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The objective of this study was to determine the impact of an inner-city, hospital-based preterm-birth prevention program on the outcome of twin pregnancies. A retrospective study of delivery outcomes from 1985 to 1992 of eligible consecutive twin deliveries that were > or = 20 weeks' gestation compared two inner-city hospitals in the Bronx, New York: one with a preterm prevention program for twin births and a comparable site offering conventional prenatal care. A group of patients receiving no prenatal care was also included. Outcomes were evaluated by prenatal-care site, except for those who received no prenatal care and delivered at either site. Data were analyzed by chi-square analysis and analysis of variance. Of the 377 twin pregnancies, 330 pregnancies were eligible deliveries. One hundred thirty-four women received prenatal care from the preterm prevention program, 161 received conventional prenatal care at a comparable site, and 35 received no prenatal care. Maternal age, parity, and mode of delivery were similar in the two delivery sites. There was an increased incidence of complications in the no-prenatal-care group compared with the groups who received the preterm prevention or conventional prenatal care. The percentage of low-birth-weight (< 2500 g) and very-low-birth-weight (< 1000 g) infants was similar in the preterm prevention and the conventional care groups. The percentage of extremely low-birth-weight (< 1000 g) infants was significantly lower in twin births of the preterm prevention site (9.7%) and the conventional site (11.3%) compared with the no-prenatal-care group (28.6%) (P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

A case of successful pregnancy in a separated conjoined twin is described. The patient underwent cesarean delivery because of the reconstructed pelvis and extensive perineal reconstruction, which resulted in dense fibrosis. Surgical records and communication with the patient's pediatric surgeons were helpful in planning for delivery.

Objective: To determine the characteristics and consequences of short labor., Methods: Ninety-nine term pregnancies with singleton vertex presentation and labor lasting 3 hours or less were compared with controls with longer labor, matched to the index cases by maternal age, parity, and birth weight., Results: Short labor occurred mostly in multiparas. Both the first and second stages of labor were found to be shortened in these cases. There was significantly more placental abruption, uterine tachysystole, and maternal cocaine use among short-labor cases. Major perineal lacerations, postpartum hemorrhage, birth trauma, and low Apgar scores were distributed approximately equally between cases and controls. A preponderance of the bad outcomes in the short labors occurred in the subgroup of those with rates of dilatation and descent that exceeded established 95th percentile limits., Conclusions: Labors of 3 hours or less in duration were strongly associated with placental abruption, but were otherwise not major contributors to maternal and fetal morbidity.

Asthma complicates 1% to 4% of pregnancies and has been associated with an increased incidence of preeclampsia, gestational diabetes, preterm delivery, and intrauterine growth retardation. Asthma must be treated promptly and aggressively to prevent maternal and fetal morbidity and mortality. New approaches to therapy emphasize treating the underlying inflammation that is associated with airway hyperreactivity as well as treating the bronchospasm directly.

Anonymous urine toxicology screening among parturient women during 1 month in 1990 and selective newborn testing during this and the subsequent 4-month period was done to assess prevalence of drug use among parturients in a municipal hospital in the Bronx and to assess impact of infant urine toxicology screening on discharge placement. Infant testing was performed for maternal history of drug use, poor prenatal care (5 or fewer visits), or infant symptoms. Urine was screened for cocaine, opiates, methadone, barbiturates, amphetamines, and benzodiazepines. Of 204 women screened, 9.3% were positive. Of these, 74% were positive for cocaine and 21% revealed polysubstance use. Only 28.6% of cocaine-positive mothers gave a history of use. Selective testing of 1196 newborns during this 5-month period revealed an apparent prevalence of cocaine exposure of 4.9%. Selective infant testing failed to identify 42.1% of newborns of cocaine-positive women. Social work evaluation was performed on all families and was the basis for reporting to state agencies for protective services. Only 6 of 83 drug-positive infants entered foster care, none because of positive toxicology per se. Selective infant toxicology studies miss many cocaine-exposed infants and has little impact on placement. Universal social work evaluation of families may be as effective and freer of bias than selective urine screening.

Heart rate patterns of 42 fetuses exposed to cocaine near the time of delivery were compared with patterns in 42 controls. Decreased long-term variability and an increased frequency of contractions were observed more often in the cocaine group (P = .046 and P = .0306, respectively). There were no significant differences in the frequency of fetal tachycardia or decelerations. Although accelerations were less frequent in cocaine-exposed fetuses, the difference compared with controls was not statistically significant. We found no characteristic heart rate pattern in fetuses exposed to cocaine near delivery. The heart rate patterns likely represent the underlying state of fetal oxygenation. Frequent contractions in an unstimulated labor should raise suspicions of maternal cocaine use.

We report a case of a large chorioangioma diagnosed prenatally with concomitant meconium peritonitis and hydrops fetalis in the second trimester. Spontaneous regression of the tumor occurred, associated with some resolution of the fetal hydrops and delivery near term with good neonatal outcome.

Of 711 patients who were delivered after one or more previous cesarean sections, 17 (2.4%) had an extremely serious complication. Uterine rupture and placenta previa or placenta accreta with accompanying hemorrhage were the major contributors to mortality and major morbidity. Nine uterine ruptures occurred, including five associated with labor with a low transverse uterine scar and one with an unknown scar (1.4% of trials of labor). There were two cases of placenta previa and five with varying degrees of placenta accreta. The nature and frequency of the observed complications emphasize the potentially serious remote consequences of cesarean section.

Little information exists to help determine the presence or significance of labor abnormalities in women attempting vaginal birth after previous cesarean. A case-control study was performed to obtain information on patterns of labor progress and the incidence of dysfunctional labor in patients having a trial of labor after previous cesarean delivery. Sixty-eight such women were matched to nulliparous and multiparous controls. Labor-curve characteristics for the group of women with previous cesarean differed significantly from those of both the nulliparas and multiparas. When stratified by history of previous vaginal birth, however, those with no previous vaginal birth were indistinguishable from nulliparous controls and those with a previous vaginal birth were indistinguishable from multiparous controls. Parity-specific criteria for the diagnosis of dysfunctional labor were thus indicated. Labor disorders were present most frequently in the previous-cesarean group with no previous vaginal birth (41.9%). This incidence did not differ significantly from that in the control nulliparas (27.1%) (P = .15), but did differ from that in the multiparas (15.8%) (P less than .01). Previous-cesarean patients with a previous vaginal birth had a frequency of labor disorders (14.3%) not significantly different from that of multiparous controls. We conclude that trial of labor in women with a previous cesarean should be evaluated by standard criteria for nulliparas if there has been no previous vaginal birth, and by criteria for multiparous women if there has been any previous infant born vaginally.

In this article, we report a case of third-trimester disseminated herpes simplex virus (HSV) infection in an immunocompromised gravida who was treated with parenteral acyclovir. Rapid resolution of lesions occurred, and the fetus was delivered at term without evident abnormalities. Of the four previous reports on this therapy, there has been one maternal death and survival of all neonates. Acyclovir should be considered in the treatment of disseminated HSV infection in pregnancy.

Fetal heart rate patterns from 15 cases of in utero bacterial fetal sepsis were reviewed. All patterns contained some abnormality, the most common being persistent tachycardia. Ninety-three percent of fetuses had periodic decelerations, which were either late or variable in nature. Neither maternal fever nor fetal tachycardia was invariably present during fetal infection. Although fetal sepsis was associated frequently with fetal heart rate pattern aberrations, no specific pattern was identified that was consistently or uniquely related to infection.