The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study.

Objective: This study was undertaken to determine whether the neonatal benefit of a single complete course of antenatal corticosteroids diminishes when delivery is remote from administration (> 14 days).

Study Design: This retrospective 2 center cohort trial included women who received a single complete course of antenatal corticosteroids and delivered a viable singleton infant between 26 and 34 weeks of gestation. Patients were divided into 1 of 2 groups on the basis of the interval from first corticosteroid dose to delivery (2-14 days and > 14 days).

Spontaneous resolution of an in utero perirenal urinoma associated with posterior urethral valves.

Ultrasound imaging of a 26-week-gestation fetus demonstrated a large, nonemptying bladder. At 27 weeks, a distended, thick-walled bladder, left hydronephrosis, and a perirenal urinoma were present, without ascites. Observation was undertaken, as the amniotic fluid volume was normal.

Is tocolysis safe in the management of third-trimester bleeding?

Objective: Expectant management is among the current treatment options for pregnancies complicated by third-trimester bleeding at <36 weeks' gestation. The use of tocolytic agents to stop associated contractions is still somewhat controversial, however, and the number of cases reported to date is small. The purpose of our study was to find a large number of cases of preterm third-trimester bleeding that was treated with tocolytic agents and evaluate them for any evidence of potential harm related to the use of these agents.

Prenatal genotyping of the Duffy blood group system by allele-specific polymerase chain reaction.

Maternal allo-immunization to antigens of the Duffy blood group system can result in haemolytic disease of the newborn (HDN), therefore, the application of allele-specific polymerase chain reaction (ASPCR) for prenatal genotyping of the Duffy antigen system to identify pregnancies at risk for HDN was evaluated. Oligonucleotide primers were designed for ASPCR of FYA, FYB and nullFY alleles. A validation study was performed using DNA isolated from 94 serotyped whole blood samples and 8 amniocentesis samples.

Prenatal genotyping of Jk(a) and Jk(b) of the human Kidd blood group system by allele-specific polymerase chain reaction.

An allele-specific polymerase chain reaction (ASPCR) assay for prenatal genotyping of the Kidd antigen system in order to identify pregnancies at risk for haemolytic disease of the newborn (HDN) was developed. Oligonucleotide primers were designed for ASPCR of JKA and JKB. A validation study was performed using DNA isolated from 54 serotyped whole blood samples and 8 amniocentesis samples.

Prolonged bedrest during pregnancy: does the risk of deep vein thrombosis warrant the use of routine heparin prophylaxis?

This is the first study to assess the risk of clinically apparent DVT in pregnant women placed in the hospital at prolonged bedrest. The outcome is discussed with reference to the risks associated with heparin. Information, including delivery data, length of hospital stay, and discharge diagnoses were extracted from a prospectively collected computerized data bank of all deliveries that occurred over a 5.

The sensitivity of allele-specific polymerase chain reaction can obviate concern of maternal contamination when fetal samples are genotyped for immune cytopenic disorders.

Objective: Fetuses at risk for immune cytopenic disorders can be identified by molecular genotyping assays. To better understand the impact of maternal contamination on genotyping results, the levels of contamination that are routinely encountered during prenatal testing of fetal samples and the sensitivity of allele-specific polymerase chain reaction in detecting paternal alloalleles were examined.

Study Design: Reconstitution experiments were performed to define the sensitivity of allele-specific polymerase chain reaction assays.

Antepartum fetal surveillance in patients with diabetes: when to start?

Objective: Although antepartum fetal well-being testing is an accepted practice in the management of diabetic patients, there are few data suggesting when to start. Our goal was to examine when testing should be started in the pregnant diabetic woman.

Study Design: Antepartum test results and patient histories were prospectively collected on all diabetic pregnancies from January 1981 through December 1991.

Cocaine intoxication presenting as preeclampsia and eclampsia.

Objective: To relate the clinical presentation of acute cocaine intoxication in the third trimester to preeclampsia and eclampsia.

Methods: Eleven women presented to Long Beach Memorial Women's Hospital and the University of California, Irvine Medical Center with hypertension and clinical symptoms of headache, blurred vision, abdominal pain, or seizures in the third trimester of pregnancy. Each had a positive urine drug screen for cocaine.

How frequently should the amniotic fluid index be repeated?

Objective: Our objective was to determine the most appropriate interval for assessing amniotic fluid volume with amniotic fluid index.

Study Design: In a retrospective analysis amniotic fluid indexes performed every 3 to 4 days in antepartum testing patients were compared with their follow-up values. Of 10,742 amniotic fluid indexes there were 7393 with follow-up values within 4 days.

Antepartum testing in the hypertensive patient: when to begin.

Antepartum testing has been recommended for patients whose pregnancies are complicated by hypertension. Although this is considered accepted practice, there are little data available to help the clinician know when to start testing. To help answer this question in patients with chronic hypertension and nonproteinuric pregnancy-induced hypertension, we reviewed the results of all antepartum tests between 1976 and 1987 in patients with these diagnoses.

Comparison of a rapid enzyme-linked immunosorbent assay test and the Gram stain for detection of group B streptococcus in high-risk antepartum patients.

Early-onset neonatal sepsis with group B streptococci is a major problem in the management of high-risk obstetrics. Intrapartum treatment of the colonized mother reduces neonatal acquisition; however, many high-risk patients are delivered before culture results are available. This study prospectively evaluated a new enzyme-linked immunosorbent assay and the Gram stain for their accuracy in rapid detection of group B streptococci in 131 high-risk patients.

The contraction stress test.

The contraction stress test has long been used to assess fetal wellbeing in the antepartum period. The CST continues to be a valuable tool for practicing obstetricians when interpreted and managed according to previously published guidelines. More recent data have further defined the level of compromise at which the CST becomes abnormal.

Maternal serum alpha-fetoprotein and fetal triploidy.

Fetal triploidy is commonly found in early pregnancy. The majority of these pregnancies spontaneously abort in the first trimester. Occasionally, the pregnancy progresses to the second and third trimesters.

Controlled trial of hydration and bed rest versus bed rest alone in the evaluation of preterm uterine contractions.

Patients who are seen with uterine contractions but without documented change in cervical dilation or effacement are often treated with intravenous hydration before the initiation of intravenous tocolytic therapy. This is done with the intention of stopping uterine activity in patients with false preterm labor. A prospective randomized study was conducted to evaluate the effect of hydration on preterm uterine contractions in patients without proved preterm labor.

Ultrasound findings in pregnancies complicated by fetal triploidy.

Antepartum ultrasound scans of seven pregnancies complicated by fetal triploidy were reviewed. Estimated gestational age (EGA) by ultrasound lagged EGA by last menstrual period in six of seven patients. Normal interval growth of biparietal diameter in the second trimester was demonstrated in all fetuses that had serial scans.