The biophysical profile as a tool for prediction of preterm delivery.

Our objective was to determine if any of the following parameters is a predictor of preterm delivery: gestational age, cervical dilatation, or biophysical profile score.Sixty-two women with certain dates, intact membranes, and preterm contractions more frequent than 300 min underwent a 30-min ultrasonographic assessment of fetal breathing movements, fetal tone, fetal movement and amniotic fluid volume, each of which was scored as 0, 1, or 2 before any tocolytics were given. The total score (0-8) was calculated and cervical dilatation was recorded. All women were subsequently placed on tocolytics. Data were analyzed using survival analysis with stepwise regression of the covariates to determine the predictive values of the total score, its individual parameters, gestational age, and cervical dilatation to the outcome variable of hours to delivery. Gestational age, cervical dilatation and time interval to delivery were categorized and entered into a logistic regression model with the total score and its components to determine predictive odds.Total score (p < 0.0001) and cervical dilatation (p < 0.0001) were the most significant variables associated with time interval to delivery, followed by gestational age (p = 0.035). When the individual biophysical parameters were entered into the model, fetal tone (p < 0.0001), cervical dilatation (p < 0.0001) and gestational age (p < 0.014) were the only variables related to time interval to delivery. Predictive odds of delivery in less than 48 h in relation to fetal tone and cervical dilatation were calculated. Total score, fetal tone, and cervical dilatation were strongly associated with time interval to delivery. Our study did not support fetal breathing movements as a predictor of preterm delivery.

Fundal height measurement. Part 4--Accuracy of clinicians' identification of the uterine fundus during pregnancy.

The purpose of this study was to determine how accurately clinicians can identify the uppermost border of the uterine fundus when they obtain fundal height measurements. Clinicians were instructed to identify the uppermost border of the uterine fundus in their usual manner and make a small pen mark on the maternal abdomen at that point. Real-time ultrasonography was then used to locate the actual level of the fundus and measure the distance between the clinician's assessment and the actual level of the fundus. Measurements were obtained from 126 women. Six clinicians participated in the study, and the differences between the clinicians' errors were not statistically significant (F = 1.26; d.f. = 5,120; P = .2873). For the entire series, the mean error was -.45 cm (SD = 1.99 cm), the mean absolute error was 1.25 cm, the maximal error was 8.6 cm, the percentage of errors that exceeded 1 cm was 42.1%, and the percentage of errors that exceeded 2 cm was 20.6%. Examiner error was not associated with factors such as maternal height, prepregnancy weight, present weight, prepregnancy body mass index, parity, gestational weeks, the amount of fat on the anterior abdominal wall, or the presence of the placenta or fetal parts in the fundus. Examiner error was influenced by thickness of the uterine wall and fetal presentation. These findings indicate that clinicians make errors in identifying the uterine fundus in a significant number of cases and that the methods used by clinicians to identify the uterine fundus need to be evaluated and improved.

Indole-3-Acetic Acid Biosynthesis in the Mutant Maize orange pericarp, a Tryptophan Auxotroph.

The maize mutant orange pericarp is a tryptophan auxotroph, which results from mutation of two unlinked loci of tryptophan synthase B. This mutant was used to test the hypothesis that tryptophan is the precursor to the plant hormone indole-3-acetic acid (IAA). Total IAA in aseptically grown mutant seedlings was 50 times greater than in normal seedlings. In mutant seedlings grown on media containing stable isotopelabeled precursors, IAA was more enriched than was tryptophan. No incorporation of label into IAA from tryptophan could be detected. These results establish that IAA can be produced de novo without tryptophan as an intermediate.

Configuration of the fetal electrocardiogram in ambulatory women in labor monitored with wideband telemetry.

The fetal electrocardiogram (ECG) in 23 ambulatory women in labor was monitored successfully with a single-channel FM telemetry unit with a 0.5-100-Hz wideband receiver to improve the quality of the ECG complex. An inverted QRS complex was seen in a patient with a deceleration and an inverted T wave during a deceleration in a patient confined to bed. A maternal artifact was transmitted in a third. The ECG complex was identical when wired patients were switched to telemetry. Thus, fetal heart rate and ECG configuration can be monitored accurately in ambulatory pregnant women.

Gonococcal endocarditis during pregnancy: simultaneous cesarean section and aortic valve surgery.

Gonococcal endocarditis is a rare and potentially fatal consequence of disseminated gonococcal infection. Presented is the first known case of culture-proved gonococcal and serratia endocarditis in pregnancy. The case was further complicated by fetal distress at 30 weeks' gestation as a result of maternal decompensation from worsening congestive heart failure secondary to rapid destruction of her aortic valve. Consequently, cardiopulmonary bypass with subsequent aortic valve replacement and implantation of a left ventriculoaortic shunt was initiated immediately after an emergency cesarean section.

Single ultrasonic estimation of fetal weight in utero compared with birth weight.

A single ultrasonic determination of fetal weight in utero was made in 270 singleton pregnancies. Infants were divided by birth weights into two groups, less than and greater than the 50th percentile. Ultrasonically determined fetal weight correlated with birth weight (R2 greater than or equal to 0.52) beyond 33 weeks' gestation. Mean fetal weights measured by ultrasound at various stages of gestation correlated well with published values.

Tocolysis with terbutaline sulfate in patients with placenta previa complicated by premature labor.

Six patients with placenta previa complicated by premature labor underwent tocolysis with terbutaline sulfate. The average prolongation of pregnancy was 3.5 weeks. Five patients were at 31 weeks' gestation or more at the initiation of tocolytic therapy and had infants who survived and were greater than 2,000 gm at birth. All patients received an average blood transfusion of 6.7 units of packed cells each.

Pregnancy termination in patients with pregnancy-induced hypertension or eclampsia at less than 22 weeks' gestation.

PIP: 3 patients with fetal death, 2 of whom had pregnancy-induced hypertension and a third with eclampsia had pregnancy termination before 22 weeks' gestation with vaginal prostaglandin E2 (PGE2) suppositories, without complication. PGE2 has a hypotensive action, decreasing blood pressure by arteriolar dilation and blocking the angiotensin-induced rise in blood pressure in the pregnant rhesus monkey and should be useful abortifacient in patients with hypertension including preeclampsia and eclampsia. One patient received magnesium sulfate and the other 2 received hydralazine and methyldopa during PGE2 administration which could alter mean arterial pressure (MAP). MAPs remained stable and dropped slightly after PGE2 administration in the 2nd and 3rd patients. These outcomes suggest that PGE2 suppositories can be used to terminate 2nd trimester pregnancy in cases of hypertension and eclampsia when routine medical management is ineffective or when fetal death occurs although caution is advised since severe hypotension can occur with PGE2 administration.^ieng

Pregnancy complicated by concurrent primary hyperparathyroidism and pancreatitis.

The third case of pancreatitis and primary hyperparathyroidism during pregnancy is reported. The patient became gravely ill with "hypercalcemic crisis" in the third trimester, the condition was stabilized by medical therapy, and the fetus was delivered when mature. This combined diagnosis is difficult to make because of the changes in calcium metabolism that accompany pregnancy and because of the opposite effects the 2 diseases have on blood calcium levels. In early pregnancy, surgical management of the parathyroid disease seems warranted after the condition has stabilized, whereas in late pregnancy medical treatment may be used and definitive surgery may be postponed until after delivery.

Anencephaly, twins and HLA-B27.

A patient with a twin pregnancy where both infants were affected with anencephaly is reported, and the world's literature on anencephaly in twins is summarized. The anomalies were diagnosed by ultrasound during the prenatal period. Studies of the genetic histocompatible lymphocyte antigens (HLA) types of both parents were performed, and they failed to demonstrate the HLA-B27 locus in either. Anencephaly in twins is an unusual phenomenon, with concordance even more rare. The possibility that anencephaly is a heterogeneous entity, both morphologically and genetically, and its relationship to the HLA locus are discussed.

Antepartum measurement of the preejection period in high-risk pregnancy.

The preejection period (PEP) of the fetal heart was measured in the antepartum period in 32 high-risk patients between 32.5 and 42 weeks' gestation. Successful measurements were made 70% of the time using an abdominal electrocardiogram and a single-crystal Doppler ultrasound transducer with narrow band-pass amplifier. PEP was found to correlate directly with gestational age (GA) and inversely with fetal heart rate (FHR). Three of 4 growth-retarded infants and another infant who was asphyxiated at birth had significant shortening of PEP prior to delivery.

Fetal heart rate variability as an indicator of fetal status.

Numerous studies have shown the clinical usefulness of monitoring fetal heart rate (FHR) variability. Among the disorders associated with decreased FHR variability during labor are fetal asphyxia and acidosis and subsequent distress in the newborn. Among the factors that influence FHR variability are maternal fever, fetal immaturity, so-called fetal sleep, fetal tachycardia, and drug administration to the mother. The nonstress test, which analyzes FHR variability and accelerations of heart rate with fetal movements, may be as useful as the oxytocin challenge test for assessing FHR variability. Doppler ultrasonic cardiography exaggerates the amount of FHR variability. FHR patterns associated with progressive loss of beat-to-beat variability in the absence of maternal drug intake necessitate intervention.