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A study is conducted using an animal model, to test the effects of prolonged in utero meconium exposure on the latter adult learning and memory, as measured by the Morris water maze. The findings of this animal suggest that prolonged in utero meconium exposure during late fetal life is associated with a delay in spatial learning in adult animals.

Abnormal fetal heart rate patterns during the first stage of labor can identify fetuses with acidosis, according to a study of 301 deliveries. These babies were also more likely to be delivered via a cesarean section.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1067/mob.2001.115745 Byline: Sean C. Blackwell, Mordechai Hallak, Sonia S. Hassan, Stanley M. Berry, Evelyne Russell, Yoram Sorokin Keywords: Magnesium sulfate; ionized magnesium; interleukin-1; interleukin-6; tumor necrosis factor Abstract: Objective: Elevated levels of inflammatory cytokines in the fetus have been linked to neurologic morbidities in preterm neonates. Magnesium sulfate is currently being studied in clinical trials as a potential fetal neuroprotective agent. The purpose of this study was to determine whether intrapartum magnesium sulfate therapy has an effect on the umbilical venous concentrations of interleukin-1[beta], interleukin-6, and tumor necrosis factor-[alpha] at delivery. Study Design: Women with singleton gestations >32 weeks with no clinical indications for magnesium sulfate therapy (preeclampsia or tocolysis) and either clinical chorioamnionitis or prolonged rupture of membranes were recruited for the study. Consenting patients were randomly assigned, in a double-blinded fashion, to receive either magnesium sulfate (6-g load then 2 g/hr) or matched volumes of lactated Ringer's solution until delivery. Fetal blood specimens were obtained by aspiration of the umbilical vein after cord clamping but before placental separation. Umbilical cytokine levels were measured with a sensitive and specific immunoassay. Results: Twenty-two patients were randomly assigned to groups and received either magnesium sulfate (n = 11) or placebo (n = 11). There were no differences in the demographic or clinical characteristics between groups. The umbilical venous ionized magnesium concentration was significantly higher in the magnesium sulfate group (2.32 [+ or -] 0.27 mg/dL vs 1.23 [+ or -] 0.15 mg/dL; P < .001). There were no statistically significant differences between groups with respect to umbilical levels of interleukin-1[beta] (1.5 pg/mL [1.5-58] vs 1.5 pg/mL [1.5-10]; P = .5); interleukin-6 (8.5 pg/mL [1-1000] vs 11.2 pg/mL [1-113]; P = .9); or tumor necrosis factor-[alpha] (16 pg/mL [7.6-20.3] vs 16.6 pg/mL [8.3-22.2]; P = .5). Conclusion: In this pilot study the intrapartum administration of magnesium sulfate does not appear to affect the concentration of inflammatory cytokines in fetal blood at delivery. (Am J Obstet Gynecol 2001;184:1320-4.) Author Affiliation: Detroit, Michigan, and Beer-Sheva, Israel From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University, Detroit.sup.a; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ben Gurion University/Beer-Sheva..sup.b Article Note: (footnote) [star] Reprint requests: Sean C. Blackwell, MD, Hutzel Hospital, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 4707 St Antoine Blvd, Detroit, MI 48201.

Seizures appear to cause changes in the binding of some excitatory amino acid neurotransmitters in the brain, according to a study in rats. Magnesium prevents these changes, and may protect the brain from seizure-induced damage.

Magnesium sulfate may slow the fetal heart rate, but the effect is very small and may not be serious. Magnesium sulfate is given to pregnant women to prevent premature labor.

The same blood tests that are used to detect Down syndrome can detect other complications of pregnancy such as preeclampsia, miscarriage, premature labor, fetal growth restriction, fetal death, and placental abruption. The test measures alpha fetoprotein, unconjugated estriol, and human chorionic gonadotropin.

Seizures in pregnant rats can cause brain damage in the pup but this can be prevented by giving the mother rat magnesium. Epilepsy during pregnancy has been shown to increase the risk of cerebral palsy, mental retardation and fetal death.

Women who experience blood clots or strokes during pregnancy may need to be tested for the presence of factor V Leiden mutation. Researchers studied 15 pregnant women admitted to a high-risk pregnancy unit because of blood clots in the deep veins, lungs, or stroke. Blood samples from seven women revealed activated protein C resistance, or the factor V Leiden mutation, which is associated with an increased risk of blood clot development. Such patients should be candidates for routine anticoagulant treatment during pregnancy and postpartum. Side effects of anticoagulant treatment should be weighed.

The effects of magnesium sulfate treatment within the rat brain may provide clues to how this treatment helps to control convulsions. Groups of six rats each were treated with either magnesium sulfate or saline either over four hours, one day or two-week time periods. Sections of brain tissue were analyzed for amino acid activity, particularly at N-methyl-D-aspartate (NMDA) binding sites. The greatest treatment effect was seen in the hippocampus, an area of the human brain with the most NMDA binding sites. There was a reduction in glutamate binding after one day of treatment but in glycine binding only after long-term treatment.

Magnesium sulfate appears to be active in regulating kainate receptor sites in the rat brain. The kainate receptors may participate in the excitatory process during convulsions. Groups of six rats were treated with either magnesium sulfate or saline over four hours, one day, or two-week time periods. Brain tissue samples were measured for amino acid binding activity particularly at the kainate binding sites. Kainate receptors were less active with the four-hour and one-day treatment but more active after the two-week treatment.

Premature rupture of membranes may not accelerate maturation of the lungs of a fetus. It may increase the risk of respiratory distress syndrome (RDS) in certain infants. RDS is a disorder associated with incomplete maturation of the lungs that frequently occurs in premature infants. Among 1,395 infants delivered between 24 and 35 weeks of gestation, 50% had premature rupture of membranes and 50% did not. RDS occurred in 25% of the infants with mature rupture of membranes, compared to 23% of those without mature rupture of membranes. The incidence of RDS was slightly higher after mature rupture of membranes when gestational age or birth weight was taken into consideration. Evaluation of data from the 1980 National Natality Survey found that premature rupture of membranes increased the risk of RDS significantly.

Researchers can use rats to study anticonvulsant drug effectiveness by stimulating hippocampal seizure activity through intracranial injection of 20 micrograms of N-methyl-D-aspartate. The hippocampus is an area of the brain thought to be associated with seizure activity. N-methyl-D-aspartate is an excitatory amino acid. N-methyl-D-aspartate receptors appear to play a role in neurological disorders such as seizures. Probes were implanted in the brains of rats to allow monitoring of electrophysiological responses and to permit drug injection. Rats were injected with doses of N-methyl-D-aspartate varying from 5 to 30 micrograms. Rats who received the 20 microgram dose had the shortest time before seizures began and all survived the procedure. Three of five rats who received the 30 microgram dose died within 30 minutes of the injection. Rats were then pretreated with MK-801, an N-methyl-D-aspartate receptor antagonist. Pretreatment with a dose of 1 milligram per kilogram of body weight reduced the time before seizures started but also decreased the total number of seizures. At the highest dose of N-methyl-D-aspartate, pretreatment prevented the death of the rats.

Magnesium sulfate injected into pregnant rats resulted in elevated levels of the substance in the fetal blood, brain and amniotic fluid. Magnesium sulfate is often used to suppress premature labor in humans. Twenty-eight pregnant rats were randomly assigned to receive injections of magnesium sulfate or an inactive substance. Those receiving an inactive substance were used for comparison. One group of rats had blood samples taken 20 minutes after injection of the drug. Two other groups were used to evaluate the effect of a prolonged increase in magnesium sulfate levels. The concentration of magnesium in fetal blood rose 18% after one injection. Fetal blood concentrations of magnesium rose by 25% after two hours of injections and by 36% after four hours. Concentrations of magnesium in amniotic fluid rose by 21% after four hours. Magnesium was found in the cortex and hippocampus of the fetal brain in the group that received four hours of treatment.

The anticonvulsant magnesium sulfate may inhibit seizures by blocking activation of N-methyl-D-aspartate (NMDA) receptors. Previous studies have suggested that NMDA receptors not only transmit but also amplify excitatory messages in the nervous system. They also appear to play a role in many neurologic disorders including epilepsy and strokes. Twenty micrograms of NMDA were injected into the hippocampus of rat brains to induce seizures. The average time until seizure onset was 91 seconds in rats that did not receive magnesium sulfate and 444 seconds in rats that received injections of magnesium sulfate prior to injection with NMDA. In rats that received magnesium sulfate injections directly in the brain, the average time until onset of seizure following injection with NMDA was 607 seconds. Sixty percent of rats that were injected with both NMDA and magnesium had seizures compared with all of the rats that were injected with NMDA but did not receive magnesium sulfate.

The drugs indomethacin and terbutaline do not appear to affect placental impedance of blood flow through the umbilical artery. Indomethacin and terbutaline are taken during pregnancy to prevent preterm labor. Blood flow velocity through the umbilical artery, as measured by the systolic/diastolic ratio, is used to determine placental resistance. Of 41 pregnant women, 15 took indomethacin, 12 took terbutaline and 14 took a placebo. There were no significant differences in systolic/diastolic ratios between the groups taking indomethacin and terbutaline and the group taking placebo. Furthermore, there were no significant differences in the systolic/diastolic ratio before and after treatment within each group.

A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study(MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects.

Prenatal hypoxic-ischemic brain injury is believed to cause permanent neurological deficits in newborns. We investigated the possibility that maternal hypoxia during pregnancy leads to offspring brain damage and its prevention by i.p. administration of MgSO4. Pregnant mice at gestation day 17 were exposed to hypoxia or air following pretreatment with saline or Mg. Newborn mice to mothers exposed to hypoxia demonstrated faster development of morphogenic parameters such as eyelid opening, hair growth and teeth eruption. In addition, hypoxia delayed the development of motor reflexes. Pretreatment with Mg compensates for hypoxia-induced impairment and in some cases accelerates the development of these functions. In conclusion, maternal hypoxia significantly modifies the developmental process of newborn mice. In our study, pretreatment with Mg showed significant prophylactic action against motor impairments.

AbstractObjective:To determine the effect of Ob/Gyn residents’ fatigue and training level on the accuracy of their clinical and ultrasonographical estimation of fetal weight (EFW). Methods:In this study, clinical and ultrasonographical EFWs were performed by various residents. Actual birth weight, gravidity, parity, gestational age, body mass index, presence or absence of diabetes and hypertensive diseases, presentation and amniotic fluid index were recorded. All EFWs were divided into 3 groups according to the hour they were performed. All residents were divided into 4 groups according to their training level. The accuracy of EFW as compared with actual birth weight was then analyzed according to the shift and to the residents’ seniority by using the ANOVA test. Multivariate analysis was performed to evaluate the factors that significantly and independently affected the weight evaluation. Results:Statistically significant differences were found between the clinical EFW and the birth weight among the working shifts for birth weights of 2,500 g and more (p = 0.032 and p = 0.035). For clinical EFW, night shifts were the most inaccurate (9.27, 8.05 and 9.78% of error for day, evening and night shift, respectively; p = 0.03). The accuracy of ultrasonographical EFW was not affected by the residents’ fatigue level. The residents’ training level did not alter the accuracy of either clinical or sonographical EFW. The accuracy of clinical EFW was affected independently by the work shift (p = 0.01), whereas no factor was found to independently effect the accuracy of ultrasonographic EFW. Conclusions:Ob/Gyn residents’ fatigue affects the accuracy of clinical but not ultrasonographical EFWs. Residents’ training level does not alter either the clinical or sonographical EFW.Copyright © 2002 S. Karger AG, Basel

HTLV-I is etiologically implicated with tropical spastic paraparesis/HTLV-I associated myelopathy, adult T-cell leukemia and certain other diseases. However, after infection the virus enters into a dormant state, whereas the characteristics of the HTLV-I related diseases indicate that their genesis requires activation of the dormant virus by a Tax-independent mechanism. In the present study we demonstrate that a variety of stress-inducing agents (TPA, cisplatin, etoposide, taxol, and 3-methylcholanthrene) are capable of Tax-independent activation of HTLV-I LTR and that this activation is detected mainly in cells that are undergoing through the apoptotic process. Furthermore, it is demonstrated that both apoptosis induction and HTLV-I LTR activation are inhibited by Bcl-2 and by PKC, indicating that these two processes are mechanistically cross-linked. In addition, using an HTLV-I producing human T-cell line which permanently express the negatively transdominant taxmutant, Δ58tax,under the Tet-Off control system, we prove that the virally encoded Taxprotein protects the host cells from apoptosis. Together, these data suggest that activation of the dormant virus in the carriers' infected T-cells by certain stress-inducing conditions and protecting these cells from the consequent apoptotic death by the viral Taxprotein emerging after this activation, might be the basis for switching the virus from latency to a pathogenic phase.

AbstractObjective:To develop an in vivo animal model for the study of the effects of intrauterine meconium exposure on the fetus. Methods:Timed pregnant Long-Evans rats were purchased on gestational day (GD) 12 and allowed to acclimate for at least 48 h prior to surgery. Laparotomy was performed and both uterine horns were exteriorized through the abdominal incision. A 26-gauge needle was used to inject either 0.1-cm3sterile normal saline or a 20% meconium suspension into each individual gestational sac. The uterus was returned to the abdomen and the incision was closed. On GD 21 (term = 21 days) a cesarean section was completed and the number and viability of fetuses in each horn were recorded. Results:A total of 14 animals were involved in this pilot study. One rat underwent sham surgery with only intra-amniotic saline injection and 13/15 fetuses survived to term. Two animals that underwent surgery on day 18 expired <24 h postinjection. Eleven maternal animals were injected on GD 20 and underwent cesarean delivery at term; survival rates for saline-injected animals were 71.2% compared to 66.2% for meconium-exposed fetuses. Conclusion:We have established an in vivo animal model that allows for the examination of the effects of prolonged intrauterine meconium exposure on the fetus.Copyright © 2001 S. Karger AG, Basel

Objective: To examine the significance of abnormal fetal heart rate (FHR) patterns during the second stage of labor in terms of pregnancy outcome.

AbstractObjective:To quantify the improvement in ultrasonographic fetal imaging following diagnostic amnioinfusion for the indication of unexplained midtrimester oligohydramnios. Methods:Patients referred for unexplained midtrimester oligohydramnios were retrospectively reviewed. Videotapes of those undergoing diagnostic antenatal amnioinfusion were analyzed for quality of visualization of routinely imaged structures before and after the infusion procedure. Results:The overall rate of adequate visualization of fetal structures improved from 50.98 to 76.79% (p < 0.0001). In fetuses having preinfusion-identified obstructive uropathy, there was improvement in identification of associated anomalies from 11.8 to 31.3%. Conclusions:Several authors have suggested that diagnostic amnioinfusion can facilitate fetal imaging and increase diagnostic precision in the setting of unexplained severe oligohydramnios. We have quantified the improvement in the rate of optimal visualization of fetal structures which likely translates, in experienced hands, into this observed improved diagnostic precision. Of particular importance is the improvement in appreciation of associated anomalies in cases of obstructive uropathy in which such findings may determine whether or not invasive fetal therapy is indicated.Copyright © 2000 S. Karger AG, Basel

Objective: To determine whether severe maternal hypoxia affects fetal rat physical characteristics and causes neuronal damage, and whether magnesium sulfate can decrease these effects.

Spontaneous rupture of the uterus during the 2ndand 3rdtrimester resulting from invasive placentation is a rare complication of pregnancy. We report a case of a 39-year-old G6P4, with four previous cesarean sections, who presented at mid-gestation with brown vaginal discharge. Invasive placenta previa was detected upon conducting abdominal ultrasound. The fetal head was seen trapped within the uterine scar, while the fetal body was visualized within the maternal abdominal cavity with intact membranes. In cases with invasive placentation, early attention to uterine rupture may reduce maternal morbidity.

AbstractObjective:To determine whether delayed induction of labor in patients with premature rupture of membranes (PROM) at term has beneficial effects on the mother or the infant. Study Design:Retrospective analysis of our database revealed 576 patients >37 weeks of gestation with PROM, who delivered live-born infants without major congenital anomalies. We analyzed the frequencies of primary cesarean, neonatal intensive care unit (NICU) admissions, and oxytocin use by time since hospital admission and interval until onset of labor. Results:NICU admission increased from 1.9% in <3 h between admission to onset of labor to 13.3% after >18 h. Admission-onset of labor interval, birth weight of <2,500 or >4,000 g and meconium were all more important determinants of NICU admission than gestational age, duration of labor, PROM, and ROM. Prolonged admission-onset of labor interval was associated with an increased risk of variable decelerations (p < 0.001). Primary cesarean rates increased progressively with longer intervals between admission and onset of labor. Stepwise discriminant function analysis revealed that labor duration, admission-onset of labor interval, gestational age, and birth weight of <2,500 g were all more important determinants of primary cesarean delivery than the durations of PROM or ROM. Conclusions:The increased frequencies of NICU admission, variable decelerations, and primary cesarean suggest that delayed labor induction after hospital admission was linked to worsened perinatal outcomes. These results may have been influenced by usually performing a single digital examination as part of initial evaluation of term patients who present with PROM. Based on our data, we suggest immediate induction for PROM at term, especially if digital examination has been performed.

OBJECTIVE:We determined the effect of peripherally administered magnesium sulfate on N-methyl-D-aspartate (NMDA) receptor binding capacity in various regions of the rat brain.METHODS:Three separate experiments were performed. 1) Six rats were injected intraperi toneally with 270 mg/kg of magnesium sulfate, followed by 27 mg/kg every 20 minutes for 4 hours; controls (n = 6) received saline. 2) Six rats received intraperitoneal injections of magne sium sulfate (270 mg/kg) every 4 hours for 24 hours, while six received saline. 3) Six rats received intraperitoneal magnesium sulfate (270 mg/kg) every 12 hours for a total of 2 weeks, and six received saline. Rats were subsequently perfused and sacrificed, and their brains were dissected, rinsed, and frozen. Cryostat sections were taken, labeled by in vitro [3H]-CGP 39653, assayed autoradiographically, and mounted on Ultrofilm for 4 weeks. Optical density measurements of binding on each section were performed using an image analyzing system. Eleven brain regions were sampled: 1, 2) frontal and occipital cortex; 3-7) hippocampus—CA-1, CA-3, stratum radiatum, stratum oriens, dentate gyrus; 8) thalamus; 9) hypothalamus; 10) caudate nucleus; and 11) cerebellum.RESULTS:The NMDA receptor binding density in the hippocampus was significantly higher than in all other brain regions in all three experiments. In experiment 1, there was no significant effect on NMDA receptor binding. However, prolonged systemic administration of magnesium sulfate for 24 hours resulted in significantly reduced [3H]-CGP binding in all brain regions sampled. After chronic magnesium sulfate administration (2 weeks), the [3H]-CGP binding was still reduced in the cortex and some regions of the hippocampus; however, there was no significant change in other regions.CONCLUSIONS:Peripheral treatment with magnesium sulfate results in a significant reduction in the NMDA receptor binding capacity in the rat brain. These results support the hypothesis that magnesium central activity is mediated, at least in part, via the NMDA receptor.(J Soc Gynecol Invest 1994 ;1 :25-30)

To determine the effect of maternal intravenous (IV) magnesium sulfate administration on fetal serum and amniotic fluid (AF) concentrations of magnesium.

To determine whether various solutions commonly used in amnioinfusion during labor affect neonatal electrolyte and blood gas values.

With the intention of preventing the attendant medical, ethical, and legal problems arising from the birth of live-born, anomalous fetuses, we initiated a program offering fetal intracardiac potassium chloride injection as an adjunctive measure in the setting of genetically indicated second-trimester abortion.

We examined whether abnormal elevations in umbilical venous pressure during intravascular transfusion predict post-transfusion mortality.

To compare the efficacy of three methods for ripening and dilating the unfavorable cervix for induction of labor.

To assess the accuracy of sonographic estimation of fetal head circumference in twin gestations.

Traditionally fluids and solid food are gradually introduced following uncomplicated cesarean delivery (CD), starting after 8 to 24 hours when bowel sounds are heard. The underlying view is that CD is a major abdominal operation and that early feeding might increase the risk of ileus and other gastrointestinal complications.

Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy. The insulin-like growth factor (IGF) system plays a key role in regulating growth and invasiveness in several malignancies, including ovarian cancer. IGF1R targeting showed antiproliferative activity of EOC cells. However, clinical studies failed to show significant benefit. EOC cells suppress antitumor immune responses by inducing dendritic cell (DC) dysfunction. The IGF1 axis can regulate DC maturation.

An association between intrauterine hypoxia and increased nucleated red blood cell (RBC) counts in the peripheral circulation has long been acknowledged. Higher counts reportedly are especially likely in neurologically impaired newborn infants. This study aimed at determining the effect of acute, severe hypoxia on peripheral nucleated RBC counts in the fetal rat. Maternal animals were randomized to either 2 hours of exposure in a hypoxia chamber or exposure to room air in a control chamber. The test chamber contained 9% oxygen, 3% carbon dioxide, and balanced nitrogen. Cesarean deliveries were carried out immediately after exposure and then at intervals up to 60 hours. There were 56 fetuses in each group.

Objective: Endocrine alterations of metabolism such as diabetes and obesity are known to affect maternal serum α-fetoprotein interpretation. Thyroid function has been questioned, e.g., because of binding globulins, but not adequately studied as to its impact upon maternal serum α-fetoprotein. The purpose of this study was to assess the possible effects of T4 and thyroid-stimulating hormone (TSH) on α-fetoprotein production, and to determine if thyroid function (hypothyroidism) alters maternal serum α-fetoprotein. Methods: We evaluated maternal serum α-fetoprotein, T4, and TSH records of 25,551 patients, between 14 and 20 weeks' gestation, on whom both studies had been ordered by the patient's primary obstetrician to rule out maternal thyroid disease in pregnancy. Statistical analyses were performed by χ2 and regression analysis. Results: Patients were stratified according to thyroid function tests into two groups: hypothyroidism (T4 < 6.5 μg/dL and/or TSH > 5.0 μU/mL), and normal or hyperthyroidism (T4 ≥ 6.5 μg/dL and/or TSH ≤ 5.0 μU/mL). Maternal serum α-fetoprotein values were compared among groups for each gestational age. No significant variation or correlation of maternal serum α-fetoprotein and thyroid function was observed. Conclusions: Although other endocrine abnormalities are known to impact maternal serum α-fetoprotein values either through decreased production, decreased placental permeability, or plasma volume distribution alterations, maternal thyroid status does not interfere with proper interpretation of maternal serum α-fetoprotein.

A patient with placenta previa presented with severe vaginal bleeding. Emergency classical cesarean was followed by hysterectomy for placenta accreta. The patient's hemodynamic status continued to deteriorate and she subsequently developed a consumptive coagulopathy secondary to massive hemorrhage. A mushroom-shaped pack, created from a sterile plastic bag filled with Kerlix gauze, was placed in the pelvis and brought out through the vagina. Traction on the pack produced pressure against the pelvic floor, controlling the bleeding. This pack was prepared quickly and removed without complication in the immediate postoperative period.

Fetal macrosomia, defined as a birth weight exceeding 4000 g, occurs in approximately 1 in 10 births in the United States. Recent studies have found that inducing labor increases the chance of cesarean section (CS) while not lowering the risk of complications of a macrosomic fetus. This study was an attempt to determine the impact of inducing labor on complications and outcomes. Subjects were 4755 consecutive women who delivered singleton fetuses weighing 4000 g or more in 1988–1999. One fifth of fetuses were delivered after inducing labor, whereas four fifths were born spontaneously. A Foley catheter was used to induce labor in 46.5% of women, oxytocin in 13%, and prostaglandin E2in 58%. Surgical induction was performed in 7% of cases. It was common for more than 1 method to be used. Women whose labors were induced tended to be of lower parity and to give birth to male infants. There were no significant differences between the induced and noninduced groups in maternal age, gestational age, or birth weight. Women in the induction group more often had mild preeclampsia, gestational diabetes, hydramnios, and oligohydramnios.

Indomethacin was given for the treatment of preterm labor in a twin pregnancy at a dosage of 200 mg/day for 7 days beginning at 34 weeks and 5 days' gestation. During treatment, one twin developed closure of the ductus arteriosus, tricuspid regurgitation, right ventricular dysfunction, and pericardial effusion. Severe oligohydramnios in both amniotic sacs appeared as well. All findings resolved within 7 days of discontinuation of the medication. The infants, delivered vaginally at 37 weeks' gestation, were alive and well at a 2-month follow-up visit. We believe that all fetuses of mothers treated with indomethacin should be closely monitored for early evidence of decreased amniotic fluid volume and constriction of the ductus arterious.

A circumscribed hyperechoic mass in the mid-portion of the left cerebral hemisphere was the presenting ultrasonographic finding in a 30-week fetus. With repeat ultrasound studies, this echo-dense mass became more sonolucent. In addition, there was an increased fluid accumulation and loss of identifiable cerebral cortex over the left parietal and occipital lobes. The patient underwent induction of labor because of progressive intracranial fluid accumulation with subsequent macrocephaly. The infant died on the fourth day of life. At necropsy, an organizing hematoma with admixtures of fresh and moderately degraded old blood was found in the left hemisphere. There was extensive resorption of the underlying cortex, leaving only a fluid-filled cavity with a meningeal covering. We believe the progressive changes that occurred after fetal intracerebral hemorrhage ultimately resulted in hydranencephaly.