Successful treatment of recurrent, intractable hyperemesis gravidarum with methylprednisolone. A case report.

BACKGROUND: Severe and persistent hyperemesis gravidarum is a disabling condition. Women may request termination of pregnancy because of the intolerable symptoms and stress. CASE: A woman requested termination of pregnancy because of severe hyperemesis gravidarum. Her first three pregnancies were also complicated by severe and persistent vomiting. The vomiting was successfully treated with a short course of methylprednisolone. CONCLUSION: Methylprednisolone is an effective treatment for severe hyperemesis gravidarum and should be considered for women whose vomiting is persistent and refractory to conventional therapy.

Reappraisal of neonatal clavicular fracture. Relationship between infant size and risk factors.

OBJECTIVE: To examine the role of fetal size in neonatal clavicular fracture. STUDY DESIGN: A retrospective, case-control study was performed on infants diagnosed with neonatal clavicular fractures and born vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within one week) and birth weight (within 250 g) and delivered within the same 24-hour period was selected at random from the delivery suite registry. The maternal and intrapartum factors were compared and the results analyzed according to whether the infants were large for gestational age (LGA) or not. RESULTS: Among 9,540 neonates delivered vaginally during this period, 151 (1.6%) had a fractured clavicle. Multivariate analysis indicated that the independent risk factors were shoulder dystocia and vacuum extraction. When analyzed according to fetal size, shoulder dystocia was significant only for LGA infants, while vacuum extraction was significant only for non-LGA infants. CONCLUSION: Independent risk factors for neonatal clavicular fracture are related to fetal size.

Transvaginal sonography in the detection of retained products of conception after first-trimester spontaneous abortion.

PURPOSE: The aim of this study was to assess the use of transvaginal sonography to detect retained products of conception after first-trimester spontaneous abortion. METHODS: All women who arrived at our hospital with spontaneous first-trimester abortions were included in this study and underwent transvaginal sonography. A sonographic diagnosis of "incomplete abortion" was based on a bilayer endometrial thickness of more than 8 mm. The final diagnosis of complete or incomplete abortion was based on the histopathologic findings at dilatation and curettage. The sensitivity and specificity of both clinical and sonographic examinations for detecting products of conception were assessed. RESULTS: A total of 113 women were recruited, and 14 were excluded for various reasons. Among 52 women with a clinically incomplete abortion, only 50% had retained products of conception. The use of transvaginal sonography resulted in a 29% (15/52) reduction of surgical intervention in these women. On the other hand, 30% (14/47) of women with a clinical diagnosis of complete abortion had retained products of conception. The sensitivity and specificity of cervical status for detecting retained products of conception were 65% and 56%, respectively, whereas the overall sensitivity and specificity of transvaginal sonographic examination (bilayer endometrial thickness 8 mm or less) were 100% and 80%, respectively. CONCLUSIONS: Transvaginal sonography is a useful supplement to clinical assessment in women who experience a spontaneous first-trimester abortion. If this modality is used to assess the uterine cavity, the cervical status can be ignored. Use of transvaginal sonography should reduce unnecessary general anesthesia and uterine curettage.

Reappraisal of neonatal clavicular fracture: relationship between infant size and neonatal morbidity.

OBJECTIVE: To examine the extent of neonatal morbidity and its relation with infant size in newborns diagnosed with clavicular fracture after vaginal birth. METHODS: A retrospective case-control study was performed on all the infants diagnosed with clavicular fractures and born vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within l week), birth weight (within 100 g), and delivered within the same 24-hour period (8 AM to 8 AM), was selected at random from the delivery suite registry. If a control could not be identified within the period, the search was extended to the previous or the following 24-hour period, and the birth weight criterion relaxed to within 250 g. The overall neonatal outcome was compared between the two groups and the morbidity was further analyzed according to whether the infants were large for gestational age (LGA) or not. RESULTS: Clavicular fracture, found in 1.6% (151 of 9540) of vaginal births, was associated with increased incidence of instrumental delivery (P =.001) and shoulder dystocia (P =.013). The associated morbidity were Erb palsy (P =.007), which was more often found in the LGA infants (P =.055), and cephalhematoma (P =.031), which was only found in the non-LGA infants (odds ratio 4.48, 95% confidence interval 1.23, 16.30). On multivariable analysis, clavicular fracture was excluded as a significant factor in these outcomes after adjusting for the effect of instrumental delivery and shoulder dystocia. CONCLUSION: Neonatal clavicular fracture is of little clinical significance, and it does not reflect quality of care.