The effect of prolonged rupture of membranes on circulating neonatal nucleated red blood cells.

OBJECTIVES: To test the hypothesis that absolute nucleated red blood cells (ANRBC) counts are higher at birth in infants who were born after prolonged rupture of membranes (PROM, >24 hours). STUDY DESIGN: Retrospective study of 31 infants admitted to the neonatal intensive care unit who were born after PROM, and pair matched for gestational age and Apgar scores with 31 no PROM controls. Venous ANRBC counts were obtained within 1 hour of life. RESULTS: Groups did not differ in birthweight, gestational age, Apgar scores, and platelets counts. The ANRBC counts and hematocrit were significantly higher in infants who were born after PROM than in controls. CONCLUSIONS: Infants born after PROM have higher ANRBC counts at birth than control infants. We suggest that increased fetal erythropoiesis exists in infants who are delivered after PROM. If correct, our interpretation supports the theory that fetal hypoxia and/or ischemia may result from PROM.

Accuracy of diagnosis of retained products of conception after dilation and evacuation.

OBJECTIVE: Uterine re-evacuation samples taken in cases of suspected residua after curettage are occasionally negative for gestational tissue. We aimed at evaluating the occurrence of such postcurettage re-evacuation-negative samples and at exploring factors that may influence their occurrence. METHODS: This was a cross-sectional comparative retrospective study of 69 consecutive women who underwent uterine re-evacuation for suspected postcurettage gestational remnants. Pathologic reports of samples drawn during re-evacuations were reviewed to determine whether the extracted tissue contained gestational tissue. The presence of factors that may influence the rate of a positive or negative sample (eg, sonographic findings, gestational age at initial procedure, and presenting symptom) was noted and compared between women with and without histologically verified remnants. RESULTS: Twenty-eight (41%) of the re-evacuation samples were histopathologically positive for gestational remnants. Residual tissue was more commonly found when the initial evacuation was performed at a more advanced gestational age (> 15 weeks). Women referred by emergency department attendants had significantly fewer positive samples. Normal expert sonographic examination practically excluded yielding samples. Conversely, no negative samples were preceded by sonographic reports mentioning residua. CONCLUSIONS: Most re-evacuation samples taken during a re-evacuation procedure for suspected residua are negative for gestational tissue. Parameters that are likely related to histologically confirmed gestational residual tissue are advanced gestational age at initial evacuation, level of the sonographer's skill, persistent bleeding as the presenting symptom, and a sonographic report specifically mentioning retained gestational tissue.