Antenatal Down syndrome screening in the United States in 2001: a survey of maternal-fetal medicine specialists.

OBJECTIVE: Our objectives were to determine patterns of antenatal Down syndrome screening and risk adjustment by maternal-fetal medicine specialists in the United States in 2001. STUDY DESIGN: A survey to investigate Down syndrome screening practice patterns was mailed to the 1,638 members of the Society of Maternal-Fetal Medicine in the United States. Practice demographics, screening patterns, and the numeric risks quoted in counseling were analyzed. RESULTS: Five hundred forty-three specialists (33.2%) responded; 530 of these specialists (97.6%) performed antenatal Down syndrome screening; all of them offered second-trimester screening, and 247 of them (45.5%) offered first-trimester screening. With the use of second-trimester ultrasonography, risk was increased by 69.4% of respondents and decreased by 33.1%. Amniocentesis was the most frequently used diagnostic test (83.2%), with loss rates quoted at 1:100 to 1:1,000. CONCLUSION: Maternal-fetal medicine specialists show a wide in variation practices used for Down syndrome screening, modification of risk, and quoted procedure-related loss rates. This information calls for a consensus regarding risks that are quoted in Down syndrome counseling.

The use of lamellar body counts to predict fetal lung maturity in pregnancies complicated by diabetes mellitus.

OBJECTIVE: The purpose of this study was (1) to correlate amniotic fluid lamellar body counts with the lecithin/sphingomyelin ratio and the presence of phosphatidylglycerol in pregnancies that were complicated by maternal diabetes mellitus and (2) to determine a lamellar body count value that maximizes sensitivity and specificity in the prediction of fetal lung maturity. STUDY DESIGN: We reviewed our prospectively collected perinatal database from November 1992 through October 1999 to identify pregnancies that were complicated by diabetes mellitus for which fetal lung maturity studies had been performed within 72 hours of delivery. Lamellar body counts were correlated with lecithin-sphingomyelin ratio and phosphatidylglycerol values. The sensitivities and specificities of various lamellar body count cutoff values were calculated with the lecithin/sphingomyelin ratio and phosphatidylglycerol values as indicators of fetal lung maturity. Receiver operating curves were used to determine the lamellar body count that indicated fetal lung maturity. Our neonatal database was reviewed for this same time period to obtain all cases of respiratory distress syndrome. The maternal data were compared with the neonatal data to determine whether distress syndrome had developed in an infant who had undergone fetal lung maturity testing respiratory. RESULTS: Lamellar body counts were correlated with lecithin/sphingomyelin ratio (r = 0.51, P <.001) and phosphatidylglycerol values (r = 0.57, P <.001) in 90 diabetic pregnant patients. A lamellar body count of 37,000/microL was found to have a sensitivity of 80% and a specificity of 100% in the prediction of fetal lung maturity by standardized methods of phospholipid analysis. There were no cases of neonatal respiratory distress syndrome in this study population. CONCLUSION: The lamellar body count is a valid, rapid screening test for the determination of biochemical fetal lung maturity in pregnancies that are complicated by diabetes mellitus. A lamellar body count of > or =37,000/microL correlated with the lecithin/sphingomyelin ratio and phosphatidylglycerol values in the pregnancies of diabetic patients. Use of lamellar body counts in pregnancies that are complicated by diabetes mellitus could decrease the need for time-consuming and more costly phospholipid profiles. A full phospholipid profile is recommended for amniotic fluid specimens with lamellar body count values of <37,000/microL.

Episodic hypothermia with hyperhidrosis in a pregnant woman.

BACKGROUND: Episodic hypothermia with hyperhidrosis is a disorder of thermoregulation, believed to be secondary to a hypothalamic dysfunction, which affects the body's thermoregulatory centers. During this rare condition, the body may sweat profusely in an attempt to maintain a lowered body temperature set point. The exact cause of episodic hypothermia with hyperhidrosis is not known. CASE: A multigravida at 35 weeks' gestation presented with symptoms consistent with hypothermia, although she was diaphoretic. Her basal body temperature was 91.2F, with a lowered blood pressure and heart rate. The fetal heart rate was 130 beats per minute and reassuring. Assisted rewarming occurred over a period of 3 hours, after which her temperature stabilized at 97.9F. The remainder of the pregnancy was uneventful, and the patient delivered a term infant with no apparent adverse effects from this episode. CONCLUSION: Episodic hypothermia with hyperhidrosis should be considered as a potential cause of hypothermia during pregnancy.