Transabdominal amnioinfusion in preterm pregnancies complicated by fetal growth restriction, oligohydramnios and umbilical cord compression.

Fetal growth restriction with oligohydramnios occurring in the preterm gestation is associated with significant fetal morbidity and mortality. We investigated the possibility that transabdominal amnioinfusion might relieve acute cord compression and allow prolongation of gestation long enough to administer corticosteroids. Four patients with fetal growth restriction, oligohydramnios and evidence of significant cord compression with otherwise reassuring fetal heart rate testing underwent transabdominal amnioinfusion. Pregnancy was prolonged 22, 38, 10 and 9 days, and cord compression was relieved in all cases. One patient showed findings consistent with reversal of chronic hypoxemia with stabilization of amniotic fluid index measurements in the normal range and normalization of fetal growth. Transabdominal amnioinfusion may be useful as an adjunctive technique to prolong pregnancy in preterm gestations with fetal growth restriction, oligohydramnios and evidence of umbilical cord compression.

Umbilical cord cyst presenting as an omphalocele at 15 weeks' gestation. A case report.

A small, cystic structure was identified on a routine ultrasound scan performed for dating at 15 weeks' gestation. Originally it was thought to be an omphalocele, but further examination confirmed its origin in the cord several centimeters distal to the fetus. Close scrutiny of ultrasonograms is important since technical capabilities permit high-resolution scans during early gestation.

Streptococcus pneumoniae associated with second-trimester chorioamnionitis. A case report.

Streptococcus pneumoniae is found rarely in the normal vaginal flora but appeared to be the cause of chorioamnionitis and premature rupture of the membranes in a 16-week gestation. Both S pneumoniae and Ureaplasma urealyticum were recovered from cervical specimens, but only the Streptococcus grew from samples taken between the placental amnion and chorion.

Antenatal diagnosis of epignathus with neonatal survival. A case report.

Antenatal diagnosis was made of bilobed epignathus arising from the fetal palate. The fetus survived. Antenatal recognition of this malformation allows adequate preparation of the neonatal and surgical teams to ensure optimal fetal survival.

Prenatal diagnosis and perinatal management of the Beckwith-Wiedeman syndrome: a case and review.

In utero diagnosis of Beckwith-Wiedeman syndrome was made after sonographic identification of an omphalocele and organomegaly in a term fetus. Although not all possible criteria for diagnosis could be antenatally confirmed, the finding of an anterior wall defect associated with macrosomia and possible macroglossia made it very likely. This enabled us to counsel the patient properly and to prepare adequate neonatal support at delivery.

Late disappearance of fetal choroid plexus cyst: case report and review of the literature.

Ultrasound diagnosis of a lateral ventricle choroid plexus cyst was made in a 20-week gestational age fetus. The cyst remained visible until the 34th week, after which it spontaneously resolved. Persistence of such cysts beyond 23 weeks has been suggested as a poor prognostic sign by some investigators. The importance of serial ultrasound evaluation and fetal karyotyping is discussed.

Biophysical profile in fetal triploidy. A case report.

A 31-week fetus died 24 hours after a reassuring biophysical profile assessment was obtained. Fetal growth retardation had been evident since early gestation, but genetic amniocentesis was not done until one week prior to death. There were no acute events (abruptio placentae, labor or a change in the maternal condition) believed responsible for the death one day after testing. After delivery by induction, the fetus was found to have features compatible with triploidy. The amniotic fluid obtained earlier ultimately yielded no cell growth, but triploidy was later confirmed by direct fetal tissue analysis. Sudden events, which cannot be predicted by any testing modality, are not the only causes of fetal death after a reassuring test. Chromosome analysis should be sought aggressively, particularly if the first attempt, as in this case, is unsuccessful. This is the first reported case of normal biophysical testing preceding the sudden death of a triploid fetus.

The fingerprint, a false-positive fern test.

Microscope slides were prepared to confirm the presence of ferning from a 32-week gestation with possible premature rupture of the membranes. Although no amniotic fluid was seen in the vagina, an atypical ferning pattern was produced and was again reproducible with fingerprints on the glass slide. Guidelines to recognize and avoid this source of error are outlined.

Fetal premature atrial contractions associated with hydralazine.

Echocardiography documented fetal premature atrial contractions after maternal hydralazine treatment for hypertension. No signs of fetal congestive heart failure were noted, and other tests of fetal surveillance remained reassuring. The arrhythmia spontaneously subsided after discontinuation of hydralazine. A possible cause-and-effect relationship of hydralazine and premature atrial contractions has not been previously reported.

Survey of ultrasound training in obstetrics and gynecology residency training programs in the United States.

A survey was mailed to all 292 nonmilitary obstetrics and gynecology residency programs in the United States. The extent and type of ultrasound training and degree of compliance with recommended guidelines was evaluated from the 230 (78.8%) responses. Criteria for evaluation were based on guidelines from the American Institute of Ultrasound in Medicine Joint Task Group on Training for Diagnosis in Obstetrical and Gynecological Ultrasound, and on recommendations from The American College of Obstetricians and Gynecologists. Although almost 98% of respondents claimed to have ultrasound "training" in their programs, more than 55% indicated no resident experience with either reading or writing ultrasound reports, and only 39% of program chiefs claimed greater experience than 200 ultrasound scans per resident over four years. Overall, it appears that current suggested guidelines are not being met.

The fetal biophysical profile in pregnancies with grade III placentas.

The components of the fetal biophysical profile of pregnancies with grade III placentas and good outcome were retrospectively analyzed and compared to the fetal biophysical components of pregnancies with grade 0 to II placentas. The results of the present study suggest that the dynamic components of the fetal biophysical profile (nonstress test, fetal breathing movements, fetal movements, fetal tone) are not altered in the presence of a grade III placenta and good pregnancy outcome; however, a greater incidence of reduced amniotic fluid volume was found in the presence of grade III placenta. The clinical significance of grade III placenta is discussed.

Recurrent bilateral renal agenesis.

Bilateral renal agenesis is usually a sporadic occurrence; recurrence in the same family is rare. A case of recurrent bilateral renal agenesis is presented.

Megacystis-microcolon-intestinal hypoperistalsis syndrome. Prenatal sonographic findings and review of the literature.

A case of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) in a male infant followed with serial prenatal sonographic examinations is presented. Upon review of the literature, 26 cases of MMIHS have been previously reported of which only 3 were males. The prenatal sonographic diagnosis of this rare syndrome is discussed along with the clinical, pathologic findings and outcome of all reported cases.

Amniocentesis with premature rupture of membranes.

Transabdominal amniocentesis was used in 73 consecutive, referred patients with premature rupture of membranes and no clinical signs of infection or labor. Positive Gram stain or positive culture of obtained amniotic fluid was used as an indication for delivery. The outcome of pregnancy in this group of patients was compared with the outcome of a historic control group of 73 patients managed conservatively without amniocentesis. Clinical amnionitis and low five-minute Apgar scores occurred significantly less often in the study than in the control group; however there was no difference in the frequency of neonatal infection, one-minute Apgar score, cord blood pH, or perinatal mortality between the two groups.

Fetal biophysical profile and the effect of premature rupture of the membranes.

A retrospective study of 1151 fetal biophysical profiles and scores associated with good pregnancy outcome was conducted over a three-year period in the author's institution. Normal fetal biophysical activities and scores were determined throughout gestation from 25 to 44 weeks in patients with intact membranes, and compared with profiles and scores of a group of patients with premature rupture of the membranes and good pregnancy outcome. These data suggest that although the biophysical scoring of the healthy fetus with intact membranes does not change significantly throughout gestation, some of the fetal biophysical variables (nonstress test, fetal breathing movements, amniotic fluid volume, and placental grading) do. The rupture of membranes was found to be associated with higher incidence of reactive nonstress testing, absence of fetal breathing, and reduced amniotic fluid volume in most gestational ages; however, the overall biophysical scoring of the healthy fetus was not altered throughout gestation by the presence of ruptured membranes.

Fetal biophysical profile in twin gestations.

The fetal biophysical profile (nonstress test, fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume, placental grading) was assessed in 49 consecutive referred high-risk patients with twin gestations. The relationship between the last fetal biophysical profile score before delivery was compared with the pregnancy outcome--as reflected by the presence of fetal distress and perinatal death. These data suggest that the fetal biophysical profile is a useful tool for observing fetal status in patients with twin gestations, and could be reliably used as a means of follow-up of nonreactive nonstress testing in these patients.

Value of fetal ponderal index in predicting growth retardation.

Fetal ponderal indexes were calculated by ultrasound examination and compared with the neonatal ponderal indexes in 113 pregnancies. The relationship between the fetal and neonatal ponderal indexes throughout gestation is described. The fetal ponderal index also was evaluated as a predictor of intrauterine growth retardation (IUGR) and was found to have sensitivity and specificity of 76.9 and 82%, respectively. These data suggest that the fetal ponderal index could be used to rule out the diagnosis of IUGR with reasonable accuracy (negative predictive value 96.4%).

Sinusoidal fetal heart rate pattern after administration of nalbuphine hydrochloride: a case report.

Nalbuphine hydrochloride (Nubain) is a synthetic analgesic available for use during labor. It is known to possibly cause respiratory depression in the neonate, but to date there are no published reports of any intrapartum alterations of fetal heart rate. A case presentation is given of a persistent sinusoidal pattern appearing after Nubain administration.

Intrapartum ultrasound diagnosis of nuchal cord as a decisive factor in management.

Reported is the case of a patient who presented in labor with a fetal heart rate tracing that showed repetitive variable decelerations. Time lapse between presentation and delivery was minimized by the ultrasound confirmation of a nuchal cord. Delivery by cesarean section was elected rather than making further attempts at maternal repositioning.