicornuate uterus, uterine didelphys) were compared to those with normal anatomy. Primary outcomes of interest were spontaneous preterm birth (PTB), breech presentation, and cesarean delivery. RESULTS: The presence of an anomaly was associated with PTB <34 weeks (adjusted odds ratio [aOR], 7.4; 95% confidence interval [CI], 4.8-11.4; P < .01), PTB <37 weeks (aOR, 5.9, 95% CI, 4.3-8.1; P < .01), primary nonbreech cesarean delivery (aOR, 2.6; 95% CI, 1.7-4.0; P < .01), preterm premature rupture of membranes (aOR, 3.2; 95% CI, 1.8-5.6; P < .01), and breech presentation (aOR, 8.6; 95% CI, 6.2-12.0; P < .01). CONCLUSION: Women with a uterine anomaly are at risk for PTB, highlighting an at-risk population that needs additional study for possible interventions for PTB prevention.

The genetic sonogram: comparing the use of likelihood ratios versus logistic regression coefficients for Down syndrome screening.

OBJECTIVES: The purpose of this study was to compare the screening efficiency for Down syndrome using likelihood ratios versus logistic regression coefficients. METHODS: We conducted a retrospective study of women at increased risk for Down syndrome referred for a second-trimester genetic sonogram. Likelihood ratios were calculated by multiplying the risk ratio from maternal serum screening by the likelihood ratios of sonographic markers. Logistic regression coefficients were calculated using a formula derived from ß coefficients generated from a multivariable logistic regression model. The screening efficiency of both methods was tested in an independent population of patients. The McNemar test was used to compare the predictive ability of the two methods. RESULTS: In the validation population, the use of likelihood ratios had an area under the receiver operator characteristic curve of 0.90 for Down syndrome detection, whereas the use of logistic regression coefficients had an area under the curve of 0.86. Adopting a risk cutoff point of 1/270, the sensitivity of likelihood ratios was 77.4% (95% confidence interval [CI], 58.9%-90.4%) with a false-positive rate of 17.9% (95% CI, 15.0%-21.1%), whereas the sensitivity of logistic regression coefficients was 93.5% (95% CI, 78.6%-99.2%) with a false-positive rate of 34.6% (95% CI, 30.9%-38.4%). There was significant difference in screening efficiency for Down syndrome detection between the two methods (exact McNemar χ(2), P < .001 ). CONCLUSIONS: With a slight reduction in the Down syndrome detection rate, the use of the likelihood ratio approach was associated with a significantly lower false-positive rate compared with the logistic regression approach.