The effect of storage conditions on amniotic fluid phosphatidylglycerol concentration.

In certain high-risk gestations, phosphatidylglycerol in the amniotic fluid is reported to be useful in predicting respiratory distress syndrome of the neonate in high-risk patients. This study of amniotic fluid phosphatidylglycerol was performed to determine the degradation of phosphatidylglycerol in both the supernatant and the lamellar bodies of amniotic fluid samples collected from normal term pregnant patients. The objective of the study was to discover whether phosphatidylglycerol retained its stability when measured in transported and stored amniotic fluid. The results of the study showed that phosphatidylglycerol remained stable in all amniotic fluid samples stored at various temperatures over a 3-week period.

Meperidine and normeperidine metabolism in the rhesus monkey.

Meperidine and its principle metabolite, normeperidine, were given intravenously to four non-human primates prior to cesarean delivery in an equivalent dose for human parturients. The status of the infants regarding neonatal depression was assessed at delivery. Repeated blood samples from both the mother and the neonate were obtained over a period of 4 days. The levels of meperidine and normeperidine were analyzed. The results showed that the metabolism of meperidine and normeperidine in the non-human primate was essentially the same as that observed in the human parturient. In addition, normeperidine appeared to be more toxic than meperidine to the neonate. Finally, there does not appear to be an evidence for neonatal metabolism of meperidine to normeperidine.

Pheochromocytoma in pregnancy: diagnosis and collaborative management.

Antenatal diagnosis and appropriate management of pheochromocytoma complicating pregnancy offers a reduction in mortality for both mother and fetus. We have presented the successful management of such a case, emphasizing the close collaboration between obstetricians, pediatricians, anesthesiologists, surgeons, and internists that is mandatory for a successful outcome.

Treatment of premature rupture of the membranes.

Few topics in obstetrics are debated more widely than the treatment of premature rupture of the fetal membranes (PROM). Over a two-year period, a retrospective analysis of 422 patients with that diagnosis revealed 86 mother-infant pairs at less than 37 weeks of gestation acceptable for review as it pertained to expectant or conservative management. The gestational age in these patients ranged from 26 to 36 weeks, with a mean of 31.9. Using the conservative management approach, 12% of the patients developed amnionitis during the antepartum period, and febrile morbidity was noted postpartum in eight patients. The neonatal outcome revealed a 14% incidence of respiratory distress syndrome (RDS). There were 18 infants with suspected sepsis, but of the 6 cases of proven infection, only 1 was related to amnionitis. Ten of the 12 infants contracting RDS were males, reflecting a reversal of the sex ratio found in those who did not develop RDS. The sex difference in the offspring was found to favor females with respect to RDS, even greater than 48 hours after rupture of the membranes. These data demonstrate that with the use of expectant management in patients with PROM at 26-36 weeks of gestation, there was no dramatic increase in maternal or neonatal infections.

Maternal administration of dexamethasone in severe pregnancy-induced hypertension.

Fourteen patients with severe pregnancy-induced hypertension and low lecithin/sphingomyelin (L/S) ratios were treated with 5 mg of dexamethasone phosphate intramuscularly every 12 hours for four doses to induce fetal pulmonary maturity. A comparison was made of the average gestational age, mean L/S ratio, method of delivery, Apgar scores, mean birth weight, and incidence of respiratory distress syndrome in these patients and in 16 patients with similar demographic backgrounds and clinical presentations who did not receive corticosteroid therapy. There was no significant difference between the two groups except that the time of treatment (or nontreatment) to delivery was longer in the steroid group. There were two cases of neonatal respiratory distress syndrome in the treatment group, and one of these infants died. In the control group, there were two neonatal deaths among four cases of respiratory distress syndrome. There was no clinical evidence of intraventricular hemorrhage in any neonate nor was there aggravation of hypertension in the parturient patients. The administration of corticosteroids to induce fetal pulmonary maturity in patients with severe pregnancy-induced hypertension who are carefully selected and monitored does not appear to be contraindicated.

Intrapartum fetal heart rate monitoring as a predictor of fetal distress and immediate neonatal condition in low-birth weight (less than or equal to 1,800 grams) infants.

Among 1,318 live born infants delivered in our institution during a 120-day period, 1,025 (77.8%) were monitored electronically. Of the 1,025 monitored infants, 89 were of low birth weight (less than or equal to 1,800 gm) and were admitted to the neonatal intensive care unit. Twenty-seven (30%) of these had abnormal fetal heart rate tracings. The remaining 62 (70%) had normal fetal heart rate tracings. Of the 27 low-birth weight neonates with an abnormal fetal heart rate tracing, 24 (89%) were asphyxiated, whereas of those 62 low-birth weight infants with a normal fetal heart rate tracing, only nine (14%) had asphyxia (p less than 0.001). Of the 27 low-birth weight neonates with abnormal fetal heart rate tracings, 20 (74%) developed hyaline membrane disease, whereas of the 62 low-birth weight neonates with normal fetal heart rate tracings, 10 (16%) developed hyaline membrane disease (p less than 0.001). The results of this study suggest that electronic fetal monitoring provides a specific and sensitive method for identifying those low-birth weight infants who are at high risk for asphyxia and hyaline membrane disease.