Hung N. Winn

Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations

Thirty-two patients with uncomplicated twin pregnancies had ultrasonographic examinations for genetic amniocentesis, confirmation of twinning, or assessment of fetal growth. The dividing membranes between the fetuses were visualized, and the thickness of the membranes was measured. With a thickness of 2 mm used as a cutoff point, the accuracy in predicting monochorionic or dichorionic twinning was 82% and 95%, respectively. Prenatal assessment of these dividing membranes may be helpful in the management of twin gestations.

The reversal of hydrops fetalis by intravascular intrauterine transfusion in severe isoimmune fetal anemia

Seventy-two intrauterine intravascular transfusions were performed on 26 patients with severe erythroblastosis fetalis. Twenty of the 26 fetuses were hydropic at the time of referral. Of the 20 hydropic fetuses, 16 (80%) survived. Hydrops was completely reversed in 13 of the 16 fetuses (81%). Total protein of less than 3 gm/dl, albumin less than 2 gm/dl, and a hematocrit level of less than 15% were associated with hydrops fetalis. After hydrops was reversed, total protein greater than 3 gm/dl, albumin greater than 2 gm/dl, along with a sustained hematocrit level of greater than 15%, were found. Only three neonates were born with minimal ascites, two of whom had had intraperitoneal transfusions before intravascular treatments. There were 21 survivors of the total group, giving an overall survival rate of 82%. There was one neonatal death from severe respiratory distress syndrome. Thirty-eight percent of the neonates did not require exchange transfusions in the newborn period. Intrauterine intravascular transfusions appear to be an effective mode of therapy in severe erythroblastosis fetalis and not only increase survival rates but also decrease neonatal morbidity and mortality.

Does preeclampsia influence fetal lung maturity

Abstract Objective: This retrospective study compared the fetal lung maturity biochemical profile of patients having preeclampsia with that of patients having preterm labor. Study Design: Amniotic fluid was obtained by transabdominal amniocentesis in 90 patients, 59 patients with preterm labor (PTL) and 31 patients with preeclampsia (PRE). Pregnancies with fetal growth restriction were excluded. Fetal lung maturity was assessed by lecithin/ sphingomyelin ratio (L/S) and by a fluorescence polarimetry assay (FLM). Mean values of L/S ratios and FLM were compared between the PTL and the PRE groups, each within two gestational age subgroups (27–32.9 weeks gestation and 33–36 weeks gestation). Student t-test, Chi-square test Fishers exact test were used for statistical analysis. A p value < 0.05 was considered significant. Results: During the gestational age interval of 33–36 weeks, the mean L/S ratios were significantly lower in pregnancies complicated by PRE than in those complicated by PTL (1.99 ± 0.26 and 2.4 ± 0.57, respectively; p = 0.01). Similarly, during this gestational age interval, the FLM values were also lower in PRE than in PTL, although the difference did not reach statistical significance. Conclusion: During the gestational age between 33 and 36 weeks of gestation, the biochemical profile of preeclamptic patients without IUGR has a significant lower L/S ratio compared to that of preterm patients.

Severe Takayasu's arteritis in pregnancy: The role of central hemodynamic monitoring

Maternal cardiovascular complications have been attributed to the dramatic hemodynamic changes associated with labor and delivery in patients with Takayasus arteritis. The role of central hemodynamic monitoring in the management of a pregnant patient with severe Takayasus arteritis is discussed.

Can ultrasonography replace amniocentesis in fetal gender determination during the early second trimester

Fetal gender was prospectively determined by ultrasonography in 115 patients with singleton pregnancies between 16 and 20 weeks of gestation. Gender determination was performed as a part of the sonographic examination preceding genetic amniocentesis, and the results were compared to the amniotic fluid fetal karyotype results. Our rate of visualization of the fetal external genitalia was 83.5%. The accuracy rate for gender determination was 90% in male infants and 100% in female infants, with an overall rate of prediction of 92.7%.

Use of the fetal chest in estimating fetal weight

OBJECTIVE This study was designed to develop formulas using the chest circumference instead of the abdominal circumference for estimating fetal weight. STUDY DESIGN Ultrasonographic measurements of the chest circumference, biparietal diameter, abdominal circumference, humeral length, and femoral length were obtained in 75 term fetuses of uncomplicated pregnancies within 24 hours of delivery. Three equations for fetal weight estimation that used the chest circumference, instead of the abdominal circumference, in combination with the biparietal diameter or the humeral length were developed by regression analysis. RESULTS The average mean errors of fetal weight estimation for these equations vary from 7.1% to 7.6%. CONCLUSIONS These equations may be used in predicting the birth weight when the fetal abdomen is altered by certain fetal abnormalities.

The neonatal bisacromial diameter : a prenatal sonographic evaluation

This study was designed to determine which fetal ultrasonographic parameter best correlates with the neonatal bisacromial diameter (BAD). The latter is defined as the distance between the two acromions of the scapulae. The study population included fifty-four uncomplicated singleton pregnant patients whose infants with birth weights of more than 3000 grams were delivered within a week of ultrasound examinations. Six fetal biometric parameters: circumferences of the chest, abdomen, head, arm, and thigh, and estimated fetal weight were obtained by ultrasonography and were compared with the BAD. The best predictor of the neonatal bisacromial diameter was the fetal chest circumference (r = 0.67, p = 0.003) followed by the arm circumference, (r = 0.59, p = 0.03). The fetal chest circumference correlates well with the neonatal shoulder girth as reflected by the neonatal bisacromial diameter.

Fetal Parvovirus B19 Infection Doppler Studies Allow Noninvasive Treatment of Ascites

Fetal anemia due to marrow suppression from parvovirus B19 infection may lead to fetal hydrops. In cases of hydrops, outcomes include spontaneous resolution, fetal death without intrauterine fetal transfusion, resolution after transfusion, and fetal death after transfusion. Differentiating those who will have spontaneous resolution from those requiring transfusion is problematic and sometimes based on fetal hematologic parameters measured at funicentesis or somewhat subjective sonographic observations. We report a case in which Doppler sonography was used to obviate funicentesis, fetal transfusion, and their attendant risks. High middle cerebral artery (MCA) peak systolic velocity (PSV) is associated with anemia. In this case, improvement from moderate to mild ascites and normal MCA PSV supported the likelihood of spontaneous resolution in progress.

Transactions of the 70th annual meeting of the central association of obstetricians and gynecologistsReview of the professional medical liability insurance crisis: lessons from Missouri merit prize☆

Objective This study was undertaken to document and generalize the professional liability insurance (PLI) crisis.