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

OBJECTIVE: Our purpose was to compare midtrimester amniocentesis-related fetal loss rates between obstetrician-gynecologists and perinatologists. STUDY DESIGN: This cohort study analyzes 1384 midtrimester amniocenteses from January 1, 1996, to December 31, 1999. Obstetrician-gynecologists who split their practices between two or more hospitals and explained fetal losses (eg, fetal anomalies, aneuploidy) were excluded from analysis. Eight obstetrician-gynecologists performed 138 procedures; 3 perinatologists performed 1246 procedures. Three experienced obstetrician-gynecologists accounted for 113 procedures. Analysis was by chi2. RESULTS: Within 30 days of midtrimester amniocentesis, there were 3 fetal losses for obstetrician-gynecologists and 4 for perinatologists (P =.02, chi2 = 5.19, degrees of freedom = 1). Obstetrician-gynecologist loss rates were 1 in 46 procedures versus 1 in 312 procedures for perinatologists. Losses were clustered among the 3 experienced obstetrician-gynecologists (P <.01, chi2 = 6.93, degrees of freedom = 1). The experienced obstetrician-gynecologist fetal loss rate was 1 in 38 amniocenteses, and the perinatologist fetal loss rate was 1 in 312. CONCLUSION: The risk of fetal loss from midtrimester amniocentesis appears to be higher when performed by an obstetrician-gynecologist compared with a perinatologist.

Use of two Greenfield caval filters to prevent recurrent pulmonary embolism in a heparin-allergic gravida.

BACKGROUND: Maternal mortality may be reduced by prompt diagnosis and treatment of pulmonary embolism. CASE: A 25-year-old pregnant woman required a second Greenfield filter after developing a heparin allergy and recurrent pulmonary embolism. CONCLUSION: Heparin allergy has not been reported previously in pregnancy. A Greenfield filter may be used in this circumstance. Extension of the thrombus cephalad to the filter can cause recurrent emboli, so deployment of a second caval filter may be an effective remedy.

Prenatal diagnosis of spontaneous rupture of the fetal bladder with color Doppler ultrasonography.

Rupture of the fetal-neonatal bladder that results in urinary ascites has rarely been reported in the literature. In this report we present the first case of spontaneous rupture of the fetal bladder in which the diagnosis was made prenatally by means of color Doppler ultrasonography.

Immediate delivery room repair of fetal abdominal wall defects.

Eighteen patients with a prenatal diagnosis of fetal abdominal wall defect were delivered by cesarean section and repaired either immediately (begun within 15 min, n = 9), or by the traditional (delayed) method (n = 9, average delay = 4.4 h). Neonates repaired immediately had comparable gestational ages and birthweight, however, subjectively had less edematous bowel with less fibrous peel. These fetuses were more likely to be closed primarily (7/9 vs. 4/9), spent less time on a ventilator (8.1 vs. 17.9 days), seemed to be fed sooner (7.6 vs. 17.9 days), and discharged home earlier (14.3 vs. 24.0 days). Our results suggest that for fetuses delivered by cesarean section, early defect repair may reduce bowel edema and fibrous peel formation thus facilitating primary closure, with earlier ventilator weaning, feeding and discharge home.

Fetal hemoglobin quantitations using the Hemocue system are rapid and accurate.

OBJECTIVES: To determine whether hemoglobin quantitations using the Hemocue system, a rapid and portable hemoglobin photometer, on fetal blood obtained via funipuncture were accurate compared to the Coulter S-Plus IV. We also examined whether gestational age or extremes in hemoglobin levels significantly affected the accuracy of the Hemocue system. METHODS: We performed fetal hemoglobin quantitations using both systems on 58 specimens obtained between 18-38 weeks' gestation. Correlation between values by both systems was determined by linear regression analysis. The effects of gestational age and hemoglobin extremes on the accuracy of the Hemocue system were evaluated by stepwise regression. RESULTS: The mean Hemocue value was 12.0 +/- 2.4 g/dL (range 3.3-16.4); the mean Coulter value was 11.7 +/- 2.3 g/dL (range 3.6-16.2). The regression equation for Hemocue (y) versus Coulter (x) values was y = 0.72 + 0.97x; r = 0.94 (P < .0001). Neither gestational age nor hemoglobin extremes significantly affected the accuracy of the Hemocue system. CONCLUSION: The Hemocue system is rapid and accurate for fetal hemoglobin quantitation between 18-38 weeks' gestation regardless of extremes in gestational age or hemoglobin levels.

Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: I. Clinical issues.

OBJECTIVE: With the intention of preventing the attendant medical, ethical, and legal problems arising from the birth of live-born, anomalous fetuses, we initiated a program offering fetal intracardiac potassium chloride injection as an adjunctive measure in the setting of genetically indicated second-trimester abortion. METHODS: A lethal fetal injection was offered to patients carrying chromosomally or structurally abnormal fetuses at 19-24 weeks' gestation who desired abortion. When the patient elected this procedure, real-time ultrasound guidance was used to inject 3-5 mL of potassium chloride (2 mEq/mL) directly into the fetal cardiac chambers, followed by observation of fetal heart activity to ascertain cessation. Labor was subsequently induced with uterotonic prostaglandins. RESULTS: The procedure caused immediate cessation of fetal heart motion in 20 of 21 cases. There were no maternal complications. No fetuses were live-born. CONCLUSIONS: Direct fetal intracardiac potassium chloride injection effectively causes immediate fetal cardiac arrest. This approach may be adopted in cases of abortion by labor-induction methods at advanced gestations to ensure that the abortus is stillborn.

Effect of repeated hyperbaric exposures on the menstrual cycle: preliminary study.

Two healthy female volunteers were subjected to hyperbaric air pressure of 5 ATA comparable to 130 feet of sea water (fsw) for 20 min 7 or 8 times during their menstrual cycles (experimental cycles). During the experimental cycles hormone assays for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and testosterone were performed before and after each dive on alternate days between the 5th and 11th cycle days (follicular phase), daily during the time ovulation was expected to occur, and on alternate days during the luteal phase; these were compared with the same assays throughout control cycles, during which the subjects were not pressurized. Periodic pressurization produced no significant changes in hormone patterns; ovulation was not inhibited and menstrual periods were unchanged.

Hyperbaric exposure during pregnancy in sheep: staged and rapid decompression.

Hyperbaric exposure during pregnancy in sheep: staged and rapid decompression. Undersea Biomed Res 1983; 10(1): 11-15. --Twelve sheep with dated pregnancies were exposed for 20 min to hyperbaric pressure comparable to 165 feet of sea water weekly between the 49th and 133rd days of pregnancy. Six were decompressed in stages and six directly without decompression stops. Those that were decompressed gradually delivered normally at or near term. One lamb was abnormal, but the relationship to pressurization is unclear. Three of those decompressed rapidly aborted dead fetuses, and two others delivered mature, but affected, lambs. Under the conditions of this study staged decompression after repeated hyperbaric exposures protected the fetuses from the destructive effects of rapid decompression. Hyperbaric pressure did not alter gross anatomic development.