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  1. Article ; Online: Umbilical artery aneurysm: a case report, literature review, and management recommendations.

    Doehrman, Pooja / Derksen, Brenna J / Perlow, Jordan H / Clewell, William H / Finberg, Harris J

    Obstetrical & gynecological survey

    2014  Volume 69, Issue 3, Page(s) 159–163

    Abstract: Background: Umbilical artery aneurysm is a rare and often lethal condition frequently associated with fetal anomalies, fetal demise, and neonatal complications.: Case: We report a case of umbilical artery aneurysm discovered at 21 weeks 2 days of ... ...

    Abstract Background: Umbilical artery aneurysm is a rare and often lethal condition frequently associated with fetal anomalies, fetal demise, and neonatal complications.
    Case: We report a case of umbilical artery aneurysm discovered at 21 weeks 2 days of gestation in a fetus of normal karyotype. Maternal hospitalization occurred at 28 weeks for antenatal testing, betamethasone administration, and monitoring for expansion of the aneurysm. Delivery of a live neonate by repeat cesarean delivery was performed at 32 weeks 2 days. Pathology confirmed a 3-vessel cord with an umbilical artery aneurysm. Neonatal course was complicated by respiratory distress of the newborn, hyperbilirubinemia, anemia, difficulty feeding, and cardiac defects. The newborn was discharged from the neonatal intensive care unit on day of life 19.
    Conclusions: Umbilical artery aneurysm is highly associated with fetal complications including trisomy 18, single umbilical artery, cardiac anomalies, and intrauterine fetal demise. A normal karyotype, antenatal monitoring, and early delivery have been suggested to impact the likeliness of survival. Antenatal management strategies include consideration of nonstress testing 3 times daily, serial ultrasound assessments, testing to identify intrauterine growth restriction, and delivery by planned cesarean delivery between 32 and 34 weeks. We recommend that patients be counseled on the high risks associated with umbilical artery aneurysm and be included in discussions regarding antenatal management and delivery planning.
    MeSH term(s) Adult ; Aneurysm/diagnostic imaging ; Aneurysm/therapy ; Cesarean Section ; Female ; Genetic Counseling ; Humans ; Infant, Newborn ; Karyotyping ; Pregnancy ; Pregnancy Complications/diagnostic imaging ; Pregnancy Complications/therapy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Ultrasonography, Prenatal ; Umbilical Arteries
    Language English
    Publishing date 2014-03
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 391345-4
    ISSN 1533-9866 ; 0029-7828
    ISSN (online) 1533-9866
    ISSN 0029-7828
    DOI 10.1097/OGX.0000000000000051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Congenital Hydrocephalus: Treatment in utero

    Clewell, William H.

    Fetal Diagnosis and Therapy - Clinical Advances and Basic Research

    1988  Volume 3, Issue 1-2, Page(s) 89–97

    Abstract: Congenital hydrocephalus occurs in about 1 in every 1,000 live births. Is is rarely lethal but frequently severely handicapping. It can be diagnosed by ultrasound as early as 20 weeks of gestation. When not accompanied by other serious malformations, it ... ...

    Abstract Congenital hydrocephalus occurs in about 1 in every 1,000 live births. Is is rarely lethal but frequently severely handicapping. It can be diagnosed by ultrasound as early as 20 weeks of gestation. When not accompanied by other serious malformations, it may be amenable to treatment in utero. Experimental treatment by shunting the lateral ventricle to the amnion has been shown to control ventricular enlargement during fetal life. The mental development of treated babies has, however, been disappointing. At this time no in utero treatment of fetal hydrocephalus is being done.
    Keywords Hydrocephalus ; Ventriculomegaly ; Ventricular shunt ; Obstructive hydrocephalus ; Shunt
    Language English
    Publisher S. Karger AG
    Publishing place Basel
    Publishing country Switzerland
    Document type Article ; Online
    ZDB-ID 1066460-9
    ISSN 1421-9964 ; 1015-3837 ; 1015-3837
    ISSN (online) 1421-9964
    ISSN 1015-3837
    DOI 10.1159/000263338
    Database Karger publisher's database

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  3. Article: Obstetrician-gynecologists performing genetic amniocentesis may be misleading themselves and their patients.

    Clewell, William H / Bogle, Ann / Weston, Nicole / Greensher, Susan

    American journal of obstetrics and gynecology

    2002  Volume 186, Issue 4, Page(s) 851; author reply 851

    MeSH term(s) Amniocentesis/adverse effects ; Chromosome Aberrations ; Female ; Humans ; Physicians ; Pregnancy ; Prenatal Diagnosis
    Language English
    Publishing date 2002-04
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1067/mob.2002.121655
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  4. Article ; Online: 17-hydroxyprogesterone caproate for preterm rupture of the membranes: a multicenter, randomized, double-blind, placebo-controlled trial.

    Combs, C Andrew / Garite, Thomas J / Maurel, Kimberly / Abril, Diana / Das, Anita / Clewell, William / Heyborne, Kent / How, Helen / Huang, Wilson / Lewis, David / Lu, George / Miller, Hugh / Nageotte, Michael / Porreco, Richard / Sheikh, Asad / Tran, Lan

    American journal of obstetrics and gynecology

    2015  Volume 213, Issue 3, Page(s) 364.e1–12

    Abstract: Objective: Preterm rupture of membranes (PROM) is associated with an increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHP-C) reduces the risk of preterm birth in some women who are at risk for ... ...

    Abstract Objective: Preterm rupture of membranes (PROM) is associated with an increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHP-C) reduces the risk of preterm birth in some women who are at risk for preterm birth. We sought to test whether 17OHP-C would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes.
    Study design: This is a multicenter, double-blind, placebo-controlled, randomized clinical trial. The study included singleton pregnancies with gestational ages from 23(0/7) to 30(6/7) weeks at enrollment, documented PROM, and no contraindication to expectant management. Consenting women were assigned randomly to receive weekly intramuscular injections of 17OHP-C (250 mg) or placebo. The primary outcome was continuation of pregnancy until a favorable gestational age, which was defined as either 34(0/7) weeks of gestation or documentation of fetal lung maturity at 32(0/7) to 33(6/7) weeks of gestation. The 2 prespecified secondary outcomes were interval from randomization to delivery and composite adverse perinatal outcome. The planned sample size was 222 total women.
    Results: From October 2011 to April 2014, 152 women were enrolled; 74 women were allocated randomly to 17OHP-C, and 78 were allocated randomly to placebo. The trial was stopped when results of a planned interim analysis suggested that continuation was futile. The primary outcome was achieved in 3% of the 17OHP-C group and 8% of the placebo group (P = .18). There was no significant between-group difference in the prespecified secondary outcomes, randomization-to-delivery interval (17.1 ± 16.1 vs 17.0 ± 15.8 days, respectively; P = .76) or composite adverse perinatal outcome (63% vs 61%, respectively; P = .93). No significant differences were found in other outcomes, which included rates of chorioamnionitis, postpartum endometritis, cesarean delivery, individual components of the composite outcome, or prolonged neonatal length of stay.
    Conclusion: Compared with placebo, weekly 17OHP-C injections did not prolong pregnancy or reduce perinatal morbidity in patients with PROM in this trial.
    MeSH term(s) Adult ; Cerebral Hemorrhage/epidemiology ; Double-Blind Method ; Early Termination of Clinical Trials ; Enterocolitis, Necrotizing/epidemiology ; Female ; Fetal Membranes, Premature Rupture/drug therapy ; Gestational Age ; Humans ; Hydroxyprogesterones/therapeutic use ; Infant, Newborn ; Infant, Premature ; Injections, Intramuscular ; Leukomalacia, Periventricular/epidemiology ; Perinatal Mortality ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Progestins/therapeutic use ; Proportional Hazards Models ; Respiratory Distress Syndrome, Newborn/epidemiology ; Sepsis/epidemiology ; Time Factors ; Treatment Outcome ; Watchful Waiting ; Young Adult
    Chemical Substances Hydroxyprogesterones ; Progestins ; 17-alpha-hydroxy-progesterone caproate (276F2O42F5)
    Language English
    Publishing date 2015-09
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2015.05.009
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  5. Article ; Online: Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes.

    Combs, C Andrew / Gravett, Michael / Garite, Thomas J / Hickok, Durlin E / Lapidus, Jodi / Porreco, Richard / Rael, Julie / Grove, Thomas / Morgan, Terry K / Clewell, William / Miller, Hugh / Luthy, David / Pereira, Leonardo / Nageotte, Michael / Robilio, Peter A / Fortunato, Stephen / Simhan, Hyagriv / Baxter, Jason K / Amon, Erol /
    Franco, Albert / Trofatter, Kenneth / Heyborne, Kent

    American journal of obstetrics and gynecology

    2014  Volume 210, Issue 2, Page(s) 125.e1–125.e15

    Abstract: Objective: The purpose of this study was to compare intraamniotic inflammation vs microbial invasion of the amniotic cavity (MIAC) as predictors of adverse outcome in preterm labor with intact membranes.: Study design: Interleukin-6 (IL-6) was ... ...

    Abstract Objective: The purpose of this study was to compare intraamniotic inflammation vs microbial invasion of the amniotic cavity (MIAC) as predictors of adverse outcome in preterm labor with intact membranes.
    Study design: Interleukin-6 (IL-6) was measured in prospectively collected amniotic fluid from 305 women with preterm labor. MIAC was defined by amniotic fluid culture and/or detection of microbial 16S ribosomal DNA. Cases were categorized into 5 groups: infection (MIAC; IL-6, ≥11.3 ng/mL); severe inflammation (no MIAC; IL-6, ≥11.3 ng/mL); mild inflammation (no MIAC; IL-6, 2.6-11.2 ng/mL); colonization (MIAC; IL-6, <2.6 ng/mL); negative (no MIAC; IL-6, <2.6 ng/mL).
    Results: The infection (n = 27) and severe inflammation (n = 36) groups had similar latency (median, <1 day and 2 days, respectively) and similar rates of composite perinatal morbidity and mortality (81% and 72%, respectively). The colonization (n = 4) and negative (n = 195) groups had similar outcomes (median latency, 23.5 and 25 days; composite morbidity and mortality rates, 21% and 25%, respectively). The mild inflammation (n = 47) groups had outcomes that were intermediate to the severe inflammation and negative groups (median latency, 7 days; composite morbidity and mortality rates, 53%). In logistic regression adjusting for gestational age at enrollment, IL-6 ≥11.3 and 2.6-11.2 ng/mL, but not MIAC, were associated significantly with composite morbidity and mortality rates (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.2-11.2, OR, 3.1; 95% CI, 1.5-6.4, and OR, 1.8; 95% CI, 0.6-5.5, respectively).
    Conclusion: We confirmed previous reports that intraamniotic inflammation is associated with adverse perinatal outcomes whether or not intraamniotic microbes are detected. Colonization without inflammation appears relatively benign. Intraamniotic inflammation is not simply present or absent but also has degrees of severity that correlate with adverse outcomes. We propose the designation amniotic inflammatory response syndrome to denote the adverse outcomes that are associated with intraamniotic inflammation.
    MeSH term(s) Adult ; Amniotic Fluid/chemistry ; Amniotic Fluid/immunology ; Amniotic Fluid/microbiology ; Chorioamnionitis/microbiology ; DNA, Ribosomal/analysis ; Female ; Humans ; Interleukin-6/analysis ; Logistic Models ; Obstetric Labor, Premature ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy Outcome ; Risk Factors
    Chemical Substances DNA, Ribosomal ; Interleukin-6
    Language English
    Publishing date 2014-02
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2013.11.032
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  6. Article ; Online: Detection of microbial invasion of the amniotic cavity by analysis of cervicovaginal proteins in women with preterm labor and intact membranes.

    Combs, C Andrew / Garite, Thomas J / Lapidus, Jodi A / Lapointe, Jerome P / Gravett, Michael / Rael, Julie / Amon, Erol / Baxter, Jason K / Brady, Kim / Clewell, William / Eddleman, Keith A / Fortunato, Stephen / Franco, Albert / Haas, David M / Heyborne, Kent / Hickok, Durlin E / How, Helen Y / Luthy, David / Miller, Hugh /
    Nageotte, Michael / Pereira, Leonardo / Porreco, Richard / Robilio, Peter A / Simhan, Hyagriv / Sullivan, Scott A / Trofatter, Kenneth / Westover, Thomas

    American journal of obstetrics and gynecology

    2015  Volume 212, Issue 4, Page(s) 482.e1–482.e12

    Abstract: Objective: Microbial invasion of the amniotic cavity (MIAC) is common in early preterm labor and is associated with maternal and neonatal infectious morbidity. MIAC is usually occult and is reliably detected only with amniocentesis. We sought to develop ...

    Abstract Objective: Microbial invasion of the amniotic cavity (MIAC) is common in early preterm labor and is associated with maternal and neonatal infectious morbidity. MIAC is usually occult and is reliably detected only with amniocentesis. We sought to develop a noninvasive test to predict MIAC based on protein biomarkers in cervicovaginal fluid (CVF) in a cohort of women with preterm labor (phase 1) and to validate the test in an independent cohort (phase 2).
    Study design: This was a prospective study of women with preterm labor who had amniocentesis to screen for MIAC. MIAC was defined by positive culture and/or 16S ribosomal DNA results. Nine candidate CVF proteins were analyzed by enzyme-linked immunosorbent assay. Logistic regression was used to identify combinations of up to 3 proteins that could accurately classify the phase 1 cohort (N = 108) into those with or without MIAC. The best models, selected by area under the curve (AUC) of the receiver operating characteristic curve in phase 1, included various combinations of interleukin (IL)-6, chemokine (C-X-C motif) ligand 1 (CXCL1), alpha fetoprotein, and insulin-like growth factor binding protein-1. Model performance was then tested in the phase 2 cohort (N = 306).
    Results: MIAC was present in 15% of cases in phase 1 and 9% in phase 2. A 3-marker CVF model using IL-6 plus CXCL1 plus insulin-like growth factor binding protein-1 had AUC 0.87 in phase 1 and 0.78 in phase 2. Two-marker models using IL-6 plus CXCL1 or alpha fetoprotein plus CXCL1 performed similarly in phase 2 (AUC 0.78 and 0.75, respectively), but were not superior to CVF IL-6 alone (AUC 0.80). A cutoff value of CVF IL-6 ≥463 pg/mL (which had 81% sensitivity in phase 1) predicted MIAC in phase 2 with sensitivity 79%, specificity 78%, positive predictive value 38%, and negative predictive value 97%.
    Conclusion: High levels of IL-6 in CVF are strongly associated with MIAC. If developed into a bedside test or rapid laboratory assay, cervicovaginal IL-6 might be useful in selecting patients in whom the probability of MIAC is high enough to warrant amniocentesis or transfer to a higher level of care. Such a test might also guide selection of potential subjects for treatment trials.
    MeSH term(s) Adult ; Amniocentesis ; Biomarkers/metabolism ; Body Fluids/metabolism ; Body Fluids/microbiology ; Cervix Uteri/metabolism ; Cervix Uteri/microbiology ; Chorioamnionitis/diagnosis ; Chorioamnionitis/metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-6/metabolism ; Logistic Models ; Obstetric Labor, Premature/metabolism ; Obstetric Labor, Premature/microbiology ; Pregnancy ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Vagina/metabolism ; Vagina/microbiology
    Chemical Substances Biomarkers ; IL6 protein, human ; Interleukin-6
    Language English
    Publishing date 2015-04
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2015.02.007
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  7. Article: Small business lending and levels of report assurance

    Martin, Charles L / Clewell, William D / Handorf, William Charles

    Akron business and economic review 19 ,2, S. 69-84

    1988  

    Author's details by Charles L. Martin, Jr., William C. Handorf, and William D. Clewell
    Keywords USA ; KMU
    Language English
    Size Graph. Darst
    Publisher Univ.
    Publishing place Akron, Ohio
    Document type Article
    ZDB-ID 412836-9
    ISSN 0044-7048
    Database ECONomics Information System

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  8. Article ; Online: Twin-Twin Transfusion Syndrome: The Surgical Removal of One Twin as a Treatment Option

    Urig, Michael A. / Simpson, Gary F. / Elliott, John P. / Clewell, William H.

    Fetal Diagnosis and Therapy - Clinical Advances and Basic Research

    1988  Volume 3, Issue 4, Page(s) 185–188

    Abstract: The twin-twin transfusion syndrome, associated with acute polyhydramnios in the 18th to 28th week of gestation, has a high perinatal mortality rate. Patients managed without intervention have essentially a 100% mortality rate for the involved twins. ... ...

    Abstract The twin-twin transfusion syndrome, associated with acute polyhydramnios in the 18th to 28th week of gestation, has a high perinatal mortality rate. Patients managed without intervention have essentially a 100% mortality rate for the involved twins. Different methods of intervention have been described, including therapeutic amniocentesis, selective feticide, and placental vessel puncture. In this case report we describe selective removal of one twin at 21 weeks of gestation by hysterotomy in a patient with the twin-twin transfusion syndrome.
    Keywords Twin-twin transfusion syndrome ; Surgery, in utero
    Language English
    Publisher S. Karger AG
    Publishing place Basel
    Publishing country Switzerland
    Document type Article ; Online
    ZDB-ID 1066460-9
    ISSN 1421-9964 ; 1015-3837 ; 1015-3837
    ISSN (online) 1421-9964
    ISSN 1015-3837
    DOI 10.1159/000263354
    Database Karger publisher's database

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