Molecular cytogenetic analysis and clinical findings in a newborn with prenatally diagnosed rec(7)dup(7q)inv(7)(p22q31.3)pat.

We report prenatal and early postnatal findings in a newborn with a partial trisomy of chromosome 7 (7q31.3-qter), arising from meiotic recombination of a paternal pericentric inversion, inv(7)(p22q31.3). The inversion breakpoints were localized and the regions of duplication and deletion were defined by fluorescence in situ hybridization (FISH) analysis using a series of locus-specific and subtelomeric probes. To our knowledge, only three cases involving a recombinant 7 with duplication of 7q have been reported, two of these being first cousins. The clinical findings in our patient included skeletal abnormalities, facial dysmorphism, dilated cerebral ventricles, microretrognathia and short neck. These findings and some aspects of the neonatal course were consistent with the phenotype previously reported for duplication of distal 7q, without associated monosomy for sequences from another chromosome.

Clearance of fetal products and subsequent immunoreactivity of blood salvaged at cesarean delivery.

OBJECTIVE: To determine if fetal products can be detected after postplacental, intraoperative blood salvage, and if the product is immunoreactive with maternal serum. METHODS: We suctioned the shed blood of 27 term gravidas with intact membranes who had cesareans, beginning 4 minutes after placenta removal, into a COBE BRAT-2 salvage system (COBE Cardiovascular, Arvada, CO). Preoperative maternal and fetal cord blood samples were collected. Preprocessing and postprocessing salvaged blood was analyzed for alpha-fetoprotein (AFP), hemoglobin, hematocrit, and plasma-free hemoglobin. Papanicolaou smears and immunodiffusion using Ouchterlony methods for detection of protein-protein interactions were run on maternal serum. Postprocess salvaged blood was subjected to Kleihauer-Bethke tests, typed, and crossmatched with maternal serum, including mixed fields. No women were transfused. RESULTS: Ten of 27 women shed enough postprocess salvaged blood for analysis. Alpha-fetoprotein was cleared, but Kleihauer-Bethke analyses were positive in all postprocessing specimens. Anucleate squamous cells were detected by Papanicolaou smears in four of ten preprocessed specimens, with one cleared by processing. No antigen-antibody reaction between maternal and preprocessed or postprocessed salvaged blood was found by the Ouchterlony method. Crossmatching of the final product with maternal serum was successful, with negative mixed fields in all cases. CONCLUSION: Fetal debris was present in blood salvaged 4 minutes after removal of placenta. Despite clearance of humoral material, fetal blood cells were detectable in all postprocess salvaged blood. The product was compatible with maternal blood by crossmatching and its supernate did not immunoreact with maternal serum.

The effect of lumbar epidural anesthesia on maternal middle cerebral artery blood flow in normal pregnancy: a prospective, randomized, double-blind comparison study.

OBJECTIVE: Lumbar epidural anesthesia is associated with a transient elevation in intracranial pressure in both animals and humans and decreased cerebral blood flow in animals. We sought to determine the effect of medium-onset and slow-onset local anesthetic lumbar epidural anesthesia on maternal cerebral blood flow in normal human pregnancy. STUDY DESIGN: In an Institutional Review Board-approved, double-blind study, 24 healthy, normotensive, nonlaboring, term gravida women undergoing elective cesarean section were prospectively placed into random groups to receive either 2% lidocaine with 8.4% sodium bicarbonate (1:10) or 0.5% bupivacaine lumbar epidural anesthesia. After prehydration with 20 mL/kg crystalloid and 15-degree left-wedged supine positioning with 15-degree head tilt, transcranial Doppler ultrasound (Nicolet Pioneer EME) and simultaneous electrocardiogram, automatic blood pressure (Dinamap), and end-tidal CO2 (SAR-Trans) monitoring were performed. Pulse, blood pressure, respiratory rate, end-tidal CO2, middle cerebral artery blood flow velocity, and pulsatility index were measured at (1) baseline (once supine positioning was assumed); (2) immediately after administration of 20 mL local anesthetic; and (3) every 5 minutes for 25 minutes. Timing of the attainment of a T4 dermatome anesthetic level was noted. Comparisons were made by t test, rank sum tests, chi2, and repeated measures analysis of variance. P <.05 was considered significant. RESULTS: Maternal heart rate, blood pressure, respiratory rate, and end-tidal CO2 were not significantly different within or between groups. No significant difference was found in baseline middle cerebral artery blood flow velocity or pulsatility index values between groups. Neither middle cerebral artery blood flow velocity nor pulsatility index changed significantly within or between groups up to 25 minutes after institution of epidural anesthesia. CONCLUSIONS: Maternal middle cerebral artery blood flow velocity, as measured by transcranial Doppler ultrasonography, is maintained in normotensive, nonlaboring term gravida women receiving either lidocaine or bupivacaine lumbar epidural anesthesia, which supports intact cerebrovascular autoregulation in normal pregnancy.

Pregnancy following gastric bypass surgery for morbid obesity.

BACKGROUND: Surgical treatment for severe obesity is sometimes recommended. Many long-term risks, particularly to adolescents and to subsequent pregnancies, are still being determined. CASE: A 23-year-old woman, gravida 6, para 2, treated for morbid obesity during adolescence with gastric bypass surgery, presented at 6 weeks' gestation with severe microcytic anemia. Significant iron and cobalamin deficiencies were found. Although the vitamin B12 deficiency responded to parenteral treatment, the iron deficiency was refractory to oral supplementation because of malabsorption. By 30 weeks' gestation, the patient required blood transfusions to correct the progressive anemia. Subsequently, she delivered a healthy male infant at term. CONCLUSION: Severe iron deficiency anemia resulting from malabsorption can complicate pregnancy following gastric bypass surgery for morbid obesity. For women of childbearing age, this potential adverse effect must be considered.

Prevention of maternal hypotension by epidural administration of ephedrine sulfate during lumbar epidural anesthesia for cesarean section.

OBJECTIVE: Our purpose was to determine whether epidural administration of ephedrine sulfate simultaneously with induction of lumbar epidural anesthesia for nonemergency cesarean section reduces the incidence of maternal hypotension. STUDY DESIGN: In a double-blinded, placebo-controlled trial, 50 normotensive, nonlaboring, American Society of Anesthesiologists' class I or II women with term, uncomplicated, singleton pregnancies were randomly assigned to have normal saline solution or ephedrine sulfate administered epidurally and coincidentally with induction of lumbar epidural anesthesia for nonemergency cesarean section. All subjects were prehydrated with 25 ml/kg crystalloid and placed in supine position on a 15-degree, right-sided wedge before and after induction. Serial blood pressures were compared with baseline blood pressures, chosen as the average of three preinduction blood pressures. Hypotension was defined as a decline in systolic blood pressure to < or = 90 mm Hg or < or = 70% of baseline. Differences between groups were analyzed by Fisher's Exact Test. Significance was determined at p < 0.05. RESULTS: The incidence of hypotension in the control group was 24%, which was not significantly different from the incidence of 32% in the treated group. CONCLUSION: Prophylactic epidural administration of ephedrine sulfate does not reduce the incidence of maternal hypotension after lumbar epidural anesthesia for nonemergency cesarean section.

Baseline serum and cerebrospinal fluid magnesium levels in normal pregnancy and preeclampsia.

OBJECTIVE: To determine whether baseline cerebrospinal fluid magnesium levels in preeclampsia differ from those in normal pregnancy, and to ascertain whether pre-treatment cerebrospinal fluid magnesium levels correlate with serum levels, which would suggest a baseline alteration in the blood-brain barrier in preeclampsia. METHODS: When spinal analgesia or anesthesia was administered for delivery, serum and cerebrospinal fluid magnesium levels were determined in 20 normal gravidas and 20 preeclamptic women not treated with magnesium sulfate. Data were analyzed by two-sided Student t test and regression analysis. RESULTS: Mean (+/- standard deviation) cerebrospinal fluid magnesium level for preeclamptic patients was 2.23 +/- 0.09 mEq/L, which was not significantly different from controls. Regression analysis revealed no significant correlation between cerebrospinal fluid and serum magnesium levels for either normal or preeclamptic gravidas. CONCLUSION: During the third trimester, there is no difference in baseline, pre-treatment cerebrospinal fluid magnesium levels in preeclamptic patients compared to normal subjects, and no correlation between cerebrospinal fluid and serum magnesium over the range of baseline values.

Corticotropin-releasing hormone and pituitary-adrenal hormones in pregnancies complicated by chronic hypertension.

OBJECTIVE: We hypothesized that maternal plasma corticotropin-releasing hormone levels are elevated in chronic hypertension and that elevations modulate maternal and fetal pituitary-adrenal function. STUDY DESIGN: Venous blood samples and 24-hour urine specimens were obtained in normal and hypertensive pregnancies at 21 to 40 weeks of gestation. Corticotropin-releasing hormone, corticotropin, cortisol, dehydroepiandrosterone sulfate, and total estriol levels were measured by radioimmunoassay. Mean hormone levels were compared by unpaired t test or two-way analysis of variance. RESULTS: Plasma corticotropin-releasing hormone levels were elevated early in hypertensive pregnancies but did not increase after 36 weeks. Levels of pituitary and adrenal hormones were not different in normal and hypertensive women. However, maternal plasma estriol levels were lower in hypertensive pregnancies compared with normal pregnancies. CONCLUSIONS: Fetal 16-hydroxy dehydroepiandrosterone sulfate, the major precursor to placental estriol production, has been reported to be lower than normal in hypertensive pregnancies, possibly explaining the decreased plasma estriol levels reported here. Early stimulation of placental corticotropin-releasing hormone production or secretion may be related to accelerated maturation of placental endocrine function in pregnancies complicated by chronic hypertension.