John T. Queenan

Growth of the ultrasound fetal femur length during normal pregnancy: Part I

The growth of the ultrasound fetal femur length during normal pregnancy is presented. A total of 1,016 measurements of the fetal femur length from 14 weeks gestation through term were taken. The growth of the fetal femur describes an asymptotic curve similar to the growth of the biparietal diameter with comparable limits of 2 SD. From the serial measurements performed, the growth rate of the femur has also been calculated. This begins at 3.15 mm/wk and slowly decreases to 1.55 mm/wk toward 40 weeks gestation. Femur measurements provide the first reproducible determinations of length of the fetus to be measured by ultrasound throughout pregnancy.

Clinical study of the lactational amenorrhoea method for family planning

The effect of breastfeeding on fertility is well known; however, its use as a method of family planning was, until recently, untested. In 1988, the Bellagio Consensus Conference proposed guidelines that became the basis for a method of family planning called the lactational amenorrhoea method (LAM). The principle of LAM is that a woman who continues to fully or nearly fully breastfeed her infant and who remains amenorrhoeic during the first 6 months postpartum is protected from pregnancy during that time. We have assessed this method in the context of a breastfeeding support intervention study of 422 middle-class women in urban Santiago, Chile. The cumulative 6-month life-table pregnancy rate was 0.45% among women who relied on LAM as their only family planning method (1 woman pregnant in month 6). The findings indicate that LAM, with its high acceptance and efficacy, is a viable method of family planning and can safely serve as an introductory method for breastfeeding women.

The Lactational Amenorrhea Method (LAM): a postpartum introductory family planning method with policy and program implications.

It is well accepted that breasteeding contributes significantly to child survival and child nutrition. Healthful child spacing is associated with improved birth outcomes and maternal recovery. On a population basis, breastfeeding may contribute more to birth spacing than all family planning use combined in many countries. However, while breastfeeding does provide a period of infertility, until recently, there was no reliable way for an individual woman to capitalize on this lactational infertility for her own efficatious child spacing. The Lactational Amenorrhea Method (LAM) is a new introductory family planning method that simultaneously promotes child spacing and breastfeeding, with its optimal nutrition and disease preventive benefits for the infant. LAM, as it is called, is based on the utilization of lactational infertility for protection from pregnancy and indicates the time for the introduction of a complementary family planning method. LAM is recommended for up to six months postpartum for women who are fully or nearly fully breastfeeding and amenorrheic, and relies on the maintenance of appropriate brastfeeding practices to prolong lactational infertility, with the concomitant delay in menses return. A recent clinical trial confirmed the theoretical 98% or higher effectiveness of the method and field trials are demonstrating its aceptability. Nonetheless, some demographers and family planning organizations continue to debate its value. The development, efficacy, and sequelae of the method are presented using data from several studies by the authors.ResuméCest un fait reconnu que lallaitement naturel par la mère contribue de façon significative à la survie du nourrisson et à sa nutrition. Lespacement des naissances est associé à des accouchements et des retours de couches plus satisfaisants. Au niveau de la populations, lallaitement au sein contribue sans doute davantage à lespacement des naissances que toutes les autres méthodes de planning familial réunies. Il nen reste pas moins que, si lallaitement occasionne une période de stérilité, la femme navait jusquici acun moyen fiabel de tourner à son avatae cte stérilité du temps de lactation pour espacer efficacement les naissances. La méthode de laménorrhée de la lactation (MAL) est une méthode de planning familial nouvellment introduite qui favorise simultanéument lespacement des naissances et lallaitement au sein, tout en assurant des conditions optimales de nutrition et la prévention de maladies pour lenfant. Cette méthode fait appel à la stérilité de la lactation comme protection contre une nouvelle grossesse et permet de déceler le moment où il devient nécessaire de penser à une méthode supplémentaire de contaception. Il est recommandé aux femmes davoir recours à la MAL jusquà six mois après laccouchement, tant quuelles allaitent entièrement, ou presque, et que les règles nont pas répparu. Cette méthode table sur la poursuite de lallaitement pour prolonger la stérilité de la lactation et retarder le retour des menstruations. Une récente étude clinique a confirmé lefficacité théorique à 98%, voire plus, de cette méthode et les essaid dans la population en démontrent lacceptabilité. Néanmoins. certains démographes et certaines organisations de planning familial continuent den débattre la valuer. Le développement, lutilité et les séqualles de cette méthode sont présentés en sappuyant sur les résultats de pluisierrs études effectuées par les auteurs.ResumenSe acepta en general que el ammantamiento contribuye significantivamente a la superiviencia y nutrición de los niños. El espaciamente sano de los niños se asocia con mejores resultados de los nacimienetos y la recuperación materna. Tomando una base demográfica, es posible que el amamantamiento contribuya má al espaciamiento de los nacimientos que todo el uso combinado de la planificación familiar. Sin embargo, si bien el amamantamiento proporciona un período de infecundidad, hsta hace poco no había una forma segura que permitiera a las mujeres aprovechar esta infecundiada por amamantamiento para realizar su propio espaciamiento eficaz de los nacimientos. El Método de Amenorrea por Lactancia (LAM) es un nuevo método introductorio de la plaificación familiar que promueve similtáneamente el escpaciamiento de los nacimientos y el amamantamineto, con sus beneficios óptimos de nutrición y prvención de enfermedades prar el niño. El LAM se basa en la tulización de la infecundidad por lactancia como prevención del embarazo e indica el momento de introducción de un método complementario de planificación familiar. El LAM se recomienda durante un período máximo de seis meses con posterioridad al parto para las mujeres que amamantan plenamente o casi plenamente y están en amenorrea, y depende del mantenimiento de prácticas apropiadas de amamantamiento para prologar la infecundidad por lactancia, con la demora concomitante en le retorno de la menstruación. Un ensayo clínico reciente confirmó la eficacia teórica del 98% o superior del método y los ensayos de campo están demostrando su aceptabilida. Sin embargo, algunos demógrafos y organizaciones de planificación familiar continúan debatiendo su valor. Se presenta el desarrollo, la eficacia y las secuelas del método utilizando datos de diversos estudios de los autores.

Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning

OBJECTIVEnOur purpose was to ascertain the effects of timing of conception on the risk of spontaneous abortion.nnnSTUDY DESIGNnTo assess these effects, women who conceived while using natural family planning were identified in five centers worldwide between 1987 and 1993. Timing of conception was determined from 868 natural family planning charts that recorded day of intercourse and indices of ovulation (cervical mucus peak obtained according to the ovulation method and/or basal body temperature). Conceptions on days - 1 or 0 with respect to the natural family planning estimated day of ovulation were considered to be optimally timed, and all other conceptions were considered as non-optimally timed. The rate of spontaneous abortions per 100 pregnancies was examined in relation to timing of conception, ages, reproductive history, and other covariates with bivariate and multivariate statistical methods.nnnRESULTSnThere were 88 spontaneous abortions among 868 pregnancies (10.1%). The spontaneous abortion rate was similar for 361 optimally timed conceptions (9.1%) and 507 non-optimally timed conceptions (10.9%). However, among 171 women who had experienced a spontaneous abortion in a prior pregnancy, the rate of spontaneous abortion in the index pregnancy was significantly higher with non-optimally timed conceptions (22.6%) as compared with optimally timed conceptions (7.3%). This association was not observed among 697 women with no history of pregnancy loss. The adjusted relative risk of spontaneous abortion among women with non-optimally timed conceptions and a history of pregnancy loss was 2.35 (95% confidence intervals 1.42 to 3.89). The excess risk of spontaneous abortion was observed with both preovulatory and postovulatory conceptions.nnnCONCLUSIONSnOverall, there is no excess risk of spontaneous abortion among the pregnancies conceived during natural family planning use. However, among women with a history of pregnancy loss, there is an increased risk of spontaneous abortion associated with preovulatory or postovulatory delayed conceptions.

Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.

OBJECTIVESnThe purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning.nnnMETHODSnWomen who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression.nnnRESULTSnThe women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups.nnnCONCLUSIONSnNo increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.

Magnetic resonance imaging of vasa praevia

A 34 year old primigravid woman had an ultrasound examination at 20 weeks of gestation that showed a complete placenta praevia. Follow up transvaginal sonography at 24 weeks of gestation revealed echolucent linear structures overlying the cervix, suggesting a vasa praevia. The placenta appeared to have two lobes, with vessels running over the cervix between them. Pulsed Doppler demonstrated a fetal pulse rate of 140 beats per minute in these vessels. We decided to perform magnetic resonance imaging on the patient in order to determine whether vasa praevia could be diagnosed using magnetic resonance imaging, and also to see whether magnetic resonance imaging could add any further information beyond that which we already had with ultrasound and Doppler. We obtained approval from our Institutional Review Board to perform a magnetic resonance imaging on the patient for further evaluation of the vasa praevia. The patient was counselled, and informed consent was obtained. T2-weighted magnetic resonance imaging revealed three areas of signal void overlying the cervix (Fig. 1). Using two-dimensional time-of-flight sequences, flow was demonstrated through these structures. There was flow through two vessels in one direction (Fig. 2A), and flow through the third vessel in the opposite direction (Fig. 2B), consistent with the expected directions of flow in the umbilical arteries and the vein. The placenta was shown to have an accessory lobe, and these vessels ran between the lobes. The woman was hospitalised in the third trimester and was delivered by elective caesarean section at 351⁄2 weeks of gestation. The diagnosis of vasa praevia was confirmed at delivery; the placenta had two lobes, with communicating vessels running over the cervix between them. The live male infant had Apgar scores of 8 and 9, and was discharged home eight days later. The infant is doing well at 10 months of age.

Present status of intrauterine treatment of hydrocephalus and its future

At a time when the intrauterine diagnosis of hydrocephalus is common and pioneering efforts of antenatal therapy are evolving, an assessment of intrauterine treatment of this disorder becomes pertinent. Consequently, the current status of the intrauterine treatment of fetal hydrocephalus is presented. The new data from the International Fetal Surgery Registry at the University of Manitoba in Winnipeg are discussed. The technical problems of antenatal shunting, the clinical trials, and experimental treatment are assessed. The prognostication and possible new approaches in intrauterine treatment of hydrocephalus are presented as well as the new diagnostic and surgical techniques. The outcome of the antenatal diagnosis and treatment of fetal hydrocephalus is evaluated.

Ultrasound fetal femur length in relation to intrauterine growth retardation. Part II.

With the establishment of a normal range of values for the growth of the ultrasound fetal femur length, a new approach for the study of growth-retarded fetuses is suggested. Ultrasound femur length was measured on a group of high-risk pregnancies, and its ability to differentiate the symmetrically small from the asymmetrically small fetus was studied. A reduced ultrasound fetal femur length correlated in all cases with a shortened crown-heel length in the neonate. By adding this ultrasound parameter to those routinely measured on the fetus, a three-dimensional profile can be constructed.

Pregnancy outcome associated with natural family planning (NFP): scientific basis and experimental design for an international cohort study

Although natural family planning (NFP) is a form of contraception without ostensible maternal risks (other than pregnancy), potential fetal risks could exist if aging gametes are involved in inadvertent fertilization. In the following report, we first review animal studies firmly establishing that aging sperm and aging oocytes (delayed fertilization) cause chromosomal abnormalities in mammals and other species. We next review human studies associating decreased coital frequency with trisomy and studies of NFP populations that generally show no increased frequency of anomalous offspring or spontaneous abortions. Our rationale for initiating an international cohort study is presented, along with the experimental design selected. Preliminary findings indicate that the experimental design chosen will indeed provide information allowing NFP safety to be assessed definitively.ResuméBien que le planning familial naturel (PFN-NFP) soit une forme de contraception ne présentant pas de risques manifestes pour la mère (autres quune grossesse), il pourrait y avoir des risques potentiels pour le foetus si des gamètes âgés sont par inadvertance fécondés. Nous passons en revue tout dabord des études effectuées sur des animaux, établissant fermement que le sperme veillissant et les oocytes vieillissants (fécondation retardée) provoquent des anomalies chromosomales chez les mammifères et dautres espèces. Nous examinons ensuite des études sur des humains, qui associent diminution coitale et trisomie, et des études de populations pratiquant le PFN, qui ne révèlent généralement pas de fréquence accrue denfants anormaux ou davortements spontanés. Cette communication expose la raison pour laquelle nous avons entrepris une étude sur une cohorte internationale, ainsi que le concept dexpérimentation que nous avons choisi. Les constatations préliminaires indiquent que ce concept fournira véritablement des informations qui permettront dévaluer de façon définitive la sécurité du PFN.ResumenAunque la planificación familiar natural (PFN) es una forma de anticoncepción sin riesgos maternos ostensibles, (fuera del embarzo) podrían existir posibles riesgos fetales di gametos que están envejeciendo son inadvertidamente fertilizados. La primera revisión de estudios en animales establece firmemente que espermatozoides y oocytos en envejecimiento (fertilización tardía), causan anormalidades cromosómicas en mamíferos y otras especies. A continuación revisamos estudios en humanos que asocian la disminución de la frecuencia coital con trisomía, y estudios de poblaciones practicando PFN que generalmente no muestran aumento en la frecuencia de descendientes anormales o de abortos espontáneos. Presentamos nuestras razones para iniciar el estudio de una cohorte internactional ademas del diseño experimental elegido proveerá información alegando que la inocuidad de la PFN sea definitivamente valorada.

Does midtrimester ΔOD450 of amniotic fluid reflect severity of Rh disease

Thirty-two patients with Rh-immunized pregnancies had amniocenteses between 16 and 20 weeks gestation. Serial amniotic fluid values of delta optical density at 450 nm were studied to predict the severity of Rh disease. A value >0.15 indicated severe Rh immunization. Values