Frequency of uterine contractions in asymptomatic pregnant women with or without a short cervix on transvaginal ultrasound scan.

Objective: The purpose of this study was to compare the frequency of uterine contractions in asymptomatic pregnant women with and without a short cervix (< 25 mm) on transvaginal ultrasound (TVU) and to determine the additive risk of contractions on the risk of preterm birth.

Study Design: The study involved secondary analysis of a blinded observational study of asymptomatic singleton pregnancies who were at high risk for preterm birth and who received both home uterine activity monitoring daily and transvaginal ultrasound of the cervix at 22 to 24 and 27 to 28 weeks of gestation. Thresholds for the maximum frequency of uterine contractions of 4 per hour and transvaginal ultrasound cervical length of 25 mm were used for analysis.

Frequency of uterine contractions and the risk of spontaneous preterm delivery.

Background: The measurement of the frequency of uterine contractions has not been useful for reducing the rate of preterm delivery in randomized trials. Nonetheless, ambulatory monitoring of contractions continues to be used in clinical practice.

Methods: We assessed the frequency of uterine contractions as a predictor of the risk of spontaneous preterm delivery before 35 weeks of gestation.

A blueprint for academic obstetrics and gynecology.

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.

Gaucher's disease in pregnancy.

Gaucher's disease is an autosomal recessive lysosomal storage disease, resulting from a deficiency of the enzyme glucocerebrosidase, important for the physiologic recycling of cell membrane lipids. The clinical symptoms and disease presentations of Gaucher's disease are heterogeneous, including hepatosplenomegaly, bone "crisis" and fracture, anemia, thrombocytopenia and in some forms, rapid neurological decompensation. Similarly, the genetic variability of Gaucher's disease is diverse, and in some aspects affects phenotypic expression.

Fetal oxytocin and its extended forms at term with and without labor.

Objective: We examined the concentrations of oxytocin and extended forms of oxytocin in umbilical plasma with and without labor.

Study Design: Umbilical venous and arterial blood were sampled in 27 term fetuses delivered vaginally and 13 delivered abdominally before labor. Extended forms and oxytocin were measured by radioimmunoassay and compared by analysis of variance or t test.

The predictive value of intrapartum fetal heart rate abnormalities in the extremely premature infant.

Objective: Our purpose was to evaluate the validity of intrapartum fetal heart rate tracings in predicting short- and long-term outcomes of infants delivered between 24 and 26 weeks.

Study Design: Fetal heart rate tracings obtained during the last hour before delivery of fetuses delivered at 24 to 26 weeks' gestation were reviewed. Two perinatologists blinded to neonatal outcome evaluated the tracings for the following attributes: baseline rate and variability, presence and severity of decelerations, and overall impression (reassuring, nonreassuring, or ominous).

Fetal renal pulsed Doppler waveform in prolonged pregnancies.

Objective: Our purpose was to determine Doppler waveforms of the fetal human renal artery in prolonged pregnancy in the presence or absence of oligohydramnios.

Study Design: Fifty patients at or after 40 weeks were studied. Ultrasonography was performed to determine the amniotic fluid index by the four-quadrants technique.

Validation of noninvasive fetal renal artery flow measurement by pulsed Doppler in the lamb.

Objective: Our objective was to evaluate the accuracy of quantitative measurement of blood flow of the left renal artery in the fetal lamb by means of range-gated, two-dimensional pulsed Doppler ultrasonography.

Study Design: Doppler measurements were compared with invasive measurements obtained with a perivascular flow probe (Transonic) placed on the fetal renal artery. Renal blood flow was manipulated acutely either by volume expansion or depletion or by means of pharmacologic agents.

Pregnancy outcome following ultrasound diagnosis of macrosomia.

Both elective cesarean and early induction have been proposed for pregnancies in which the fetus is suspected to be macrosomic by ultrasound examination. We studied 242 nondiabetic women with estimated fetal weights (EFWs) by ultrasound of at least 4000 g or the 90th percentile for gestational age at 36 or more weeks' gestation. In 66 of 86 women (77%) delivering within 3 days of ultrasound examination, EFW exceeded birth weight.

Low incidence of positive amnionic fluid cultures in preterm labor at 27-32 weeks in the absence of clinical evidence of chorioamnionitis.

In order to determine the utility of amniocentesis for detecting subclinical chorioamnionitis in asymptomatic afebrile women in preterm labor with intact membranes, we enrolled 47 women between 27-32 weeks' gestation in a prospective study. After enrollment, 38 women fulfilled all clinical and laboratory criteria for the study; nine women were excluded because they had a leukocyte count exceeding 15,000/microL. None of the 38 asymptomatic afebrile women had a positive culture from the amnionic fluid for bacteria, fungi, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, or any viruses.

Histologic chorioamnionitis and preterm delivery in different patient populations.

The placentas of 1843 deliveries were examined for the presence of histologic chorioamnionitis, which was classified as mild, moderate, or severe. Chorioamnionitis was present in 7.5% of patients who underwent cesarean before labor and in 18 and 32% of those delivering at term and preterm, respectively.

Preterm birth prevention: evaluation of a prospective controlled randomized trial.

Over a 3-year period 5457 indigent patients were scored for risk of preterm birth and 4595 women were delivered at greater than or equal to 20 weeks' gestation. Patients at high risk (18.1%) were randomized into control and intervention groups.

Evaluation of risk scoring in a preterm birth prevention study of indigent patients.

A total of 4591 indigent patients were scored for risk of preterm labor and birth by the Creasy et al. scoring system and delivered at greater than or equal to 20 weeks' gestation. Of 462 preterm deliveries (less than 37 weeks), only 39.

The clinical significance of hemorrhagic endovasculitis of the placenta.

Hemorrhagic endovasculitis of the placenta has been reported to correlate with intrauterine growth retardation, perinatal morbidity and mortality, and long-term developmental delay. At a regional obstetric hospital we identified 13 cases of hemorrhagic endovasculitis among 1938 placentas from singleton pregnancies of greater than or equal to 20 weeks' gestation over a 3-month period, an incidence of 0.67% of unselected pregnancies.

Kell sensitization in pregnancy.

Maternal anti-Kell antibody was found in 127 of 127,076 pregnancies during a 16-year period (0.1%). Thirteen Kell-sensitized pregnancies ended with a Kell-positive newborn infant, five of these had a poor perinatal outcome (hydrops, intrauterine or neonatal death, hemoglobin less than 7.

Sonographically documented disappearance of fetal ascites.

Two patients with sonographically documented fetal ascites are described. Workup for immunologic or nonimmunologic causes was negative. Subsequent sonar examinations demonstrated disappearance of fetal ascites.

Variable heart rate decelerations and transcutaneous PO2 during umbilical cord occlusion in fetal monkeys.

In five near-term monkeys under ketamine anesthesia, fetal heart rate, blood pressure, intrauterine pressure, and transcutaneous oxygen tension (tcPO2) were recorded continuously while the umbilical cord was occluded for 15 or 30 seconds. Fetal heart rate decreased 55 +/- 19 bpm, (mean +/- SD) and 78 +/- 20 bpm, respectively, with 15 and 30 second occlusions, while tcPO2 declined 6.0 +/- 1.

Portal venous blood flow distribution to liver and ductus venosus in newborn lambs.

Changes in the distribution of portal venous blood flow to the left and right lobes of the liver and through the ductus venosus were determined from before birth through 9 days of age in 25 chronically catheterized fetal and newborn lambs. Blood flow distribution was calculated by means of the radionuclide-labeled microsphere technique. With umbilical cord clamping portal venous blood flow distribution to the right lobe of the liver decreased when compared to that in the term fetus; distribution to the left lobe and ductus venosus increased.

A comparison of terbutaline and ethanol in the treatment of preterm labor.

Ninety-two women in preterm labor were randomly assigned to either terbutaline or ethanol. In women with intact membranes, terbutaline was significantly more effective than ethanol in preventing progressive cervical dilation during the first 36 hours of treatment while betamethasone was given to the mother. Additionally, pregnancy was maintained significantly longer in women with intact membranes who were treated with terbutaline (15 +/- 4 days) rather than with ethanol (10 +/- 3 days).

Comparison of continuous transcutaneous Po2 measurement with intermittent arterial Po2 determinations in fetal lambs.

This study determined the validity of transcutaneous Po2 (tcPo2) versus Pao2 determinations in the sheep fetus. In 7 fetal lambs catheters were placed in the carotid artery and the trachea, and ECG leads and a tcPo2 electrode were attached. Intermittently determined Pao2 values were compared to continuously recorded tcPo2 values.

Prolonged in utero retention and mummification of a Macaca mulatta fetus.

An intrauterine mummified fetus in a Macaca mulatta was delivered surgically 708 days after onset of the last menstrual flow. Supracervical hysterectomy and left salpingo-oophorectomy were done. The fetus consisted of a compressed but complete skeleton and hairy skin adherent to the intact, thin uterine wall.