A review of thromboembolic complications in pregnancy.

Combined with the enlarging uterus compressing the venous system of the pelvis and the vessel trauma incurred in delivery, an increase in clotting factor production in pregnancy predisposes the gravid patient to the peril of thromboembolism. When a patient has an inherited thrombophilia and becomes pregnant, this combination of risk factors in the presence of pregnancy may be the tipping point, pushing the coagulation cascade into an activated state. All thrombophilias, deep vein thrombosis, and pulmonary embolism are factors associated with complications in pregnancy that may lead to catastrophic consequences. This review report on the most frequent thromboembolic complications in pregnancy.

The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity.

OBJECTIVE: Our hypothesis was that the degree of antenatally diagnosed cerebral ventriculomegaly is related to aneuploidy, perinatal mortality and long-term neurological morbidity. METHODS: Ninety-one cases of ventriculomegaly identified from 1 June 1994 to 1 July 1999 were examined for prenatal, intrapartum and neonatal complications. Pediatric follow-up was reviewed for infants with ventriculomegaly from birth up to as long as 4 years. Minor neurological morbidity was defined as a score of 70-80 on the clinical adaptive test/clinical linguistic and auditory milestone scale and included mild motor or language delay. Major morbidity included a score of < 70, evidence of cerebral palsy, or seizure disorder. The incidence of neurological complications was compared, on the basis of the degree of ventriculomegaly, with group 1 being > 10-15 mm and group 2 being > 15 mm. RESULTS: Twenty-seven cases (18 with neural tube defects and nine with holoprosencephaly) were excluded. Among the remaining 64 patients, 39 had a ventricular diameter of > 10-15 mm and comprised group 1. Five of the 39 cases (12.8%), all with other ultrasound anomalies, elected to terminate. The incidence of aneuploidy in group 1 was 14.2%. Among the 19 cases with isolated ventriculomegaly, 17 (89%) were normal and two (11%) had minor neurological morbidity. In group 1 there were two cases associated with cytomegalovirus (CMV) infection. Of the 25 cases in group 2, eight (32%), all with other ultrasound anomalies, elected to terminate. The incidence of aneuploidy in group 2 was 17.4%. For the nine cases with isolated ventriculomegaly of > 15 mm, one (11%) was normal (p < 0.001), five (56%) had minor neurological morbidity requiring a ventriculoperitoneal shunt (p = 0.035), and three (33%) had major neurological morbidity (p = 0.045) when compared to cases of isolated ventriculomegaly in group 1. There was one case of CMV infection in group 2. All perinatal deaths in both groups were associated with other anomalies. CONCLUSIONS: Amniocentesis to determine karyotype and the presence of CMV is warranted for all cases of ventriculomegaly of > 10 mm. The degree of antenatal ventriculomegaly is related to pediatric neurological morbidity and, when it is > 15 mm, it is associated with an increase in abnormal neurological development.

Low 1-hour glucose screens and small for gestational age infants.

OBJECTIVE: To determine whether a 1-hour glucose screen done at 26 to 29 weeks' gestation that is below the fifth percentile is predictive of having a small for gestational age (SGA) infant. STUDY DESIGN: Pregnancies with 1-hour glucose screens were analyzed retrospectively. A total of 600 cases had values below the fifth percentile (< 71 mg/dl). A total of 6784 controls had values between the 25th and 75th percentiles. Infants were classified as being SGA if they had birth weights less than the 10th percentile adjusted for gestational age and infant gender. The Student's t-test, Fisher's exact test, and logistic regression were used for statistical analysis. RESULTS: The incidence of SGA infants differed significantly between cases and controls, 16.2% versus 12.0% (p = 0.0043). This association remained significant after adjustment for race (p = 0.02). CONCLUSION: A 1-hour glucose screen with a result that is less than the fifth percentile is an independent risk factor for having an SGA infant.

Helical CT amniography of congenital diaphragmatic hernia.

OBJECTIVE: Accurate prenatal diagnosis of congenital diaphragmatic hernia is important for perinatal planning and potential fetal surgery. We describe the application and usefulness of helical CT amniography in the evaluation of suspected congenital diaphragmatic hernia in three fetuses. CONCLUSION: Helical CT amniography is an efficient means for evaluation of congenital diaphragmatic hernia. Accurate diagnosis was made in all three patients.

Correlation of maternal triple screen values with fetal liver length.

Objective: To determine if a relationship exists between fetal liver length and any of the three serum markers (AFP, uE3, and hCG) that constitute the maternal triple marker screen.Methods: From March to November of 1996, 124 randomly selected women between 17.0 and 20.3 weeks gestation underwent serum triple screen testing on the same day that an anatomy sonogram was performed by a single sonographer. Fetal liver size was measured between the right hemidiaphragm and the tip of the right hepatic lobe. All triple marker screen results were obtained from the same commercial lab. Utilizing linear regression analysis, liver length adjusted for gestational age was plotted versus AFP, uE3, and hCG measurements (expressed as multiples of the median).Results: Of the 124 subjects, 17 (14%) were white and 97 (78%) were black; the remaining 10 (8%) were unknown or other. Neither hCG nor AFP measurements had a statistically significant association with liver length after taking into account gestational age (linear regression: R = -0.018, P =.848 and R = 0.100, P =.269 for hCG and AFP, respectively). Interestingly, a statistically significant correlation was identified between uE3 levels and fetal liver length (R = 0.205, P =.023).Conclusions: No statistical significance was identified between either maternal serum hCG or AFP and fetal liver size. A statistically significant correlation between maternal serum uE3 and liver size was observed. Although preliminary, sonographic evaluation of fetal liver size has little role in elucidating the etiology of abnormal hCG or AFP levels, but may be relevant in the interpretation of abnormal uE3 values.

Comparison of calcium release from sarcoplasmic reticulum of slow and fast twitch muscles.

The mechanism of Ca2+ release from the sarcoplasmic reticulum (SR) of slow and fast twitch muscle was compared by examining biochemical characteristics, ryanodine binding, Ca2+ efflux, and single Ca2+ channel properties of SR vesicles. Although many features of the Ca2+ release channel were comparable, two functional assays revealed remarkable differences. The comparable properties include: a high molecular weight protein from both types of muscle was immunologically equivalent, and Scatchard analysis of [3H]ryanodine binding to SR showed that the Kd was similar for slow and fast SR. In the flux assay the sensitivity to the agonists caffeine, doxorubicin, and Ca2+ and the antagonists Mg2+, ruthenium red, and tetracaine differed only slightly. When SR vesicles were incorporated into lipid bilayers, the single-channel conductances of the Ca2+ release channels were indistinguishable. The distinguishing properties are: When Ca2+ release from passively 45Ca(2+)-loaded SR were monitored by rapid filtration, the initial rates of Ca2+ release induced by Ca2+ and caffeine were three times lower in slow SR than in fast SR. Similarly, when Ca2+ release channels were incorporated into lipid bilayers, the open probability of the slow SR channel was markedly less, mainly due to a longer mean closed time. Our results indicate that slow and fast muscle have ryanodine receptors that are biochemically analogous, yet functional differences in the Ca2+ release channel may contribute to the different time to peak contraction observed in intact slow and fast muscles.