The frequency of aneuploidy in prenatally diagnosed congenital heart disease: an indication for fetal karyotyping.

The frequency of chromosomal abnormalities in infants with congenital heart disease has been estimated from postnatal clinic data to be 5% to 10%. Over an 18-month period we performed fetal echocardiograms on 502 fetuses and found cardiac anomalies in 34. Eleven of these fetuses (32%) had abnormal chromosomes.

The use of intravenous pancuronium bromide to produce fetal paralysis during intravascular transfusion.

Intravascular fetal transfusion can be complicated by difficulty in maintaining vascular access because of fetal movements. Treatment by intramuscular pancuronium bromide has been proposed as a means of arresting fetal movements, although this treatment requires a separate puncture for injection. We report in this article our experience with intravenous fetal injection of pancuronium bromide to produce muscular paralysis during fetal transfusion.

Development of a benign intrapericardial tumor between 20 and 40 weeks of gestation.

A case of a massive benign intrapericardial teratoma that presented at two weeks of age with significant respiratory distress is described. In retrospect, it was discovered that this infant had been evaluated by fetal echocardiography while in utero at 20 weeks of gestation due to a maternal history of surgically corrected tetralogy of Fallot. The fetal echocardiogram demonstrated normal intracardiac anatomy and no evidence of either a pericardial mass or effusion.

Combined echocardiographic and Doppler assessment of fetal congenital atrioventricular block.

Fetal heart rate monitoring was combined with fetal echocardiography for examination of atrial reactivity during labour in five fetuses with second or third degree heart block. Alterations in vagal tone accompanying uterine contraction influence atrial rate, even when the ventricle is not under atrial 'control'. Fetal echocardiography enabled diagnosis of the underlying basis of the arrhythmia and located the optimal position for recording atrial activity with an external heart rate monitor.

Fetal echocardiographic screening for congenital heart disease: the importance of the four-chamber view.

The four-chamber view of the heart has been proposed as a screening method for obstetrical sonographers to assess the fetus for the presence of congenital heart disease. We examined the fetuses in 1022 pregnancies and found 74 structurally abnormal hearts. Seventy-one of these (96%) were found to have an abnormality as seen in the four-chamber view.

Antenatal diagnosis and obstetric management of Dandy-Walker syndrome.

Real-time ultrasound equipment has the potential for investigating the fetal neural axis and allows the diagnosis of many anomalies arising from this area. Five cases of Dandy-Walker syndrome, one of the major causes of congenital hydrocephalus, were diagnosed antenatally. In all cases ultrasound allowed specific recognition of the defect in the cerebellar vermis.

The value of serial human chorionic gonadotropin testing as a diagnostic tool in ectopic pregnancy.

This study examines the sensitivity of serial human chorionic gonadotropin determinations in the detection of ectopic pregnancy for patients who present with human chorionic gonadotropin titers less than 6500 mIU/ml. A log human chorionic gonadotropin time curve was used to calculate the slope of change. A slope below 0.

Congenital heart disease and extracardiac anomalies: associations and indications for fetal echocardiography.

Fetal echocardiography is a well-established technique for the prenatal identification of congenital heart disease. One of the indications for its use is the presence of extracardiac anomalies, as such coexistent defects may have important implications for obstetric and neonatal management. We have reviewed the obstetric and pediatric literature to examine reported associations.

The impact of fetal echocardiography on perinatal outcome.

Fetal echocardiograms were performed in 266 gravidae over a one-year period for a variety of previously identified indications. The largest group consisted of 112 patients referred because of other family members with congenital heart disease (CHD). Of these, only one fetus had CHD.

Intrathecal morphine analgesia for vaginal delivery in a woman with a single ventricle. A case report.

In a pregnant woman with a single cardiac ventricle, the coexisting cardiac anomalies provided a means of compensation. For vaginal delivery, intrathecal morphine was used for analgesia.

Percutaneous umbilical blood sampling in the management of Kell isoimmunization.

As the use of Rhesus immune globulin has decreased the incidence of Rh sensitization, other red blood cell antigen systems have become relatively more common. The most common of these is the Kell antigen, which often produces unexpectedly severe fetal disease. High-resolution ultrasound was used to guide in the sampling of fetal blood directly from the umbilical cord as an aid in the management of these patients.

Hermansky-Pudlak syndrome in pregnancy: two case studies.

Pregnancies in two patients with Hermansky-Pudlak syndrome, oculocutaneous albinism with hemorrhagic diathesis, are presented. Outcomes were good despite prior reports of postpartum hemorrhage in patients with this syndrome. This autosomal recessive disease is relatively common in parts of Puerto Rico.

Intestinal parasites and other infections during pregnancy in Southeast Asian refugees.

An influx of Indochinese refugees into the Philadelphia area prompted a review of their reproductive performance as related to parasitic diseases and other infectious complications. A total of 100 infants were delivered of 97 women over an 18-month period (41 Vietnamese, 28 Laotian, 26 Cambodian, 2 Thai). Intestinal parasites were present in 65% of the mothers.

Fetal atrioventricular valve insufficiency associated with nonimmune hydrops: a two-dimensional echocardiographic and pulsed Doppler ultrasound study.

Of 466 fetuses who underwent cardiac ultrasound examination with cross-sectional and M mode echocardiography and pulsed Doppler ultrasound and in whom we were able to follow the natural history, 12 were found to have atrioventricular valve insufficiency and nonimmune hydrops. Eleven fetuses (all of whom had structural heart disease) died either in utero or during the early postnatal period. In the one surviving hydropic fetus with supraventricular tachyarrhythmia and atrioventricular valve regurgitation but without structural heart disease, all the abnormalities disappeared on treatment with digoxin and verapamil.

The effect of different human chorionic gonadotropin assay sensitivity on screening for ectopic pregnancy.

The distribution of human chorionic gonadotropin levels in 184 patients with ectopic pregnancy is examined. The impact of changing the sensitivity of human chorionic gonadotropin testing on the incidence of false negative results is discussed. Pregnancy blood tests with a detection threshold of 200 mIU/ml were associated with an 11.

Diagnosis of ectopic pregnancy: value of the discriminatory human chorionic gonadotropin zone.

A prospective study was conducted to test the hypothesis that the absence of an intrauterine gestational sac when the serum level of human chorionic gonadotropin (hCG) is above 6500 mIU/mL is indicative of ectopic pregnancy. A total of 383 patients who were clinically suspected to have ectopic pregnancies had pelvic ultrasound examinations with serum hCG determinations on the day of the scan. There were 217 (57%) intrauterine gestations, 104 (27%) ectopic pregnancies, and 62 (16%) spontaneous abortions.

Contraction stress testing with nipple stimulation.

The contraction stress test (CST) is used widely as a measure of fetoplacental respiratory reserve. With contractions traditionally induced by intravenous oxytocin, the test has been limited in its use by time, expense and patient discomfort. In a prospective evaluation of the effectiveness of nipple stimulation for the production of uterine contractions, a successful CST was obtained in 94% of the attempts, with a mean total test time of 12 minutes.

Treatment of fetal supraventricular tachyarrhythmias.

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm.

Value of culdocentesis in the diagnosis of ectopic pregnancy.

The diagnostic value of culdocentesis was examined in all patients admitted with hemoperitoneum during a three-year period. There was a total of 158 women with positive culdocentesis, of whom 132 (83.5%) had tubal ectopic pregnancies and 26 had other diagnoses.

Sonographic monitoring to guide the performance of postabortal uterine curettage.

This communication describes a technique of sonographically monitored uterine curettage. This method is of particular value in the management of postabortal endomyometritis associated with retained products of conception or in any situation in which anatomic variation (for instance, retroversion) makes curette insertion difficult.

[Clinical evaluation of high-frequency positive pressure ventilation (HFPPV) in morbid obesity].

Clinical evaluation of High Frequency Positive Pressure Ventilation (H.F.P.

Carbon monoxide intoxication in early pregnancy.

Carbon monoxide exposure has been described as having both acute and chronic effects; acute intoxication early in pregnancy has not been previously reported, however. A case of carbon monoxide poisoning at 8 weeks' menstrual age is described with good fetal outcome. Appropriate literature is briefly reviewed.