Hydrolethalus syndrome in a non-Finnish family: confirmation of the entity and early prenatal diagnosis.

We present a family in which the first affected child presented with a 'milder' form of the hydrolethalus syndrome and survived to seven months, and two subsequent pregnancies with typical features detected early by ultrasound evaluation. We propose that the 'milder' cases are indeed true cases of the hydrolethalus syndrome and that allelic variability may be responsible for these 'non-typically Finnish' findings. We also demonstrate that, especially in families where there has been a previously affected fetus, echographic diagnosis can be made in the first trimester, as early as the 11th week of gestation.

Periventricular/intraventricular hemorrhage following early and delayed umbilical cord clamping. A randomized controlled trial.

Objective: To test the hypothesis that early compared with delayed clamping of the umbilical cords of low-birthweight babies may increase the incidence of periventricular/intraventricular hemorrhage (PVH/IVH).

Design: Randomized controlled trial.

Setting: The labor wards of 3 teaching hospitals of the University of the Witwatersrand, Johannesburg.

Major complications associated with extra-amniotic prostaglandin F2 alpha termination of the mid-trimester pregnancy.

Extra-amniotic prostaglandin F2 alpha (PGF2 alpha) termination of mid-trimester pregnancy can be associated with serious complications, defined for the purposes of this study as unintended major surgery or death as a result of the termination. A retrospective study of 319 such mid-trimester terminations at Johannesburg hospital revealed that 3 patients required hysterectomy, 1 developed a large tear of the posterior cervix and 1 died suddenly during the procedure. We are therefore considering changing our methods for second-trimester terminations.

The obstetrician's dilemma during delivery of the very-low-birth-weight infant.

Delivery of the premature infant weighing less than 1,500 g poses a significant dilemma for the obstetrician. First-discharge survival of 218 very-low-birth-weight infants was retrospectively analysed and the survival rate of infants with a birth weight of less than 800 g was found to be only 15%. If the birth-weight of the infant was between 800 g and 999 g or 1,000 g and 1,500 g, the survival rates were 49% and 84%, respectively.

Dilatation of the cervix with dinoprostone ('Prepidil gel') prior to insertion of an intrauterine device: report of two cases.

Routine insertion of an intrauterine device (IUD) is usually a simple procedure in parous and nulliparous subjects. There is normally very little cervical resistance, depending on the type of IUD used. We describe two cases in which cervical dilatation to allow passage of an IUD was facilitated by the intracervical insertion of 0.