Obstructed labor and shoulder dystocia.

Dystocia of labor has become one of the leading indications for operative delivery during the past few years. Dystocia of the first stage of labor complicates 8-11% of all vertex delivery, and in the second stage of delivery it is at least as common. Dystocia may result in part from three factors: uterine activity, the fetus, and the pelvis.

Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid.

Objective: To determine the clinical significance of meconium-stained amniotic fluid (AF) observed at amniocentesis in patients with preterm labor.

Methods: A nested case-control study was constructed based on the color of AF during amniocentesis. Forty-five women admitted with preterm labor and meconium-stained AF were matched for gestational age at admission and compared with 135 women with preterm labor and clear AF.

Toward fetal therapy using needle embryofetoscopy.

Our objective was to explore the feasibility of using both transvaginal endoscopy and transabdominal needle embryofetoscopy for early prenatal diagnosis. Our experience with both terminating and continuing pregnancies is presented in this report. Following the granting of informed consent, patients undergoing first-trimester terminations were invited to participate in this program.

Needle embryofetoscopy and early prenatal diagnosis.

Needle embroyfetoscopy (NEF) permits direct visualization of the embryo/fetus with a specially designed 16-gauge double-barrel instrument sheath which is passed transabdominally into the amniotic cavity. We report the case of a woman with a MSAFP of 2.5 MOM who had declined amniocentesis.

Doppler velocimetry and the assessment of fetal well-being in normal and diabetic pregnancies.

Doppler ultrasound has been proposed as a useful addition to antepartum testing in high-risk pregnancies. Increased placental resistance has been associated with underlying placental vascular disease, as well as abnormal fetoplacental blood flow. Since pregnancies complicated by diabetes are at risk for these complications, the application of Doppler ultrasonography for such pregnancies has been evaluated by several investigators.

Transabdominal needle embryofetoscopy: a new technique paving the way for early fetal therapy.

Objective: To explore the feasibility of using a newly devised needle endoscope to conduct transabdominal first-trimester endoscopy for both embryonic visualization and blood sampling.

Methods: Following informed consent, 12 patients at 8-12 weeks' gestation undergoing first-trimester termination were invited to participate in this study. Transabdominal needle embryofetoscopy was also performed in one continuing pregnancy.

Retinal and pregnancy outcomes in the presence of diabetic proliferative retinopathy.

The objective of this study was to examine the retinal and pregnancy outcomes of pregnancies complicated by advanced diabetic retinopathy. Twenty pregnancies complicated by advanced diabetic retinopathy were included in this retrospective study. The data were analyzed to determine trends in perinatal outcome and to document the ophthalmologic performance.

The relation between human fetal growth and fetal blood levels of insulin-like growth factors I and II, their binding proteins, and receptors.

Objective: To determine the relation between normal human fetal growth and the levels of insulin-like growth factors (IGF-I, IGF-II), their receptors, and IGF binding protein-3 (IGFBP-3) in both the maternal and fetal compartments.

Methods: Serum samples were obtained from normal pregnant women (n = 52) and their fetuses (n = 32) via funipuncture at 21-34 weeks' gestation (mean 29 +/- 4.3) and from term neonates (n = 20) between 38-41 weeks (mean 39 +/- 0.

Diabetes mellitus in pregnancy and the assessment of umbilical artery waveforms using pulsed Doppler ultrasonography.

The utility of Doppler ultrasonography as a means of assessing potential alterations of vascular resistance prior to fetal or maternal compromise is very attractive. We investigated this relationship by prospectively performing Doppler studies of the fetal umbilical artery in 56 diabetic patients, 14 of whom had varying degrees of vascular complications. When regression curves were established for the S/D ratio, the Pourcelot index, and the resistance index of the fetal umbilical artery, the mean Doppler values were higher in diabetic patients with vasculopathy than in nondiabetic control patients or in diabetic patients without vasculopathy.

Metabolic changes in diabetic and nondiabetic subjects during pregnancy.

Diabetes mellitus with its resulting derangement of various metabolic fuels, carbohydrates, amino acids, lipids, and ketones has the potential to adversely affect the developing fetus. Therefore, strict glycemic control in pregnancy has become the standard of care in modern obstetrics. A considerable amount of research has been undertaken into the metabolic changes that occur during pregnancy in both women with insulin-dependent diabetes and gestational diabetes.

Eradication of Viridans streptococci from the amniotic cavity with transplacental antibiotic treatment.

We report a case of eradication of Viridans streptococci from the amniotic cavity in a patient with preterm labor and intact membranes by transplacental antibiotic treatment. Following this modality of treatment, preterm labor was arrested and the pregnancy continued uneventfully until normal term delivery. We suggest that transplacental antibiotic treatment should be seriously considered as part of the medical armamentarium for treatment of patients with preterm labor and microbial invasion of the amniotic cavity.

Gaining access to the embryonic-fetal circulation via first-trimester endoscopy: a step into the future.

Objective: To assess the feasibility of gaining access to the embryonic-fetal circulation via first-trimester transcervical embryoscopy.

Methods: A fiberoptic endoscope with a 3.5-mm, wide-angle lens was passed transcervically through the chorion and into the exocoelomic cavity of women undergoing pregnancy termination.

Relationship between C-reactive protein levels and intraamniotic infection in women with preterm labor.

The purpose of this study was to determine the relationship between C-reactive protein (CRP) levels and intraamniotic infection in 48 women presenting with preterm labor and intact membranes. Blood samples for CRP tests were obtained immediately before the performance of transabdominal amniocentesis. The prevalence of amniotic fluid cultures positive for organisms was 14.

Estrogen and progesterone receptors in the uterine artery of rats during and after pregnancy.

Changes in the level of estrogen and progesterone receptors in the uterine artery of the rat were studied during pregnancy in order to evaluate the estrogen dependency of this artery. The weight of the uterine artery and its content of estrogen and progesterone receptors were measured. The steroid receptor content was also measured in the uterus and aorta as the tissues of these organs are estrogen-responsive and non-responsive, respectively.

Metabolic fuel mixtures and diabetic embryopathy.

The incidence of congenital anomalies remains the major cause of morbidity and mortality among the offspring of diabetic women. Animal and human studies indicate that these malformations occur early in pregnancy and are influenced by the abnormal maternal metabolic milieu. This article reviews the recent advances in understanding the pathogenesis of diabetic embryopathy.

[Limulus amebocyte lysate assay for diagnosing intraamniotic infection].

The value of the Limulus amebocyte lysate assay (LAL) in the diagnosis of intraamniotic infection was determined in amniotic fluid from transabdominal amniocenteses in 51 women in preterm labor with intact membranes. The prevalence of positive amniotic fluid cultures was 21.5% (11/51) in detecting intraamniotic infection.

Familial occurrence of thrombotic thrombocytopenic purpura in two sisters during pregnancy.

The etiology of thrombotic thrombocytopenic purpura is not fully understood. A genetic predisposition and other inciting factors have been suggested by several studies to bring about the full-blown syndrome. We report two cases of thrombotic thrombocytopenic purpura in two sisters with sudden onset during late pregnancy.

The prevalence and clinical significance of intraamniotic infection with Candida species in women with preterm labor.

Intraamniotic infection is considered a major etiologic factor of preterm birth. Positive amniotic fluid cultures are rarely contaminated with Candida species. The presence of this microorganism is associated with a poor pregnancy outcome.

[Complications of third stage labor and the puerperium in preterm and term deliveries].

Preterm delivery is the leading cause of perinatal morbidity and mortality worldwide. The purpose of the present study was to determine whether preterm delivery is associated with complications of the third stage of labor and of the puerperium. Retained placentas occurred more frequently in 99 women with preterm vaginal delivery than in 97 with term vaginal delivery (13.

Cesarean section by local anesthesia in patients with familial dysautonomia.

We describe a 29-year-old patient with familial dysautonomia who underwent cesarean section because of severe intrauterine fetal growth retardation. The surgery was done after induction of local anesthesia to avoid the critical and sometimes fatal complications of general anesthesia known in patients with familial dysautonomia. Surgery was uneventful and almost painless.

Changes in amniotic fluid concentrations of prostaglandins E2 and F2 alpha in women with preterm labor.

There is a paucity of data regarding the concentration of prostaglandins (PGs) in the amniotic fluid of women with preterm labor. The purpose of this study was to determine if preterm labor is associated with changes in amniotic fluid concentration of prostaglandins E2 and F2 alpha. Amniotic fluid was retrieved by transabdominal amniocentesis from women with preterm labor and intact membranes.

Plasma antithrombin III levels in pre-eclampsia and chronic hypertension.

Plasma levels of antithrombin III were tested during pregnancy in a control group of normal patients and in a study group that included patients with moderate and severe pre-eclampsia and chronic hypertension. The control group showed mean antithrombin III activity of 97.9 +/- 20.