Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy.

The topics of neonatal encephalopathy and cerebral palsy, as well as hypoxic-ischemic encephalopathy, are of paramount importance to anyone who ventures to deliver infants. Criteria sufficient to define an acute intrapartum hypoxic event as sufficient to cause cerebral palsy have been advanced previously by both The American College of Obstetricians and Gynecologists (ACOG) and the International Cerebral Palsy Task Force. ACOG convened a task force that over the past 3 years reviewed these criteria based upon advances in scientific knowledge.

Value of ultrasound in the early diagnosis of prerupture uterine horn pregnancy. A case report.

Background: The poor outcome of rudimentary horn pregnancies is due to delayed diagnosis.

Case: Pregnancy in a rudimentary uterine horn was detected by ultrasound prior to rupture. The rudimentary horn was resected without complications.

Impairment of fetal growth potential and neonatal encephalopathy.

Objective: This study was undertaken to determine the frequency of growth impairment in neonates with encephalopathy.

Study Design: In a case-control design, neonates with neonatal encephalopathy (NE) meeting criteria for an acute intrapartum hypoxic event (IHE, n = 21) and those who did not meet these criteria (n = 20) were compared with controls. The controls were 42 neonates without complications matched 2:1 for gestational age with IHE cases.

Expression of regulator of G protein signaling-2 in rat myometrium during pregnancy and parturition.

Objective: The purpose of this study was to determine the potential physiologic roles of myometrial regulator of G protein signaling-2 (RGS2), a G protein-associated GTPase, by the analysis of the changes in RGS2 messenger RNA expression during pregnancy and parturition and to examine factors that regulate these changes.

Study Design: Myometrial RGS2 messenger RNA levels were analyzed by Northern blotting in rats (1). during pregnancy, parturition, and in the postpartum period; (2).

Embolism during pregnancy: thrombus, air, and amniotic fluid.

Pulmonary embolism is the primary cause of acute respiratory decompensation during pregnancy. Regardless of the nature of the embolism, a high index of suspicion, early diagnosis, and aggressive resuscitation need to be instituted to achieve a successful maternal and fetal outcome. Several clinical characteristics will assist practitioners to distinguish among the different forms of embolism and to institute specific measures of treatment.

Temporal and demographic trends in cerebral palsy--fact and fiction.

The rate of cerebral palsy has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5-fold increase in the cesarean delivery rate over the same period of time. However, neonatal survival has improved during these decades. These observations have lead to the hypothesis that increased survival of premature, neurologically impaired infants may have masked an actual reduction in cerebral palsy among term infants as a result of the use of electronic monitoring and the avoidance of intrapartum asphyxia.

Neonatal encephalopathy and cerebral palsy: a knowledge survey of Fellows of The American College of Obstetricians and Gynecologists.

Objective: To assess practicing obstetricians' knowledge of the etiology and pathophysiology of neonatal encephalopathy and its relationship to cerebral palsy.

Methods: A questionnaire designed to test both knowledge and practice patterns was mailed to 413 members of the Collaborative Ambulatory Research Network of The American College of Obstetricians and Gynecologists (ACOG), as well as 600 randomly selected non-Network ACOG Fellows. The questionnaire was composed of 15 knowledge questions and three clinical scenarios containing seven knowledge questions.

Documentation of amniotic fluid embolism via lung histopathology. Fact or fiction?

Objective: To evaluate pulmonary histopathology for confirming amniotic fluid embolism.

Study Design: The Capra hircus (goat) model with fresh, homologous amniotic fluid was used. Raw fluid (n = 8), fluid filtered through a 5-microns filter (n = 14) and meconium-stained fluid with 1-7% solid debris (n = 7) were injected.

The effect of in utero exposure to indomethacin on the need for surgical closure of a patent ductus arteriosus in the neonate.

Objective: Our purpose was to determine the effect of in utero exposure to indomethacin on the need for surgical closure of a patent ductus arteriosus (PDA).

Study Design: Perinatal variables were compared between infants at <32 weeks who required surgical closure of PDA after failed medical management and those who did not. Statistical analysis was performed by Student t, Mann-Whitney, chi(2), and multiple logistic regression tests.

Smallpox and pregnancy: from eradicated disease to bioterrorist threat.

Health care personnel must be prepared for the threat of bioterrorism. Our objective is to educate primary care providers, obstetricians in particular, in the prevention, diagnosis, and treatment of smallpox. Smallpox poses a particularly serious threat because of its high case-fatality rate in unvaccinated populations (no one younger than 25 years has been vaccinated, and older persons have little remaining residual immunity).

Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy.

Objective: To identify the proportion of major organ system injury in cases of acute intrapartum asphyxia that result in neonatal encephalopathy.

Methods: A prospectively maintained database was cross-referenced using medical record coding to identify diagnoses of acute intrapartum asphyxia, acute birth asphyxia, or neonatal encephalopathy over a 6-year period. An acute intrapartum asphyxial antecedent was validated with emphasis on excluding long-standing or chronic conditions where injury likely occurred before presentation.

Blood gas, cardiopulmonary, and urine electrolyte reference values in the pregnant yellow baboon (Papio cynocephalus).

We measured urine sodium and potassium; respiratory rate, lung water, and arterial and mixed venous blood gases; adult and fetal heart rates; hematocrit, plasma sodium and potassium; cardiac output; and arterial, pulmonary artery, central venous, and pulmonary wedge pressures in 13 clinically normal, pregnant yellow baboons (papio cynocephalus). Arithmetic means, standard deviations, and coefficients of variation were calculated to develop reference values; in addition, the 95% confidence limits for ranges were established and regression analyses were performed to determine relationships between parameters. Comparison of derived data with those from published values for nonpregnant baboons indicated differences similar to those seen when examining pregnant and nonpregnant humans.