Vaginal electrohysterography: the design and preliminary evaluation of a novel device for uterine contraction monitoring in an ovine model (.).

Objective: Tocodynamometry is the most common method of labor evaluation but most clinicians would agree it has limited utility before 26 weeks of gestation. The obesity epidemic has further reduced our ability to accurately detect uterine contractions using the tocodynamometer at any gestational age. We sought to design and test a novel contraction monitor that bypasses the maternal abdomen.

Fetal death resulting from an isolated congenital partial pericardial defect.

Background: Congenital pericardial defects occur from a defect in the formation of the pleuropericardial membrane during embryonic development. This defect may be asymptomatic but can be fatal if complicated by herniation of any portion of the heart.

Cases: We report two cases in which herniation of a portion of the heart occurred through a partial left pericardial defect and resulted in fetal death.

Performance of estimated glomerular filtration rate prediction equations in preeclamptic patients.

Accurate estimation of the glomerular filtration rate (GFR) in patients with preeclampsia requires the collection of a 24-hour urine and can have important therapeutic and diagnostic implications. This procedure is often difficult or impossible to accomplish in this patient group. In this study, the Cockcroft-Gault, the Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia.

Clinical consequences of an increasing trend of preferential use of cultured villi for molecular diagnosis by CVS.

Objective: To compare the use of uncultured versus cultured villus cells for DNA-based prenatal diagnosis.

Methods: A retrospective review of molecular testing of chorionic villus sampling (CVS) cases from 1988-2007. Method of analysis, gestational age (GA) at CVS and at diagnosis, time from procedure to results, results of maternal contamination studies, and the laboratory employed were abstracted from patient charts.

The association of hypotonia and depression in the term and near-term neonate with metabolic acidemia.

Aims: To determine the association of hypotonia and depression in neonates at or near term with metabolic acidemia at birth (umbilical arterial pH<7.0 and base excess <-12 mM).

Methods: This case-control study identified 87 infants without chromosomal or congenital abnormalities born at a single university hospital between 7/91 and 10/04 with hypotonia at birth requiring resuscitation and admission to the neonatal intensive care unit that had a cord gas at delivery.

Intrahepatic vein for fetal blood sampling: one center's experience.

Objective: The objective of the study was to examine 1 center's experience with fetal blood sampling via the fetal intrahepatic vein (IHV) and cordocentesis.

Study Design: Consecutive IHV and cordocentesis procedures between July 1987 and February 2006 were compared with respect to success rates, streaming at the sampling site, nonreassuring fetal heart rate (NRFHR), or need for urgent delivery post procedure. A subanalysis of cases with fetal thrombocytopenia was performed.

Intrapartum electronic fetal monitoring and the identification of systemic fetal inflammation.

Objective: To determine if intrapartum electronic fetal heart rate monitoring (EFM) can identify the fetal in utero systemic inflammatory response or neonatal sepsis, risk factors for the development of brain injury.

Study Design: This case-control study matched cases with both histologic chorioamnionitis and funisitis (75 preterm and 63 term) to the next delivery without placental or cord inflammation by gestational age and mode of L delivery. The last 2 hours of EFM prior to delivery were reviewed by 3 perinatologists blinded to placental pathology.

Estimation of glomerular filtration rate in preeclamptic patients.

Accurate estimation of the glomerular filtration rate (GFR) in patients with preeclampsia is often difficult or impossible to accomplish. In this study, the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and MDRD2 formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia. The estimated GFR calculated from these formulas was compared with the creatinine clearance values obtained from a 24-hour urine collection in 209 preeclamptic patients recruited from five large hospitals.

Phenotypic characteristics shared by preeclamptic patients and an animal model of the syndrome: report of a pilot study.

Background: Preeclampsia is a disorder that affects between 3% and 10% of all pregnancies. Progress in the understanding of the etiology (or etiologies) of this disorder has been impeded by the lack of suitable animal models of its early pathogenesis. Etiologic possibilities abound, and there are a number of considerations that suggest that preeclampsia is not one disease but rather a group of diseases with similar phenotypic characteristics.

Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans.

Objective: Our primary objective was to examine the relationship between umbilical arterial gas analysis and decision-to-delivery interval for emergency cesareans performed for nonreassuring fetal status to determine if this would validate the 30-minute rule.

Study Design: For this retrospective cohort study, all cesarean deliveries performed for nonreassuring fetal status from September 2001 to January 2003 were reviewed. A synopsis of clinical information that would have been available to the clinician at the time of delivery and the last hour of the electronic fetal heart rate tracing prior to delivery were reviewed by three different maternal-fetal medicine specialists masked to outcome, who classified each delivery as either emergent (delivery as soon as possible) or urgent (willing to wait up to 30 minutes for delivery) since immediacy of the fetal condition is the key factor affecting the type of anesthesia used.

Nulliparity and duration of pregnancy in multiple gestation.

Objective: We sought to test the hypothesis that nulliparous women with multiple gestations would be more likely to have shorter gestational durations, a higher frequency of previable deliveries, and fewer pregnancy complications when compared with parous women.

Methods: We reviewed the medical records of women who delivered a multiple gestation at 15 or more weeks at 2 institutions between January 1, 1990 and June 30, 2002 (n = 1,035). We recorded demographic data, medical complications, and pregnancy outcomes and analyzed these using paired t tests for continuous variables, chi(2) for categorical variables, and linear regression analysis for the effect of multiple variables on the primary outcome variable, gestational age at delivery.

A dilated fetal stomach predicts a complicated postnatal course in cases of prenatally diagnosed gastroschisis.

Objective: The purpose of this study was to determine whether dilation of the fetal stomach is associated with increased perinatal complications in infants with prenatally diagnosed gastroschisis.

Study Design: From 34 newborn infants with gastroschisis who were delivered at our institution over a 10-year period, 2 groups were analyzed on the basis of the presence or absence of a dilated fetal stomach. Reactive versus nonreactive nonstress test results were recorded, when performed.