alpha-Fetoprotein: relationship between maternal serum and amniotic fluid levels.

Levels of alpha-fetoprotein were determined in 297 paired samples of maternal serum and amniotic fluid from patients with normal pregnancies at 16 to 17 completed weeks of gestation. Gestational ages were determined by menstrual history and ultrasonography, and the assays for alpha-fetoprotein were performed by a single reference laboratory. The results of the study failed to demonstrate any statistical relationship between the concentrations of alpha-fetoprotein in these two fluid compartments (r = 0.006). This finding was confirmed when the results at 16 and 17 weeks were analyzed individually. These findings indicate that amniotic fluid levels of alpha-fetoprotein cannot be predicted by those levels determined in maternal serum, and that simple diffusion is an inadequate explanation for the transfer of alpha-fetoprotein from amniotic fluid to maternal serum. The lack of correlation also emphasizes that the sensitivity and specificity of maternal serum alpha-fetoprotein screening for neural tube defects must continue to be based upon the detection rates in large population studies and the determination of "normal" values by reference laboratories.

Cervical incompetence: diagnosis and outcome.

The results of 147 cervical cerclage procedures were reviewed in a retrospective study. Patient history and past reproductive performance were assessed to determine which factors were predictive of successful pregnancy outcome after cervical cerclage. A past history of spontaneous second trimester abortion or premature labor was associated with a better outcome than was a history classically associated with cervical incompetence. Morbidity immediately following the procedure was low, however significant morbidity related to cervical scarring occurred at the time of delivery. There was poor correlation between the clinical history, examination and adjunctive tests of cervical incompetence, and the pregnancy outcome following cerclage. These observations indicate the need for a prospective, randomized study of the efficacy of this procedure.

The myth of goiter in pregnancy.

A common belief is that pregnancy causes goiter. Forty-nine matched pairs each consisting of a pregnant and a nonpregnant woman were examined by means of a blind, multiple-observer design. In 22 pairs the pregnant woman had the larger thyroid, whereas in 20 pairs the opposite was true. In six pairs the thyroid glands were not palpable, and in one pair the thyroid glands were of equal size. Five pregnant and three nonpregnant women had clinically significant goiters. None of the differences was statistically significant. No significance appeared when the data were controlled for race, age, body weight, or family history of thyroid disease. Therefore, goiter in pregnancy should be considered to be a pathologic condition in an iodine-replete population.

Maternal mortality. A survey of 118 maternal deaths and the avoidable factors involved.

From January 1973 to December 1975, 26 018 women were delivered at Edendale Hospital. During the same period, 4 478 patients aborted there. Maternal deaths during this period numbered 118, a mortality of 4,5/1 000 total births. Avoidable factors influencing the mortality may have been present in 28 (2387%).

Delivery of Siamese twins by Caesarean section.

The diagnosis of a pair of Siamese twins and their delivery by Caesarean section are described. A major cardiac anomaly precluded surgical separation.