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Background: After Hurricane Katrina, the 2 primary teaching sites for Louisiana State University Health Sciences Center in New Orleans were destroyed. In this study, we examine the measures the Louisiana State University Department of Obstetrics and Gynecology took to provide uninterrupted education for Obstetrics and Gynecology residents and the outcome of those measures., Methods: Information was gathered from the program director's office and the Accreditation Council for Graduate Medical Education website. Resident turnover during the disaster and where residents trained before and after Katrina were tabulated. Council on Resident Education in Obstetrics and Gynecology scores, obstetric statistics, and American Board of Obstetrics and Gynecology pass rates before and after Katrina were analyzed for significant differences from year to year., Results: After Katrina, all residents were shifted to other teaching sites in the state, and the program gained 2 additional private teaching sites. The department lost 10 residents in the year following Katrina and replaced them with 5 new residents for the next academic year. There was no significant difference in Council on Resident Education in Obstetrics and Gynecology scores for individual residents from 2004 to 2006, and the median score for the program has not changed significantly for the past 4 years. The only number that has changed is the number of cesarean sections performed by second-year residents, which decreased significantly from 2005-2006 to 2006-2007 but has stabilized over the last year. The classes of 2004-2006 had 100% pass rates on the written American Board of Obstetrics and Gynecology examination, with 1 failure in 2007., Conclusions: The Obstetrics and Gynecology program at Louisiana State University Health Sciences Center provided uninterrupted training for residents through cooperation with other Louisiana State University facilities and private institutions in the state. We saw a small decrease in the number of cesarean sections performed by our second-year residents 1 year after Katrina; however, the rest of the resident experience has remained stable.

Background and Goal: Late pregnancy rescreening is advised for at-risk patients, but data supporting this recommendation are lacking. The intent of this study was to determine the value of a late-pregnancy test for gonorrhea after a negative initial test at the beginning of prenatal care., Study Design: A retrospective chart review of clinic records over a 29-month period identified patients with a positive DNA direct assay for gonorrhea either initially or at 34 weeks., Results: Of 751 women, 38 (5.1%) had gonorrhea diagnosed at their first testing; 19 women (2.5%) were positive only at their second screening. For one patient, both tests were positive., Conclusion: Repeating screening for gonorrhea at 34 weeks in a high-prevalence population is warranted.

Objective: Our purpose was to compare fetal heart rate reaction to external physical stimulation with the non-stress test (NST)., Methods: This was a prospective study evaluating documentation of fetal heart accelerations by two methods. The standard NST was performed prior to the ultrasound evaluation. The NST results were not available to the ultrasonographer. M-mode ultrasound was used to establish a stable fetal heart rate. The ultrasound transducer was used to stimulate fetal movement by indentations of the uterus over the fetal small parts. A second fetal heart rate was determined within 15 s after stimulation., Results: A total of 122 patients had 159 studies performed. The fetal heart rate range due to fetal startle (recoil) was -22 to 14 (median of 3) in the 45 fetuses with non-reactive NSTs and 1 to 38 (median of 15) in the 114 fetuses with a reactive NST (p <0.001). A receiver operating curve comparing the fetal response to the startle and the NST revealed an area under the curve of 0.972, consistent with high specificity and sensitivity., Conclusion: The fetal heart rate response to external stimulation correlates with the formal NST.

Objective: Our aim was to determine the prevalence of thrombocytopenia in pregnant patients who did and did not use cocaine., Study Design: A 1:1 case-control study of 326 patients attending an inner-city, neighborhood-based antenatal program between January 1992 and December 1998 is presented. Data concerning cocaine use (history and urine toxicology study) and platelet count, along with gestational age, were compared by nonparametric techniques (chi2 test, Fisher exact test, Wilcoxon rank sums, and receiver operating characteristic curve)., Results: The prevalence of thrombocytopenia during pregnancy was not different between cocaine-using patients (13/160; 8.1%) and nonusing patients (11/160; 6.9%; difference not significant). In patients who abused cocaine and for whom both positive and negative urine screening results were obtained concomitantly with platelet levels, no difference in platelet counts was evident. Overall, thrombocytopenia occurred more often in the third trimester than earlier in pregnancy for both control and cocaine-using pregnant women., Conclusion: Cocaine use among pregnant women was not associated with thrombocytopenia. A low platelet count was found more often later in pregnancy.

Objective: This study evaluated the relationship between marijuana use and sexually transmitted diseases in pregnant women., Methods: A retrospective review of clinic records over a 12-1/2 month period identified all women entering prenatal care. Eighty-six women using no illicit substance other than marijuana were compared to 441 drug-free women. The prevalence of gonorrhea, chlamydia, syphilis, human immunodeficiency virus, hepatitis B surface antigen, human papilloma virus, and herpes was ascertained., Results: No significant differences were found in the prevalence of any single sexually transmitted disease between pregnant women who used marijuana and drug-free pregnant women. When the presence of one or more sexually transmitted disease was considered, again no difference was found., Conclusion: Marijuana use was not associated with sexually transmitted disease in pregnant women.

This study evaluates risk factors associated with low birthweight in an African-American population. Records of 225 women delivering liveborn, nonanomalous singletons weighing < 2500 g were reviewed. The next parturient, matched for race only, of a similar infant weighing > or = 2500 g constituted the control. This case-control study was conducted among women delivering at University Hospital in New Orleans during 1996-1997. Mothers of infants weighing < 2500 g were more likely to not have finished high school (49% versus 38%), to have received no prenatal care (26% versus 7%), or to have five or fewer visits if care was obtained (52% versus 33%). The mother was more likely to weigh < 60 kg (49% versus 32%), to smoke (24% versus 11%), or to have used cocaine (18% versus 5%) or alcohol (11% versus 5%). Parturients of low birthweight newborns were more likely to have had a prior low birthweight infant (44% versus 19%) and themselves to have had a birthweight < 2500 g (30% versus 13%). Regression analysis confirmed the importance of three parameters as associated with low birthweight: no prenatal care (odds ratio [OR] = 6.0 [1.1-31.4]), alcohol use (OR = 5.2 [1.1-24.8], and low maternal birthweight (OR = 3.9 [1.9-7.9]. These results indicate that evaluations of low birthweight in African Americans should consider maternal birthweight and that efforts to improve pregnancy outcome should be structured in terms of generations.

Objective: To analyze the relationship of phencyclidine (PCP) and pregnancy outcome, as judged by low birth weight (< 2,500 g)., Study Design: A retrospective, case-control study of PCP use was conducted among pregnant women who delivered at a large hospital in New Orleans. PCP use was ascertained by urine screening at the time of obstetric admission. Three control patients were selected for each case, matched for age, parity and month of delivery. The study intended to address the prevalence of low birth weight., Results: Between January 1990 and June 1996, 13,653 patients delivered. Of these, 23 were identified as PCP users. PCP users had smaller infants (2,698 vs. 3,011 g, P < .05); that may have been accounted for by a reduction in gestational age (37.3 vs. 38.3 weeks, P = NS). The users were more likely to give histories of using tobacco, alcohol or marijuana but not cocaine. Syphilis and diabetes mellitus were found more often in the study group. Multisubstance use was also common in the study group. The prevalence of low birth weight was not statistically different for the study and control groups., Conclusion: PCP use was not associated with an increase in low birth weight. When identified, patients using PCP require comprehensive evaluation.

Objective: This study identified behaviors or conditions associated with cocaine use among prenatal patients and evaluated pregnancy outcomes., Study Design: A case-control study of patients attending a neighborhood-based prenatal program was conducted. For each patient who used cocaine, the next prenatal registrant with both a negative history of cocaine use and a negative urine screen for cocaine served as the control., Results: Cocaine use was associated with older, multiparous women who had a history of prior low birth weight infants. Prenatal care was obtained later and less frequently. Other substances, including tobacco, alcohol, and marijuana, were more commonly used. A history of physical abuse and violence, as well as incarceration, was identified more often. The prevalence of syphilis was higher. Women who used cocaine were delivered of their infants earlier; prematurity occurred more often. Their infants were smaller. Regression analysis identified factors other than cocaine as important in either low birth weight or preterm delivery. Attainment of a greater number of prenatal care visits was associated with improved outcome., Conclusion: Women who use cocaine have numerous significant life disturbances, which may collectively influence pregnancy outcome. Cocaine use itself is a marker and did not appear to influence the prevalence of low birth weight or preterm delivery.

The objective was to assess the occurrence of miscarriages, low birth weight, and karyotype abnormalities found with low and elevated maternal serum alpha-fetoprotein (MSAFP) among women who had genetic amniocentesis performed. A retrospective study of 2,159 women who had MSAFP analysis prior to amniocentesis was conducted. Pregnancy outcomes were obtained from record review and physicians follow-up. Limits of MSAFP used in analysis were <0.5 adjusted multiples of the median (MOM) (lower levels) and >2.0 MOM (upper levels). Autosomal trisomy was found in 1.6% with low, 0.9% normal, and 0.6% with elevated MSAFP values. Sex chromosome abnormalities were present only in patients with normal MSAFP, [45X (n = 6), 47XXY (n = 2), 69XXX]. Of five open neural tube defects, four had elevated MSAFP and one had a normal value. Omphalocele was identified in four patients, two with normal and two with elevated MSAFP. Gastroschisis was found in one low and one elevated MSAFP. Amniotic fluid alpha-fetoprotein (AFAFP) values did not correlate with MSAFP values. Patients with low MSAFP levels had a greater prevalence of abnormal karyotype (19 of 249, prevalence = 0.076) than patients with an elevated MSAFP level (2 or 166, prevalence = 0.012 OR (odds ratio) = 0.20 (P value = 0.024) when unadjusted for maternal age, and OR = 0.09 (P value = 0.001) when adjusted for maternal age. Spontaneous abortion occurred more often in patients with elevated (4 of 166, or 4%) than normal or low (20 of 1948, or 1%) values of MSAFP (odds ratio 4.32, P = 0.020 when adjusted for maternal age). Birth weight below 2,500 g was present less frequently with low or normal MSAFP (136 of 1,760, or 7.7%) than in elevated MSAFP (21 of 144 or 14.6%) (odds ratio 2.04, P = 0.005, unadjusted; and odds ratio = 2.32, P = 0.003, adjusted for maternal age). Female fetuses were present more often with low MSAFP (136 of 249, or 55%) than elevated levels 43% (71 of 164, or 43%; P = 0.024). We conclude that patients undergoing genetic amniocentesis with MSAFP <.5 MOM are less likely to miscarry, deliver a low birth weight newborn, or have a male infant than patients with MSAFP levels >2.0 MOM.

Objective: To evaluate the effectiveness of an advanced-practice nurse-obstetrician collaborative prenatal practice., Methods: A group of 194 consecutively enrolled medically low-risk obstetric patients was identified between January 1, 1994 and December 31, 1994 at Neighborhood Pregnancy Care, a collaborative-practice site. An equal number of medically low-risk patients attending the Louisiana State University obstetric clinic at the Medical Center of Louisiana at New Orleans was selected randomly from among those registering the same month. The two groups were compared on the primary outcome variable, low birth weight. Data were analyzed by chi2, Fisher exact test, t test, and regression models., Results: We compared 179 collaborative-care and 181 university patients with retrievable information. By univariate analysis, collaborative-care patients more often were teenagers and black, and less likely to be married or employed. Collaborative-care patients had more prenatal visits and were more likely to participate in Medicaid, but less likely to deliver at the Medical Center of Louisiana at New Orleans. Birth weight and gestational age at delivery were greater. Both delivery before 37 weeks (7.3% versus 17.7%, P < .001) and birth weight less than 2500 g (8.9% versus 19.3%, P < .001) were less common. When differences identified at the initial obstetric visit were considered, multivariate weighted logistic regression confirmed the importance of prenatal care at the collaborative-practice program for low birth weight (odds ratio [OR] 0.37; 95% confidence interval [CI] 0.19, 0.71) and preterm delivery (OR 0.36; 95% CI 0.16, 0.78). When all differences were entered, low birth weight remained a significantly less likely occurrence at the collaborative-practice site (OR 0.46; 95% CI 0.23, 0.92)., Conclusion: An advanced-practice nurse-obstetrician collaborative practice may be implemented successfully and lead to acceptable perinatal outcomes, as judged by low birth weight and prematurity.

Objective: In this article we describe a program that evolved from collaborative care given to a low-risk population into collaborative care that included patients at high risk., Study Design: The study population comprised women attending a prenatal program in an urban, underserved neighborhood. Clinic records were reviewed for number of patient enrollments and total patient visits, as well as providers utilized. Episodic audit over a 3-year period of 180 of 869 patients initiating prenatal care was done. Data from vital statistics for 1992 and 1993 were evaluated for adequacy of prenatal care and yearly births for the census tract served. Analysis was descriptive., Results: Almost all of the patient population served was found to be at psychosocial high risk. Approximately 10% had significant obstetric or medical complications. Infections, especially sexually transmitted diseases, were common. Fewer than 1% of the patients were referred to another provider for treatment. The program demonstrated an increase in patient volume, improved retention of patients for complete prenatal care and delivery, a reduction in patients receiving no or inadequate care, and a reduction in yearly births., Conclusion: The collaborative practice model may be extended to high-risk populations.

Objective: This study analyzed the relationships between cocaine use, various other parameters, and perinatal outcomes., Study Design: A case-control study of cocaine use was conducted among pregnant women delivered at a large urban hospital in New Orleans, Louisiana. Two control patients for each case, matched for age, race, parity, and month of delivery, were selected., Results: Between April and September 1990, there were 2332 admissions to the obstetric service; urine toxicology screens were obtained on 2225 patients. Cocaine metabolites were identified in 166 patients; 138 of these women had data that could be evaluated. These data were compared with those of 276 control patients, and the findings were analyzed. Complications that occurred significantly more often in study patients included vaginal bleeding, abruptio placentae, premature rupture of the membranes, meconium staining of the amniotic fluid, and low birth weight. Study patients were found to use prenatal care less often (45.0% vs 86.4%) and to smoke cigarettes more often (67.4% vs 35.1%). Regression analysis identified lack of prenatal care and smoking as important variables in birth weight. When these two variables were excluded, identifiable differences in bith weight between cocaine and control mothers were no longer present., Conclusion: The reduction in birth weight experienced by patients who used cocaine may be explained by lack of prenatal care and by smoking. Other identified differences observed between study and control patients were not significantly altered by smoking or prenatal care.

This study was undertaken to compare the morbidity of cesarean section hysterectomy (C-HYST) and cesarean section bilateral tubal ligation (C-BTL) in a nonemergency or elective environment. Charts were reviewed for patients who underwent elective C-HYST or elective C-BTL before the onset of labor, without the use of antibiotics. Demographics, maternal morbidity, operative difficulties and postoperative complications were compared. Statistically significant differences in patient demographics include a higher maternal age in the C-HYST group than for those in the C-BTL group (31.0 +/- 5.8 versus 27.7 +/- 5.4 years; p = 0.002). C-BTL patients had higher gestational ages (39.4 +/- 1.6 versus 38.7 +/- 1.3 years; p = 0.0017). The C-HYST group had a higher estimated blood loss (1,201 +/- 472 versus 718 +/- 364 milliliters; p = 0.001), change in hematocrit level (6.0 +/- 4.4 percent versus 4.5 +/- 3.4 percent; p = 0.013) and operating time (115 +/- 37 versus 74 +/- 26 minutes; p = 0.0001). Blood transfusion was similar in both groups. Febrile morbidity was higher in the C-BTL group (68.0 percent versus 50.0 percent; p = 0.01). Endometritis was the significant determinant of febrile morbidity for the C-BTL group (41.7%) and cuff cellulitis in the C-HYST group (25.6 percent). Intraoperative and postoperative complications between the two groups were rare and not statistically different. Clinical morbidity for C-HYST is not significantly different than C-BTL. Elective C-HYST may be used in place of C-BTL when indications for hysterectomy are present.

Objective: To compare the tocolytic efficacy and side effects of parenteral and oral magnesium and terbutaline., Methods: Ninety-eight patients in labor between 23-35 weeks were prospectively entered into a controlled trial of intravenous and oral magnesium versus subcutaneous and oral terbutaline. Tocolytic effectiveness was judged by delay of delivery for 48 hours or 1 week, and to 37 weeks or more. The need to change therapy to the alternate drug was identified, as were side effects. Entrance characteristics of the population, initial pelvic examination, and concomitant infection or cervicovaginal isolates were noted. Outcomes included gestational age at delivery, birth weights, and Apgar scores. Outcome analysis was based on initial tocolytic therapy., Results: Significantly more patients in the magnesium group delivered at 37 weeks or more: 34 of 46 versus 27 of 52 (P < .05). No significant differences were found for delivery by 48 hours or 1 week. The interval between treatment and delivery was greater for magnesium: 7.1 +/- 3.9 versus 5.0 +/- 3.2 weeks (P < .005). Failure to achieve 37 completed weeks was more often due to obstetric complications than to preterm labor itself. Tocolytic effectiveness was reduced if secondary therapy or re-treatment was required or if the patient had cervical dilatation of 3 cm or greater. Infectious complications were common but were not associated with tocolytic effectiveness. Side effects were more noticeable with oral magnesium and subcutaneous terbutaline., Conclusions: For short-term tocolysis, no significant difference was found between magnesium and terbutaline. Magnesium was associated with a higher term delivery rate. Idiopathic preterm labor accounted for only a small part of the overall prematurity in the study population.

Previous reports have suggested that pregnant diabetic patients have higher carriage rates of group B Streptococcus (GBS) than nondiabetic gravidas. In order to evaluate this in our population, we cultured the posterior pharynx, endocervix, vagina, and rectum of 101 diabetic pregnant women and 100 nondiabetic gravida patients. The colonization rate of GBS was higher in the diabetic population, 31.7%, than in the nondiabetic group 19.0%, (p < 0.039). The vagina was the site most often positive in both diabetic and nondiabetic populations (23.8% and 17.0%, respectively, p = NS). The second site to culture positive overall and the only individual site that was positive significantly more often in diabetics was the rectum (16.9% versus 7.0%, p < 0.05). Differences in colonization rates were not evident when insulin requirement and diabetic classes were considered.

Objective: Because poor fetal growth is a significant cause of perinatal morbidity and mortality, a prospective study was undertaken to evaluate the ability of real-time ultrasonography and Doppler velocimetry to detect the small-for-gestational-age fetus., Study Design: A prospective study of 136 women at risk for fetal growth abnormalities was conducted. Patients were delivered within 3 weeks and had live-born, nonanomalous, singleton infants. The relative estimated fetal weight (estimated fetal weight divided by the median birth weight for gestational age) and the systolic/diastolic ratio were measured and compared with receiver-operator characteristic curves. In this method the area under the curve is the index of performance., Results: Forty-six infants were small for gestational age. Although both relative estimated fetal weight (area under the curve = 0.923) and systolic/diastolic ratio (area under the curve = 0.837) were significantly associated with the small for gestational age fetus, the former was more strongly correlated, p = 0.021., Conclusion: Relative estimated weight is more sensitive and specific and should be the preferred parameter when gestational age is known.

Circumvallate placenta, a form of placenta extrachorialis, should be included in the differential diagnosis of vaginal bleeding in the second trimester with a normally implanted placenta. Heretofore, the diagnosis was made after delivery. This report presents a case of circumvallate placenta diagnosed prenatally by ultrasound. Key features included an infolding of the fetal membrane upon the fetal surface of the placenta during the middle of the second trimester. By the third trimester, only a bright border at the periphery of the placenta was noted. Antenatal diagnosis can be made and pregnancy outcome potentially altered.

A modified biophysical profile was assessed serially in 47 patients with premature rupture of membranes who were not in labor. This profile included fetal movement, fetal tone, fetal breathing, amniotic fluid volume, and placental grade. The most recent study, obtained within 2 days of delivery, was compared with pregnancy outcome as reflected by the development of chorioamnionitis and/or neonatal sepsis. No study patient received antibiotics, steroids, or tocolytics before labor. Neither the composite biophysical profile nor any of its components were found to be different between patients with and without clinical chorioamnionitis. Neonatal sepsis was not observed. These data do not support the use of the biophysical profile as a predictor of maternal infection.

Umbilical cord arterial and venous blood gas values were compared in 63 twin pairs, of which 57 pairs had birth weights of 1500 g or more each. Small differences between the first and second twins existed for PO2, PCO2, and pH. However, bicarbonate values did not differ significantly. These cord gas differences represent minor respiratory aberrations, as reflected by a tendency toward carbon dioxide retention by the second twin. Route of delivery, time interval between deliveries, and nonvertex presentations were not associated with significant deviations from these observed acid-base patterns.

Examination of paired umbilical arterial and umbilical venous blood gases for 147 term, healthy newborns revealed a strong correlation of pH, bicarbonate, and base excess with the 1-minute Apgar score. Although significantly different from each other, a strong correlation existed between the gas measurements of the two vessels. The lower limit of pH for the umbilical artery was 7.12 and for the vein, 7.25. The arterial-venous difference for bicarbonate but not pH, oxygen or carbon dioxide tension, or base excess was correlated with the 1-minute Apgar score.

Histidyl proline diketopiperazine values have been established in human amniotic fluid (n = 81) and maternal serum (n = 36) throughout gestation (10 to 42 weeks). Newborn cord serum (n = 10) and first-voided fetal urine (n = 10) levels were also documented. These measurements reveal increasing amniotic fluid levels with term gestation values (15,551 pg/ml) nearly thirteen-fold higher than maternal serum concentrations (1150 pg/ml). Corresponding fetal urine and cord serum concentrations were 16,781 and 2160 pg/ml, respectively. The amniotic fluid values are not influenced by fetal sex or maternal labor, nor do they correlate with amniotic fluid alpha-fetoprotein levels. However, there is a significant inverse correlation (r = -0.628; p less than 0.0001) between amniotic fluid prolactin and histidyl proline diketopiperazine after midgestation. The hypothesis that histidyl proline diketopiperazine may be a regulatory peptide for decidual prolactin production was tested by culturing term decidua in the presence of varying concentrations of histidyl proline diketopiperazine, but no inhibitory effect was observed. Decidual cultures did not produce measurable amounts of histidyl proline diketopiperazine. It is suggested that amniotic fluid histidyl proline diketopiperazine is derived from fetal urine.

In a cross-sectional study of 210 pregnancies resulting in above-average-sized term infants, ponderal and ponderal-like indices were found to be highly correlative with fetal overgrowth. Clinical usefulness, however, is limited because for each index, most large-for-gestational age infants remain unidentified.

Fetal weight in utero was estimated sonographically within one week of delivery in 70 live-born fetuses of diabetic gravidas. The best estimates of weight were obtained with formulas dependent on biparietal diameter, abdominal circumference, and femur diaphysis length, and with formulas using the two variables of femur diaphysis length and abdominal circumference. Use of a special formula for the fetus of a diabetic mother was not of additional benefit. Acceptable weight estimates for the macrosomic diabetic fetus were not obtained.

Intravenous magnesium sulfate and terbutaline were compared as treatments for premature labor. A successful treatment was the arrest of labor for 24 hours. Early treatment was essential for successful management of premature labor. In this study, magnesium sulfate and terbutaline were equally effective in controlling premature labor. Whereas terbutaline was associated with significant alterations in diastolic blood pressure, maternal pulse, fetal heart rate and potassium concentration, magnesium sulfate was not. Magnesium sulfate holds promise as a tocolytic agent, and further clinical study of it is warranted.

Renal disease in pregnancy may be progressive but only rarely. The problems encountered that create maternal and fetal morbidity and mortality relate to the development of superimposed preeclampsia and renal failure. Diagnosis is important to differentiate the cause of renal pathology so that appropriate treatment can be undertaken. The use of medications in renal disease in the presence of hypertension is controversial; however, adequate therapy should be given if indicated. Most cases of renal disease in pregnancy do not require termination; however, counseling concerning pregnancy is needed initially or subsequently.

Amniotic fluid (AF) was collected from 37 selected patients by amniocentesis, aspiration through a pressure catheter, or aspiration at the time of cesarean section. The unspun AF was examined directly by Gram stain for bacteria and white blood cells (WBC) and was cultured. Thirteen AF cultures were positive, defined as growth on primary plating media which corresponded to greater than 10(2) colony-forming units (CFU) per milliliter. Almost equal numbers of aerobic and anaerobic bacteria were isolated. The presence of bacteria, but not WBC, on Gram stain of AF correlated significantly with a positive culture, which indicated that microscopic examination of AF would usually predict the culture result. Growth of greater than 10(2) CFU/ml from AF was significantly associated with clinical chorioamnionitis, but colonization also was observed in five afebrile patients, four of whom were in premature labor. In patients delivered by cesarean section, bacteria on Gram stain and a positive culture from AF each were significantly correlated with postpartum endometritis.

In pregnancy, sickle cell trait is associated with an increased incidence of urinary tract infection. Hemoglobin S levels vary from 25% to 44%. Patients with lower hemoglobin S levels are less likely to have urinary tract infections than patients with higher levels of hemoglobin S.

Term, large for gestational aged newborns were retrospectively evaluated. The fetal parameter of relative growth, was measured using the ratio of fetal length to abdominal circumference (FL/AC). This measurement was not different between diabetic and nondiabetic gravidas who delivered LGA infants when ultrasound was obtained within 1 week of delivery.

In a cross-sectional study of 210 pregnancies resulting in above-average-sized term infants, biparietal diameter, femur length, and abdominal circumference were found to differ among three birth weight percentile groups (greater than 90, 76 to 90, and 51 to 75). Growth rates, however, were similar. Estimated fetal weights, derived from four formulas, showed the same pattern. Differences between large for gestational age infants and other above average sized infants exist; changes in growth are likely to have occurred before the thirty-third week of gestation.

In a study of 324 term pregnancies, fetal measurements (biparietal diameter, femur length, and abdominal diameter) obtained within one week of delivery correlated more strongly with relative birth weight than with menstrual age.

Sonar biparietal diameter, femur length, abdominal circumference, femur length/abdominal circumference ratio, ponderal index, and estimated fetal weight were obtained within ten days of delivery of small-for-gestational-age (SGA) (N = 102) and non-SGA (N = 204) newborns. The effectiveness of each ultrasound variable in the antenatal recognition of the SGA fetus was assessed. An abnormal abdominal circumference was the best predictor, confirming SGA in 98% of cases. Other variables (biparietal diameter, femur length, femur length/abdominal circumference ratio, ponderal index, or estimated fetal weight) were less accurate for predicting SGA. When we determined expected results based on a 10% prevalence of SGA, negative predictive value was greater than 92% for all variables studied; however, with the exception of estimated fetal weight and femur length, positive predictive values were disappointing, including abdominal circumference (21%). This report establishes the limits of ultrasound-derived growth variables in the antenatal identification of the SGA fetus.

Ultrasonographic examinations, including placental grading, were done in 145 smoking and 100 nonsmoking low-risk obstetric patients at 37 weeks' gestation. Extensive calcification--grade III changes--occurred significantly more often in smokers than in nonsmokers (36 versus 14%; P less than .0001). Two groups of smokers, consuming five to 15 cigarettes per day or one or more packs per day, also had significant differences in grade III placenta when compared with nonsmokers. Smokers under age 20 years were more likely to have premature grade III changes; however, parity did not influence premature placental calcification in smokers and nonsmokers. The incidence of small for gestational age infants delivered was not significantly higher in smokers, and grade III placental changes appeared to occur no more often in SGA infants of smokers than of nonsmokers. Our findings suggest that the smoking gravida is at increased risk for premature placental calcification.

Among 246 term patients undergoing ultrasonic evaluation within 1 week of delivery, a grade-three placenta was found in 39.4%. Advanced placental maturity was not associated with altered fetal growth rates or an increase in small- or large-for-gestational infants. At term, advanced placental maturity is not associated with aberrant fetal growth.

In a cross-sectional study of 87 large-for-menstrual-age term infants, intrauterine growth was found to be linear, 34 g per day. Differences between diabetic and nondiabetic pregnancies were not evident.

Maternal mortality rates after cesarean delivery are low, but cesarean section is more hazardous than vaginal delivery by a factor of two to four. Operative complications can be minimized by careful technique and are more often seen in emergency than elective cases. Prophylactic antibiotics are of some benefit in reducing postoperative endometritis in patients with risk factors. Cesarean birth rarely causes the death of a newborn. Nevertheless, significant newborn pulmonary problems, especially respiratory distress syndrome, may follow an inappropriately timed cesarean delivery. Careful attention to clinical measures and supporting evidence of pulmonary maturity from ultrasound will avoid most instances of iatrogenic prematurity. Amniocentesis, with a higher complication rate than ultrasound, may still be required to prove pulmonary maturity in some circumstances. If concern or doubt precludes elective delivery of patients with previous low transverse uterine incisions, one can wait for the patient to go into spontaneous labor.

In 42 diabetic patients evaluated by ultrasonography in the third trimester of pregnancy, 12 fetuses were found to have the diabetic halo. Of that group, the estimated fetal weight exceeded the 90th percentile in eight of nine studies in which the weight could be estimated sonographically. Overgrowth of the fetal head was not a finding in this group of patients and was not associated with the diabetic halo. The diabetic halo appears to be more accurate than the biparietal diameter as an indicator of infants that are large for gestational age.

There were 107 episodes of pyelonephritis associated with pregnancy or the early puerperium occurring in 103 gravidas investigated retrospectively for information concerning prematurity, low birthweight, and antibiotic susceptibility patterns in the recovered microorganisms. No difference was found in the incidence of prematurity on low birthweight between that group and a control group of gravidas from the same population. Members of the Enterobacteriaceae genus were the most common bacterial isolates from the urine, with a large portion of E. coli being resistant to both ampicillin (33%) and cephalothin (13%). Treated pyelonephritis associated with pregnancy does not appear to predispose to prematurity or low birthweight in this population. Also, initial therapy with a first-generation cephalosporin may no longer be appropriate, because a significant number of isolates (11%) were resistant to cephalothin.