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Pregnancy during familial Mediterranean fever complicated with amyloidosis and severe nephrotic syndrome is rare and may cause several maternal and fetal complications. Asymmetrical intrauterine growth retardation, superimposed preeclampsia, thromboembolic phenomena, resistant anemia and renal failure only partially represent the possible complications. A successful outcome of a full-term pregnancy is presented and the efficiency of colchicine, a high protein diet, acetylsalicylic acid and dipyridamole is discussed.

During the past 30 years there has been great progress in perinatology. However, perinatal mortality has remained relatively high. To reduce perinatal mortality and morbidity, high risk pregnancy units have been established throughout the world. Our unit was established in 1976 for women with diseases complicating pregnancy, and in whom evaluation of fetal respiratory and metabolic function is indicated. The cesarean section rate during these 12 years was 33%. There was no maternal mortality. The intrauterine fetal death rate was 10.3 per 1,000 (very low for this unique population) and the corrected perinatal mortality was 3.4 per 1,000. The monitoring and treatment protocols, developed and applied in this unit, resulted in a significant decrease in fetal morbidity and mortality. These dramatically improved results demonstrate and justify the need for high risk pregnancy units.

Fetal movements were assessed in 7 cases of systemic lupus erythematosus (SLE). The daily fetal movement count was lower than normal in 4 cases. Three patients with renal disease and raised blood pressure had decreased fetal movements until cessation and poor fetal outcome. Uncomplicated cases of SLE did not manifest cessation of fetal movement, and their fetal outcome was favorable. When a decrease in fetal movements becomes apparent and the condition is verified by other biophysical tests, the patient should be delivered provided the fetus is viable.

Maternal hyperventilation can cause transient reduction in fetal oxygen tension. Fifty women with normal and high-risk pregnancies, between the 32nd and 43rd week, were voluntarily hyperventilated; in 33, fetal heart rate (FHR) acceleration or transient tachycardia were observed (reactive FHR). Of the 33 pregnancies the outcome was good in 30 (91%) as judged by the absence of perinatal death, no fetal distress in labor and no intrauterine growth retardation (IUGR). In 14 patients in whom there was no FHR response to maternal hyperventilation (non-reactive FHR), the outcome of pregnancy was significantly worse; one infant died neonatally, 10 were either chronically (IUGR), or acutely distressed. Only in 3 was the outcome good (21%). The study showed that there is good correlation between a "reactive" FHR and favorable neonatal outcome, and between a "non-reactive" FHR and an unfavorable neonatal outcome.

Serum prolactin values in normal pregnant women showed a progressive increase from a mean value of 50 ng/ml in the 12th week to 270 ng/ml at term, with the range at term being 100-600 ng/ml. There was a fairly good correlation (r = 0.7) between the values of 24-hour urine estriol in 138 determinations and in the serum prolactin in 133 pregnant women. The regression lines of serum hPRL values with time of gestation in cases of intrauterine growth retardation (IUGR) and diabetes mellitus were less steep than those seen in normal pregnancy. The serum hPRL value of patients with preeclamptic toxemia, latent diabetes, premature rupture of membranes, or multiple pregnancies were found not to differ significantly from the values observed in normal pregnancy. The results indicate that prolactin determinations in pathologic pregnancies are not useful as an aid in their evaluation.

Fetal Heart Rate (F.H.R.) in association with fetal movement was evaluated in 141 normal and pathological pregnancies. In the normal cases only 31% showed an acceleration of F.H.R. in association with fetal movement. The majority of the normal cases, 62%, did not demonstrate changes in F.H.R. in association with fetal movement. In the pathological pregnancies there were no characteristic changes in F.H.R. associated with fetal movement. It appears that F.H.R. acceleration associated with fetal movement cannot be used as an index for fetal well being.

A case of maternal pulmonary edema occurring in a patient in the 32nd week of gestation is presented. This was our first case of pulmonary edema seen during a period of five years' usage of isoxsuprine in the treatment of premature labor. The patient presented was 28 years old, gravida 2, para 1, admitted to the maternity ward with premature uterine contractions. Her past history eliminate cardiac or pulmonary disease. Isoxsuprine therapy was begun with initial dose of 0.04 mg/min. and increased to 0.32 mg/min., the total dose administered was 560 mg during 48 hours. During this period she was given in dexamethasone 24 mg. Fluid balance on the first day of the treatment was +1.7 liters and on the second day +5.2 liters. Forty-eight hours from the commencement of the treatment, the patient experienced shortness of breath and chest pain. Physical examination disclosed wet rales over both lungs, sinus tachycardia and tachypnea. Laboratory examination disclosed hypopotassemia of 3 mEq/liter, hypoxemia (PO2 of 80 torr on 0.5 FiO2 face mask) with mild hyperventilation 28 torr PCO2 with normal ph 7.43. Recognition of the early signs of pulmonary edema enable swift clinical diagnosis and steps to be taken to prevent disasterous condition due to progressive hypoxemia. The prompt treatment in this complication includes discontinuation of isoxsuprine and fluid administration, placement of the patient in an erect position, intravenous furosemid 40 mg, oxygen supplement by face mask and 25 mg of meperidine. The patient's condition dramatically improved though the lung fields became completely clear from wet rales only eight hours from the start of dyspneic attack.(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal activity expresses the fetal condition in utero. Absence of fetal movements may signify fetal distress. The reduction in fetal movements (FM) to 3 or less or their cessation for at least 12 h with audible heart beats was referred to by us as movement alarm signal (MAS). The rate of MAS in 662 complicated pregnancies was studied. There were 43 patients (6.5%) with MAS mainly in cases of fetal malformations and conditions associated with reduced uteroplacental blood flow. In 13 cases a nonintervention approach was undertaken and all the fetuses died in utero. The remaining 30 cases with MAS were delivered promptly, mainly by Cesarean section and live births resulted. Eight of these died neonatally. It is suggested that in cases of MAS the diagnosis of fetal distress should be verified by additional tests. Should fetal distress be confirmed, especially in cases of polyhydramnios, oligohydramnios and symmetrical growth retardation, every effort should be made to exclude fetal malformations before delivery is undertaken especially by Cesarean section.