I. Gull

Vascular endothelial growth factor is increased in patients with preeclampsia.

PROBLEM: This study was conducted to determine whether altered levels of vascular endothelial growth factor (VEGF) may play a role in the pathogenesis of preeclampsia.

Congenital cytomegalovirus infection

OBJECTIVE Congenital cytomegalovirus is the most common viral infection affecting approximately 1% of newborns. The virus can be transmitted to the fetus during both primary and recurrent infection. Although most of the infants are asymptomatic at birth, up to 15% develop late complications. The annual cost of treating cytomegalovirus infection complications in the USA is two billion US dollars. Many issues regarding cytomegalovirus infection such as routine screening, antenatal diagnosis and vaccination during pregnancy are unsettled and disputed. The aim of this article is to review the current literature on the subject and to draw some conclusions. DESIGN Review of the current literature. CONCLUSIONS At present, it appears that there is no indication for routine prenatal screening, while other issues, such as the most accurate method for antenatal diagnosis and the indications for pregnancy termination are, as yet, unsettled.

Umbilical cord blood acid‐base values in uncomplicated termvaginal breech deliveries

Background. This prospective study was conducted to compare the umbilical cord blood acid-base values of uncomplicated, assisted, vaginal-breech-delivery term neonates with those of uncomplicated, cephalic-vaginal delivery term neonates and to determine whether a different metabolic status should be expected in neonates born by way of uncomplicated vaginal breech delivery. Methods. Umbilical cord artery and vein blood samples were obtained from 30 term neonates with frank or complete breech presentations who were born by uncomplicated assisted vaginal breech delivery. All these neonates had an Apgar score of >7 at 5 min and an uneventful neonatal course (study group). For each neonate in the study group the two consecutive term neonates who were delivered by uncomplicated cephalic spontaneous vaginal delivery, and had uneventful neonatal courses, served as controls (control group). Results. The umbilical cord artery blood pH and pO 2 were significantly lower (p<0.001 and <0.01, respectively) and the pCO 2 was significantly higher (p<0.001) in newborns of the study group, compared to the controls. The umbilical cord vein blood pH was significantly lower (p<0.01), and the pCO 2 significantly higher (p<0.01) in the study group. Conclusions. The umbilical cord blood acid-base values of uncomplicated, vaginal-breech-delivery term neonates differ significantly from those of uncomplicated, cephalic-vaginal delivery neonates. These differences may represent a greater degree of acute cord compression that reflects the different mechanisms of labor in vaginal breech delivery.

Intrauterine irrigation with prostaglandin F2‐α for management of severe postpartum hemorrhage

BACKGROUND Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F2-alpha to control severe postpartum hemorrhage may avert surgery for the control of bleeding. METHODS After ruling out the possibility of genital tract injuries, 18 patients with severe postpartum hemorrhage caused by uterine atony were enrolled in the study. None of the patients responded to treatment with oxytocin, methylergonovine, or uterine massage. A Foley catheter was introduced into the uterine cavity and the balloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12 24 hours. RESULTS In 17 patients (94.4%) bleeding ceased within several minutes of initiation of intrauterine prostaglandin F2-alpha infusion, the uterus was firmly contracted and uterine bleeding did not recur. In one patient with placenta increta bleeding continued and hysterectomy was performed. None of the patients had any side effects. CONCLUSIONS Intrauterine irrigation with low concentrations of prostaglandin F2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuous hemostasis. Moreover, the minute dosage used eludes potentially complicating side effects.

Can Labor with Breech Presentation Be Induced

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.

Breech delivery: The value of X-ray pelvimetry

OBJECTIVE The study was conducted to compare maternal and neonatal outcome of two groups of nulliparae with breech presentations, who were selected for vaginal delivery by protocols differing only in their use of X-ray pelvimetry. STUDY DESIGN We reviewed all term singleton breech deliveries of nulliparous patients who were eligible for vaginal trial of labour in our Centre between 1992 and 1994. In Group A (n=85) X-ray pelvimetry was performed, and in Group B (n=70) it was not. Obstetric management was otherwise similar. Admission to the two departments was on alternate days. RESULTS The rate of caesarean section was similar in both groups (Group A, 36.4% vs. Group B, 42.8%; P>0.05), however, the indications for caesarean section differed. Neonatal outcome was similar in both groups. Maternal febrile morbidity was higher in Group B patients, especially those who underwent caesarean section after a trial of labour. CONCLUSION X-ray pelvimetry in nulliparae with breech presentation is associated with reduced maternal febrile morbidity, but does not improve neonatal outcome.

Multiple pregnancy F41Early versus late multifetal pregnancy reduction, comparison of pregnancy outcome

Background

Effect of the Supine Position on Uterine and Umbilical Blood Flow during the Third Trimester of Uncomplicated Pregnancies in Multiparous Patients

We established the effects of the supine position on umbilical blood flow when measured during the third trimester in 30 multiparous, normotensive patients. Blood flow in the umbilical and uterine arteries and blood pressure in the brachial and popliteal arteries were blindly taken by two different observers: first in the lateral and 5 min later in the supine position. There was a significant difference in mean blood pressure between the two postures. However, there was no statistical difference in the pulse pressure or in systolic/diastolic ratio in the umbilical and uterine arteries between the two positions. Postural changes in normotensive multiparous patients do not affect uterine and umbilical blood flow during the third trimester of uncomplicated pregnancies.

P03.14: Diagnosis of severe Ebstein's anomaly at 14 weeks following increased NT

by measurement of combined lung to head ratio. At 38.GW the newborn was delivered by caesarean section on mother’s demand (weight 3400-g, umbilical artery pH 7.31). Due to symptomatic appearance, the decision for surgical repair was taken. Anatomical anomalies like tricuspid atresia or Ebstein malformation must be considered as a differential diagnosis of a right atrial enlargement. Surgical repair should be performed by centers of expertise in neonatal heart surgery.

P15.16: Sonographic measurements of fetal nuchal fold, cerebellum and cisterna magna, in normal fetuses at the early second trimester of pregnancy

Human small supernumerary marker chromosomes (sSMC) are present in 0.043% of newborn infants. They can be defined as additional centric chromosome fragments and generally are equal in size or smaller than a chromosome 20 of the same metaphase spread. Prenatal diagnosis of supernumerary marker chromosomes (SMC) is problematic because of the difficulty of predicting the phenotype. The assessment of phenotypic risk is based on the size, morphology and origin of the SMC. We found a sSMC in long term culture of chorionic villi performed for increased nuchal translucency in a 38 year old woman at 12+4 weeks gestation. Amniocentesis was performed at 15+5 weeks: GTGbanding analysis of amniotic cells confirmed the presence of the additional marker chromosome (karyotype:47,XX,+mar). Both parents had normal karyotypes. Fluorescence in situ hybridization (FISH) analysis using chromosomal specific alphoid satellite DNA probes and whole chromosome paint probes showed that the extra sSMC was derived from chromosome 14. Further characterization of SMC performed by centromere-near-specific multicolor FISH (subcenM-FISH) showed it was an inv dup(14)(q11.1). This region consist of heterochromatic material: SMC without euchromatic content are more likely to result in normal phenotypes. Maternal uniparental disomy for chromosome 14 (associated with precocious puberty, short stature and highly variable developmental delay) was excluded by microsatellite analysis. Pregnancy was continued. No morphological abnormalities were observed on any ultrasound examinations performed during pregnancy. No dysmorphic features were noticed at birth. At 1 year follow-up, the child was growing and developing normally. This case illustrates how a combination of ultrasound examination, FISH characterization and molecular analyses may enhance the accuracy of the information given (diagnosis and prognosis, risk estimates) during prenatal counseling.