Prenatal diagnosis of complicated abdominal wall defects.

The accurate prenatal diagnosis of anterior abdominal wall defects is important because it affects patient management and prognosis. The pathophysiology of each defect leads to key characteristics that make it possible to differentiate one entity from another. Among these features are the location of the defect in relation to cord insertion, the size and contents of the defect, and the associated anomalies. This article reviews the underlying defects, the characteristic ultrasound findings, the associated anomalies, and the prognosis of simple and complicated abdominal wall defects. The basic features of simple abdominal wall defects (i.e., omphalocele and gastroschisis) were used as the initial points of assessment. A comparison of the different features of these abnormalities and how they differ from one another resulted in the development of criteria that facilitated the understanding of the different ultrasound manifestations of these anomalies.

Outcomes of newborns with gastroschisis: the effects of mode of delivery, site of delivery, and interval from birth to surgery.

OBJECTIVE: Our purpose was to determine the impact of delivery site, delivery mode, and delivery-to-surgery interval on outcomes for neonates diagnosed with gastroschisis. STUDY DESIGN: Data were obtained retrospectively by chart review on 56 newborns diagnosed with gastroschisis. Outcome measures examined included primary closure, days to enteral feeding, days in intensive care, total length of stay, and hospital charges. RESULTS: Inborn infants experienced fewer days to enteral feeding (p < 0.01)., shorter total lengths of hospital stay (p < 0.01), and lower hospital charges (p < 0.01). Newborns delivered by cesarean section tended to have longer lengths of stay (p = 0.07), greater hospital charges (p = 0.06), and significantly longer lengths of stay in intensive care (p = 0.05). Shorter intervals from delivery to surgery were observed for inborn neonates (p < 0.01) and for those delivered by cesarean section (p < 0.05). No relationships between hours from delivery to surgery and neonatal outcomes were observed. CONCLUSIONS: Delivery at a regional center is associated with improved outcomes, whereas cesarean deliveries were associated with worse outcomes. We observed no salutary effect related to the interval between delivery and initial surgical repair.

Categorization of heart rate-eye movement patterns in human fetuses using the statistical technique of discriminant analysis.

The purpose of this study was to determine if discriminant analysis could be used to categorize fetal heart rate (FHR) - fetal eye movement (FEM) patterns. Statistical characteristics from 27 normal human fetuses at term for behavioral states, transitions, and insertions were established by combining the digitized FHR-FEM data for subjectively identical epochs. The mean FHR, the variance about the mean, and the presence or absence of FEM were calculated for each 3-min block in a sliding moving window with a 1-min step size. For each fetus, discriminant analysis was then used to assign 3-min blocks to either a behavioral state, a transition, or an insertion by comparing the statistical properties of a 3-min block with that of the data base. We found no difference between discriminant analysis and visual assignment in the average time spent in behavioral states 1F, 2F, and 4F, or in the mean duration of the transition/insertion periods. There was a highly significant linear relationship between computer-generated and visually-determined durations for behavioral states 1F (r = 0.972, p < 0.0001) and 2F (r = 0.989, p < 0.0001) and for the transition/insertion periods (r = 0.863, p < 0.0001). We conclude that discriminant analysis is a reliable computer-based method for behavioral state identification.

Early heart rate response of normal human term fetuses to vibroacoustic stimulation.

We examined cardiac reactivity in the first 45 seconds following a single 1 second vibroacoustic stimulus (VAS) to determine if the prestimulus fetal heart rate (FHR) pattern was predictive of the immediate post-VAS heart rate response. Forty-nine normal human fetuses between 37 and 41 weeks of gestation were observed to enter quiet sleep and remain in that state for 3 to 5 minutes before testing. In general, VAS elicited an initial acceleratory response of approximately 20 beats/min above the mean prestimulus heart rate followed by a deceleratory response to an average of approximately 4 beats/min below baseline values. Fetuses with different average prestimulus heart rate patterns generally differed in their early cardiac response to VAS: when compared to a high baseline FHR, a low resting heart rate was associated with a greater increase in heart rate above baseline (r = -0.401; P = 0.03), a greater decrease below prestimulus values (r = -0.312; P = 0.03), and a greater difference between maximum and minimum heart rates (r = -0.465; P = 0.001). Higher baseline heart rates were associated with lower FHR variability in the prestimulus period (r = -0.422; P = 0.009). When we examined the time course of the early response, we found that fetuses that achieved a maximum heart rate quickly exhibited less of an increase above prestimulus values (r = 0.894; P = 0.005), displayed a greater decrease below baseline (r = 0.507; P = 0.0002), and reached the minimum heart rate faster (r = 0.575; P = 0.0001) than fetuses that required longer to achieve a maximum cardiac response.(ABSTRACT TRUNCATED AT 250 WORDS)