Monocyte monolayer assay as a predictor of severity of hemolytic disease of the fetus and newborn.

The monocyte monolayer assay (MMA), an in vitro model of in vivo antibody-mediated red blood cell destruction, was previously reported to predict the severity of hemolytic disease of the fetus and newborn accurately when only Rh antibodies and antigen-positive babies were studied. We studied 33 women whose serum contained antibodies with the potential to cause erythroblastosis fetalis; 7 of the 33 women had antibodies other than Rh. None of the babies of the ten women who had consistently negative test results required intrauterine or neonatal transfusions. False-positive MMA results were sometimes found when the fetus was antigen negative. Although the predictive value of a negative MMA was 100%, the efficiency of the MMA was no better than that of the antibody titer. Because of the lack of advantage of the MMA as well as the time and expense it requires, we cannot recommend the general clinical application of this test at this time.

PCP in amniotic fluid and breast milk: case report.

The presence of phencyclidine (PCP) in breast milk and amniotic fluid of a young drug abuser is described. Implications drawn from these data include the possible use of amniocentesis in women with well-documented histories of drug abuse who have low levels of PCP in urine, and the restriction of breast feeding in women who have abused PCP.

Amniotic fluid beta-endorphin and beta-lipotropin concentrations during the second and third trimesters.

Amniotic fluid beta-endorphin (beta-EP) and beta-lipotropin (beta-LPH) were measured by radioimmunoassay after silicic acid extraction and gel chromatographic separation of the two peptides in uncomplicated second-trimester and term pregnancies, in diabetic patients at term, and in pregnancies complicated by Rh-isoimmunization, premature labor, and intrauterine growth retardation. Furthermore, the lecithin/sphingomyelin (L/S) ratios as well as the dehydroepiandrosterone sulfate (DHEA-S) and cortisol levels were determined in most of the amniotic fluid specimens. Both the mean (+/- SE) beta-EP (65.3 +/- 9.1 fmol/ml) and beta-LPH (150 +/- 15.8 fmol/ml) concentrations were significantly higher in the 20 patients with normal pregnancies of 16 to 21 weeks' duration than those found in 21 patients with uncomplicated term pregnancies of 38 weeks' gestation, averaging 42.6 +/- 6.0 and 80.1 +/- 10.7 fmol/ml, respectively. The mean amniotic fluid beta-EP and beta-LPH concentrations measured in the latter subjects were similar to those observed in 23 diabetic patients with otherwise uncomplicated term pregnancies. The mean amniotic fluid beta-EP and beta-LPH levels found in the limited number of patients with Rh-isoimmunization (N = 9), premature labor (n = 8), and intrauterine growth retardation (n = 5) with pregnancies of 24 to 36, 24 to 36, and 34 to 38 weeks' gestation, respectively, were not significantly different from the mean amniotic fluid beta-EP and beta-LPH concentrations of uncomplicated term pregnancies. In all patients but those with Rh-isoimmunization, beta-EP concentrations exhibited a positive correlation with beta-LPH levels. However, the molar beta-LPH:beta-EP ratio was significantly lower at term than during the early second trimester. Neither beta-EP nor beta-LPH correlated with the amniotic fluid L/S ratio and only beta-LPH exhibited a significant inverse correlation with amniotic fluid DHEA-S. The latter was significantly higher in uncomplicated term than second-trimester pregnancies. These results confirm that immunoassayable beta-EP is present in amniotic fluid and declines toward term. These data demonstrate that immunoassayable beta-LPH is present in amniotic fluid and show a more pronounced decrease toward the end of pregnancy than beta-EP. Neither peptide, at least on account of the amniotic fluid levels, appears to be associated with fetal maturation. The physiologic significance of amniotic fluid beta-EP and beta-LPH and their possible role as markers of fetal response to stress remain to be elucidated.

Phencyclidine in umbilical cord blood: preliminary data.

The epidemic abuse of phencyclidine (PCP) has become a major psychiatric issue within the past decade. With the assistance of highly sensitive capillary gas chromatographic-nitrogen detector measurements, PCP's true pervasiveness is only now being appreciated. To further quantitate the severity of the problem, the authors analyzed samples of umbilical cord blood from 200 patients on the obstetrics service of a major university medical center. Preliminary results revealed that 24 (12%) of the samples were positive for PCP (.10-5.80 ng/ml). The authors discuss the significance of this finding with regard to psychiatry, obstetrics, pediatrics, and juvenile law.

The use of ultrasound in the prediction of fetal pulmonary maturity.

Previous studies suggest that ultrasound criteria of biparietal diameter (BPD) and/or placental grade permit elimination of amniocentesis for pregnancy dating. To evaluate the potential risks and benefits of such a modified approach to determining fetal maturity, this prospective study, in which a BPD of greater than or equal to 9.2 cm or a Grade III placenta was used instead of amniotic fluid analysis, was undertaken. One hundred fifty-three infants were delivered electively between March, 1981, and January, 1982, on the basis of ultrasound parameters of pulmonary maturity. None of the electively delivered infants developed respiratory distress syndrome. We conclude from these preliminary results that the ultrasonically determined BPD of greater than or equal to 9.2 cm Grade III placenta is at least as sensitive as the lecithin/sphingomyelin ratio in predicting pulmonary maturity in our patient population.

Real-time ultrasound of the placenta in assessment of fetal pulmonic maturity.

The use of ultrasound is a noninvasive method of assessing fetal maturity. However, in order for it to be a substitute for amniocentesis, a high degree of accuracy is required. Static ultrasound examination of placental development has revealed certain patterns of maturity which have suggested to be predictors of fetal pulmonary maturity. This study analyzes 100 patients near term for the accuracy of placental grade in predicting pulmonary maturity when measured by the lecithin/sphingomyelin ratio and by clinical development of the respiratory distress syndrome in the neonate. A mature placental grade (Grade III) determined by real-time sonography corresponded to fetal lung maturity in all cases (n = 15). Placental grade as determined by this methodology appeared to be an accurate predictor of fetal maturity in the population examined.

Endodermal sinus tumor: report of a case associated with pregnancy.

The case of a 15-year-old black primigravida with an 18-week intrauterine gestation and concurrent endodermal sinus tumor is presented. Rationale for therapy is discussed.