Sildenafil citrate therapy for severe early-onset intrauterine growth restriction.

Sildenafil citrate therapy for severe early-onset intrauterine growth restriction. BJOG 2011;118:624-628. Currently, there is no effective therapy for severe early-onset intrauterine growth restriction (IUGR). Sildenafil citrate vasodilates the myometrial arteries isolated from women with IUGR-complicated pregnancies. Women were offered Sildenafil (25 mg three times daily until delivery) if their pregnancy was complicated by early-onset IUGR [abdominal circumference (AC)< 5th percentile] and either the gestational age was <25(+0) weeks or an estimate of the fetal weight was <600 g (excluding known fetal anomaly/syndrome and/or planned termination). Sildenafil treatment was associated with increased fetal AC growth [odds ratio, 12.9; 95% confidence interval (CI), 1.3, 126; compared with institutional Sildenafil-naive early-onset IUGR controls]. Randomised controlled trial data are required to determine whether Sildenafil improves perinatal outcomes for early-onset IUGR-complicated pregnancies.

Doppler velocimetric indices from the abdominal and placental ends of the umbilical artery of growth-restricted fetuses.

PURPOSE: In normal pregnancies, as gestation advances, a progressive decrease is observed in the differences between Doppler indices recorded at the 2 extremities of the umbilical cord. The purpose of this study was to determine whether the same pattern is observed in pregnancies complicated by intrauterine growth restriction (IUGR). METHODS: Forty-seven fetuses with sonographic diagnosis of IUGR underwent investigation by Doppler sonography. Blood flow velocities were measured at the abdominal and placental ends of the umbilical cord. The systolic-diastolic ratio, pulsatility index, and resistance index were calculated for each site. The differences in values between the 2 ends of the cord were calculated (abdominal end minus placental end) and then compared with the differences calculated for normal fetuses. RESULTS: In contrast to normal fetuses, IUGR fetuses with abnormal Doppler measurements had significant differences in the pulsatility and resistance indices between the 2 ends of the cord after 28 weeks of gestation. In addition, when compared with normal fetuses, the IUGR fetuses had a significantly greater difference in the values for the 2 ends of the cord for all indices. CONCLUSIONS: These results emphasize the importance of identifying the sampling site for serial Doppler investigations in IUGR-complicated pregnancies.

Is the ultrasound definition of fluid collections in non-immune hydrops fetalis helpful in defining the underlying cause or predicting outcome?

The ultrasound findings in 132 patients with non-immune hydrops referred for echocardiographic assessment were retrospectively reviewed. Structural assessment was combined with evaluation of pleural and pericardial effusions, ascites and skin edema. Patients were divided into groups based on the underlying etiology of hydrops. Seventy patients were found to have cardiac abnormalities, including 45 with structural heart disease. Other causes included. chromosomal anomalies, infection, extra-cardiac anomalies, genetic syndromes and, in 40 patients, unknown cause. Analysis of patterns of fluid accumulation revealed a significantly decreased incidence of pleural effusions and ascites in fetuses with an underlying cardiac abnormality. Cardiomegaly based on the cardio-thoracic ratio was significantly more frequent in the cardiac group. When patients were grouped by outcome, no pattern of fluid distribution was found to be characteristic for survival or death. We conclude that ultrasound definition of fluid collections in non-immune hydrops may be helpful in predicting the underlying cause of the hydrops, although there are no specific patterns predictive of outcome.

Evaluation of two rapid group B streptococcal antigen tests in labor and delivery patients.

Two rapid group B streptococcal antigen tests were compared with nonselective blood agar culture in 1062 unselected patients admitted to labor and delivery. Vaginal specimens taken from each patient on admission were used to perform each of two rapid tests and corresponding cultures. The rapid tests were the Streptex latex agglutination assay and the Equate Strep B test, which uses a solid-phase immunoassay. Overall, 105 patients (9.9%) had at least one positive culture. The sensitivities for the rapid tests were 15.1% for Streptex and 21.5% for Equate. Specificities were 99.3 and 98.7%, respectively. Sensitivity was minimally increased in the setting of ruptured membranes for both tests. Likewise, use of separate swabs for streaking the culture plate and performing the rapid test increased the sensitivity, but this was not significant for either test. In control experiments, the limit of sensitivity of both rapid tests was 5 x 10(6) colony-forming units. We conclude that at present, these tests are not sensitive enough for routine use in this type of clinical setting.

The incidence of positive amniotic fluid cultures in patients preterm labor with intact membranes.

The possible relationship between intrauterine infection and preterm labor has received considerable attention in recent years. The purpose of this study was twofold: first, to determine the frequency of asymptomatic infection in patients who came to the hospital in preterm labor, and second, to determine the significance of a positive amniotic fluid culture in relation to latency period and likelihood of preterm delivery. Patients who came to the hospital in preterm labor with intact membranes between 20 and 35 weeks' gestation underwent transabdominal amniocentesis. Amniotic fluid was sent for Gram stain and culture. Patients received tocolytic therapy as clinically indicated. Of 127 patients cultured, seven (5.5%) had positive amniotic fluid cultures. These patients had a significantly decreased latency period from amniocentesis to delivery (4.4 days versus 28.6 days), and a significantly increased chance of being delivered of preterm infants (100% versus 52.5%), as compared with patients with negative cultures. The rate of positive Gram stain was 7 of 125 positive. However, there was no correlation between positive Gram stain and positive culture results. Similarly, positive Gram stain results were not associated with any difference in the latency period or rate of preterm delivery.

Prenatal ultrasonic diagnosis of multiple bowel atresias.

This case illustrates the course of an obstructive process through spontaneous perforation resulting in decompression of dilated bowel loops. The resulting meconium peritonitis appeared as fetal ascites. Postnatal investigations and laparotomy confirmed the diagnosis of a rare form of multiple congenital atresias of the bowel.