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Zebrafish (Danio rerio) were fed high and low-frequency diets over 40 days to assess the effect of diet on bone parameters. Fish fed 3×/day (High) were significantly greater in total weight and length vs. fish fed 2×/week (Low; <0.01). The High group had significantly higher vertebral bone density (p = 0.0009) and lower bone volume (p = 0.04) compared to the Low group. Scales from the Low group also had higher density of resorption lacunae in their scales (p = 0.02). We interpret these data to hypothesize that higher leptin titers associated with reduced calorie intake is generally catabolic to bone in zebrafish., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [CBB] and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The author is an Associate Editor for General and Comparative Endocrinology and was not involved in the editorial review or the decision to publish this article., (Copyright © 2025. Published by Elsevier Inc.)

The Perinatal Quality Foundation has created an examination containing both knowledge-based and judgment questions relating to the interpretation of electronic fetal heart rate monitoring for credentialing all medical and nursing personnel working on a labor and delivery floor. A description of the examination and the rationale for its use throughout the United States is presented., (Copyright © 2014. Published by Mosby, Inc.)

In 2004, leaders in first-trimester aneuploidy screening and a multidisciplinary group of experts established the Nuchal Translucency Quality Review Program, a national program to standardize education, credentialing, and quality monitoring of nuchal translucency. Since its inception, the program has credentialed more than 6,600 physician and ultrasonographer participants and collected more than 2.4 million nuchal translucency measurements. Ongoing quality monitoring is conducted through statistical analysis comparing the distribution and standard deviation of participants' nuchal translucency measurements against those obtained from a standard referent curve. Results of these analyses are distributed to participants quarterly and are used to track each participant's performance and to trigger performance improvement activities or mandatory remediation. This program could serve as a template for future education and credentialing programs that include partnerships with academic leaders, national professional organizations, and industry.

Despite advances in obstetric and neonatal care, the last several decades have not witnessed an improvement in the prediction or prevention of term cerebral palsy. Obstetric interventions such as electronic fetal heart rate monitoring and cesarean delivery, although biologically plausible as intervention strategies, do not improve perinatal outcomes in clinical practice. In reaction to mounting medicolegal pressure, obstetricians continue to increase the number of cesarean deliveries they perform as a form of defensive medicine, despite evidence that this practice is not associated with improved perinatal outcomes. The current standard for expeditious delivery in a case of potential fetal compromise is described by the "30-minute rule." However, obstetricians' determinations of the need for expedited delivery may be a preferable guide for appropriate delivery timing.

Objective: Our purpose was to study fetal growth after reduction of high-order multiple gestations to twins., Study Design: Birth weight and gestational age data were collected for 236 triplet and greater multiple pregnancies reduced to twins (113 triplets, 89 quadruplets, and 34 quintuplets or above) and was compared with those of a control group of unreduced twins., Results: Rates of intrauterine growth restriction per pregnancy were significantly different between the nonreduced and all categories of reduced multifetal pregnancies. The incidence of intrauterine growth restriction was 19.4% in the nonreduced twins, 36.3% in pregnancies reduced from triplets, 41.6% in pregnancies reduced from quadruplets, and 50% from higher-order multiple gestations. There was a statistically significant trend toward increasing frequency of intrauterine growth restriction with increasing starting fetal number (p = 0.04). The increase in intrauterine growth restriction was primarily accounted for by twin pairs with only one growth-restricted newborn., Conclusion: Multifetal pregnancy reduction does not reduce the incidence of intrauterine growth restriction in the remaining fetuses to that of nonreduced twins.

Objective: Although an association between subclinical intrauterine infection and preterm birth is well established, there is conflicting evidence regarding the benefits of antibiotic administration to women in preterm labor with intact membranes. We attempted to determine the effect of ampicillin-amoxicillin and erythromycin treatment on prolongation of pregnancy, the rate of preterm birth, and neonatal morbidity in patients with preterm labor and intact membranes., Study Design: A multicenter, randomized, double-blinded, placebo-controlled trial was designed and implemented by the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development. Two hundred seventy-seven women with singleton pregnancies and preterm labor with intact membranes (24 to 34 weeks) were randomly allocated to receive either antibiotics or placebos., Results: Of the 2373 patients screened for participation in this study in six medical centers, 277 women were enrolled (n = 133 for antibiotics group vs n = 144 for placebo group). In each study group, 60% of patients completed all the study medications. The overall prevalence of microbial invasion of the amniotic cavity was 5.8% (14/239). No significant difference between the antibiotic group and the placebo group was found in maternal outcomes, including duration of randomization-to-delivery interval, frequency of preterm delivery (< 37 weeks), frequency of preterm premature rupture of membranes, clinical chorioamnionitis, endometritis, and number of subsequent admissions for preterm labor. Similarly, no significant difference in neonatal outcomes could be detected between the two groups including respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, and admission and duration of newborn intensive special care unit hospitalization., Conclusion: The results of this study do not support the routine use of antibiotic administration to women in preterm labor with intact membranes.

To assess the correlation between Doppler velocimetry and perinatal outcome in the postdates pregnancy, 75 women who were at least 41 weeks' gestation were evaluated twice weekly until delivery. Evaluation included Doppler velocimetry of the umbilical and uterine-arcuate arteries, as well as nonstress testing and amniotic fluid volume estimation. The mean umbilical artery systolic-diastolic ratio (S/D) was significantly higher in the pregnancies with subsequent abnormal perinatal outcomes than in those with normal outcomes (2.42 versus 2.19; P = .03). Using a receiver operating characteristic curve, an abnormal umbilical artery S/D was defined as 2.40 or greater. Using this value, sensitivity was 57.1% and specificity was 77.8%. Our study suggests that an umbilical artery S/D of 2.40, rather than the more traditionally accepted cutoff of 3.0, may be a useful threshold to identify those postdates pregnancies at high risk for abnormal perinatal outcome.

Pregnancies with decreased amniotic fluid volume are prediposed to umbilical cord compression and variable fetal heart rate declerations. Intrapartum amnioinfusion has been utilized in an effort to reduce cord compression. Previous studies suggested that amnioinfusion may improve the fetal metabolic state and reduce the incidence of cesarean delivery in selected patients. In this study the hypothesis was tested that intrapartum amnioinfusion will relieve cord compression in pregnancies complicated by oligohydramnios and will result in a reduced incidence of fetal intolerance to labor as well as improved fetal acid-base status at delivery. Thirty-five patients fulfilling the inclusion criteria were randomized to either the control (n = 16) or amnioinfusion treatment group (n = 19). Analysis of the data suggested that the two groups were similar for the perinatal parameters evaluated. No differences were observed in the umbilical artery blood gas analysis or incidence of cesarean section between the two groups. Intrapartum amnioinfusion does not appear to improve the perinatal outcome in pregnancies with oligohydramnios.

Northwestern Perinatal Center in Chicago, Illinois, developed and implemented a maternal-fetal transport system. The system is unique not only because it is in a metropolitan area but also because the transport teams are nurses only in more than 95% of the maternal-fetal transports. Rationale and design of the system, development of the team, discussion of problems, and certification process for nurses is presented.

Serial ultrasound estimates of fetal biparietal diameter and abdominal circumference were used as differential indices of intrauterine growth of insulin-insensitive and insulin-sensitive structures, respectively, in 23 White's classes A to C diabetic women. Biparietal diameter in all fetuses conformed to growth patterns for fetuses of nondiabetic mothers. However, two patterns were noted for abdominal circumference. Normal increases occurred in 13 fetuses; in the remaining ten, growth of abdominal circumference exceeded upper normal limits from weeks 28 to 32 of gestation onward. This latter group with putative "accelerated somatic growth" in utero had more immunoreactive insulin in amniotic fluid, weighed more at birth, and had more subcutaneous fat. Serial differential ultrasonography may be useful for detecting evolving macrosomia in diabetic pregnancies, and fetal insulin or insulin-like principles may contribute to the macrosomia.

Five hundred eighty-eight women who were delivered of twins at 13 hospitals affiliated with the Northwestern University Medical School or its outreach institutions between 1971 and 1975 were studied. Eighty-six of the infants did not survive the pregnancy, delivery, or the first week post partum. Maternal demographic and obstetric characteristics are outlined. Infants are categorized by birth order and by birth weight. The mean weight (and standard deviation) of first twins was 2,388 gm (+/- 742 gm) and that of second twins was 2.314 gm (+/- 766 gm). The rate of pregnancy wastage was highest in mothers who were under 20 years of age, who were of low parity, and who were delivered prior to the physiologic maturation of the fetus. The crude mortality rate of twin 1 was 6.1/100 versus 8.5/100 for twin 2. The causes of death in all infants over 2,000 gm are listed. All pregnancy losses are categorized into unavoidable deaths (26.6%), probably not avoidable deaths (59.4%), and possibly avoidable deaths (13.9%).

The case of a 37-year-old primigravida with severe obstructive lung disease and alpha1-antitrypsin deficiency is reported. Serial pulmonary function studies and arterial blood gases were obtained during the antenatal and postpartum periods. Intrauterine fetal growth was monitored with serial ultrasonic fetal biparietal diameter determinations. Serial oxytocin challenge tests were used to monitor uteroplacental function. Aggressive chest physiotherapy was used to maintain good maternal bronchopulmonary hygiene. A normal female infant was delivered vaginally at 38 weeks' gestation following an uneventful labor. The available obstetric literature regarding the outcome of pregnancy in patients with obstructive lung disease and cystic fibrosis is reviewed. This literature suggests that pregnancy in a patient with severe obstructive lung disease should be considered a medical indication for therapeutic abortion. Successful delivery of this patient with severe obstructive lung disease and alpha1-antitrypsin deficiency suggests that these conditions are not a contraindication to successful outcome of preganncy for both mother and child.

To test the applicability of equations for fetal weight estimations in a group of fetuses suspected of being large for gestational age, real-time ultrasound measurements of fetal biparietal diameters and abdominal circumferences were obtained for 34 fetuses of diabetic mothers. In the first phase of the study the accuracy in the prediction of weight was assessed with use of two known equations. In the second phase, biparietal diameter, abdominal circumference, and actual birth weight data of the 34 study fetuses were used as independent variables to determine the best-fitting equation for relating estimated fetal weight (EFW) to biparietal diameter (BPD) and abdominal circumference (AC); this equation is log (EFW) = 0.02597 AC + 0.2161 BPD - 0.1999 (AC X BPD2)/1000 + 1.2659. The standard deviation of differences is 322.26 gm and multiple R = 0.781. In the final phase the reliability of this equation was compared to those of Thurnau and Shepard in 34 additional fetuses of diabetic gravid women. The data suggest that in these fetuses suspected of being large for gestational age the weight estimates calculated at or near term may be enhanced if predictive equations are formulated specifically from the data for such fetuses.

Fetal heart rate abnormalities associated with prolonged pregnancy have been attributed to umbilical cord vulnerability rather than placental insufficiency. Although intrapartum fetal heart rate patterns indicative of umbilical cord compression are common beyond 41 weeks' gestation, fetal intolerance to labor develops only in a subset of such patients. To test the hypothesis that suboptimal placental function contributes to reduced amniotic fluid volume and, ultimately, to fetal intolerance to labor, we prospectively collected biochemical and clinical data on 112 prolonged pregnancies. Data analysis was blinded to outcome and included cord blood acid-base measurements and intrapartum fetal heart rate interpretation. We observed a high incidence of umbilical cord compression (46.4%), but this finding was not predictive of emergent delivery in 32 of 52 cases (61.5%). Fetal acidosis (arterial pH less than 7.20) occurred more often in patients with cord compression, but the anticipated increase in carbon dioxide tension was not observed. Instead, a primary metabolic or combined acidosis was encountered in those fetuses delivered emergently. The additional findings of lower amniotic fluid volume and diminished birth weight in those patients delivered for fetal intolerance to labor suggest a direct role for suboptimal placental function in selected patients with prolonged pregnancy.

Amniotic fluid glucose was measured in 189 amniotic fluid samples from 117 well-controlled Class A to F diabetic pregnant women from 32 to 40 weeks' gestation. A simultaneous maternal plasma glucose level was determined at each amniocentesis. Samples were obtained with the mother in the fasting or nonfasting (3.8 hours after breakfast) state. Amniotic fluid glucose correlated significantly with simultaneous maternal glucose (r = 0.562; p = 0.001). A significant downward linear trend of mean amniotic fluid glucose with advancing gestational age was demonstrated (p less than 0.01). No trend of mean simultaneous maternal glucose with gestational age was seen. These results were not affected by maternal prandial status at the time of amniocentesis. It is concluded that amniotic fluid glucose decreases with advancing gestational age in well-controlled diabetic pregnant women independent of maternal glycemic levels. Studies of amniotic fluid glucose and/or its relationship to other metabolic hormones must take this into account.

Electroacupuncture (ACP) during childbirth was used in 12 parturients. On the average, it produced 66 percent analgesia in 7 patients for 139 minutes while patients were in active, progressive labor. When ACP no longer could relieve pain, spinal, epidural, or double-catheter technic produced complete analgesia in all patients. ACP did not adversely affect the fetus or uterine contractions and had no harmful aftereffect on mother or neonate. However, its use as a routine method had disadvantages because analgesia was inconsistent, unpredictable, and incomplete. The technic was time-consuming, limited the patient's movement, added more wires and machinery, and interfered with electronic monitoring of the mother and fetus.

The clinician considering administration of steroids to prevent respiratory distress syndrome (RDS) should attempt to identify patients who do not have criteria previously shown to increase the likelihood of benefit in the prevention of RDS. It is possible to accurately predict the interval to delivery in most cases. Four hundred thirty-nine patients at risk to deliver prior to 37 weeks have been screened for factors known to decrease the likelihood of benefit. Only 47 (10.7%) screened candidates have no exclusion criteria. Twenty-seven (6.9%) of 392 excluded neonates developed RDS; 20 of the 27 were predicted to and did deliver in less than 24 hours after initial screening. Only one case was inappropriately excluded. Fetal surfactant assessment is crucial; pulmonary maturity excludes 19% at 28 to 33 weeks and 35% at 34 to 37 weeks. Careful screening for exclusion factors known to decrease the likelihood of steroid derived benefit is essential when use of a drug with potential long-term consequences (risk) is considered.

Expectant management of prolonged pregnancy is predicated on reassuring biophysical testing. However, even the combination of a reactive nonstress test and normal amniotic fluid volume may not prevent subsequent morbidity. To test the hypothesis that diminished cord Wharton's jelly incurs risk of peripartum cord compression in addition to decreased amniotic fluid, 68 patients with confirmed gestational age greater than or equal to 41 weeks were evaluated prospectively with semiweekly nonstress tests and weekly ultrasound examinations. Amniotic fluid volume was assessed, and umbilical cord diameter was measured and then correlated with the quantity of Wharton's jelly at delivery, determined by cord circumference. A significant correlation between cord circumference and umbilical cord diameter was observed, even in those patients with decreased amniotic fluid volume. Either an amniotic fluid volume less than 3.8 cm or an umbilical cord diameter less than 1.6 cm was associated with significant cord compression patterns. Peripartum morbidity was greatest in the presence of a smaller cord and decreased fluid, suggesting a synergism between these two factors for the risk of cord compression in prolonged pregnancy.

The development of 50 children relative to the fetal heart rate patterns they demonstrated during labor and delivery was prospectively studied. Normal deceleration patterns were recorded for 12 of the children, while 16 were recorded as moderately severe and 22 as severe variable or late deceleration patterns. The parity and socioeconomic status of the mothers and the sexes of the infants were similar among the groups. A statistically significant developmental difference in favor of children with normal fetal heart rate patterns was seen in the first year of life. However, at 6 to 9 years of age the difference in neurologic and cognitive development was no longer evident. These data do not support the hypothesis that brief abnormal fetal heart rate patterns recorded during labor are indicative of irreversible central nervous system injury.

In this report the predictive value of ultrasonic targeted imaging for fetal anomalies (TIFFA) is defined. Six hundred fifteen pregnant women at high risk for birth defects were scanned from January, 1980, to December, 1983. Follow-up evaluation was available on 569 fetuses. The pregnancies were classified into five groups according to the indications used for ultrasonic targeted imaging studies. The largest number of women were placed in group 1 and were referred because of a variety of abnormalities in previous or ongoing pregnancies. The women classified in the other four groups were examined because of maternal or fetal reasons related to specific craniospinal (29%), urinary (7.9%), gastrointestinal (6.7%), and skeletal (3.7%) defects. In our series the predictive values of abnormal and normal ultrasonic targeted imaging studies were 95% and 99%, respectively. A detailed breakdown of the accuracy of ultrasonic targeted imaging in relation to each anatomic category is presented; these data are useful in counseling gravid women with anomalous fetuses.

Fetal facial reactions and response decrement patterns to external noise stimulation were studied to characterize normal fetal neurobehavior in the third trimester. Response decrement, or habituation, is thought to reflect higher central nervous system function. Two hundred women with uncomplicated pregnancies, who were subsequently delivered of healthy infants at term, were studied between 26 and 41 weeks' gestation. After ultrasound views of the fetal face were obtained, a vibratory acoustic stimulus was applied repetitively to the maternal abdomen near the fetal head. Response decrement was defined as cessation of all components of the facial reaction, except eye blinking, over two sequential stimuli. Three response patterns were scored: (1) no startle, (2) startle without response decrement, and (3) response decrement by 12 stimuli. Whereas only 53% of fetuses between 26 and 27 weeks displayed startle reaction, all fetuses displayed startle responses by 28 weeks. As gestational age advances, an increasing number of fetuses exhibit response decrement, from no decrement at 26 to 27 weeks to 100% decrement at 40 to 41 weeks. A maturation of neurobehavioral response patterns takes place in normal third-trimester pregnancies. Response decrement testing may be a useful tool for in utero neurologic evaluation.

Intrapartum events were studied in 272 patients with meconium-stained amniotic fluid. All infants underwent DeLee suction followed by intubation and 58 of 272 had meconium present below the vocal cords at delivery. Neither the total duration of variable fetal heart rate decelerations or a continuous saltatory pattern nor the presence or absence of late decelerations could be related to an increased risk of meconium below the vocal cords. When a rising baseline fetal heart rate and decreased variability were present as well, a significantly greater proportion of patients had meconium below the vocal cords. Routine obstetric and pediatric suctioning did not prevent the single death that occurred in a fetus who had deep meconium aspiration in utero.

The development of 50 high-risk infants who were provided intrauterine monitoring during labor was prospectively evaluated. Twelve infants had normal fetal heart rate patterns, 16 moderate-severe variable patterns, and 22 severe variable or late deceleration patterns. The parity, socioeconomic status, race of the mothers, and sex of the infants were similar in each group. The infants were examined neurologically 48 to 72 hours after birth and at 2, 4, 6, 9, and 12 months of age. Denver Developmental Standard testing was performed at 2, 4, 6, 9, and 12 months of age. A statistically significant developmental bias was seen favoring those infants with normal fetal heart patterns. Fetal heart rate patterns predicted abnormal performance more accurately than did Apgar scores. Although this data is incomplete, the duration of ominous fetal heart rate patterns appears to adversely affect development.