Search

The efficacy of cervical ripening with two Foley catheter volumes, 30mL and 80mL, is compared in a study. Results show that ripening of the unfavorable cervix in primiparous women with a Foley catheter balloon inflated with 80mL of sterile saline resulted in more dilation, faster labor, and a decreased need for oxytocin than with a balloon inflated with a 30mL of the solution.

Pregnancies complicated by diabetes may result in fetal birth defects only if poor blood sugar control occurs at specific times of fetal development. Researchers induced high blood sugar levels in pregnant rats to determine their effect on fetal development. High blood sugar levels caused defects in fetal development during days 10 and 11 of the rat pregnancy. A 20% rate of defects occurred at blood sugar levels double the normal concentration, a 50% rate of defects at blood sugar levels four times the norm, and a 100% rate of defects at blood sugar levels six times the norm. High blood sugar levels had to be sustained for at least two hours for defects to occur. Defects may not occur if high blood sugar levels are not present during critical periods of development.

Byline: E.Albert Reece, Arnon Wiznitzer, Carol J. Homko, Zion Hagay, Ying King Wu Keywords: Diabetic embryopathy; rat embryo culture Abstract: OBJECTIVE: Our goal was to determine the relationship between critical factors and conditions such as gestational age and exposure time to elevated glucose levels in diabetic embryopathy. STUDY DESIGN: A postimplantation rat embryo culture was used as a model for investigation. The effect of various factors on embryonic development was studied. Experiments were conducted with increasing glucose concentrations (150 to 905 mg/dl, n = 186), at various gestational ages (10 to 12 days, n = 169), and for varying durations of exposure (30 to 180 minutes, n = 169). Gross morphologic characteristics of the yolk sac and embryo were assessed. RESULTS: Embryopathy was induced by hyperglycemia in a dose-related fashion: a 20% rate at two times control glucose concentration, almost a 50% rate at four times control, and approximately a 100% abnormality rate at more than six times control. A critical window in gestational age, days 10 to 11, and a minimum exposure time to hyperglycemia of 2 hours were necessary to induce teratogenesis. CONCLUSIONS: Diabetic teratogenesis occurs in a dose-related fashion and requires a minimum exposure time and critical gestational age. Only synchronization of these critical conditions induces embryonic maldevelopment. Furthermore, nonsynchronized aberrant conditions may result in apparently normal embryonic development. (AM J OBSTET GYNECOL 1996;174:1284-8.) Author Affiliation: Philadelphia, Pennsylvania Article History: Received 16 March 1995; Revised 22 May 1995; Accepted 15 September 1995 Article Note: (footnote) [star] From the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine., [star][star] Reprint requests: E. Albert Reece, MD, Department of Obstetrics and Gynecology and Reproductive Sciences, Temple University School of Medicine, 3401 North Broad St., 7-OPB, Philadelphia, PA 19140., a 0002-9378/96 $5.00 + 0 6/1/69314

Byline: Zion J. Hagay, Galya Biran, Asher Ornoy, E.Albert Reece Keywords: Congenital cytomegalovirus infection; prenatal diagnosis; serologic tests; mass screening Abstract: OBJECTIVE: The purpose of this study was to review the accuracy of current tests used for the diagnosis of in utero cytomegalovirus infection and to discuss the potential value of preconceptional and postconceptional screening programs for prevention of congenital infection. STUDY DESIGN: A computer-assisted search was performed for relevant English language publications between 1987 and 1994. We identified 119 cases of suspected intrauterine cytomegalovirus infection in which either amniotic fluid or fetal blood had been analyzed antenatally. RESULTS: Congenital cytomegalovirus infection affects 0.5% to 2.5% of all newborns. The rate of transmission to the fetus after primary infection during pregnancy ranges from 15% to 50%. Of the fetuses infected in utero, 10% exhibit congenital cytomegalovirus syndrome. Evaluation of 119 cases of suspected infection has shown that polymerase chain reaction and cultures of amniotic fluid are the most reliable tests for prenatally determining the presence of viral particles. However, efficacy of routine antenatal screening in reducing the rate of fetal disease is limited. CONCLUSION: It is concluded that at present the accuracy of tests used for the diagnosis of in utero cytomegalovirus infection is undetermined. Serologic screening of all pregnant women is of limited value and at present is not recommended. (AM J OBSTET GYNECOL 1996;174:241-5.) Author Affiliation: Rehovot and Jerusalem, Israel, and Philadelphia, Pennsylvania Article History: Received 15 December 1994; Revised 24 March 1995; Accepted 4 May 1995 Article Note: (footnote) [star] From the Departments of Obstetrics and Gynecology, Kaplan Hospital,a the Jerusalem Institute of Child Development and Laboratory of Teratology, The Hebrew University, Haddasah Medical School, b and Temple University School of Medicine. , [star][star] Reprint requests: Zion J. Hagay, MD, Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel., a 0002-9378/96 $5.00 + 0 6/1/66061

Higher than normal levels of the copper zinc superoxide dismutase gene in fetuses may protect them from developing abnormally as a result of diabetes in their mothers. Copper zinc superoxide dismutase is an enzyme that may rid the body of oxygen free radicals, which are overproduced in connection with diabetes mellitus and may cause fetuses to form abnormally. Researchers induced diabetes in mice that were pregnant with embryos either with the human copper zinc superoxide dismutase gene or without it. Mouse embryos with the copper zinc superoxide dismutase gene did not experience growth reductions, had a low rate of malformation and a low rate of fetal death, whereas embryos without the gene were more likely to be small, malformed, or to die before the end of pregnancy.

Brief episodes of moderate low blood sugar do not appear to affect the fetus of insulin-dependent diabetic women. While it is known that tight metabolic control improves pregnancy outcomes among insulin-dependent diabetics, this results in frequent episodes of hypoglycemia. Ten insulin-dependent diabetic women at gestational ages ranging from 27 to 37 weeks underwent a controlled reduction of blood sugar by infusing insulin. Maternal blood sugar was reduced to 45 mg/dl for 40 minutes. Electronic fetal monitoring and ultrasound imaging evaluated fetal heart rate, fetal practice breathing movements (a measure of fetal well-being), and fetal limb movements. Placental perfusion was evaluated via Doppler ultrasound studies as well. No adverse fetal effects were found. The effects of long-term or severe hypoglycemia on the fetus has not been studied.

OBJECTIVE: New portable devices have become available for home monitoring of fetal heart rates; these devices have the potential to immediately transmit these tracings to a medical facility. The null hypothesis of this study is the inability of mothers to perform their own nonstress tests (self-nonstress tests) and that such tests are not comparable to those performed by professional medical personnel (assisted nonstress tests). STUDY DESIGN: The feasibility of maternal self-testing was established in 50 high-risk patients followed by a controlled clinical trial conducted in 60 patients. The latter study represents the first controlled trial in which patients performed self-nonstress tests at their homes and transmitted the tracings via telecommunication to our perinatal unit. In all cases these patients came to our hospital within 60 minutes after the self-nonstress tests to have a perinatal nurse perform a second nonstress test. The pairs of self and assisted fetal heart rate tracings were independently reviewed by two investigators. RESULTS: The self and assisted tracing pairs were judged satisfactory for interpretation in 100% and 90%, respectively; self and assisted were interpreted by each examiner to be nonreactive in 20% and 14%, respectively. However, both examiners were unable to distinguish between tracings generated by assisted nonstress and self-nonstress tests. Furthermore, cost analysis revealed an estimated twofold savings with self-nonstress testing compared with the assisted nonstress test. CONCLUSION: Self-nonstress testing is a reliable and accurate method of antepartum fetal heart rate testing. This method of fetal assessment not only introduces a new approach to fetal surveillance with added convenience to patients, but may also significantly reduce medical cost without compromising the results of fetal testing. (Am J Obstet Gynecol 1992;166:489-92.)

Accurate, rapid diagnosis of the presence of microbes in the amniotic fluid is essential to prevent complications, which can include premature delivery and a host of problems for both mother and infant. However, many medical centers that use amniocentesis (sampling of amniotic fluid) analyze their samples using the Gram stain, a microbiological method that can fail to detect microorganisms in as many as half the cases in which they are present. In this study, the amniotic fluid white blood cell count was evaluated as a method of diagnosing microbial invasion. Amniotic fluid samples were taken from 195 patients undergoing preterm labor with a single fetus; the patients underwent treatment with tocolytic agents (to inhibit uterine contractions). The samples were evaluated with the Gram stain and in tissue culture, as well as for concentrations of white blood cells. Pregnancies progressed to term in 84 cases (43 percent) and microorganisms were present in 25 cases (12.8 percent). Those with positive culture results had higher levels of white blood cells than those with negative results. The sensitivity of the white blood cell count (extent to which that test correctly identified the infected women) was 80 percent; and its specificity (extent to which the test correctly diagnosed the absence of infection) was 87.6 percent. The sensitivity of the white blood cell count was higher than that of the Gram stain, but its specificity was lower. On the whole, the amniotic fluid white blood cell count is sensitive, simple, and inexpensive. Patients with levels equal to or less than 50 cells per cubic millimeter were at risk for premature delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Women with ovarian cystic teratoma can probably become pregnant and deliver a healthy baby. In a study of 49 women with this benign tumor, 63 out of 68 pregnancies were not affected by the tumor, and the tumor did not grow bigger during the pregnancy.

Ureaplasma urealyticum was isolated from the amniotic fluid of a patient with preterm premature rupture of membranes at 24 weeks. A second amniocentesis performed 48 hours later indicated an increase in the number of neutrophils in the amniotic fluid. Treatment with erythromycin, ampicillin, gentamicin, and clindamycin was instituted for a period of 6 days. Amniotic fluid analysis from a third amniocentesis performed 24 hours after discontinuation of antibiotic treatment revealed only a few white blood cells and was negative for microorganisms. The pregnancy continued for 22 days after admission, at which time spontaneous labor began. The neonate survived with no sequelae and had negative blood cultures. Antibiotic treatment was associated with eradication of Ureaplasma urealyticum from the amniotic cavity, pregnancy prolongation, and neonatal survival. (Am J Obstet Gynecol 1992;166:618-20.)

Retained placenta is a placenta that does not spontaneously separate from the uterus within 30 minutes after delivery of the infant. Retained placenta appears to occur at a higher rate in preterm deliveries (between 20 and 36 gestational weeks) than in term deliveries. Since approximately one-fifth of the women who deliver preterm infants also have microbiological evidence of bacteria in the amniotic fluid (in which the fetus floats), it is possible that retention of the placenta is associated with infection. To learn more about this, medical records were reviewed from 231 preterm vaginal deliveries and 561 term vaginal deliveries (the latter served as controls) at one medical facility. The preterm patients had undergone amniocentesis (removal of a sample of amniotic fluid) upon admission to the hospital for evaluation of possible microorganism content. One hundred twenty-five women had preterm labor with intact membranes (the membranes that surround the fetus) and 106 had premature rupture of membranes (PROM). Slightly more than 9 percent of the women with preterm vaginal delivery had retained placentas, compared with slightly more than 1 percent of the women with term deliveries, a statistically significant difference. No difference in the proportion of retained placentas was found between the PROM and non-PROM groups. The greater incidence of retained placenta in preterm births was not associated with either a positive result for microorganisms or with the presence of chorioamnionitis (inflammation of the amniotic membranes). The results show that preterm delivery is associated with retained placenta, but suggest that intrauterine infection and inflammation are not associated with retention. Other possible explanations are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)