Administration of heparin by subcutaneous infusion with a programmable pump.

Heparin has a short half-life (8 to 12 hours) and therefore must be administered by continuous infusion or by intermittent subcutaneous injection. Intermittent subcutaneous injection may lead to fluctuation in the levels of anticoagulation attained. In correcting this deficiency, the programmable automated subcutaneous infusion pump in conjunction with weekly home nursing visits has been used. Eight pregnant women with documented deep venous thrombosis or embolic events before pregnancy who received such therapy were studied. Eight similar subjects who received intermittent subcutaneous injection, matched for age, parity, site of deep venous thrombosis, and days on a regimen of heparin therapy, served as the control group. The mean daily dose of heparin by subcutaneous infusion pump was higher (29,445 vs 13,822 U), resulting in smoother, more therapeutic heparinization (mean partial thromboplastin time, 20.6 vs 10.4 seconds above control) when compared with the intermittent subcutaneous injection group (p less than 0.05, p less than 0.007). There were two complications (hematoma, site infection) in the intermittent subcutaneous injection group while none occurred in the subcutaneous infusion pump group. When used in concert with weekly home visits, the subcutaneous infusion pump method of administration allowed more even control of anticoagulation, appeared to result in fewer complications (although not statistically significant), and subjectively was better received by patients than the intermittent subcutaneous injection technique.

Normal length of fetal kidneys: sonographic study in 397 obstetric patients.

This study was done to measure normal lengths of fetal kidneys sonographically during pregnancy. Knowledge of these measurements may allow earlier diagnosis of a variety of abnormalities. The greatest length of each of 498 kidneys in 397 consecutive fetuses between 18 and 41 weeks gestation was measured on sonograms. Gestational ages were determined by last menstrual period and biometry; significant discrepancies led to case exclusion. Abnormal fetuses, twins, offspring of diabetic mothers, and fetuses with renal pelvic dilatation of 4 mm or greater were excluded to avoid any questionable measurements. The results show that mean lengths are greater and confidence intervals are wider than previously reported. Renal lengths are similar to those reported in premature and full-term neonates. Strong correlation exists between renal length and gestational age, determined by biparietal diameter, femoral length, and abdominal circumference, and an average of the three. No significant difference was found between right and left renal lengths in fetuses in whom both kidneys were imaged. Average renal lengths are significantly different when compared across the range of gestational ages (p less than .001). No correlation is seen (r = .00) between parental height or weight and fetal renal length. Our results show that fetal renal lengths are longer than previously reported.

Disseminated Kaposi's sarcoma in pregnancy: a manifestation of acquired immune deficiency syndrome.

The first case of acquired immune deficiency syndrome (AIDS) in pregnancy is reported. The patient, a drug addict, presented with lymphadenopathy, pulmonary infiltrates, and skin lesions of Kaposi's sarcoma, a tumor rarely found in young women in this country. The helper T-lymphocyte to suppressor T-lymphocyte ratio showed the profound inversion characteristic of this cell-mediated immune deficiency disease. Chemotherapy, a combination of doxorubicin, bleomycin, and vinblastine, was initiated during pregnancy. A growth-retarded infant was delivered vaginally. At four months of life, the infant had no apparent evidence of immune deficiency. Transplacental transmission of AIDS has not, as yet, been demonstrated. The social factors, clinical and laboratory features, and the controversies surrounding this new disease are discussed.

Fetal arrhythmia.

Seven human fetuses with intermittently recurring cardiac arrhythmias of ectopic origin were studied intensively during labor and the early neonatal period. Neonatal outcome, judged by Apgar scores and neonatal acid-base parameters, was favorable in all 7 patients. Three of the seven arrhythmias reverted spontaneously to sinus rhythm within 72 hours, and six of the seven resolved by 5 days of age. One neonate, with supraventricular tachycardia, developed congestive heart failure, necessitating digitalization, but was free of symptoms at 6 weeks and showed no evidence of congenital heart disease. The literature on fetal cardiac arrhythmias is reviewed. A number of etiologic mechanisms and several methods of pharmacologic therapy of these irregularities have been proposed. These cases suggest, however, that fetal arrhythmias of ectopic origin need not represent signs of fetal distress or cardiac anomaly and may be inocuous. Evidence to date indicates that in utero pharmacologic treatment of fetal arrhythmias is not indicated.