Pregnancy with uterine vascular malformations associated with hemorrhagic hereditary telangiectasia: a case report.

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant condition. It is rarely seen in pregnancy and even more rarely has uterine manifestations.

Case: A 29-year-old primigravid woman with HHT was noted to have vascular manifestations of her disease in the lower uterus, distal rectum, pelvis, and bladder before pregnancy.

Neonatal survival rates in 860 singleton live births at 24 and 25 weeks gestational age. A Canadian multicentre study.

Objective: To determine the current survival rate of singleton living newborns born at gestational age of 24 and 25 weeks, using obstetric factors available to the physician before birth.

Design: Retrospective study of all live births in 13 of 17 Canadian tertiary centres. Population All singleton live births without congenital abnormalities.

Has the outcome for extremely low gestational age (ELGA) infants improved following recent advances in neonatal intensive care?

The objectives of this paper are to examine (a) the survival of extremely low-gestational-age (ELGA) infants born at 23-28 weeks' gestational age (GA) and (b) the neurodevelopmental outcome at 18 months corrected age for those born at 23-25 weeks' GA during 1991-1993, when antenatal steroids, surfactant, and dexamethasone for bronchopulmonary dysplasia had become accepted treatments; and to compare with an earlier (1983-1989), previously published large cohort (in a presurfactant era) from our institution. Perinatal and neonatal data on all births delivered at 23-28 weeks' GA at British Columbia's tertiary perinatal center were analyzed for survival rates by GA. Survivors of those born at 23-25 weeks' GA underwent neurodevelopmental assessment at a corrected chronological age of 18 months.

Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation).

Objectives: To determine gestational age (GA)-specific mortality rates; the effects of GA, birth weight, sex, and multiple gestation on mortality rates; short-term morbidity for infants born at 23 to 28 weeks GA; and impairment rates at a corrected chronologic age of 18 months for those born at 23 to 25 weeks GA.

Methods: A data base analysis was performed with a linked obstetric and a neonatal database. GA was determined by obstetric data and confirmed by early ultrasonography (available in 88%) on all births < 30 weeks GA at British Columbia's tertiary perinatal center from 1983 to 1989.

Expectant management of choriocarcinoma limited to placenta.

Choriocarcinoma limited to placenta was discovered "incidentally" following a seemingly uneventful term pregnancy. The newborn had unsuspected severe anemia and thrombocytopenia, due to fetomaternal hemorrhage. His recovery was good following transfusions.

ITP in pregnancy: use of the bleeding time as an indicator for treatment.

ITP is a relatively common disorder seen in pregnancy. Current recommendations for management of patient with ITP recommend maintaining the platelet count above 50 x 10(9)/L and the bleeding time less than 20 min. It has been well documented that the bleeding time in ITP is disproportionately shortened in many patients relative to the platelet count.

A randomized trial of electronic fetal monitoring in preterm labor.

Intrapartum electronic fetal heart rate (FHR) monitoring and fetal blood gas sampling were compared with periodic auscultation of FHR in a multicentered randomized trial of preterm singleton pregnancies with fetal weights of 700-1750 g. Two hundred forty-six pregnancies were studied (electronic FHR monitoring N = 122, auscultation N = 124). Perinatal or infant death was associated with 14% of pregnancies with electronic FHR monitoring and 15% with auscultation.

Pulmonary edema associated with isoxsuprine therapy.

A 0.5% incidence of pulmonary edema was observed when the records of 1,407 patients treated with parenteral isoxsuprine over a 7-year interval were reviewed. Drug infusion rates were within the normal range in the seven affected patients.

Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?

The perinatal mortality rate among very low-birth weight infants has been decreased by 20% during the last 4 years of the 1973 to 1980 period here reported. The concurrent increase in the cesarean section rate from 11.9% to 49.

The prenatal prediction of thrombocytopenia in infants of mothers with clinically diagnosed immune thrombocytopenia.

The management of the pregnant patient with immune thrombocytopenia is complicated by the unavailability of the fetal platelet count. Since the transplacental passage of antiplatelet antibodies mediates infant thrombocytopenia, measurement of maternal platelet-associated IgG might predict infant outcome. We related the maternal platelet count and platelet-associated IgG level to the infant's platelet count in 41 pregnancies in 38 patients who were clinically diagnosed as having immune thrombocytopenia.

Gynecologic aspects of the "routine" checkup.

A Pap test, advice about contraception, and instruction in breast self-examination--these are important components in the routine physical checkup of female patients. The practice of office gynecology is a demanding but rewarding part of general medical practice.

Relationship between cortisol and lecithin/sphingomyelin ratios in human amniotic fluid.

Amniotic fluid was obtained from 85 women during the last trimester of gastation and analyzed for cortisol by a radioimmunoassay procedure and for lecithin/sphingomyelin (L/S) ratios by a combined thin-layer chromatography densitometer scanning technique. A total of 114 samples were examined. Cortisol values ranged from 38 to 438 ng.

Fetal monitoring.

The severe risk situations characterized by fetal growth retardation are outlined. The small fetus, whether growth retarded or severely premature, is best delivered where both fetal monitoring and newborn resuscitation are available. The moderate risk fetus can be monitored at home base with clinical skills described in this article.

Perinatal death and damage: predictive and preventive considerations.

The author reviews some of the classical clinical entities which carry with them major degree of risk to the fetus and newborn. He lists systems which facilitate the identification of high risk patients on a statistical basis, and describes easily applied clinical examination techniques which may help in screening and diagnosing previously unrecognized serious problems of feto-placental malfunction.The author then discusses the more sophisticated methods of detecting and managing serious high risk pregnancies, highlighting the severe degree of risk created by the additional stress of labor, superimposed on previous chronic feto-placental malfunction.