Pregnancy outcome after premature rupture of the membranes at or before 26 weeks' gestation.

Pregnancy outcome was examined in 59 clinically stable patients with rupture of the membranes at or before 26 weeks' gestation. The mean gestational age at rupture of the membranes was 23.2 weeks, and the mean latent period was 21.5 days. Delivery occurred within 7 days in 29 patients (49.2%), chorioamnionitis developed in 27 patients (45.8%), and operative delivery was required in 24 patients (40.7%). Sixty-three infants were delivered, with a perinatal mortality rate of 49.1%. Among survivors, 84% required newborn intensive care during the initial hospitalization, 77% were discharged with minor to moderate reversible sequelae, and 16% were discharged with sequelae that were likely to be of long-term duration. Obstetric factors present at rupture of the membranes were evaluated for their ability to predict maternal and neonatal morbid outcomes; obstetric interventions were evaluated for their ability to modify outcomes. These data suggest that outcomes in this subset of patients may not be uniformly dismal, and support clinical decision-making on an individualized basis.

Vascular anastomoses in fused, dichorionic twin placentas resulting in twin transfusion syndrome.

We have provided pathologic documentation of vascular anastomoses across fused, dichorionic placentas. These placental anastomoses resulted in the twin transfusion syndrome.

Questionable role of amniocentesis in the etiology of amniotic band formation. A case report.

A preterm infant had an amniotic band sequence. Anomalies included left leg amputation and digital anomalies of the hands. The umbilical cord was short, and histologic sections of the placenta demonstrated partial avulsion of the amnion and fibrosis of the underlying chorion. Ultrasound at 21 weeks was normal, there was no history of trauma during the pregnancy, and no amniocentesis had been performed. Despite isolated case reports of amniotic band sequence associated with amniocentesis, we doubt that amniotic band formation is a significant risk after second-trimester amniocentesis.

Parental and physician-related determinants of consent for neonatal autopsy.

We undertook a cross-sectional epidemiologic study of potential determinants of parental consent for neonatal autopsy at the Brigham and Women's Hospital, Boston. Data were abstracted from maternal and infant medical records in 184 cases of neonatal death occurring between January 1982 and October 1984. The overall consent rate for neonatal autopsy was 72%. Multivariate analysis by logistic regression found previous fetal loss, gestational age, and cause of death to be significantly different between the groups of consenters and nonconsenters. Parents least likely to consent to autopsy were those who had no history of previous fetal loss, who had pregnancies in which the birth weight of the infant was less than 1000 g or the gestational age was less than 28 weeks, or those who had an infant die of extreme prematurity. Factors not significantly associated with consent were maternal age, race, marital status, transfer status, type of prenatal care, the infant's sex, and the staff position of the requester. A second phase of the study surveyed physicians' attitudes regarding the importance of neonatal autopsy. The staff position and previous experience of the physician-requester, in addition to the presumed cause of the infant's death, were significantly associated with the rating assigned to the importance of the autopsy. These findings suggest that the mother's past and present obstetrical experience, the presence of extreme prematurity, and possibly the attitude and experience of the physician requesting autopsy permission may exert important influences on the likelihood of obtaining consent for a neonatal autopsy.