Longitudinal reference range for umbilical cord cross-sectional area in twin pregnancies at 18-32 weeks of gestation.

OBJECTIVES: The objectives of this study were to establish gestational age-specific reference ranges for cross-sectional area of the umbilical cord, and its components, in twin pregnancies and to compare them with previously reported singleton reference ranges. METHODS: This was a prospective longitudinal study involving uncomplicated dichorionic twin pregnancies. Sonographic measurements of the cross-sectional area of the umbilical cord, umbilical vein and arteries and Wharton's jelly were obtained in a plane adjacent to the fetal abdomen, every 3 weeks, between 18 and 32 weeks of gestations. Multilevel regression analysis was used to determine gestational age-specific reference ranges for each parameter, and these were plotted against singleton pregnancy references. RESULTS: Three hundred and thirty four ultrasound scans were performed in 44 twin pregnancies, between 18 and 32.9 weeks (mean: 3.8 ± 0.7 scans/pregnancy and mean interval between scans: 3.3 ± 0.9 weeks). All umbilical cord cross-sectional areas (total, vein, artery and Wharton's jelly) showed a significant increase with gestational age. Compared with singleton pregnancy ranges, mean values were considerably lower in twin pregnancies and resemble the lower limits observed in singletons. CONCLUSION: In twin pregnancies, cross-sectional area of the umbilical cord, and its components, increases between 18 and 32 weeks, and mean values are substantially lower compared with singleton pregnancies.

Are children with clefts underweight for age at the time of primary surgery?

Children with clefts, especially those with a cleft palate, have an impaired sucking mechanism and are therefore prone to nutritional problems. This study was undertaken to determine whether children with clefts of the lip and/or palate are underweight for age at the time of primary surgery. Underweight for age was defined as being less than 80 percent of expected weight for age or below the 3rd percentile as plotted on standard percentile charts. The records of all children with clefts seen at the Red Cross Children's Hospital between 1976 and 1996 were reviewed. Of these 740 records, 100 were excluded for inadequate data (47), severe systemic syndrome (27), no operation done (22), or craniofacial cleft (4). The records of 640 children were thus included; 195 (30.5 percent) were underweight for age. By comparison, only 13.7 percent of a similar group of noncleft controls (n = 872) were underweight for age. The difference between these two groups was highly significant (p < 0.01). Factors that influenced weight at the time of primary surgery were type of cleft and age at the time of surgery. Children with cleft palate, whether associated with a cleft lip or not, were found to be more underweight for age than those with an isolated unilateral cleft lip (p = 0.008). Children who had surgery after the age of 1 year were 1.5 times more likely to be underweight for age than children who had surgery under 1 year of age (p < 0.01). Children with isolated cleft palates who were underweight for age had a tendency toward a higher fistula rate (36 percent) than those of normal weight (24 percent) (p = 0.18).

Velopharyngeal incompetence after adenotonsillectomy in non-cleft patients.

This report discusses 15 non-cleft palate children who developed velopharyngeal incompetence (VPI) after adenotonsillectomy. Eight boys and 7 girls with a mean age of 6.2 years (range 4.3-11 years) were treated between 1970 and 1993. After 2 years conservative management to allow for spontaneous resolution, only (7 children) 47% achieved normal resonance. Speech therapy was employed mainly for those patients with unrelated articulation errors. Fifty-three percent (8 children) required surgery for persistent hypernasality and in 6 a pharyngoplasty was performed and in one child a posterior pharyngeal cartilage graft was inserted. One case is still to have surgical intervention. Half of the non-cleft children who develop VPI after adenotonsillectomy will respond to conservative management.

Speech results after repair of the cleft soft palate.

The purpose of this study was to investigate the speech results of five different techniques of repair of only the cleft soft palate and also to assess the effect of timing of repair on speech results. A total of 184 patients (73 males, 111 females) underwent either a Dorrance repair (25 patients), a Wardill repair (41 patients), a Perko repair (19 patients), a von Langenbeck repair (79 patients), or a Furlow Z-plasty (20 patients) between 1964 and 1989. Articulation, intelligibility, and resonance were assessed by usually two but at least one speech therapist. All the children underwent videofluoroscopy. The follow-up period was from 3 to 24 years, with a mean of 9.6 years. The Furlow Z-plasty and Perko repair yielded the best speech results. There was a significant difference in speech and less velopharyngeal incompetence (Fisher's exact test, p = 0.0218) when the palate was repaired prior to 6 months of age as compared with after 6 months of age (for all the techniques except the Dorrance repair). Fistulas are uncommon after repair of only the soft palate.

Treatment of velopharyngeal incompetence by the Furlow Z-plasty.

Velopharyngeal incompetence occurs in approximately 25% of cases after primary palatoplasty. There is controversy regarding the best method of surgical management of velopharyngeal incompetence. Between 1986 and 1993, 13 children with velopharyngeal incompetence after primary palatoplasty underwent Furlow Z-plasty repair. All children were assessed by a speech therapist and with videofluoroscopy pre- and postoperatively. The Furlow Z-plasty was performed at a mean age of 7.8 years (range, 4-12 years). Eleven children achieved normal resonance, and all 13 demonstrated improved velopharyngeal function on videofluoroscopy. The Furlow Z-plasty is effective treatment for children with velopharyngeal incompetence.

The modified Z-plasty for unilateral cleft lip repair.

In 1965 Davies described a Z-plasty technique for the repair of a unilateral cleft lip. The technique has been modified so that the scars are more aesthetically placed and the orbicularis muscle correctly aligned. A prospective study was performed comparing the results of this modified Z-plasty with the rotation advancement repair. Twelve patients had a modified Z-plasty and 10 a rotation advancement repair. The modified Z-plasty compares favourably with the rotation advancement technique for the repair of a unilateral cleft lip. In particular, the incidence of asymmetry of lip height was greater in the rotation advancement group.