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Pure fetal blood was obtained by cordocentesis in 101 fetuses of 96 patients at 15 to 38 weeks' gestation. Rapid karyotype was obtained within 2 to 4 days by fetal lymphocyte culture. Chromosomal abnormality was detected in 12 (11.9%) fetuses. Abnormal karyotype was found in 5 of 44 fetuses with structural malformations, 3 of 13 fetuses with intrauterine growth retardation or oligohydramnios, 1 of 3 fetuses with nonimmune hydrops fetalis, 2 (one monozygotic set) of 10 discordant twins, 1 of 12 isoimmunized gestations, none of 8 cases with advanced gestational-maternal age, and none of 6 immune thrombocytopenia cases. This suggests that rapid karyotype should be obtained in all cases of fetal structural malformations, intrauterine growth retardation, and nonimmune fetal hydrops, and may be obtained incidentally in isoimmunized pregnancies and discordant twins to assist in clinical management.

Sonography has a major role in the identification, evaluation, and treatment of the hydropic fetus. Although the prognosis of the NIH fetus is generally poor, the IIH fetus can frequently be treated effectively by transfusions performed by percutaneous needling of the umbilical vein. In addition, sonographic guidance of percutaneous umbilical vein sampling affords an accurate assessment of the etiology of NIH by facilitating karyotyping of the fetal blood.

In a group of 152 high-risk pregnancies, 266 oxytocin challenge tests were reviewed. There were 137 patients with persistently negative oxytocin challenge tests with only one false-negative test being recorded. Fifteen patients who displayed a positive test at some time in their antepartum course are discussed along with other aspects of the oxytocin challenge test.

Oligohydramnios is associated with increased perinatal mortality and morbidity. Traditional methods of in utero fetal evaluation have been unsuccessful in reliably distinguishing oligohydramnios with normal outcome from that associated with increased perinatal morbidity. A prospective study was undertaken to establish the predictive value of Doppler velocimetry in identifying the fetus with oligohydramnios at increased risk of adverse perinatal outcome. Twenty-two gravid women with subjective oligohydramnios on ultrasound had continuous-wave umbilical artery velocimetry. Subjects were divided into two groups based on the results of Doppler analysis. Group 1 (N = 13) had normal umbilical Doppler waveforms. In this group, 12 of 13 patients had normal perinatal outcome, defined by the absence of intrapartum fetal distress or evidence of intrauterine growth retardation. Group 2 consisted of nine subjects with abnormal waveforms. Perinatal morbidity occurred in 100% in this group. We conclude that an abnormal umbilical artery waveform may provide confirmatory evidence of impending fetal compromise when the antenatal sonographic diagnosis of oligohydramnios is made.

The physician who encounters a patient in late pregnancy with a neural tube defect is presented with a difficult task of management and treatment. A thorough examination of the defect(s) is mandatory. This can be accomplished best with ultrasound examination. It is then imperative to assess the severity and survivability of the fetus, and to counsel properly the patient as to diagnosis, severity, and options available. After discussion with the proper consultants, patients should have considerable input into the management, and should be informed adequately to make an intelligent and proper decision. After careful assessment and thorough consultation and counseling with the patient and her support person, therapy can be initiated, followed by some type of grief counseling with appropriate follow-up. Patients also should be informed as to subsequent risks and what, if anything, could possibly be done to prevent recurrences. By this careful and thorough approach it is hoped that physicians who encounter neural tube defects late in pregnancy will make a considerable difference in the physical as well as the emotional health of the patient.

We trust that this communication will further the understanding of the concepts involved in wrongful life and wrongful birth and will assist the conduct of medical practice in such a way to minimize risks to patients and ultrasound physicians with regard to their liability. When these physicians are involved in wrongful life cases, we believe that the concepts presented will assist them in understanding the legal and societal environment in which they find themselves. We hope also that this communication may assist the defense attorney to more effectively prepare a response to the plaintiff's legal theory. Knowledge should provide understanding, if not relief.

The nonstress test is a commonly used tool for fetal well-being assessment. The antenatal death rate using the nonstress test as a primary modality is significantly higher than that with the use of the contraction stress test. The nonstress test is commonly performed on a once-a-week basis. The rate of stillbirths with reactive nonstress tests, performed once a week, was 6.1 per 1000 in the author's previously published report. Nonstress tests were performed on a twice-a-week basis beginning January 1981, and results are reported on 913 such patients. The rate of stillbirths with reactive nonstress tests was reduced to 1.9 per 1000 in this second group. It is suggested that the patients who are at risk for fetal stress should be evaluated on a twice-a-week basis when the nonstress test is used as the primary test.

Presented is a patient with acute onset of preeclampsia and abruptio placenta at approximately 26 weeks' gestation. Ultrasonography demonstrated evidence of in utero fetal intracranial hemorrhage, which was confirmed at autopsy. The implication of this finding is discussed.