The tumor necrosis factor alpha and its soluble receptor profile in term and preterm parturition.

Objective: The common terminal pathway of parturition describes the anatomic, biochemical, endocrine, and clinical events present in the fetus and mother in both term and preterm labor. Labor at term is thought to result from physiologic activation of this pathway, whereas preterm labor is the result of pathologic activating events. The purpose of this study was to determine whether physiologic and pathologic activation could be discerned by the analysis of a cytokine-receptor signaling system.

N-methyl-D-aspartate receptor binding is altered and seizure potential reduced in pregnant rats.

The objective of this study was to determine if a change in brain tissue excitatory amino acid receptor binding occurs during pregnancy using in vitro quantitative autoradiography and to examine seizure potential during pregnancy via central injection of N-methyl-D-aspartate (NMDA). For the receptor autoradiography studies, eight pregnant rats (day 21) and eight non-pregnant rats were euthanized with carbon dioxide, perfused, their brains dissected and frozen. Cryostat sections were taken and labeled in vitro by one of the following ligands: [3H]-CGP 39653, [3H]-glycine, [3H]-MK-801, [3H]-2-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) or [3H]-kainate.

Ontogeny of recurrent hydrocephalus: presentation in three fetuses in one consanguineous family.

A consanguineous couple had 3 pregnancies in which prenatally diagnosed hydrocephalus was observed (in 1 female and 2 male fetuses). This case appears to represent an autosomal recessive form of hydrocephalus, given the consanguinity, affected sibs of both genders, and no evidence for intrauterine infection, chromosome abnormality, or neural tube defect.

Conservative surgery in a young patient with peritoneal psammocarcinoma.

Psammocarcinoma is a rare epithelial neoplasm of the ovary and peritoneum. The reported management of patients with this tumor includes radical surgery and chemotherapy. We report the case of a young woman with metastatic psammocarcinoma treated with conservative surgery who is alive 6.

Maternal-Fetal Medicine Units (MFMU) studies of inhaled corticosteroids during pregnancy.

Few prospective clinical trials exist to address the use of asthma medications during pregnancy in relation to neonatal outcomes. There is a need to identify favorable pregnancy outcomes in relation to the successful treatment of pregnant women with asthma. To this end, 3 studies have been initiated: (1) a retrospective analysis of inhaled steroid use in a maternal-fetal medicine research center, (2) a large observational cohort study assessing the effects of different types of asthma treatments on perinatal outcomes, and (3) a randomized clinical trial comparing theophylline and inhaled beclomethasone in the treatment of pregnant women with moderately severe asthma.

A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition.

Objective: There is no evidence for the participation of the human fetus in the mechanisms responsible for the onset of preterm labor. We propose that preterm labor in the setting of infection results from the actions of proinflammatory cytokines secreted as part of the fetal and/or maternal host response to microbial invasion. The objective of this study was to determine whether a systemic fetal inflammatory response, defined as an elevation of fetal plasma interleukin-6 concentrations, has a temporal relationship with the commencement of labor.

Pastoral care utilization among women electing pregnancy termination for fetal anomalies.

Objective: To identify determinants of requesting pastoral care (PC) at the time of pregnancy termination for fetal anomalies.

Methods: PC was provided by a hospital-based chaplain. Data were reviewed for 88 women who elected pregnancy termination.

Limited clinical utility of midtrimester fetal morphometric percentile rankings in screening for birth weight abnormalities.

Objective: Our purpose was to determine whether midtrimester fetal ultrasonographic morphometric percentile rankings are sensitive screening tests for preterm labor or birth weight abnormalities.

Study Design: Stepwise multiple regression and chi 2 analysis were used to identify midtrimester fetal measurements predicting birth weight and gestational age. Receiver-operator characteristics curves were used to evaluate abdominal circumference percentiles as a test for large-for-gestational-age and small-for-gestational-age infants.

Maternal thrombocytopenia. Predicting neonatal thrombocytopenia with cordocentesis.

Objective: To evaluate the efficacy of cordocentesis for predicting fetal thrombocytopenia in the presence of maternal thrombocytopenia.

Study Design: We studied platelet counts obtained by cordocentesis from 42 consecutive immune thrombocytopenia purpura patients. Platelet counts were obtained on 36 neonates, and the statistical analysis included only these infants.

Maternal thyroid function does not alter maternal serum alpha-fetoprotein interpretation.

Objective: Endocrine alterations of metabolism such as diabetes and obesity are known to affect maternal serum alpha-fetoprotein interpretation. Thyroid function has been questioned, e.g.

Prenatal diagnosis of fetal herpes simplex infection.

Background: Intrauterine infection with herpes simplex virus (HSV) has been associated with a significant number of neonatal HSV infections. When these infections begin in utero, the associated morbidity is more severe, and treatment regimens may be less effective.

Case: A 24-year-old nullipara with an abnormal triple screen and multiple ultrasound abnormalities at 19 weeks' gestation underwent amniocentesis and cordocentesis.

Preliminary experience with triamcinolone acetonide during pregnancy.

Although inhaled corticosteroids have been recommended, there are no published reports of triamcinolone acetonide therapy for asthma during pregnancy. The objective of this study was to report our experience with triamcinolone acetonide during pregnancy. This was a retrospective cohort study in a tertiary care urban hospital.

Faint and positive amniotic fluid acetylcholinesterase with a normal sonogram.

Objective: Both faint and positive amniotic fluid acetylcholinesterase determinations have been associated with fetal abnormalities. We evaluated the effect of a normal sonogram and positive or faint acetylcholinesterase level on the risk for anomalies.

Study Design: Between Jan.

Abnormal nuchal findings on screening ultrasonography: aneuploidy stratification on the basis of ultrasonographic anomaly and gestational age at detection.

Objective: Our purpose was to determine the specific likelihood of different aneuploidies by gestational age in patients with nuchal folds and simple and septated nuchal membranes.

Study Design: Retrospective database analysis was performed of 158 consecutive patients with a nuchal fold or simple or septated nuchal membrane on either abdominal or vaginal ultrasonography.

Results: Thirty-eight patients with nuchal folds, 65 with simple nuchal membranes, and 55 with septated nuchal membranes were evaluated.

Ethical issues surrounding multifetal pregnancy reduction and selective termination.

MFPR and selective terminations satisfy the criteria of enabling pregnancies to continue with the least harm and most benefits to all involved. The surviving infants can be saved from certain death (abortion) or higher risks of severe harm and death and of an extended stay in neonatal intensive care (premature delivery). In the hands of trained operators, MFPR and selective termination is, in our opinion, the best means to protect the mother's health and well-being, given it is available and approved by the parents.

Brain ionized magnesium and calcium levels during magnesium supplementation and deficiency in female Long-Evans rats.

Objective: To examine the effect of changes in the state of magnesium balance on ionized magnesium and ionized calcium in serum and brain tissue of female rats.

Methods: Forty-two mature rats were used in the study. To induce hypermagnesemia, 12 rats received 270 mg/kg of magnesium sulfate intraperitoneally, followed every 20 minutes for 2 hours with 27 mg/kg magnesium sulfate.

Fetal ionized magnesium levels parallel maternal levels during magnesium sulfate therapy for preeclampsia.

Objective: Little is known about ion regulation in fetuses. Our aim was to determine the effects of magnesium sulfate therapy on ionized (bioactive) magnesium in the cord blood of pregnancies complicated by preeclampsia.

Study Design: Seventy-four pregnant women were studied (37 preeclamptic and 37 controls matched for maternal age, gravidity, and gestational age).

Modified stylet technique for tenting of amniotic membranes.

A modified amniocentesis technique can reduce the failure rate in cases of tenting of the membranes. Failure to aspirate amniotic fluid (AF) because of amniotic membrane tenting may persist after advancement and rotation of the needle. In such cases, the membranes may be pierced by using a stylet that is longer than the length of the needle.

International, collaborative experience of 1789 patients having multifetal pregnancy reduction: a plateauing of risks and outcomes.

Objective: To develop the most up-to-date, complete data base of multifetal pregnancy reduction (MFPR) from cases, and to provide the best counseling for couples with multifetal pregnancies.

Methods: From nine centers in five countries, 1789 completed MFPR cases were collected and outcomes evaluated. Pregnancy losses were defined as through 24 weeks and deliveries categorized in groups of 25-28, 29-32, 33-36, and 37 or more weeks.

Changes in health care delivery: a threat to academic obstetrics.

Objective: Our purpose was to examine the effect of anticipated health care policy changes on delivery trends at leading academic obstetric institutions.

Study Design: The 51 centers in the United States with the most Society of Perinatal Obstetricians presentations in the past 2 years were surveyed regarding annual deliveries from 1990 to 1993 and reasons for any changes. Analysis of variance and chi 2 analysis were used as appropriate.

Premature parturition is characterized by in utero activation of the fetal immune system.

Objective: At birth the fetus emerges from a sterile environment into a nonsterile one. This process is associated with activation of the fetal immune system which protects the fetus against infection in the newborn period. We conducted this study to determine whether activation of the monocyte-neutrophil system occurs in fetuses before premature birth.

Computer-generated admission forms have greater accuracy.

We examined the accuracy of computer-generated admission forms to standardized handwritten admission forms for 40 patient records. There was a mean of 8.3 errors among handwritten forms but only 0.

Underappreciated risks of the elderly multipara.

Objective: Our purpose was to identify the age-related increased risks of the elderly gravida by clarifying the effects of age and parity, their combination, and their interaction.

Study Design: We studied 9556 singleton pregnancies in women aged 20 to 29 years or > or = 35 years delivered over an 8-year period. Data were analyzed by stepwise multiway contingency table analysis, with p < 0.

Gynecologic disorders in women with Ehlers-Danlos syndrome.

Objective: We characterized the population with Ehlers-Danlos syndrome with regard to genital prolapse, urinary incontinence, and other gynecologic disorders.

Methods: Forty-one adult women who had registered for a first-ever Ehlers-Danlos multidisciplinary clinic participated in the study. Each had a comprehensive standardized evaluation, including gynecologic history, physical examination, urodynamic testing, and physical therapy evaluation.