Prenatal diagnosis of unilateral megalencephaly by 2D and 3D ultrasound: a case report.

Unilateral megalencephaly is a rare malformation of the central nervous system characterized by an overgrowth of one cerebral hemisphere due to an anomaly of neuronal cell migration. It shows macroscopic and histological alterations of the central nervous tissue. We report on a case of this malformation detected prenatally with the support of 3D ultrasonography.

Influence of cigarette-smoking on the result of the triple test.

The aim was to establish whether the risk of trisomy 21 in women smokers undergoing triple test differs to women nonsmokers, whether increased smoking changes the hormonal values, and if the cessation of smoking at the beginning of pregnancy has any influence on the triple test. 1,854 pregnant women were interviewed regarding their smoking habits at the time of the triple test. They were divided into 5 groups: (a) nonsmokers; (b) smokers before pregnancy; (c) 1-5 cigarettes; (d) 6-10; (e) 11 or more. MOM values of AFP, E3 and beta-HCG and Down risk calculated by the triple test were compared within the 5 groups. Increasing smoking was associated with a reduction in MOM values of beta-HCG. Smokers were significantly less likely to be counseled for karyotyping (cut-off level 1:250) than nonsmokers. The values of women who stopped smoking at the beginning of pregnancy were not different to nonsmokers. The results suggest the benefits of inclusion of smoking habits for the calculation of the triple test.

Group B streptococci during pregnancy: a comparison of two screening and treatment protocols.

OBJECTIVE: The objective was to evaluate whether the rate of neonatal group B streptococcal infection could be reduced by screening for group B streptococci during the third trimester of pregnancy. STUDY DESIGN: Two periods in which different screening and treatment protocols were applied were compared. In period A all mothers showing high-risk factors were given peripartal antibiotic coverage. In period B vaginal and rectal smears were routinely obtained in gestational week 34 and cultured for group B streptococci. If culture results were positive, the woman received peripartal antibiotics. The incidence of group B streptococcal infections and the number of peripartal antibiotic doses were established by comparing 3700 neonates (3623 mothers) in period A with 3648 neonates (3569 mothers) in period B. RESULTS: In period A, 20 group B streptococcal infections were recorded. Of these, 5 were severe to life-threatening. In period B, 4 group B streptococcal infections were observed. Two were severe and occurred in neonates born before the mothers could be screened. Another 2 were mild and occurred in neonates whose mothers had negative screening test results. The reduction was significant by the chi2 test (chi2 = 9.19, Yates' corrected P = .0024). The rates of peripartal antibiotic treatment were 11.9% in period A and 14.5% in period B. CONCLUSION: Although no neonate died of group B streptococcal sepsis in either of the 2 periods, the protocol used in period B clearly reduced the incidence of group B streptococcal infection. The number of peripartal antibiotic doses required was not much higher than in period A. Screening for group B streptococci in week 34 seems to be a valuable contribution to further improvement of neonatal outcome.

Computer system validation: an overview of official requirements and standards.

A brief overview of the relevant documents for companies in the pharmaceutical industry, which are to be taken into consideration to fulfil computer system validation requirements, is presented. We concentrate on official requirements and valid standards in the USA, European Community and Switzerland. There are basically three GMP-guidelines. their interpretations by the associations of interests like APV and PDA as well as the GAMP Suppliers Guide. However, the three GMP-guidelines imply the same philosophy about computer system validation. They describe more a what-to-do approach for validation, whereas the GAMP Suppliers Guide describes a how-to-do validation. Nevertheless, they do not contain major discrepancies.

Pyelonephritis in pregnancy.

Pyelonephritis, while rare in nonpregnant women, is the leading cause of hospitalization for nonobstetric indications in pregnant women. Pregnancy complications such as preterm labor and intrauterine growth retardation have been associated with pyelonephritis. Pyelonephritis can also lead to life-threatening conditions such as endotoxic shock and respiratory insufficiency. Thus the condition requires hospitalization and close follow-up in the pregnant women.

Fetal abdominal hyperechoic mass: diagnosis and management.

In the last 2 years, we have had the opportunity to follow 12 cases diagnosed with hyperechoic abdominal masses. Four of the cases ended with a fetal demise, while 7 resulted in the birth of an anomalous or medically ill neonate. Only 1 case has shown spontaneous resolution of the hyperechoic mass with the birth of a normal neonate. The in utero diagnosis of a hyperechoic abdominal mass should encourage the clinician to further investigation since the differential diagnosis is quite diverse. Appropriate counselling for the patient is a necessary part of prenatal care.