The accuracy of late third-trimester antenatal screening for group B streptococcus in predicting colonization at delivery.

We reevaluated the accuracy of antenatal group B streptococcal (GBS) culture results in predicting colonization at the time of delivery in a general practice setting. Patients who had late third-trimester antenatal GBS cultures were prospectively identified. A repeat GBS culture was performed when admitted in labor using a strict protocol and laboratory analysis.

Longitudinal study of CD4+ cell counts in HIV-negative pregnant patients.

Objective: To evaluate the absolute CD4+, CD8+, and lymphocyte cell counts and percentages from the first trimester through 6-12 weeks post-delivery in normal human immunodeficiency virus (HIV)-negative pregnant patients.

Methods: A longitudinal laboratory analysis was performed during pregnancy that involved 51 HIV-negative subjects with blood analysis obtained in all trimesters, at delivery, and 6-12 weeks post-delivery. Twenty-five HIV-negative non-pregnant controls were also evaluated.

The fetal heart monitor tracing in pregnancies complicated by a spontaneous umbilical cord hematoma.

The objective of this study is to present and describe the fetal heart rate appearance in pregnancies complicated by an antenatal spontaneous umbilical cord hematoma that resulted in a live birth. Three cases of antenatal spontaneous umbilical cord hematoma are described. All three patients presented with a complaint of decreased fetal movement.

Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases.

Background: The diagnosis of carbon monoxide poisoning in the third trimester of pregnancy requires an index of suspicion, and the appearance of the fetal heart monitor tracing may help in this regard.

Cases: Three cases of third-trimester acute carbon monoxide poisoning occurred. In each pregnancy, the fetal heart monitor tracing on admission was correlated with the maternal carboxyhemoglobin level, and how the pattern changed following the institution of therapy was analyzed.

The fetal heart monitor tracing in pregnancies complicated by fetal thyrotoxicosis.

Fetal tachycardia caused by the transplacental passage of thyroid stimulating immunoglobulin is well established, but very little information exists regarding the fetal heart rate appearance of this form of tachycardia. Two cases of fetal tachycardia are described in pregnancies complicated by fetal thyrotoxicosis where maternal thyroid history was unknown at the time of testing. For each pregnancy, the fetal heart monitor tracing is depicted and described.

Detection of phosphatidylglycerol in frozen amniotic fluid by rapid assay of fetal lung maturity.

Objective: The study objective was to analyze the accuracy of the antibody-mediated rapid assay slide agglutination AmnioStat-FLM (Irvine Scientific, Santa Ana, CA) test in detecting the presence or absence of phosphatidylglycerol (PG) in amniotic fluid samples that have been frozen.

Study Design: A prospective blinded evaluation was performed in which fresh samples of amniotic fluid were initially analyzed for PG by the rapid assay (AmnioStat-FLM) test and the results reported for patient management. The specimens were then coded, patient identification was removed and specimens were then frozen.

Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis.

Objective: The purpose of this study was to determine if antenatal fetal surveillance should be considered in pregnancies complicated by fetal gastroschisis, and if so, what gestational age should testing begin.

Study Design: During an 18-year period, all pregnancies delivered of a newborn that had gastroschisis were identified. Numerous data parameters were collected, including gestational age at delivery, birthweight, indication for delivery, antenatal testing results if performed, and neonatal outcome.

Pregnancy outcome after a primary antenatal hemorrhage between 16 and 24 weeks' gestation.

Objective: Numerous studies have evaluated pregnancy outcome after previable antenatal hemorrhage, though nearly all of these have included first-trimester pregnancies. The study objective was to examine the pregnancy outcome after a primary antenatal hemorrhage that occurs between 16 and 24 weeks' gestation.

Study Design: During a 12-year period, all pregnancies that experienced a first episode of antepartum hemorrhage occurring between 16 and 24 weeks' gestation were identified.

Update on the utilization of grafts in pelvic reconstruction surgeries.

Purpose Of Review: Implanted grafts are increasingly used by pelvic reconstructive surgeons and gynecologists. In addition, the marketing of a variety of grafts has been aggressively expanded without scientific evidence to support their use. This review aims to provide an update of the current status and role of grafts in reconstructive pelvic surgery and to review the current knowledge of the biology of currently marketed synthetic and biologic grafts.

The use of prostaglandin E2 in pregnant patients with asthma.

Objective: Prostaglandin E(2) is a pharmacologic agent that is used commonly in obstetrics; however, its usage in patients with asthma is unclear. The study objective was to examine pregnant patients with asthma who received prostaglandin E(2).

Study Design: All pregnancies that were given prostaglandin E(2) suppositories and/or gel were recorded prospectively from January 1989 through December 2000.

Is the incidence of fetal-to-maternal hemorrhage increased in patients with third-trimester bleeding?

Objective: If a pregnancy is complicated by third-trimester bleeding, is there a higher risk of fetal-to-maternal hemorrhage that might necessitate the administration of additional anti-D immune globulin to prevent alloimmunization in the patient who is Rh D-negative? The study objective was to analyze prospectively the incidence of fetal-to-maternal hemorrhage in pregnancies that were complicated by third trimester bleeding compared with three control groups.

Study Design: Pregnancies that were complicated by third-trimester bleeding, preterm premature rupture of the membranes, and preterm labor were identified prospectively on admission. A group of preterm patients with no complications was also collected prospectively.

Antepartum use of antibiotics and early-onset neonatal sepsis: the next 4 years.

Objective: The purpose of this study was to analyze the incidence of early-onset neonatal sepsis and the presence of antibiotic resistance of the isolated bacteria and its relationship to antibiotic chemoprophylaxis that occurred during the 4 years that followed the publication of the most recent group B streptococcal guidelines.

Study Design: A prospective cohort study was performed between January 1, 1997, and December 31, 2000. All cases of early-onset neonatal sepsis were gathered prospectively.

The presence of hepatitis B surface antigen and deoxyribonucleic acid in amniotic fluid and cord blood.

Objective: It is uncertain whether neonatal infection with hepatitis B, despite treatment after delivery with immunoglobulin and vaccine, is the result of prior in utero transmission of the virus or treatment failure. Furthermore, the potential risk of hepatitis B transmission from the mother to the fetus at the time a genetic amniocentesis is performed is also a concern. In an attempt to better elucidate these controversies, amniotic fluid and cord blood specimens obtained from pregnant women positive for hepatitis B surface antigen were analyzed for the presence of hepatitis B surface antigen and hepatitis B deoxyribonucleic acid.

Neonatal outcome when delivery follows a borderline immature lecithin to sphingomyelin ratio.

Objective: Occasionally, clinicians are presented with a complicated preterm pregnancy where fetal pulmonary maturity testing might be used to help guide management decisions. However, should delivery be allowed if the lecithin to sphingomyelin ratio (L/S ratio) is not quite mature? The incidence of newborn complications after delivery with L/S ratio values of 1.8 and 1.

The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants.

Objective: To determine the incidence of grade III or IV intraventricular hemorrhage in very low birth weight (VLBW) infants born at level I hospitals and transported to one tertiary center compared with those delivered at the same level III facility.

Methods: We evaluated all newborns admitted to a large tertiary neonatal intensive care unit from June 1, 1992, through December 31, 1995. All live born infants with birth weights of 500-1200 g and at least 24 weeks' gestation were included.

A "bloodless cesarean section" and perinatal transmission of the human immunodeficiency virus.

Objective: Perinatal transmission of the human immunodeficiency virus is the main pathway for children to become infected with this virus; however, the relative contribution and timing of this transmission, whether transplacental or by exposure through the birth process, have not yet been elucidated. An obvious question is whether the mode of delivery has an impact on this transmission rate. However, a routine cesarean section will primarily diminish the duration of exposure of maternal bodily fluids to the neonate but does not prevent the baby from being exposed to maternal blood coming from the uterine incision.

Perinatal outcome with the modified biophysical profile.

Objective: Our purpose was to evaluate perinatal outcomes in high-risk pregnancies monitored with a modified biophysical profile.

Study Design: All non-insulin-dependent patients referred for antepartum fetal surveillance received a modified biophysical profile biweekly. A modified biophysical profile is a combination of a nonstress test and an amniotic fluid index.

A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation.

Previous randomized controlled studies of corticosteroids for the reduction of respiratory distress syndrome have failed to demonstrate benefit in very early premature gestational age groups. A randomized, double-blind, placebo-controlled clinical trial of betamethasone given to mothers with intact membranes and threatened premature delivery between 24 and 28 weeks of pregnancy was conducted. Thirty-six patients were randomized to receive betamethasone, two doses of 12 mg, 24 hours apart, and 41 received placebo.

The lambda fetal heart rate pattern: an assessment of its significance in the intrapartum period.

The "lambda" fetal heart rate (FHR) pattern was first described in 1977 as a pattern involving an acceleration followed immediately by a deceleration. However, its clinical significance has not been elucidated. During 6 months, 56 patients with this pattern were identified, representing 4% of all deliveries during this period.