Perinatal outcomes in a prospective matched pair study of pregnancy and unexplained elevated or low AFP screening.

Unexplained elevated or low maternal serum alpha-fetoprotein (MSAFP) is reported to indicate adverse perinatal outcome. We designed a prospective matched pair study to gain additional information about the type and frequency of adverse neonatal or maternal outcomes. Subjects were selected from 16,445 women who received second trimester MSAFP screening during the 4.5 year study period. For each unexplained elevated or low subject, a control patient in the second trimester of pregnancy was chosen by matching eight individual traits. After follow-up, 356 pairs were identified, for the unexplained low MSAFP group and 139 pairs for the unexplained elevated MSAFP group. Outcome information was obtained by way of a physician questionnaire. For the unexplained low MSAFP group, complications occurred no more often than for the paired controls and these pregnancies may not be considered at high risk for adverse outcome. Our study supports a strong association between unexplained elevated MSAFP and adverse neonatal outcomes of low birth weight, fetal death, preterm delivery, and fetal growth retardation. The highest frequency of adverse neonatal outcome occurred when the multiple of median value was > or = 4.0. Our study does not support an association between elevated MSAFP and maternal complications of hypertensive disorder, oligohydramnios, or placental abruption.

A microcomputer data base system for maternal serum alpha fetoprotein screening programmed in BASIC.

A computer program was developed for the IBM PC computer to be used for maternal serum alpha fetoprotein screening (MSAFP). This program, written in BASIC, 1) maintains a data base for patients tested, 2) allows input and storage of MSAFP results, 3) calculates the gestational age dependent result in multiple of the median (MOM), 4) makes an individualized interpretation of the result based on maternal age, weight and diabetes, 5) makes an appropriate recommendation for subsequent action based on the result, and 6) prints a report containing the above information. In addition, the program will print a daily log of patients tested, provides a follow-up sheet to assist in tracking abnormal results to term, converts the data files into files which can be easily intergrated into more powerful data base programs, and generates a monthly statement for billing purposes. The program can be easily modified by someone with minimal training in the BASIC programming language.

Yersinia enterocolitica in Kansas. Attempted recovery from 1,212 patients.

An attempt was made to isolate Yersinia enterocolitica, by cold enrichment, from the stool of 1,212 patients seen at the Wesley Medical Center in Wichita, Kansas. Y. enterocolitica was isolated from 5 (0.4%) of the patients. Shigella was isolated from 36 (3.0%) patients while either Salmonella or Campylobacter were each isolated from 15 (1.2%) patients. Two of our five Yersinia isolates were from patients admitted to the hospital with diarrhea. One was from a patient who developed transient diarrhea while in the hospital, and the other two were from patients without diarrhea. In our opinion, the data do not justify the routine examination of stool specimens for Y. enterocolitica.

A review of laboratory methods for identification of group B streptococci (Streptococcus agalactiae).

A selected review is presented of the history of Group B streptococcal infections and the laboratory tests used to identify Group B streptococcus (Streptococcus agalactiae), an opportunistic pathogen which causes serious infections in newborn infants and compromised patients in other age groups. Its isolation may be increased by growth in a selective medium. The methods for Group B streptococci identification include the hydrolysis of sodium hippurate, the CAMP reaction, pigment production, and antibiotic disk susceptibility. Also, immunological tests, such as Lancefield's classical precipitin test, immunofluorescence staining, counterimmunoelectrophoresis, and coagglutination are available.