Amniocentesis: indications, technic, and complications.

Common indications for amniocentesis are to assess fetal maturity, to determine the prognosis of Rh isoimmunization, for genetic counseling, and occasionally to diagnose fetal distress or to localize the placenta. The percutaneous transabdominal technic is reviewed, and some of the common complications are discussed.

Fetal scalp abscess secondary to intrauterine monitoring.

Thirty-one cases of fetal scalp abscess secondary to internal fetal monitoring over a 32 month period were reviewed. The over-all incidence was 1:230 monitored labors, or 0.4 per cent. Twenty-nine infants were cultured, with no growth in 10, Staphylococcus epidermidis in 11, and pathogenic organisms in the remainder. Gram stains of the exudates generally supported the culture results. All cases responded to drainage, local care, and systemic antibiotics, with no deaths. One case of osteomyelitis of the skull was confirmed roentgenographically. A strong correlation between prolonged rupture of the membranes and scalp abscess was observed, but no definite infectious origin was confirmed. The etiology of scalp abscess secondary to monitoring remains obscure.

Enzymatic differentiation in human amniotic cells.

Enzymatic study in noncultured amniotic fluid cells from 87 women at different stages of pregnancy was performed by electrophoresis. Of these patients, 33 had normal pregnancies and the remaining 54 had various complications of pregnancy. The electrophoretic patterns of lactate dehydrogenase, alpha-esterase, and acid phophatase were altered in samples obtained either at different gestation periods or from normal and complicated pregnancies. Malate dehydrogenase and protein bands did not show any alteration. Glucose-6-phosphate dehydrogenase and alkaline phophatase were not detectable. 6-Phosphogluconate dehydrogenase was detectable in samples of complicated pregnancies. The significance of the altered patterns of enzymes is discussed.

Total urinary estrogens in complicated pregnancies.

One hundred fifty-seven pregnancies complicated by different degrees of diabetes, toxemia, and hypertension were studied with serial urinary placental estrogen determinations. A simple and fast method for total placental estrogen determination was used. The level of total estrogen excretion was related to Apgar score in cases of class B diabetes, severe toxemia, and also in moderate toxemia when estrogen excretion was falling. Mean estrogen levels did not differ as a function of severity of diabetes. Levels did differ with severity of toxemia; however, only the difference in mean estrogen excretion between mild and severe toxemia was significant. Estrogen excretion was very low in hypertension but was not related to Apgar score. This study concludes that total urinary estrogens constitute only a single parameter necessary in the management of high-risk pregnancies.