Intravenous immunoglobulin for recurrent unexplained pregnancy loss: a case report.

Background: Recurrent unexplained pregnancy loss plagues obstetricians. Many therapies are controversial, including intravenous immunoglobulin (IVIG). There have been limited studies to support or oppose its use.

Antibiotic prophylaxis at Cesarean delivery.

Objective: Our aim was to compare the efficacy of ampicillin, cefotetan, and ampicillin/sulbactam in the prevention of post-Cesarean endomyometritis.

Methods: Consenting patients undergoing Cesarean delivery at the University of Louisville Hospital were enrolled in a prospective, double-blinded randomization to receive either ampicillin/sulbactam (Group 1), cefotetan (Group 2), or ampicillin (Group 3) single dose antibiotic prophylaxis following umbilical cord clamping. The primary outcome variable was the frequency of endomyometritis in the respective groups.

Is vaginal delivery preferable to elective cesarean delivery in fetuses with a known ventral wall defect?

Objective: We sought to test the hypothesis that vaginal delivery compared with elective cesarean delivery results in improved neonatal outcome in fetuses with a known isolated ventral wall defect.

Study Design: We performed a retrospective chart review.

Results: Between 1989 and 1999, we identified 102 infants with a confirmed antenatal diagnosis of an isolated ventral wall defect with either the diagnosis of an omphalocele or gastroschisis.

A prospective, randomized, clinical study to compare the clinical safety, effectiveness, and cost of oral ofloxacin/clindamycin vs intravenous clindamycin/gentamicin for the treatment of postpartum endomyometritis.

Objective: The primary objective of this prospective, randomized, clinical study was to compare the safety, clinical and microbiologic efficacy, and cost of oral ofloxacin in combination with clindamycin vs intravenous (IV) clindamycin/gentamicin in the early empiric treatment for hospitalized patients with mild to moderate postpartum endomyometritis. The secondary objective is to reduce total hospital and patient treatment cost. Postpartum endomyometritis is a major cause of infectious morbidity in the obstetric patient.

Predictive value of fetal ultrasonography in the diagnosis of a lethal skeletal dysplasia.

Background: Certain ultrasonographic findings identified in a fetus suspected of having a skeletal dysplasia may be predictive of a lethal outcome.

Methods: We evaluated 27 fetuses suspected of having a skeletal dysplasia using targeted ultrasonography between 16 and 31 weeks' gestation. Clinical examination and skeletal radiography were done after delivery.

Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial.

Objective: Our aim was to determine whether the presence of fetal fibronectin in vaginal secretions of patients with symptoms suggestive of preterm labor predicts preterm delivery.

Study Design: Patients who were examined at the hospital between 24 weeks' and 34 weeks 6 days' gestation with intact membranes, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilation < 3 cm were recruited at 10 sites. Swabs of the posterior fornix were assayed for the presence of fetal fibronectin by monoclonal antibody assay, with a positive result defined as > or = 50 ng/ml.

Mirror image duplication of the hands and feet: report of a sporadic case with multiple congenital anomalies.

Mirror image duplication of the hands and feet is a rare entity. Based on 3 previous reports, findings include nasal abnormalities, dimelia of ulna and fibula, tibial hypoplasia and mirror image duplication of hands and feet. We report on a sporadic case in which mirror image duplication was associated with multiple congenital anomalies.

A non-trophoblastic tumor co-existing with a triploid fetus.

Non-trophoblastic neoplasms are the most frequent, benign tumors of the placenta, occurring in approximately 1% of all placentas examined. A case is described of a 24-year-old woman who presented with severe, early-onset pre-eclampsia, high human chorionic gonadotropin (hCG) levels, and a triploid fetus and who was found to have a small choriohemangioma. The woman, gravida 2 para 1, was referred to our hospital for perinatal evaluation.

Differential cyclooxygenase-1 and -2 gene expression in human myometria from preterm and term deliveries.

The expression of cyclooxygenase-1 (COX-1) and COX-2 genes in myometria from preterm and term pregnancies was investigated by in situ hybridization, immunoblotting, and immunocytochemistry. In situ hybridization revealed that myometrial smooth muscle contained both COX-1 and COX-2 messenger ribonucleic acid transcripts. Immunoblotting revealed that myometria contained 55- and 67-kilodalton COX-1 proteins as well as 72- and 56-kilodalton COX-2 proteins.

The current impact of the hypertensive disorders of pregnancy.

The present investigation examines the effect of the various hypertensive disorders of pregnancy on perinatal outcome. Five hundred and five pregnancies associated with hypertension were reviewed, yielding an overall incidence of 8%. Multiparas accounted for 34.

Obstetric correlates of neonatal retinal hemorrhage.

Objective: To determine whether maternal or fetal factors, other than vacuum-assisted delivery, play a role in neonatal retinal hemorrhage, and whether correlates are similar in retinal hemorrhage after spontaneous vaginal delivery.

Methods: A cross-section of assisted deliveries at an urban hospital (n = 156) over 7 months were compared with contemporaneous spontaneous vaginal deliveries (n = 122). A subset of assisted deliveries (n = 87) was prospectively randomized to forceps or vacuum-assisted delivery by sealed envelope.

Human fetal response to vibroacoustic stimulation as a function of stimulus duration.

The effect of stimulus duration on the initial fetal heart rate (FHR) acceleration response was evaluated by assessing its amplitude and span following a single vibroacoustic stimulation with durations of 0 (sham), 1, 3, or 5 seconds. Statistically significant differences were observed in the mean amplitude and duration of acceleration in groups 3 and 5 when compared with groups 0 and 1 (P less than .05).

Doppler flow velocities in single umbilical arteries.

Fetal compromise has been associated with an umbilical artery waveform pattern of low or absent diastolic velocity relative to systolic velocity. Fetuses with single umbilical arteries have an increased risk of major malformations, mortality, retarded fetal growth, and prematurity. In this study Doppler flow velocities were obtained in 13 fetuses (four twin fetuses and nine singletons) with a single umbilical artery.

Cervical cerclage in early pregnancy.

A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed. For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage: group 1 less than or equal to 13 weeks; group 2 greater than 13 weeks, but less than 18 weeks; group 3 greater than or equal to 18 weeks.

Alcohol use in pregnancy.

The epitome of FAS and ARBD has been documented substantially in the medical literature. There appears to be little question that alcohol is a teratogen. The precise nature for the mechanism of causing congenital defects, whether it be direct or indirect, is still unknown.

Peritoneal closure or non-closure at cesarean.

The value of peritoneal closure at the time of cesarean birth was evaluated prospectively. Two hundred forty-eight women undergoing low transverse cesarean through a Pfannenstiel skin incision were assigned to one of two groups: peritoneum open (N = 127) or peritoneum closed (N = 121). The mean (+/- SEM) surgical time in the open group (48.

Effect of maternal-fetal movement on concentration of cells obtained at genetic amniocentesis.

The number of viable amniotic fluid cells in the aliquot obtained at amniocentesis is an important determinant of the success of subsequent cell culture. However, cell concentration and viability are highly variable, even in samples of equivalent gestational age. We studied the effect of prescribed maternal position change or spontaneous fetal movement on the concentration, viability, and subsequent harvest time of amniotic fluid cells removed at genetic amniocentesis.