Decreased fetal movement prompts investigation of prenatal/neonatal nemaline myopathy: the possible merit of fetal movement count.

We highlight the merit of fetal movement count to identify a fetus with neuromuscular disorder: nemaline myopathy. A 38-year-old 1-para woman not in a consanguineous marriage had decreased fetal movement. This, together with increased amniotic fluid volume, led us to perform detailed ultrasound examinations, which revealed stretch contracture of the knee joints, leading us to suspect fetal neuromuscular disorders. At 38(2/7), she gave birth vaginally to a 2444 g female infant. Her respiration was very weak, requiring respiratory support. Contractures of the upper/lower extremity joints and club feet were observed. All skeletal muscles were hypotonic. Biopsized muscle cells showed nemaline bodies, confirming the diagnosis of nemaline myopathy. Fetal movement count may contribute to the identification of fetal neuromuscular diseases, such as nemaline myopathy.

A novel method for evaluating uterine cervical consistency using vaginal ultrasound gray-level histogram.

AIMS: To evaluate uterine cervical consistency using a vaginal ultrasound gray-level histogram. METHODS: Vaginal ultrasound and digital examination were performed for 214 women with low-risk singleton pregnancy during 27-30(th) pregnancy week. The mean gray-level (MGL) of an ultrasound gray-level histogram, representing the echogenicity of a region of interest, was measured in the midsection of anterior and posterior cervical walls. The difference in MGL between anterior and posterior (AP difference) was related to the Bishop sub-score for cervical consistency (0, 1, or 2), determined before ultrasound. RESULTS: A larger positive AP difference indicated significantly lower Bishop sub-score. After analyzing the receiver operator characteristic curves for the AP difference, a value of 1.42 and -1.98 was the best cut-off value to determine a hard cervix (score 0) and a soft cervix (score 2), respectively. To identify a hard cervix, this test had 71% sensitivity and 82% specificity. For a soft cervix, it was 66% and 87%, respectively. CONCLUSIONS: A more echogenic anterior than posterior cervix indicates a hard cervix; the greater the difference in echogenicity between anterior and posterior walls the harder the cervix. The difference in MGL of the ultrasound gray-level histogram may enable objective evaluation of cervical consistency.

Establishing a reference value for the frequency of fetal movements using modified 'count to 10' method.

AIMS: To establish a reference value for the frequency of fetal movements perceived by the mother during the second half of pregnancy. METHODS: The study subjects consisted of 705 low risk Japanese pregnant women who continuously received antenatal care. We asked women to record the time required to perceive 10 fetal movements ('count to 10' time) everyday. We asked women to record it, not at a fixed time (i.e. evening time), but whenever they felt the fetus move the most actively. The position during counting (i.e. sitting position) was also not specified, and thus we named this method as modified 'count to 10' method. Satisfactory recordings were obtained from 690 women, which we used for analysis. RESULTS: The 'count to 10' time was almost the same from 22 weeks (10.9; 7.3-18.0 (median; interquartile range)) until 32 weeks (10.0; 6.2-15.6), and it Thirty-two weeks showed the shortest time, which gradually increased toward 40 weeks (14.8; 9.5-24.0). Its 90th percentile was approximately 25 and 35 min at 22-36 weeks and at 37-40 weeks, respectively. CONCLUSIONS: For the first time we established a reference value for perceived fetal movements throughout the second half of pregnancy. The present modified 'count to 10' method requires less time than the previous method. Approximately 98% (690/705) of women gave us satisfactory recordings. This reference value may be of use in identifying mothers with decreased fetal movements.

Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases.

OBJECTIVE: An extensive study as to whether maternal age itself is a risk factor for blood loss during parturition. METHOD: A total of 10,053 consecutive women who delivered a singleton infant were studied. The excess blood loss was defined separately for women with vaginal and cesarean deliveries as > or = 90th centile value for each delivery mode. The effects of 13 potential risk factors on blood loss were analyzed using multivariate analysis. RESULTS: The 90th centile value of blood loss was 615 ml and 1,531 ml for women with vaginal and cesarean deliveries, respectively. A low lying placenta (odds ratio [OR], 4.4), previous cesarean (3.1), operative delivery (2.6), leiomyoma (1.9), primiparity (1.6), and maternal age > or = 35 years (1.5) were significant independent risk factors for excess blood loss in women with vaginal delivery. Placenta previa (6.3), leiomyoma (3.6), low lying placenta (3.3), and maternal age > or = 35 years (1.8) were significant independent risk factors for excess blood loss in women with cesarean sections. CONCLUSION: A maternal age of > or = 35 years was an independent risk factor for excess blood loss irrespective of the mode of delivery, even after adjusting for age-related complications such as leiomyoma, placenta previa, and low lying placenta.