Sectio parva for fetal preservation.

Selective abdominal delivery, or sectio parva, is cesarean delivery of one of multiple fetuses, but not the other(s). Eleven cases have been reported for the purpose of aborting one twin, and this is the second report of an attempt to improve the outcome of both twins. Perinatal outcomes have ranged from almost immediate delivery of the second twin because of placental abruption, to elective delivery of the survivor at term.

Complex adnexal mass in pregnancy: predictive value of color Doppler sonography.

We sought to establish color Doppler sonographic criteria specific to benign and malignant neoplasms in pregnant patients for parameters already reported for complex adnexal masses in nongravid patients. Thirty-four patients with complex adnexal masses were evaluated during the second trimester with transabdominal sonography and transvaginal color Doppler sonography. The lowest pulsatility index obtained was chosen to be indicative of histologic type. A pulsatility index of less than 1.0 in a morphologically suspect area was taken to be suggestive of malignancy. Prospective diagnoses made by color Doppler sonography were compared with actual histologic diagnosis. Three malignant ovarian lesions and five tumors of low malignant potential were identified correctly, with a sensitivity of 0.89 and a mean pulsatility index of 0.71 (range, 0.44 to 1.3). The mean pulsatility index for benign masses was 1.21 (range, 0.4 to 2.8) (P = 0.03). The negative predictive value of a pulsatility index greater than 1.0 was 0.93. The positive predictive value and false-positive rate for a pulsatility index less than 1.0, however, were 0.42 and 0.48, respectively. Low impedance was associated with malignant ovarian masses detected during pregnancy. A considerable overlap in blood flow patterns, however, may cause incorrect assignment of malignant potential to some benign lesions.

The polled locus maps to BTA1 in a Bos indicus x Bos taurus cross.

Two hundred and nine reciprocal backcross and F2 progeny produced by embryo transfer from Angus (Bos taurus) and Brahman (Bos indicus) parents and their 60 parents and grandparents were utilized to localize the locus (POLL) responsible for the polled phenotype in a genetic map of bovine chromosome 1. Progeny were scored for polled, scurred, and horned phenotypes at 1 year of age and again following skull disection at slaughter at 20 months of age. Phenotype frequencies were independent of gender. One hundred and forty-two informative meioses for POLL and 13 microsatellite loci with an average of 267 informative meioses per locus contributed to a genetic map spanning 124.6 cM with an average interval of 9.6 cM. POLL mapped proximal to the centromere and 4.9 cM from TGLA49 supporting a previous study that employed two anonymous microsatellites. Difficulties in discriminating between scurred and horned phenotypes indicate that bracketing markers will be essential for refining the model for inheritance of the horned, scurred, and polled phenotypes and for effective marker assisted selection (MAS) for polled.

Placenta previa increta diagnosed at 18 weeks' gestation. Report of a case with sonographic and pathologic correlation.

BACKGROUND: Placenta previa incerta, although uncommon, assumes considerable clinical significance because of the morbidity associated with severe hemorrhage, uterine perforation and infection. The majority of cases are unanticipated and initially identified intraoperatively. CASE: Placenta accreta was diagnosed sonographically at 18 weeks' gestation in a multipara who had previously undergone cesarean delivery. Additionally, the gestation was complicated by chronic renal failure secondary to systemic lupus erythematosus. After appropriate counseling, total abdominal hysterectomy was performed prior to fetal viability. CONCLUSION: Early sonographic evaluation of the placenta is recommended for those at significant risk of invasive placentation. Timely detection facilitates proper preparation and should reduce maternal morbidity.

Base deficit and oxygen transport in severe preeclampsia.

OBJECTIVE: To evaluate the relationship of anaerobic metabolism, as reflected by the calculated base deficit, with oxygen transport and left ventricular function in women with severe preeclampsia. METHODS: Forty women with singleton pregnancies and severe preeclampsia who met prescribed criteria for invasive hemodynamic monitoring had arterial blood gas and hemodynamic values obtained immediately after placement of a pulmonary artery catheter. Oxygen transport indices were stratified according to the admission base deficit. RESULTS: Linear regression analysis demonstrated a strong negative correlation between the calculated base deficit and the oxygen delivery index (r = -0.64), cardiac index (r = -0.62), and left ventricular stroke work index (r = -0.58). A baseline maternal base deficit exceeding -8.0 mEq/L consistently predicted fetal acidosis, fetal death, and maternal end-organ ischemic injury. CONCLUSION: The calculated base deficit reliably reflects maternal oxygen transport dynamics and identifies patients at risk for end-organ injury. Ventricular contractility and oxygen delivery decline with mounting oxygen debt.