Asha Rijhsinghani

Risk of preeclampsia in second-trimester triploid pregnancies

Objective To determine the magnitude of the risk and the predictive clinical characteristics for development of preeclampsia when triploidy is diagnosed in the second trimester. Methods A retrospective analysis of databases maintained by the cytogenetics laboratories at the University of Iown and University North Carolina was performed to identify all cases of triploidy. We examined the karyotype, maternal serum screening (particularly the hCG level), ultrasound results, and evidence of maternal hypertensive disease. Results Seventeen cases of triploidy were identified between 1987 and 1996. Preeclampsia or hypertension complicated six of these cases with onset between 15 and 22.5 weeks gestation. In these six cases, the serum hCG level was extremely high. Serum results were available in seven cases in which preeclampsia did not develop, and the hCG levels were under 0.09 multiples of the median in five of the seven cases. In all six cases in which preeclampsia or hypertension developed, there was stenographic evidence of placentomegaly. Sonographic findings in 16 17 cases revealed fetal growth restriction, oligohydramnios, fetal anomalies, placentomegaly, or a combination of these. Conclusion In our series of pregnancies complicated by triploidy, the risk of developing preeclampsia or hypertension in the second trimester was 35%. It appears that elevated serum hCG levels and placentomegaly are associated with a higher risk of preeclampsia but low hCG levels are not. This information is important in counseling patients who are hesitant to terminate a pregnancy purely for a fetal abnormality, even if the anomaly is lethal.

The association between manual removal of the placenta and postpartum endometritis following vaginal delivery

Objective To determine whether manual removal of the placenta after vaginal delivery is a risk factor for postpartum endometritis. Methods A retrospective cohort study of vaginal deliveries compared 1052 patients who had manual removal of the placenta with 1085 patients whose placentas delivered spontaneously. Subjects were selected randomly from the 25,687 vaginal deliveries at the University of Iowa Hospitals during 1979–1992. The presence of endometritis was determined using information in medical records. The data were analyzed using odds ratios (OR) and multiple logistic regression. Results After controlling for confounding variables, manual removal of the placenta was associated with postpartum endometritis (adjusted OR 2.9, 95% confidence interval [CI] 1.7–4.9). Other risk factors for endometritis included maternal age less than 17 years (OR 3.3, 95% CI 1.5–7.2), postpartum anemia (OR 2.9, 95% CI 1.9–4.5), and membranes ruptured longer than 24 hours (OR 2.5, 95% CI 1.4–4.3). Conclusions Manual removal of the placenta is a risk factor for postpartum endometritis after vaginal delivery.

Prenatal diagnosis of Apert syndrome

Objective: The role of the human fibroblast growth factor receptor (FGFR) gene family in current prenatal diagnosis and management of craniosynostosis syndromes and skeletal dysplasias is discussed. Method: We present the antenatal ultrasound findings, diagnosis, and management of 2 cases of Apert syndrome before and after molecular prenatal diagnosis was available. Results and Conclusion: Discovery of mutations in FGFR genes now allows the definitive antenatal diagnosis of Apert syndrome, other craniosynostosis syndromes, and skeletal dysplasias.

Dysfibrinogenemia and placental abruption.

Women with congenital dysfibrinogenemia have greater risk of obstetric complications, including spontaneous abortion and postpartum thrombosis, than the general population. Congenital dysfibrinogenemia is caused by genetic mutations that create dysfunctional fibrinogen resistant to thrombin cleaving. Dysfibrinogenemias present with hemorrhage (25%) or thrombosis (20%) or are asymptomatic (55%) and detected by presurgical coagulation studies. A primigravida with placental abruption was diagnosed subsequently with dysfibrinogenemia.

Acute Compartment Syndrome: Clinical Course and Laboratory Findings in Pregnant Patients with McArdle's Disease

Dear Editor,nnPatients with McArdles disease are often diagnosed secondary to exercise intolerance, myalgia, fatigue, poor endurance, and muscle swelling, among other symptoms. In these patients, the resting serum creatine kinase (CK) levels are known to be elevated. There is little information regarding the effects of labor and delivery on the disease. We would like to report our experience in patients with McArdles disease that were followed during their pregnancy and in the peripartum period. Following delivery, one of the patients developed sudden severe ankle pain which was consistent with and subsequently confirmed as acute compartment syndrome. The rise in serum creatine kinase by itself was not diagnostic of postpartum compartment complication but when combined with clinical findings, the condition was recognized and treated.nnMcArdles disease is a genetic condition that is predominantly passed in an autosomal recessive fashion [1,2]. Patients with McArdles disease have inadequate amounts of skeletal muscle specific glycogen phosphorylase, myophosphorylase which subsequently leads to elevation in CK levels [1,3,4]. These patients suffer from exercise intolerance characterized during anaerobic activities and intense aerobic activities [1,3,4]. A high-resting serum CK level after demanding physical exertion is characteristic of McArdles disease [1]. A diet consisting mostly of complex carbohydrates in …

Discrepancy in placental echogenicity: a sign of twin anemia polycythemia sequence

Twin anemia polycythemia sequence (TAPS) is a form of twin‐to‐twin transfusion syndrome that occurs very rarely and may not be diagnosed until after delivery. The condition leads to increased risk of perinatal morbidity and mortality. We present two cases of monochorionic diamniotic twins, in which the diagnosis of TAPS was made after documenting a discrepancy in the echodensities of the two portions of the placenta. Postnatal hemoglobin differences between the twins confirmed the diagnosis of TAPS. On the basis of these two cases, it appears that the heterogeneity in placental echogenicity is a sign of TAPS and Doppler measurement of middle cerebral artery peak systolic velocity is helpful for early diagnosis and management with timely delivery.

Elevated delta OD 450 due to transient abnormal myelopoiesis in a Down syndrome fetus with hepatosplenomegaly on ultrasound

Transient abnormal myelopoiesis (TAM) is a relatively common finding in children with Down syndrome but has also been diagnosed prenatally, most often presenting with fetal hepatosplenomegaly. We report a case of TAM with hepatosplenomegaly found on ultrasound and associated with an increased amniotic fluid Δ OD 450 value. TAM is most commonly transient but can be associated with fatality and therefore should be considered in the differential diagnosis when fetal hepatosplenomegaly is found on ultrasound. Amniocentesis with chromosomal analysis and a Δ OD 450 may aid in diagnosing TAM and predicting the severity of the liver involvement.

Does observed vs expected lung head ratio correlate with neonatal survival in infants with congenital diaphragmatic hernias

This was a retrospective cohort study that utilized an ongoing data base of all CDH cases treated at the University of Iowa Hospital and Clinics. LHR was measured from antenatal ultrasounds and O/E LHR was calculated using the online database on TOTALtrial.com. OI data from previously published research study at the University of Iowa was used. The ANOVA test was used to analyze LHR data, while the Kruskal Wallis test was used to analyze O/E LHR and OI data. All analyses were performed using the SAS data analysis software.