Midtrimester Rh sensitization associated with circulating anticardiolipin antibodies and elevated maternal serum alpha-fetoprotein. A case report.

The incidence of antepartum Rh isoimmunization has been limited by third-trimester Rh immune globulin (RhIg) administration. Prophylactic failures are uncommon but can occur if sensitization takes place prior to the 28th week of gestation. We report a case of midtrimester Rh sensitization in an anticardiolipin antibody-positive primipara coincident with the discovery of an elevated maternal serum alpha-fetoprotein value, oligohydramnios and fetal growth retardation. This case suggests that fetal-maternal hemorrhage and subsequent sensitization may be facilitated by anticardiolipin antibody-induced placental damage. Prophylactic midtrimester RhIg administration might avoid sensitization in similar cases.

Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients.

OBJECTIVE: We compared the use of aspirin alone with combined therapy (prednisone plus aspirin) in antiphospholipid antibody-positive obstetric patients with prior adverse pregnancy outcome. STUDY DESIGN: Thirty-nine patients meeting specific laboratory and clinical inclusion criteria were randomized to receive either combined therapy (prednisone plus low-dose aspirin, n = 17) or aspirin alone (n = 22). The daily aspirin dose was 81 mg; prednisone was begun at 20 mg/day and increased or decreased on the basis of observed changes in serial antibody levels. Perinatal outcomes were compared between groups. Evaluation of treatment-related maternal complications and serial antibody titers was also accomplished. RESULTS: Thirty-four randomized subjects were evaluable (prednisone plus low-dose aspirin, n = 12 vs aspirin only, n = 22); no perinatal losses were observed in the study cohort. Preterm delivery was experienced by significantly more patients receiving prednisone plus low-dose aspirin than aspirin only (8/12 vs 3/22, respectively; p = 0.003), and prednisone exposure appeared to be an independent risk factor for preterm birth. CONCLUSIONS: The use of prednisone therapy in conjunction with low-dose aspirin does not appear to improve outcome and may provoke obstetric complications in antiphospholipid antibody-positive patients.

Post-term pregnancy.

Prospective gestational age assessment using clinical and technical based data avoids unnecessary patient and physician apprehension, iatrogenic risk and expense. Careful antepartum and intrapartum monitoring of fetal condition is required to avoid excessive morbidity and mortality in those patients whose unfavorable cervical condition disallows the safe induction of labor beyond 41 weeks of gestation.

Antenatal corticosteroids to prevent neonatal respiratory distress syndrome: risk versus benefit considerations.

The clinician considering administration of steroids to prevent respiratory distress syndrome (RDS) should attempt to identify patients who do not have criteria previously shown to increase the likelihood of benefit in the prevention of RDS. It is possible to accurately predict the interval to delivery in most cases. Four hundred thirty-nine patients at risk to deliver prior to 37 weeks have been screened for factors known to decrease the likelihood of benefit. Only 47 (10.7%) screened candidates have no exclusion criteria. Twenty-seven (6.9%) of 392 excluded neonates developed RDS; 20 of the 27 were predicted to and did deliver in less than 24 hours after initial screening. Only one case was inappropriately excluded. Fetal surfactant assessment is crucial; pulmonary maturity excludes 19% at 28 to 33 weeks and 35% at 34 to 37 weeks. Careful screening for exclusion factors known to decrease the likelihood of steroid derived benefit is essential when use of a drug with potential long-term consequences (risk) is considered.

Electron microscopy of tobacco mosaic virus prepared with the aid of negative staining-carbon film techniques.

The negative staining-carbon technique has been applied to suspensions of freshly prepared type strain tobacco mosaic virus particles in high concentrations. Electron microscope images show that paracrystalline arrays of the virus were formed, in which large areas of rods could be viewed along their long axes and in parallel arrays in horizontal positions. High-resolution micrographs showed the protein structure units in rods photographed in both vertical and horizontal orientations.