Pregnancy anxieties and natural recognition in baby-switching.

Recent media reports in the USA of baby-switching at birth have caused anxiety for a number of maternity patients. Although alternative precautionary procedures are being implemented by hospitals to prevent baby-switching, ways to allay the maternity patient's anxiety must also be considered. While maternity patients can be expected to recognize their neonates, it is less clear how well they perform recognition under specified conditions.

A single physician's experience with four thousand six hundred genetic amniocenteses.

Objective: We sought to assess changes in indications, technique, successful fluid aspiration, and pregnancy outcomes in a large cohort of genetic amniocenteses performed by a single physician.

Study Design: Records were reviewed regarding 4600 women who underwent genetic amniocentesis by a single physician between 1972 and 2000. Changes in indications, procedural technique, ease of performance, amniotic fluid reports, and pregnancy loss rates were tabulated and compared over time.

Indications for examination of spontaneous abortion specimens: a reassessment.

The clinical evaluation of recurrent pregnancy loss is assessed in light of recent technical advances in trophoblast culture, ultrasonography, and chromosome analysis. With an algorithm based on karyotype results, cost-benefit calculations confirm that an average savings of $1099.47 per patient could be achieved if a policy of karyotype analysis of recurrent abortion specimens was emphasized.

Practice activities and career satisfaction among fellows of the South Atlantic Association of Obstetricians and Gynecologists.

Objective: The practice activities and career satisfaction of obstetricians and gynecologists in private practice were compared with those in a teaching faculty setting.

Study Design: The 475 fellows of the South Atlantic Association of Obstetricians and Gynecologists were surveyed; 314 responses (66.1%) were received.

A counseling dilemma involving anencephaly, acrania and amniotic bands.

A suggested fetal anencephaly on routine office ultrasound examination resulted in a diagnosis of fetal acrania when targeted ultrasonography was performed by a consultant. Following pregnancy termination, examination of the abortus revealed partial cranial destruction secondary to an amniotic band. It is often difficult to distinguish between anencephaly, acrania, and amniotic band sequence prenatally, but postnatal differentiation is imperative for accurate risk assessment in genetic counseling.

Effectiveness of 1% lidocaine dorsal penile nerve block in infant circumcision.

A prospective, controlled, double-blinded investigation was conducted to evaluate whether infants undergoing circumcisions with 1% lidocaine dorsal penile nerve blocks experienced decreased stress as compared with those receiving saline solution injections or no injections. Stress was measured in terms of pulse rate and oxygen saturation on a pulse oximeter. A subjective grading scale was also developed to measure infant irritability.

Ultrasound and the prenatal diagnosis of congenital anomalies: a medicolegal perspective.

A survey was conducted to determine the frequency of obstetric ultrasonography use, its value in detecting fetal anomalies, and the frequency with which ultrasound errors lead to malpractice allegations. Questionnaires were sent to one-fifth of The American College of Obstetricians and Gynecologists Fellows in District IV and were returned by 68%. Ultrasound equipment is housed in the offices of nearly 64% of the responding obstetricians, and ultrasound scanning is used in 69% of pregnancies in the district.

Incidental detection of premature centromere separation in amniocytes associated with a mild form of Roberts syndrome.

Premature centromere separation (PCS) was detected in amniocytes after an amniocentesis was done because of markedly elevated maternal serum alpha-fetoprotein values in a healthy primiparous young woman. PCS has been associated with the Roberts-SC phocomelia syndrome (RS). By 23 weeks' gestation, ultrasonic evaluations did not reveal abnormal fetal development.

Low serum alpha-fetoprotein level and sex chromosome monosomy.

A case of 45,X karyotype in association with low maternal serum alpha-fetoprotein levels is reported. Previous cases of trisomy have been linked to low alpha-fetoprotein levels. Cases of sex chromosome aneuploidy may be included in the group of aneuploidies with low levels of maternal serum alpha-fetoprotein.

Schistocytosis, aminotransferase elevation and thrombocytopenia in preeclampsia/eclampsia.

Some preeclamptic patients have schistocytosis, abnormal liver function tests and thrombocytopenia. To determine how strongly these three abnormalities cluster with each other, a sequential series of 49 preeclamptic or eclamptic patients was analyzed for the presence of schistocytosis, serum aminotransferase elevation and thrombocytopenia. These three abnormalities were found less often together (the HELLP syndrome) than singly or in pairs.

Sonographic findings in abdominal pregnancy.

The sonograms of 20 proven cases of abdominal pregnancy were evaluated to determine the frequency of specific abnormalities associated with this condition. The most frequent and reliable finding was separation of the uterus from the fetus (90%). Extrauterine placenta (75%) and oligohydramnios (45%) were next in frequency.

Pseudoepidural reverberation artifact: a common ultrasound artifact in fetal cranium.

High-intensity reverberation artifacts frequently occur within the fetal cranium during obstetric ultrasound examinations. One hundred ninety-six static ultrasonograms obtained from 100 consecutive obstetric patients were reviewed to determine the incidence, shape, and location of high-intensity reverberation artifacts within the fetal head. Such artifacts occurred in one-third of the fetuses examined.

Preterm rupture of the membranes: combination therapy.

Preterm rupture of the membranes poses perhaps the greatest threat to perinatal survival. Unfortunately, the literature leaves us in a quandry as to the management of the problem. At the Medical University of South Carolina for the past 3 years, aspects of both active and passive management have been used.

Antepartum heart rate testing in diabetic pregnancy.

Fetal death in utero remains a significant contributor to diabetics' perinatal mortality despite the reassuring results of antepartum heart rate testing. We retrospectively reviewed 48 pregnancies (one set of twins) of class B-F diabetic women with a reactive nonstress test (NST) or a negative contraction stress test (CST) within one week of delivery. Four fetal deaths occurred four to seven days after the test; no fetal deaths occurred within three days of it.

Plasma fibronectin levels in preeclampsia: a possible biochemical marker for vascular endothelial damage.

Fibronectin is a plasma glycoprotein which is involved in coagulation, platelet function, tissue repair, and the vascular endothelial basement membrane. We have found plasma fibronectin concentrations to be elevated in a group of preeclamptic patients. This finding is consistent with other evidence for a role of the vascular endothelium in preeclampsia.

Use of indigo carmine for twin amniocentesis and its effect on bilirubin analysis.

Indigo carmine is used commonly to mark the first-entered amniotic sac in twin amniocenteses. The presence of this dye significantly affects amniotic fluid bilirubin analysis. A method of chloroform extraction is recommended for determination of bilirubin in amniotic fluid previously contaminated by indigo carmine.

Diabetic halo.

In 42 diabetic patients evaluated by ultrasonography in the third trimester of pregnancy, 12 fetuses were found to have the diabetic halo. Of that group, the estimated fetal weight exceeded the 90th percentile in eight of nine studies in which the weight could be estimated sonographically. Overgrowth of the fetal head was not a finding in this group of patients and was not associated with the diabetic halo.

Ultrasound in the diagnosis of fetal malformations. Implications for obstetric management.

The prenatal diagnosis of congenital malformations through ultrasonography leads to major considerations regarding subsequent pregnancy management. These diagnoses are useful in reaching decisions concerning elective abortion, planning the time and method of delivery, and arranging for appropriate support personnel. Although the possibility of fetal anomaly must be considered in all obstetric ultrasonograms, review of 56 malformations diagnosed prenatally found that 31 were studied because of uterine size incompatible with gestational age.