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We have compared the deduced envelope (E) protein sequences of two biologically well-characterized yellow fever (YF) virus vaccine strains. The 17DD strain has been produced in Brazil for more than 50 years and used to successfully vaccinate millions of people worldwide. The 17D-213 is a candidate vaccine strain produced in tissue culture which has previously passed the monkey neurovirulence assay for testing human YF vaccines. Nucleotide sequence analysis of polymerase chain reaction-amplified cDNA revealed a number of mutations which were strain- and substrain-specific. A major difference of 17DD and 17D-213 as compared to 17D-204 and Asibi was the existence of a potential N-linked glycosylation site located at amino acid residues 153 and 151 of 17DD and 17D-213, respectively. These acceptor sites are apparently utilized for the addition of high-mannose carbohydrate chains as shown by endoglycosidase analyses of immunoprecipitated E proteins. Glycosylated E protein is also used to assemble YF vaccine virions. This work and eventual complete nucleotide sequence analysis of both vaccine strains should help to define possible changes involved in YF virus attenuation and allow their biological importance to be determined using a recently developed system for generating YF virus from cDNA. In addition, these data provide an estimate on the extent of genetic variability among YF 17D seeds and vaccines.

Studies relating to the treatment of human taeniasis in the Philippines using Atabrine, bithionol, and mebendazole are reviewed. Cure rates of 93.7% for Atabrine, 85%-100% for bithionol, and 84.62% for mebendazole are reported. Aside from these studies, recent experience in the treatment of Taenia saginata infections at the Department of Parasitology, College of Public Health, is also reported. Twenty patients referred to the department were treated, 3 with bithionol, 17 with praziquantel. Of the 17 patients treated with praziquantel, the study reported cure rates of 47-88.24%.

To determine whether serial ultrasonographic examinations with basic anatomic surveys provide an adequate screen for congenital abnormalities that are more common in twins, we compared the results of prenatal sonograms and neonatal examinations for 314 twins (157 pairs) delivered during a recent 42-month period. An anomaly was defined as major if it potentially required surgical repair or precluded normal life expectancy; otherwise it was defined as minor. Thirty-three twins (9.5%) had 40 anomalies; 28 (9%) were major and 12 (4%) were minor. Prenatal ultrasonography with cardiac screening limited to the four-chamber view provided detection of 39% of all major anomalies, 55% of noncardiac major anomalies but none of the cardiac lesions, and 69% of the major anomalies for which routine prenatal management should be altered. No false-positive diagnoses incorrectly altered management. We conclude that serial prenatal ultrasonographic examinations are useful in detecting noncardiac anomalies for which twins are at increased risk, but the four-chamber view is not an adequate screen for the cardiac malformations of twins.

The annular ligament that attaches the circumference of the base of the stapes to the margin of the oval window (fenestra vestibuli) was stained with selective methods for elastic system fibers and was also studied at the ultrastructural level after tannic acid-glutaraldehyde fixation. Although the annular ligament is devoid of elastic fibers, it is rich in elastic-related fibers (i.e. = oxytalan and elaunin fibers). Elaunin fibers predominate in the annular ligament itself and they are continuous with the oxytalan fibers which are embedded in the matrix of the articular cartilage.

Ascaris lumbricoides worm populations were studied from 150 Filipino children (0-14 years) dewormed with pyrantel pamoate (Combantrin) or oxantel-pyrantel pamoate (Quantrel). Populations were classified according to intensity of infection: very light, light, moderate or heavy. A total of 2072 adult worms were sexed (939 males and 1133 females) and weighed. Descriptive statistics on the weights obtained from each sex were derived and one-way ANOVA was performed to compare the mean weights among the 4 intensity classes. Linear regression analysis (individual worm weight versus total worm burden) was also employed to equalize the possible influence of host factors. Statistical analysis revealed that mean weights of both sexes were significantly different and decreased as worm burden increased. This strongly suggests that the "crowding effect" phenomenon may also apply to Ascaris lumbricoides, and not only to tapeworms, as reported in the literature.

Ultrasonographic technique allows for noninvasive quantification of amniotic fluid volume in pregnancy. A series of 12 pregnancies with ultrasonographically confirmed hydramnios is presented in detail. Following the diagnosis of hydramnios an intensive system-by-system evaluation of the fetal structures was performed. Developmental defects known to be associated with the production of hydramnios were detected in 83% of these pregnancies. Anomalies detected included abdominal wall defects, abnormalities of the central nervous system, pleural effusions, obstructions of the fetal gastrointestinal tract, and others. The early definition of hydramnios and the subsequent discovery of anomalies associated with increased amniotic fluid volume may lead to alteration in prenatal care, in intrapartum management, and in postdelivery resuscitative measures in these complicated pregnancies. In this series, despite early diagnosis of hydramnios and associated fetal developmental anomalies, complications of the pregnancies directly resultant from hydramnios resulted in a high perinatal mortality rate.

Transabdominal amniocenteses were performed on both sacs of 14 sets of twins. In each instance one sac was marked with methylene blue to correctly identify the fluids. The lecithin/sphingomyelin ratio was determined on each fluid, and the correlation coefficient between the two sets of fluids was 0.86. There was no significant difference in the fluids' L/S ratios. The importance of this in terms of understanding the variables affecting fetal lung maturation and in clinically managing twin pregnancies is stressed.

A detailed study was made of 150 women delivered of their infants within 72 hours of an amniocentesis where the lecithin/sphingomyelin (L/S) ratio was 2.0 or greater. There were nine neonates with respiratory distress (6.0 per cent). There were two neonatal deaths, both due to severe congenital heart disease. A mature amniotic fluid L/S ratio predicts a newborn infant who will not have respiratory distress syndrome (RDS) in most pregnancies. There is a significantly increased risk of RDS in neonates with a mature L/S ratio if the mother has insulin-dependent diabetes or if there is a resulting low Apgar score. The method of delivery (cesarean section or vaginal) does not affect the frequency of RDS where the L/S ratio is 2.0 or more.

That the lecithin/sphingomyelin (L/S) ratio correlates very closely with fetal gestational age in the uncomplicated pregnancy is well accepted. The presence of fetal or maternal disease has been found to accelerate or retard the development of fetal lung maturity in certain pregnancies. Although only a very small number of isoimmunized pregnancies has been evaluated in the obstetric literature, there is general acceptance that most isoimmunized pregnancies have delayed pulmonary maturation. Our observation has been that, in mild to moderately severe isoimmunized pregnancies, fetal lung maturation is not delayed. This study was designed to compare fetal pulmonary maturation in pregnancies affected by isoimmunization to that in a control group of unaffected but sensitized pregnancies. The results of this study suggest that pulmonary maturation in the mild to moderately affected pregnancy as measured by the L/S ratio is neither delayed nor accelerated but unchanged when comparison is made to the control group.

Anorectal carriage as a possible primary source of vaginal colonization by group B Streptococcus was investigated. The study was performed during two separate periods and included 789 pregnant women and 422 neonates. Specimens from multiple sites were obtained for culture from all women and infants and were streaked onto blood agar plates containing 8 mug of gentamicin sulfate/ml and 15 mug of nalidixic acid/ml, which allow selective growth of streptococci. Cultures positive for group B streptococci were obtained from 162 (20.5%) of the pregnant women and from 50 (11.8%) of the neonates. Rectal cultures were positive for streptococci in 142 (17.9%) of the women, and vaginal cultures gave positive results in 81 (10.2%). The higher incidence of positive results in rectal as opposed to vaginal cultures (ratio of 2:1) was encountered during all phases of the study. This finding suggests that the gastrointestinal tract may be the primary site of colonization by group B Streptococcus and that vaginal colonization may represent contamination from this source.

Twenty-nine women in premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) treatment group. Thirteen serial blood samples were drawn during the first 12 hours of therapy by intravenous drug infusion and they were analyzed for a variety of metabolic substances. There was a significant increase in the blood glucose level in the ritodrine group after one hour and this persisted for the 12 hours of intravenous drug treatment. Plasma insulin levels similarly did not increase in the placebo but significantly rose in the ritodrine group by 30 minutes, peaked at 2 1/2 hours, and remained elevated throughout the infusion. There were no significant differences between levels of plasma glucagon, cholesterol triglyceride, human placental lactogen, or human chorionic gonadotropin in the two treatment groups. Ritodrine caused significant maternal and fetal tachycardia. Its use in women with carbohydrate abnormalities should be monitored carefully. The increased glucose levels may lead to an increased fetal weight.

Placental grading has been proposed as a substitute for amniotic fluid analysis for predicting fetal pulmonary maturity. The efficacy of placental grading was prospectively evaluated by grading the placenta at the time of 174 amniocentesis procedures done for determination of fetal pulmonary maturity. Grade III changes in the placenta were a rare finding that occurred in only 7% of the examinations performed. Placental grading proved to be insensitive in that it predicted pulmonary maturity in only 5% of pregnancies in which amniotic fluid analysis predicted a mature fetus. In addition, placental grading falsely predicted fetal pulmonary maturity in 42% of patients in whom Grade III placental changes were found. These findings suggest that the determination of Grade III changes in the placenta occurs too rarely to be of use in predicting fetal pulmonary maturity in the uncomplicated pregnancy. Incorrect prediction of pulmonary maturity by placental grading in the complicated pregnancy makes this test of little value in the management of high-risk pregnancy.

Seventy-eight amniotic fluid samples were obtained by transabdominal amniocentesis and were analyzed for their L/S ratio and optical density at 400 and 650 nm. The L/S ratio was considered to be mature if the values were greater than 2.0. The optical density of the fluids decreased with prolonged refrigeration. With freshly centrifuged samples, the OD650 reading of greater than 0.15 gave the best correlation with the mature L/S ratio. There were 3.8% false positive results and 14.1% false negative results. The study confirms that the OD650 test on fresh amniotic fluid is a rapid and inexpensive way to determine fetal maturity. All samples with values of less than 0.15 must, however, also be tested for their L/S ratio since some of the infants with these values may also be mature.

Exposure to diethylstilbestrol in utero is recognized to be associated with a wide range of developmental abnormalities in the female genital tract, the most prominent being adenocarcinoma of the vagina. Recently anatomic anomalies have been discovered with increasing frequency. This case illustrates the association of exposure to diethylstilbestrol, cervical incompetence, and poor reproductive history, and stresses the importance of early evaluation.

Of 468 diagnosis-related groups identified by the federal government for Medicaid reimbursement, 15 are related to obstetric hospital care. Each diagnosis-related group is considered a distinct group in which cases are homogeneous with respect to resource consumption. Because the diagnosis-related group system is based primarily on data from community and secondary care hospitals, it does not differentiate sufficiently among high-risk obstetric patients seen at tertiary care institutions, such as Florida's Regional Perinatal Intensive Care Centers. We developed an alternative scheme for diagnosis-related groups, called obstetric care groups, using the federal diagnosis-related groups as the model from which to depart. Data collected for 4192 women during a 2 1/2-year period indicate that obstetric care groups provide more homogeneous groups than diagnosis-related groups for our population of high-risk patients. The obstetric care groups differentiate between no complications, one complication, and two or more complications, while the diagnosis-related groups differentiate only between no complications and one or more complications. Also, complications for obstetric care groups are based on only 19 diagnoses that contribute significantly to resource consumption, while the list of possible complications exceeds 200 for diagnosis-related groups. Although the obstetric care group classification system is simpler than that for diagnosis-related groups, it results in a more accurate reimbursement of hospitalization charges for high-risk obstetric care.

The validity of continuous tissue pH measurements was established in the fetal and neonatal goat model. Simultaneous determinations of tissue, arterial, and venous pH were done during alterations in acid-base status. A highly significant correlation was found between tissue and blood pH levels (r = 0.89, p less than 0.001). These data confirm the accuracy of the tissue pH instrumentation in predicting core blood pH status and support the potential usefulness of the instrumentation in perinatal medicine for continuous fetal acid-base monitoring.

While Apgar scores provide a valid prediction of mortality in term infants (primarily reflecting asphyxia), intervening variables in premature newborns complicate interpretation. Physiologic states normal to preterm infants (such as, decreased muscle tone) can depress scores but may not influence survival significantly. Therefore the relationship between Apgar scores and survival in term and preterm infants differs. Because of the paucity of studies on preterm infants, we tested Apgar scores, as well as birthweight and gestational age, as outcome predictors in 748 low-birthweight infants (500-1800 gm). Our purpose was to assess the relationship between 1- and 5-minute Apgar scores and survival, and to evaluate all combinations of the four variables as outcome predictors. Univariate analysis showed a significant relationship between each of the four variables and survival; however, no single variable accounted for more than 32% of the variance in outcome, thus no single factor could be invoked as the major determinant of survival. Logistic regression analyses demonstrated the interrelationships of the four variables to survival. While both Apgar scores were related to survival, independent of the effects of birthweight and gestational age, they were slightly less predictive than either of these variables alone. However, when 1- and 5-minute Apgar scores were combined with gestational age, the predictive value was slightly better than any of the four variables alone or in other possible combinations.

Evaluation of a mass screening program to detect hepatitis B surface antigen in the obstetric population of Shands Hospital, University of Florida in Gainesville, from January 1, 1983, through December 31, 1985, was undertaken. Prevalence of hepatitis B surface antigen seropositivity was 0.54%. Review of medical records revealed that 67% of patients with positive hepatitis B surface antigen screens had no risk factors identifiable by routine prenatal history. Although all patients were screened on admission to the hospital, the results of the immunoassay were not available in time for staff to institute isolation procedures for the laboring mother or unwashed neonate. In 82% of the cases, treatment of neonates occurred later than 12 hours after delivery (the current Centers for Disease Control recommendation). It is recommended that prenatal screening of all patients with a hepatitis B surface antigen immunoassay be done by 34 weeks' gestation where the patient population is of predominantly low socioeconomic status to ensure appropriate isolation and timely neonatal immunoprophylaxis.

A case of maternal sickle cell anemia crisis is presented. A continuous fetal heart rate (FHR) tracing demonstrates late decelerations that reversed when the mother's condition improved. The importance of recognizing this reversible late deceleration problem is discussed in terms of increasing fetal maturity.

Recurrent first trimester abortions led to evaluation of a 25-year-old woman. Studies revealed she had hypofibrinogenemia (68 mg/dL) without evidence of dysfibrinogenemia or increased fibrinogen turnover. She was also found to have a unique 46,XX, t(7;12) (p 15.2;q24.31) karyotype. Hypofibrinogenemia and identical chromosomal abnormalities were found in other members of her kindred. Southern blots of genomic DNA from the patient, her mother, and her daughter hybridized to human fibrinogen probes showed alpha, beta, and gamma fibrinogen genes to be present and without structural alterations when compared to normal controls. We conclude that the chromosomal abnormality and the hypofibrinogenemia are related but in an unclear manner. Because fibrinogen infusion in the proposita was associated with successful gestation, we also concluded that the chromosomal abnormality itself was not responsible for the repeated abortions but that fibrinogen concentration may be critical in securing implantation.

There were 254 cases studied in which two tests of fetal maturity were performed within 72 hours of each other. The two tests were an x-ray fetogram and an amniotic fluid L/S ratio determination. All fetograms were read by one author for the presence of distal femoral epiphysis (DFE). It was assumed that DFE permits estimation of fetal bone maturation and L/S ratio permits estimation of fetal lung maturity. The DFE results gave a 40% false-positive rate in predicting a mature L/S ratio (greater than 2.0) and a 38.7% false-negative rate. Of the 21 patients who delivered within 3 days of the performance of the two tests, all neonates did well when there were no visible DFE's but a mature L/S ratio. There is a significant lack of specificity and sensitivity of the fetogram DFE's in predicting a mature L/S ratio. Since infant lung maturation is a critical factor in predicting neonatal survival, these results suggest that the x-ray DFE is unacceptable as a single maturity test for use in a perinatal center managing complicated obstetric cases.

This paper describes a technic of intrauterine transfusion using continuous real time ultransonic assistance and discusses complications of intrauterine transfusion. The advantage of ultrasound-assisted intrauterine transfusion in reducing fetal injury and radiation exposure is emphasized.

The cause(s) of decreased amniotic fluid in the absence of fetal anomalies and intrauterine growth retardation is not clear. A prospective study was performed to evaluate umbilical and uterine artery Doppler velocimetric results in pregnancies complicated by decreased amniotic fluid. Three medically high-risk groups were studied: women with (1) normal fluid and intact membranes, (2) decreased fluid and intact membranes, and (3) decreased fluid and ruptured membranes. The decreased fluid/intact membranes group had a significantly increased incidence of abnormal uterine artery waveforms (diastolic notching or absence of end-diastolic velocity); however, uterine systolic/diastolic ratios were not significantly different. The umbilical systolic/diastolic ratios were marginally higher in the intact membranes/decreased fluid group when compared with the ruptured membranes group. This study suggests that problems with maternal blood supply to the placenta may be related to decreased amniotic fluid when membranes are intact.

The diagnosis of urinary-tract anomalies in the fetus can frequently be made with antenatal ultrasound imaging. This report details 19 cases of fetal urinary-tract malformation diagnosed during a 30-month period. Early onset and more complete urinary-tract obstruction, oligohydramnios, renal dysplasia, and pulmonary hypoplasia occur frequently in cases where urinary-tract anomalies were detected in utero. The frequent association of other major structural anomalies, severe renal damage, and irreversible pulmonary hypoplasia make imperative an intensive evaluation of the fetus before considering invasive surgical procedures.

Continuous tissue pH monitoring of the fetus was successfully conducted in 13 of 21 patients (61.9%) during labor. There was a significant correlation between the tissue pH and both the scalp capillary blood pH (r = 0.94, P less than 0.001) and the umbilical artery blood pH (r = 0.92, P less than 0.01). These findings confirm the accuracy of the tissue pH instrumentation in reflecting fetal acid-base status and support the potential usefulness of the instrumentation in perinatal medicine for continuous fetal acid-base monitoring.

Three primigravidas developed Rh sensitization after unexplained third-trimester fetal death. One patient manifested sensitization after the diagnosis of fetal death had been made but before delivery occurred. The other two demonstrated anti-D antibodies early in the next pregnancy, despite having received postpartum Rh immunoglobulin. Unsensitized Rh-negative women with unexplained third-trimester fetal death should be screened routinely for fetomaternal hemorrhage when fetal death is discovered, so that adequate prophylaxis against Rh sensitization can be given.

Changes in placental texture and structure on ultrasonic examination have been suggested as correlating to advancing fetal pulmonary maturity. The association of preterm appearance of Grade III changes in the placenta in the complicated pregnancy suggests that these changes are associated with a decrease in placental function and premature senescence of the placenta. Placentas were routinely graded on all obstetric examinations performed during a 1-year period of time. Those pregnancies in which Grade III changes in the placenta prior to term were reviewed. A high incidence (78%) of perinatal problems were found in association with preterm appearance of Grade III changes. Perinatal complications included maternal hypertensive disorders, intrauterine growth retardation, abruptio placentae, and fetal distress in labor. The high incidence of these disorders in preterm pregnancies with Grade III changes in the placenta suggests that the sonographic changes found reflect placental dysfunction or senescence rather than normal maturational development. The appearance of Grade III changes in the placenta in the preterm pregnancy is suggested as a predictive indicator of potential perinatal problems in late pregnancy.

Factors affecting the adherence of group B streptococci to human vaginal epithelial cells in vitro were examined. Maximal adherence was achieved within 15 min of incubation of bacteria with epithelial cells. Adherence was temperature and pH dependent; maximal adherence occurred at 37 degrees C and pH 5.5. Killing of streptococci with ultraviolet light or penicillin did not affect adherence. Similarly, adherence was not altered by preincubating epithelial cells at 65 degrees C for 30 min. Thus neither bacterial nor epithelial cell viability appears to be a prerequisite for adherence. Preincubation of streptococci at 65 degrees C for 30 min resulted in a marked decrease in adherence, whereas preincubation of group B streptococci with neuraminidase was associated with a significant increase in adherence. The adherence of strains belonging to five different group B streptococcal serotypes was not altered by group-specific or type-specific rabbit antisera. These findings suggest that the site for adherence on the bacterial cell wall is heat sensitive and is marked by sialic acid, but is not related to either group-specific or type-specific antigens.

According to the new federal diagnosis-related group (DRG) system, hospitals are reimbursed fixed sums based on discharge diagnoses, rather than variable sums that depend on specific goods and services consumed and number of days hospitalized. The government is now exploring DRGs as a potential mechanism for reimbursing physicians. In Florida, two DRG-type reimbursement systems were developed for neonatal and obstetrical hospitalizations in tertiary care settings, as departures from the federal DRG system. Called neonatal care groups (NCGs) and obstetrical care groups (OBCGs), both classification systems predicted hospital charges in these settings more accurately than did federal DRGs. The feasibility of a prospective pricing system for neonatologists and obstetricians based on NCGs and OBCGs was investigated. The data showed that neonatologists' charges had a high correlation with hospital charges (r = .90) and that increasing levels of intensity of care as defined by the NCGs were reflected by consistent increases in reimbursement to neonatologists. If the NCG system were to be applied, neonatologists would receive compensation equivalent to that which they currently earn according to the fee-for-service system. In contrast, obstetricians' charges bore almost no relationship to hospital charges. However, modest differences in obstetrician's charges did emerge as a reflection of number of complications, which are incorporated into the OBCG categories; this suggests that a reimbursement system based on hospital OBCG categories might be applied to obstetricians.

Studies conducted on three normally menstruating women demonstrated a distinct cyclic variation in adherence of group B streptococcus type III to vaginal epithelial cells. This cyclic variation consisted of a gradual rise in adherence during the first half of the menstrual cycle, reaching a maximum on day 14, followed by a sharp decline to low levels of adherence that persisted through the second half of the cycle. These changes in adherence correlated directly with the variation in the pyknotic index of the vaginal epithelial cells, suggesting that hormonal factors played a role in adherence of group B streptococci to vaginal epithelium.

The records of 1,021 primigravida women who delivered single infants from 1973 to 1976 and who were in the adolescent (ages 10-15) and mature (ages 20-24) age groups were reviewed. It was found that the adolescent patient is more often black and unmarried, and has less prenatal care than the mature woman. There was a higher frequency of hypertensive disorders in the adolescents but this was related to race. The adolescent had fewer breech deliveries and more postpartum endometritis and premature deliveries. There was no significant difference in the fetal, neonatal, and perinatal mortality in the adolescent pregnancies.

Twenty-nine women with premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) drug group. The 2 groups were of similar age, parity, weight, gestational age, and cervical change at the onset of treatment. They were treated sequentially with intravenous, intramuscular, and oral drugs and monitored carefully during therapy. There was a significant increase in both the maternal and fetal heart rates during ritodrine treatment, and also a significant decrease in maternal blood pressure. Ritodrine-treated women often complained of palpatations. There was no significant difference in the extension of pregnancy, birth weight, or infant survival for the ritodrine group. Although the 1-minute Apgar scores in the ritodrine group were higher, the 5-minute scores were similar in both groups.

The relationship between fetal femur length and biparietal diameter on ultrasound examination was evaluated in a large, unselected obstetric population of 12-40 weeks' gestational age. The derived ratio of fetal femur length to biparietal diameter was evaluated retrospectively as a tool for examining the technical reliability of fetal measurements obtained and as a screening mechanism for detecting asymmetric fetal development. The ratio of femur length to biparietal diameter is of value as an aid to the detection of fetal developmental anomalies and should be a routine parameter considered in the performance of an obstetric ultrasound examination.

Fetal congenital anomalies have become the major cause of perinatal morbidity and mortality in pregnancies complicated by insulin-dependent diabetes. We evaluated the use of level II ultrasound in predicting congenital anomalies, to determine if the management of pregnant women with insulin-dependent diabetes would be altered by these findings. We examined 43 insulin-dependent diabetic pregnancies. In this group, 10 newborns (23%) were diagnosed either at birth or later to have an abnormality. Of these, four (9%) were diagnosed by ultrasound. Of the seven cases that were undiagnosed, three women did not undergo the level II examination, two women had lesions undetectable by ultrasound, and in two women cardiac abnormalities were missed. Of the four congenital anomalies that were prenatally diagnosed, the findings influenced the management in three cases. The level II ultrasound used as a screening test had a 67% sensitivity and a 100% specificity, with a positive predictive value of 100% and a negative predictive value of 91%. We conclude that high-resolution ultrasound may be used as a screening tool for congenital anomalies in the insulin-dependent diabetic pregnancy. This study also suggests that the use of fetal echocardiography with evaluation of aortic and pulmonary outflow tracts, the arch of the aorta, and ventricular size may be helpful in the diagnosis of fetal cardiac anomalies in the pregnant woman with insulin-dependent diabetes.

Fetal movements were measured by 37 pregnant women during a 10-minute period while they were lying on their left side at various times during the day with the highest rates in the evening. Preliminary assessments of fetal movement and serum hPL levels in pregnant women suggest that the two tests might complement each other in providing more information about the status of the placenta and fetus.

Ultrasonic determination of fetal femur length is useful as a parameter in the determination of fetal gestational age. One hundred thirty measurements were made in pregnancies at 14 to 36 weeks' gestation. The measurements were plotted against gestational age, and we found that a strong correlation exists between fetal femur length and fetal gestational age, with 95% confidence limits of plus or minus seven days. This ultrasound parameter of fetal age assessment should be added to the other methods available for accurate dating of pregnancy.

For more than two decades, Apgar scores have been used to predict developmental outcome in newborns. However, most studies have used full-term babies for their data base, and the predictive value of Apgar scores for low birthweight infants has remained unclear. This study was designed to provide a data base for premature infants, demonstrating to what degree Apgar scores predict developmental outcome. We tested Apgar scores alone and in combination with two other easily quantified variables, birthweight and gestational age, as predictors of risk for 256 infants weighing less than 1800 gm at birth. Although significant correlations existed between Apgar scores and Bayley Mental and Psychomotor Developmental Indices, multiple regression analyses demonstrated that these relationships were not significant independent of birthweight and gestational age. That is, after controlling for birthweight and gestational age, Apgar scores did not predict morbidity in low birthweight infants and should not be used to provide a developmental prognosis.

Specimens from 20 human term placentas were stained with 4 different antisera produced against porcine relaxin (Rlx) using the avidin-biotin immunoperoxidase procedure. Cells of the parietal decidua adherent to the fetal membranes, cells of the chorionic cytotrophoblast, as well as cells of the placental basal plate consistently stained with all 4 anti-Rlx sera. Occasionally, Rlx was detected in epithelial cells lining the amniotic membrane. The syncytiotrophoblast stained for Rlx in 2 specimens only. This response was seen only in syncytiotrophoblast that lined villi in close proximity to the basal plate. Syncytiotrophoblast of the chorionic villi either did not stain at all or gave very weak positive immunostaining with the anti-Rlx sera in all specimens. No difference was noted in staining patterns among placentas delivered by elective cesarean section or vaginal delivery.

A 1,340-g male neonate was delivered by emergency cesarean section at 28 weeks' gestation following failed therapy with isoxsuprine hydrochloride and fetal distress. Transverse-lie presentation with the posterior side of the thorax wedged into the maternal pelvis and the head flexed firmly against the anterior side of the thorax led to a severe deformation sequence initially interpreted as multiple congenital malformations. This case illustrates the difficulty in distinguishing between pure deformations and malformations with and without subsequent deformations. It also emphasizes the clinician's need for a definitive diagnosis to guide the management of suspected malformations that are potentially lethal or portend a poor neurodevelopmental outcome.

A study was performed to compare the influence of pregnancy weight gain on infant birth weight and outcome among two groups of indigent women from the rural South: those who were highly overweight before pregnancy (greater than or equal to 135%) and those who were of average weight (90% to 120% of standard weight for height). The groups had comparable numbers of black and white subjects. Pregnancy weight gain affected birth weight in the average-weight group but did not significantly affect birth weight in the highly overweight group. Infant outcomes for both groups were similar. These findings suggest that consideration should be given to not requiring a minimum weight gain for women whose degree of overweight equals or exceeds 135% of standard body weight for height.

Three perinatal health indicators (serum human placental lactogen [hPL] levels, serum free estriol [E3] levels, and OCT) were simultaneously completed in 149 high-risk women who were more than 34 weeks pregnant. There was a significant correlation between the hPL and E3 results (r = 0.28, p less than 0.01). There was a 15.4% positive OCT result rate and the blood hormone values for the negative and positive OCT groups were compared. There was a significantly lower hPL value in the positive OCT group (4.7 +/- S.E.M. 0.4 vs. 6.2 +/- S.E.M. 0.2 micrograms/ml for positive and negative groups, respectively), whereas the free E3 levels were not different in these two OCT groups (14.8 +/- S.E.M. 1.5 vs. 16.3 +/- S.E.M. 0.7 ng/ml for positive and negative groups, respectively). The free E3 value did not help in predicting the OCT result as the low free E3 subgroup had the same frequency of positive OCT result as did the over-all group. There was a highly significant increase in the positive OCT results (42.9%) in women with a low hPL value (p less than 0.01). In those women with an hPL value of 6.0 microgram/ml or more there were only 8% positive OCT's. It is concluded that on hPL test at about 34 weeks of gestation could be used to screen pregnant women, and if the value were low (less than 4.0 microgram/ml) an OCT evaluation test would be indicated, for there is a very high frequency of positive results in that subgroup of women.