Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops.

Purpose: To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities.

Materials And Methods: Five fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation.

Screening for cervical neoplasia in an unselected rural Guatemalan population using direct visual inspection after acetic acid application: a pilot study.

Objective: To assess the acceptability of cervical screening using direct visual inspection after acetic acid application followed by immediate cryotherapy for cervical intraepithelial neoplasia among women in rural Guatemala.

Materials And Methods: An unselected group of 1,052 women voluntarily registered to undergo cervical screening using direct visual inspection of the cervix after acetic acid application. Women with acetowhite changes consistent with cervical intraepithelial neoplasia were offered immediate cryotherapy.

Screening for gestational diabetes mellitus in adolescent Hispanics.

Objective: To determine the incidence of gestational diabetes mellitus in an adolescent Hispanic population and calculate the cost of screening.Methods: A retrospective chart review of deliveries to adolescent (<20 years old) Hispanic women from January 1991 through May 1996 was performed. The incidence of gestational diabetes mellitus (GDM) was determined and the cost of screening calculated.

Screening for gestational diabetes mellitus in adolescent Hispanic Americans.

Objective: To determine the incidence of gestational diabetes mellitus (GDM) in an adolescent Hispanic American population.

Study Design: A retrospective review of 326 women < 20 years of age who identified themselves as Hispanic American was conducted and the incidence of gestational diabetes determined.

Results: Thirty adolescent Hispanic Americans (9.

A randomized comparison of extra-amniotic saline infusion and intracervical dinoprostone gel for cervical ripening.

Objective: To compare extra-amniotic saline infusion to intracervical dinoprostone gel for preinduction cervical ripening.

Methods: Women with Bishop scores less than 5 were assigned randomly to either extra-amniotic saline infusion (n = 26) or intracervical dinoprostone gel (n = 26) for preinduction cervical ripening. A sample size of 50 would have 80% power to detect a 10-hour difference in the mean time from start of cervical ripening to delivery for the two methods of intervention, with a type I error of .

Fetal heart rate characteristics at 25 to 28 weeks' gestation.

The objective of this article is to define normative fetal heart rate (FHR) tracing characteristics between 25-28 weeks' gestation in a low-risk population with normal pregnancy outcomes and to determine which criteria best determine FHR reactivity. Continuous FHR tracings were reviewed from 188 low-risk women participating in a trial of the Mammary Stimulation Test (MST) at 25-28 weeks' gestation. A reactive tracing required the presence of > or =two accelerations in 20 min.

Screening for gestational diabetes mellitus in adolescent pregnancies.

Objective: Our purpose was to determine the incidence of gestational diabetes mellitus in an adolescent population and to determine the cost of screening.

Study Design: A retrospective review of 509 adolescent pregnancies was performed. The incidence of gestational diabetes mellitus was determined and the cost of screening analyzed.

Fetal fibronectin levels are elevated in maternal plasma and amniotic fluid of patients with severe preeclampsia.

Objective: Our purpose was to investigate levels of fetal fibronectin in maternal plasma, amniotic fluid, and umbilical cord plasma from patients with severe preeclampsia.

Study Design: The study group comprised 20 patients with severe preeclampsia (group A). An antepartum comparison group was composed of 20 healthy patients matched for gestational age (group B).

Immunoreactive tumor necrosis factor-alpha is elevated in maternal plasma but undetected in amniotic fluid in the second trimester.

Objective: We investigated the participation of the cellular arm of the immune system in adaptation to pregnancy by assessing plasma and amniotic fluid levels of the cytokine tumor necrosis factor-alpha.

Study Design: Fifty-five healthy pregnant women who underwent second-trimester genetic amniocentesis at a mean gestational age of 17.0 +/- 1.

Prediction of preterm birth in nulliparous patients.

Objective: Our goal was to determine whether the mammary stimulation test combined with a risk scoring system and cervical examination at 26 to 28 weeks' gestation could effectively identify private nulliparous patients at risk for spontaneous preterm birth.

Study Design: The mammary stimulation test was performed by 267 nulliparous patients with singleton gestations at 26 to 28 weeks. Risk scores were determined by the method of Creasy et al.

Mammary stimulation test predicts preterm birth in nulliparous women.

Objective: This prospective clinical trial was designed to assess the ability of the mammary stimulation test to predict preterm birth in a private nulliparous population.

Study Design: The mammary stimulation test was performed between 26 and 28 weeks' gestation by 267 nulliparous women with singleton pregnancies. Test results were blinded to both patient and referring physician.

Tumor necrosis factor-alpha is elevated in plasma and amniotic fluid of patients with severe preeclampsia.

Objective: Our purpose was to investigate whether markers for activation of the immune system are present in patients with preeclampsia by assessing maternal plasma and amniotic fluid for tumor necrosis factor-alpha and interleukin-1 beta.

Study Design: Twenty-one patients with severe preeclampsia composed the study group (group A). An antepartum comparison group was composed of healthy nulliparous patients not in labor and matched for gestational age (group B).

Elective and routine induction of labor. A retrospective analysis of 274 cases.

A retrospective analysis of elective induction of labor at term and routine induction after 42 completed weeks' gestation was conducted to assess neonatal and maternal outcome in a low-risk obstetric population at a tertiary care facility. In 1989, 639 labor inductions were performed at the Christ Hospital and Medical Center. Two hundred one inductions were performed between 37 and 41 6/7 weeks' (elective induction), while 73 were performed at 42 weeks' gestation and beyond (routine induction).

Neonatal morbidity after preterm delivery in the presence of documented lung maturity.

Objective: Our purpose was to determine the incidence of significant neonatal morbidity in fetuses with documented pulmonary maturity delivered before 37 weeks' gestation.

Study Design: A retrospective review of 213 pregnancies with documented fetal lung maturity (lecithin/sphingomyelin ratio > or = 2.0 or phosphatidylglycerol present) and delivery before 37 weeks was performed.

Sonographic diagnosis of congenital heart disease: comparison between the four-chamber view and multiple cardiac views.

Objective: To report our experience in the detection of congenital heart disease using both the four-chamber view of the heart as part of the standard obstetric ultrasound examination and multiple cardiac views as part of the detailed targeted examination.

Methods: All admissions to Children's Memorial Hospital of Northwestern University Medical Center with the diagnosis of congenital heart disease between June 1988 and April 1992 were identified (N = 1947). These admissions were matched to deliveries (N = 19,321) that occurred at Prentice Women's Hospital during the same period; of these, 10,004 had at least one obstetric ultrasound examination.

Placenta accreta is associated with elevated maternal serum alpha-fetoprotein.

Objective: To determine whether placenta accreta/percreta/increta is associated with elevation of second-trimester maternal serum alpha-fetoprotein (MSAFP) levels.

Methods: We reviewed the medical records of 44 women who had emergency cesarean hysterectomy. Twenty women had placenta accreta/percreta/increta (study group) and 24 underwent cesarean hysterectomy for other indications (control group).