Dibe Martin

Sonographic diagnosis of caudal regression in the first trimester of pregnancy.

Caudal regression syndrome (CRS) represents a continuum of congenital anomalies that may include incomplete development of the sacrum and, to a lesser extent, the lumbar vertebrae, disruption of the distal spinal cord, and extreme lack of growth of the caudal region. 1 First-trimester prenatal diagnosis of CRS is challenging because of incomplete ossification of the sacrum at that time.2 Most case reports of CRS have occurred during the second trimester. 3-10 We report a case of CRS diagnosed during the first trimester on the basis of transvaginal sonography.

Genetic Amniocentesis Complications: Is the Incidence Overrated?

Aims: To estimate the complication rate of 2nd-trimester amniocentesis and to determine the associated risk factors. Methods: A retrospective chart review of genetic amniocenteses performed at a single tertiary care institution, from 1996 to 1998, was done. The variables studied included gestational age, indication for amniocentesis, number and site of needle punctures, and amniotic fluid color. Complications included fetal loss, rupture of membranes, and bleeding. Results: Out of the 1,347 procedures analyzed, the most common indications were advanced maternal age (72.3%) and abnormal triple screen (20.3%). Transplacental genetic amniocenteses totaled 234 (17.4%). Clear fluid was observed in 98.2% of the patients. Twenty-two complications (1.6%) were observed: fetal loss (0.22%), bleeding (0.59%), and rupture of membranes (0.82%). An abnormal karyotype was detected in 34 (2.5%) fetuses. In separate univariate logistic regression analyses, complications were significantly associated with gestational age [odds ratio OR = 1.19; 95% confidence interval CI = (1.08, 1.32); p = 0.001], number of punctures [OR = 8.2; 95% CI = (1.76, 37.97); p = 0.007], and ultrasound anomalies [OR = 5.82; 95% CI = (1.65, 20.58); p = 0.006]. Gestational age and number of punctures remained significant in multivariate logistic regression analysis. Conclusions: Genetic amniocentesis performed at a tertiary care institution is rather safe, and the fetal loss rate of 0.22% is significantly lower (p < 0.001) than the previously published incidence of 1/200. The risk of complications is significantly and independently associated with advanced gestational age and number of punctures.

Cervical length and the risk of spontaneous labor at term

Objective:To investigate the relationship between cervical length (CL) at 37 to 40 weeks and delivery within 7 days and delivery by 41 weeks.Study design:We performed transvaginal ultrasound to measure CL in women with singleton gestations at 37 to 40 weeks. We then used a receiver operating characteristic curve (ROC) to assess the relationship between CL and delivery within 7 days and delivery by 41 weeks.Result:For the 120 women included in the analysis, the mean CL (±s.d.) was 25.3±9.8 mm. The logistic regression model to predict each of the outcomes includes gestational age at ultrasound (GA-US) and CL. Neither birthweight, nor parity seems to affect the probability of delivery within 7 days. The ROC curve was used to assess the probability of spontaneous labor within 7 days at each CL measurement. The likelihood ratio of delivery within 7 days when CL is ⩽10 mm is 12.Conclusion:CL measurement at 37–40 weeks is an independent predictor of delivery within 7 days and delivery by 41 weeks regardless of GA-US. This information can be utilized when counseling patients regarding the management of term pregnancies.

The Effects of Amnioinfused Solutions for Meconium-Stained Amniotic Fluid on Neonatal Plasma Electrolyte Concentrations and pH

OBJECTIVE: To determine if amnioinfused normal saline or lactated Ringers solution in cases of meconium-stained amniotic fluid is associated with significant changes on neonatal plasma electrolyte concentrations or pH.STUDY DESIGN: This was a prospective randomized study using normal saline or lactated Ringers solution for amnioinfusion in women with thick meconium in the amniotic fluid. The control group was composed of women with clear amniotic fluid not receiving amnioinfusion. Cord blood arterial sampling was analyzed for sodium, potassium, and chloride plasma concentrations and pH. The sample sizes allowed for an α of 0.05 and power of 0.80.RESULTS: We evaluated 61 cases (20 normal saline solution, 20 lactated Ringers solution, and 21 control). No significant differences in cord blood arterial plasma concentrations of sodium (p=0.43), potassium (p=0.21), chloride (p=0.68), and pH (p=0.11) were noted.CONCLUSION: Use of normal saline or lactated Ringers solution for amnioinfusion in meconium-stained amniotic fluid is not associated with changes on neonatal plasma electrolyte concentrations or pH.

Perinatal morbidity: a comparison of vacuum delivery and spontaneous delivery

Objectives: To compare the risk of perinatal complications in vacuum-assisted vaginal delivery (VAC) and spontaneous vaginal delivery (SVD). Methods: We did a retrospective chart review of a random sample of women delivering via VAC at our center between 1995 and 1999 and frequency-matched the sample to an SVD group of the same gestational age, birth weight, maternal age, parity, and ethnic background. Results: A total of 710 patients’ charts (355 patients in each arm) were selected for review. We made a preliminary review of 56 VAC charts and 54 SVD charts. The two groups were comparable with respect to maternal age (mean ± SD in SVD versus VAC; 26.8 ± 5.9 years versus 25.8 ± 6.3 years), gestational age (39.1 ± 2.0 weeks versus 39.0 ± 1.6 weeks), and birth weight (3,222 ± 461 g versus 3,232 ± 526 g). Using logistic regression, gravidity was not statistically predictive of mode of delivery (P = 0.80) and neither was parity (P = 0.58). A woman who had a vacuum delivery was six times more likely to have epidural analgesia (OR = 6.6, 95%CI [2.6,16.6]), and babies delivered by vacuum were almost four times more likely to be admitted to an intensive care unit (OR = 3.7, [1.3,9.6]). There was no difference in the likelihood of meconium (OR = 1 .16,[0.4,3.0]) or laceration (OR = 1.1,[0.4–2.5]). Conclusion: Although commonly used, vacuum deliveries appear to present increased risks to newborns when compared with spontaneous vaginal deliveries. These risks are evidenced by increased intensive care unit admissions.