Prenatal diagnosis and management of sacrococcygeal teratoma.

Five fetuses, each with a sacrococcygeal teratoma (SCT) were delivered at the Royal Women's Hospital while 2 fetuses, each with a SCT were delivered at Monash Medical Centre in 1998. The number of cases reported in this series is higher than expected but it most likely occurred due to chance. The diagnosis was made prenatally in all cases. Three of the SCT were entirely external while the remaining 4 were external with intrapelvic extension. Rapid growth of the SCT occurred in 3 fetuses. This was associated with polyhydramnios in 2 fetuses. No fetus developed nonimmune hydrops. Six infants were liveborn (perinatal mortality rate of 14%), 3 of whom were delivered prior to 37 weeks' gestation. Two infants were delivered by classical Caesarean section. The remaining 4 infants were delivered by lower uterine segment Caesarean section. There was 1 perinatal death. This stillborn infant was delivered vaginally. The 6 surgical resections were performed between the 4th and 10th postnatal days. Histological examination confirmed the diagnosis of benign SCT in each. One infant developed a recurrence at 2 months of age and required chemotherapy.

Prediction of preterm labour in multiple pregnancies.

Various methods of predicting preterm labour in both singleton and multiple pregnancies have been studied including risk scoring systems, home uterine activity monitoring, cervical assessment and biochemical methods. In practice, risk scoring systems for preterm delivery perform poorly. Consensus in the literature regarding the usefulness of home uterine activity monitoring is lacking and well designed randomized controlled trials are required. Transvaginal ultrasound assessment of the cervix appears to have a role to play in the prediction of preterm labour. The presence of IFN in cervicovaginal fluid in the late second and early third trimesters is an important risk factor for preterm labour in asymptomatic women with multiple pregnancies. Preterm labour may be mediated in part by inflammatory cytokines. The measurement of these inflammatory cytokines in cervical secretions may also prove helpful in the prediction of preterm labour. It is anticipated that an improved ability to predict preterm labour in both singleton and multiple pregnancies will depend on increasing understanding of the condition's pathophysiology.

Cervicovaginal fetal fibronectin testing in threatened preterm labour--translating research findings into clinical practice.

A retrospective audit was undertaken involving 70 women with a singleton pregnancy who attended hospital with symptoms of threatened preterm labour prior to 34 weeks' gestation and who had a bedside fetal fibronectin (FFN) Membrane Immunoassay Kit Test (Adeza Biomedical) performed. The aim of the study was to determine if the results of the FFN test when used in routine clinical practice would be similar to those of a previous research study (1) that was performed at the same centre, and whether or not knowledge of the result of the FFN test might influence clinical management. The audit revealed that the sensitivity of the FFN test in the prediction of delivery prior to 34 weeks' gestation was 90%, the specificity was 82%, whilst the positive and negative predictive values were 45% and 98% respectively. These results were very similar to those of the previous, blinded research study. Compared to women with a negative FFN test, more women with a positive FFN test received corticosteroids (100% versus 71%, p=0.02) and tocolysis (35% versus 12%, p=0.04) and more remained in hospital longer than 24 hours (85% versus 56%, p=0.1).