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Unusual sonographic visualization of the interlobar fissure of the herniated fetal liver in a case of right congenital diaphragmatic hernia was misinterpreted as the right diaphragm leading to misdiagnosis of this fetal anomaly.

A prospective study of 98 pairs of nonstress tests (NSTs) was obtained simultaneously from members of 30 twin gestations. Fifty-five percent of the total fetal heart rate (FHR) accelerations of both twins were associated with each other and occurred within 15 seconds of each other. There were 8.46% synchronous FHR accelerations of both twins, possibly reflecting evoked fetal movements. Statistical analysis failed to reveal evidence of a dominant twin in utero, with one twin initiating the majority of coinciding fetal movements with statistical significance in only three gestations. Examination of combinations of the 30 separate individual significance tests using techniques of meta-analysis demonstrated a p value of 0.81, indicating lack of dominance in any of the 30 pairs of twins. The probability plot, consistent with the large p value for the combination test statistic, suggested that fetal movements in two gestations are related, strengthening the hypothesis of in utero tactile communication between twins. We conclude that the existence of a "dominant twin" in utero cannot be detected by electronic FHR monitoring methods.

We present a case that describes a partial fetal response to external vibratory acoustic stimulation in that, although no fetal movements were elicited, a blunted, brief positive cardioacceleratory response was noted. This fetus exhibited features of the Pena-Shokeir syndrome, characterized by skeletal neurogenic atrophy, yet with a normal auditory system at autopsy. This observation may suggest that the prolonged increase in the basal fetal heart noted after fetal vibratory acoustic stimulation is sustained by active fetal movements, absent in this fetus due to joint contractures.

The Roberts-SC phocomelia syndrome (pseudothalidomide syndrome) is a rare, usually lethal condition involving short limbs and occasional hydrocephalus. Presented is a case in which prenatal sonographic findings were highly suggestive of this syndrome, although not definite. In this fetus, findings of hydrocephalus, short limbs, and probable pulmonary hypoplasia changed the intrapartum management. The findings, correlated with the postmortem radiography, led to diagnosis of probable Roberts-SC syndrome.

Recurrent bilateral renal agenesis in siblings is very rare. Presented is a case diagnosed with sonographically aided amnioinfusion at 18 weeks in a woman with an infant affected with the same condition in a previous pregnancy.

Fetal ultrasound examination at 29 weeks' gestation revealed a severely symmetrically growth-retarded fetus with microcephaly, hypertelorism, and hypoplastic genitalia with a two-vessel umbilical cord. G-banding analysis on amniotic cell cultures revealed a 46, XY,r(4)(p15-q35) karyotype in each of the colonies analyzed. This prenatal diagnosis, to our knowledge the first reported, assisted clinical management of this pregnancy.

This study was performed to assess the association of lack of mandibular movement as manifested by absent fetal swallowing and micrognathia in a nonrestrictive intrauterine environment. Over a 5-year period, 14 fetuses with sonographic findings of polyhydramnios (amniotic fluid index [AFI] more than 20 cm), absent mandibular movement, and a nonvisualized fetal stomach, all consistent with absent fetal swallowing, were followed. A group of 14 fetuses, each with polyhydramnios (AFI more than 20 cm), yet with sonographic detection of fetal swallowing, served as controls. All gravidas in both groups were normoglycemic throughout gestation. Subsequent mandibular development was assessed at delivery or autopsy. Analysis of the data revealed that in the study group, 12 of these infants were liveborn, and two were stillborn. Eleven of the liveborn infants had an early neonatal death. All 14 infants of the study group demonstrated micrognathia. None of the control infants (all of whom survived) had micrognathia. In conclusion, this study supports the concept that normal mandibular growth may depend on the presence of mandibular movement during intrauterine development.

We report a case of a patient who received nalbuphine during labor. The fetus was in an awake state, but when exposed to intravenous nalbuphine manifested quiet sleep. This suggest a physiological response and not a sign of fetal compromise.

The purpose of this study was to examine the predictability of intrapair percentage differences of ultrasonic fetal biometric parameters in detecting twin discordancy. Fetal biometric parameters obtained in 90 twin gestations within 7 days of delivery were analyzed. Intrapair differences of 5% and 10% were used for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length, and HC/AC to assess their predictive value. Statistical analysis was performed using chi 2 test and Fisher's exact test. Receiver operator characteristic (ROC) analysis was done to determine if there was a difference between absolute and intrapair differences. Intrapair AC and HC differences of 5% were found to have significantly higher true positive rates in detecting discordancy. At an intrapair difference of 10%, AC and BPD were found to have high sensitivity rates in detecting discordancy. ROC analysis did not show any difference between use of absolute and intrapair difference in predicting discordancy (P = 0.0001). We conclude that fetal AC is the most significant sonographic parameter in detecting discordancy in twins.

Prospective analysis of 75 pairs of nonstress tests (NSTs) obtained simultaneously from both members of 35 twin gestations was performed to quantitatively assess the incidence of simultaneous periods of fetal heart rate (FHR) reactivity and nonreactivity of twins. Comparative analysis of the paired NSTs was used to compute rates of simultaneous fetal heart rate reactivity and nonreactivity. Statistical analysis involved comparison of weighted averages of these rates, using sequence lengths as weights. Weighted standard deviations were used to describe variability between sets of NSTs. Trend analysis was performed using weighted linear regression to calculate slopes for pairs of twins with three or more repeat NSTs. Groups of twins were compared by performing a variance stabilizing transformation on the appropriate rates, and using a two sample t test to compare the means of transformed data. Analysis of this data revealed that twins exhibited similar in utero fetal heart reactivity and nonreactivity as indicated by simultaneous electronic fetal monitoring during 79.90% +/- 1.62 (SD) of the time monitored. The incidence of periods of simultaneously reactive FHR and simultaneously nonreactive FHR were 11.79% +/- 1.02 and 68.10% +/- 2.17, respectively, irrespective of gestational age. These data confirm the hypothesis that periods of FHR reactivity and nonreactivity of twins are strongly associated with each other.

The outcomes of 41 patients with prolonged, premature rupture of membranes in the midtrimester (19.5 to 26 weeks) managed conservatively were retrospectively analyzed. The maternal obstetric history was notable for a high incidence of second trimester bleeding and a prior history of preterm delivery. The mean duration of ruptured membranes before delivery was 10.6 days and was unrelated to gestational age. Delivery occurred within 2 weeks in 75% of the cases. The major indication for delivery was chorioamnionitis in 71% of patients. The only major maternal morbidity was chorioamnionitis. The overall perinatal survival was 47%, but in infants exceeding 24 weeks' gestation or 500 gm weight, the survival increased to 75%. No significant limb abnormalities, facial anomalies, growth retardation, or pulmonary hypoplasia occurred in the study population. Long-term follow-up demonstrated that 28% of infants exhibited major neurologic or developmental deficits.

We describe a rare case in which a unilateral fetal pleural effusion was noted at 18 weeks' gestation with subsequent spontaneous resolution occurring 1 week later. Amniocentesis revealed a trisomy 21 karyotype. Chromosomal analysis may be indicated in cases in which accumulation of fluid in fetal serous cavities has spontaneously resolved.

We report a case of fetal amelia (limb deficiency). The causes of this anomaly include amniocentesis, amniotic band syndrome, teratogen exposure, or a vascular accident. Recently, chorionic villus sampling has also been implicated in the amputation of an extremity. Although chorionic villus sampling (CVS) was not performed in our case, this possible association suggests subsequent sonographic scanning following CVS should include precise delineation of all fetal limbs.

A case of prenatal sonographic diagnosis of a quadruple nuchal cord is presented. Perinatal assessment included nonstress, oxytocin challenge testing, and Doppler velocimetry studies of the umbilical artery and fetal vibratory acoustic stimulation. Obstetric management of this case is discussed.

A case is presented in which external vibratory acoustic stimulation performed following a nonreactive nonstress test produced a severe variable deceleration of the fetal heart rate. A clinically suspected nuchal cord was confirmed by ultrasound. This rapid precise antepartum diagnosis of cord compression prevented untimely delay and led to immediate abdominal delivery of a nonacidotic, yet hypoxic, infant. This report suggests care be taken when fetal vibratory acoustic stimulation is applied in cases of oligohydramnios and a known existing nuchal cord.

A patient, while on intravenous ritodrine therapy for preterm labor, experienced an episode of acute chest pain. The electrocardiogram (ECG), which was read as normal prior to ritodrine infusion, demonstrated a type I second-degree AV block which disappeared upon discontinuation of ritodrine therapy. This case illustrates the need for close ECG monitoring during ritodrine treatment when clinical symptoms arise.