Congenital midline porencephaly. Prenatal sonographic findings and review of the literature.

A case of congenital midline porencephaly, including the prenatal sonographic findings, is presented. A review of the literature showed that six cases of congenital midline porencephaly have been reported, though none had sonographic evaluation in the prepartum period. The prenatal sonographic diagnosis of this rare disorder is discussed along with the clinical and pathologic findings and outcome of all reported cases.

Fetal biophysical profile versus amniocentesis in predicting infection in preterm premature rupture of the membranes.

A comparison between daily fetal biophysical profile determinations and amniocentesis (for Gram stain and culture) was studied prospectively in 58 patients who presented with preterm premature rupture of the membranes and no apparent infection or labor. The efficacy of these two methods in predicting infection outcome--as reflected by the development of clinical amnionitis and/or neonatal sepsis--was determined. These data suggest that daily fetal biophysical profile assessment is superior to amniocentesis in predicting infection outcome in these patients. The use of frequent biophysical profile determinations should replace amniocentesis in selecting those patients with premature rupture of the membranes who are more likely to develop infection with associated fetal/neonatal sepsis.

Fetal liver ultrasound measurements in isoimmunized pregnancies.

Sixteen isoimmunized pregnancies at risk for erythroblastosis fetalis were managed by serial amniocenteses for bilirubin delta optical density at 450 nm (delta OD450). Before amniocentesis each fetus was evaluated ultrasonically and the fetal liver size, the abdominal circumference, and the umbilical vein diameter, in both the fetal liver and the umbilical cord, were measured. The ultrasonically determined fetal liver size, as well as its growth rate, was found to be greater than normal during the last two weeks before intervention (intrauterine transfusion or delivery) in all eight fetuses with severe hemolytic disease. The umbilical vein diameter in the fetal liver was above normal in only one fetus, whereas the abdominal circumference was increased in only three of the eight severely affected fetuses. These data suggest that serial fetal liver ultrasound measurements may be useful as an adjunct to amniotic fluid analysis to predict the severely affected fetus in need of prompt intervention (intrauterine transfusion or delivery).

Qualitative amniotic fluid volume versus amniocentesis in predicting infection in preterm premature rupture of the membranes.

Qualitative amniotic fluid volume assessment and amniocentesis were performed on admission in 54 patients who presented with premature rupture of the membranes and no clinical signs of infection or labor. Comparison of these two methods in predicting infection outcome--as reflected by the development of clinical amnionitis and/or neonatal sepsis--suggests them to have the same efficacy in predicting infection outcome in patients with premature rupture of the membranes. Qualitative amniotic fluid volume was found to have sensitivity 50%, specificity 92.8%, positive predictive value 66.6%, and negative predictive value 86.6%; amniocentesis was found to have sensitivity 58.3%, specificity 88%, positive predictive value 58.3%, and negative predictive value 88%. The use of ultrasonically estimated amniotic fluid volume could replace or be used in addition to amniocentesis in identifying patients with ruptured membranes at particular risk for developing infection.