Cervical length and the risk of spontaneous labor at term.

OBJECTIVE: To investigate the relationship between cervical length (CL) at 37 to 40 weeks and delivery within 7 days and delivery by 41 weeks. STUDY DESIGN: We performed transvaginal ultrasound to measure CL in women with singleton gestations at 37 to 40 weeks. We then used a receiver operating characteristic curve (ROC) to assess the relationship between CL and delivery within 7 days and delivery by 41 weeks. RESULT: For the 120 women included in the analysis, the mean CL (+/-s.d.) was 25.3+/-9.8 mm. The logistic regression model to predict each of the outcomes includes gestational age at ultrasound (GA-US) and CL. Neither birthweight, nor parity seems to affect the probability of delivery within 7 days. The ROC curve was used to assess the probability of spontaneous labor within 7 days at each CL measurement. The likelihood ratio of delivery within 7 days when CL is < or = 10 mm is 12. CONCLUSION: CL measurement at 37-40 weeks is an independent predictor of delivery within 7 days and delivery by 41 weeks regardless of GA-US. This information can be utilized when counseling patients regarding the management of term pregnancies.

Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants.

OBJECTIVE: Magnesium sulfate (MgSO(4)) is the most commonly used tocolytic agent in the US and is also employed as a prophylactic agent against seizures in pre-eclamptic women. MgSO(4) crosses the placenta and its concentration in the newborn usually exceeds that of maternal levels. The purpose of this study was to explore the relationship between antenatal exposure to MgSO(4) and the incidence of patent ductus arteriosus (PDA) in extremely low birth weight infants. STUDY DESIGN: A total of 954 neonates with birth weights between 500 and 1000 g, born at the University of Miami/Jackson Memorial Hospital between January 1995 and December 2004 and surviving for more than 3 days, were followed until death or discharge from the hospital. The incidence of PDA in infants exposed to MgSO(4) was compared with those not exposed and comparisons were also made between infants exposed to different maternal doses of MgSO(4). RESULTS: The incidence of PDA was significantly higher in the group of infants exposed to MgSO(4) compared with the unexposed control group (67 vs. 60%, P<0.018). When stratified by gestational age the differences were significant only in the group of infants with a gestational age of >or=26 weeks (58 vs. 49%, P<0.039). Logistic regression analysis to adjust for co-variables indicated an increased risk of PDA with higher doses of MgSO(4) (odds ratio 1.33 confidence interval (CI) 1.12 to 1.58, per 50 g of MgSO(4)). CONCLUSION: Antenatal exposure to MgSO(4) is associated with a higher risk of PDA in extremely low birth weight infants and this effect is more significant and dose-related in more mature infants.

Birth weight references for triplets.

OBJECTIVE: The purpose of this study was to formulate growth references that reflect triplet fetal and neonatal populations at each gestational age by combining serial ultrasonographic estimates of fetal weights and measured birth weights. STUDY DESIGN: This historical cohort study was based on 188 pregnancies of live-born triplets of > or =23 weeks' gestation. Ultrasonographic fetal weight measures were modeled as a function of gestational age for each infant. Linear regression models were used to fit the data, and weight percentiles were generated. RESULTS: Well-grown triplets fell substantially below singletons by 30 weeks and twins after 34 weeks. Trichorionic vs monochorionic or dichorionic placentation resulted in 27% higher growth at the 10th %ile, 5% higher growth at the 50th %ile, and 4% higher growth at the 90th %ile by 34 weeks. CONCLUSION: The overall pattern of fetal growth for well-grown triplets does not differ from that of singletons and twins until late gestation, confirming that, in utero, well-grown children have similar growth potentials, regardless of plurality.

The Zavanelli maneuver in two cases of shoulder dystocia.

Several reports describe the replacement of the partially delivered fetus into the vagina followed by Cesarean section after failed vaginal delivery. Undeliverable shoulder dystocia is by far the most common cause of failed vaginal delivery. The objective of this report was to review the safety and to reconsider when to perform the Zavanelli maneuver in the management of shoulder dystocia. We report two cases of severe shoulder dystocia in which commonly recommended therapeutic options failed. Cephalic replacement was performed with ease followed by Cesarean section. Endometritis was the maternal complication in both cases. Both infants had transient Erb's palsy. Although traditionally the Zavanelli maneuver is a method of last resort in the management of shoulder dystocia, consideration should be given to its use earlier in the treatment of obstructed vaginal delivery.

In utero demonstration of aberrant systemic blood supply in lung sequestration: a case report

Prenatal diagnosis of a potentially lethal condition as shown and confirmed with color flow Doppler; demonstration of an aberrant systemic blood supply

In utero demonstration of aberrant systemic blood supply in lung sequestration: a case report.

Prenatal diagnosis of a potentially lethal condition as shown and confirmed with color flow Doppler; demonstration of an aberrant systemic blood supply.