Joseph J. Scibetta

Laparoscopic transabdominal cervicoisthmic cerclage

OBJECTIVE To report a laparoscopic technique for placement of a transabdominal cervicoisthmic cerclage. DESIGN Detailed case report of one of three patients undergoing described procedure. SETTING University hospital. PATIENT A 39-year-old infertile patient with a history of cervical adenocarcinoma in situ and two cone biopsies, resulting in an essentially absent exocervix. INTERVENTION(S) Laparoscopic transabdominal cervicoisthmic cerclage placement, as an interval procedure, followed by ET of cryopreserved donor oocyte-derived embryos. MAIN OUTCOME MEASURE(S) Clinical outcome. RESULT(S) Establishment of a pregnancy delivered at 38 1/2 weeks of gestation by elective cesarean section. CONCLUSION(S) Patients believed to require a transabdominal cerclage may undergo a laparoscopic interval procedure, obviating the need for a laparotomy before or during pregnancy.

Heterotopic quadruplet gestation with laparoscopic resection of ruptured interstitial pregnancy and subsequent successful outcome of triplets

A heterotopic quadruplet gestation after in vitro fertilization and embryo transfer was complicated at 8 weeks by rupture of an interstitial pregnancy. Laparoscopic resection was performed and subsequently triplets were delivered at 34 weeks. To our knowledge, this is the first report of such a case.

An approach to the study of brain damage: The principles of fetal electroencephalography☆

Abstract Fetal electroencephalography (EEG) is technically feasible and has been accomplished in more than 300 monitored fetuses. The electrical alterations found are identifiable both in individual fetuses and between different fetuses. These patterns and changes can be differentiated from pre-existing patterns and associated with certain fetal cardiovascular heart rate changes. The preliminary follow-up findings on a small group of infants followed until one year of life are presented. The information presented here should be used as guidelines for the introduction of this technique rather than answers to the problems of clinical monitoring during birth and the relationship of that monitoring to brain damage.

Human fetal brain response to sound during labor.

Abstract The human fetal auditory evoked response (AER) to a sound stimulus is obtained early in labor and serially studied throughout childbirth. Considerable intersubject variation exists. The fetal AER latency interval is similar to that obtained in the neonate and is in the range of 200 to 500 msec. with an average amplitude of 10 μV. The response is confirmed in the neonate and has a similar latency interval but an increased amplitude of response when compared to the same fetus in utero.

The human fetal electroencephalogram: I. An electrode for continuous recording during labor

Abstract The continuous recording of the fetal EEG in labor is possible with the use of specially constructed scalp electrodes. The quality of the recording is equal to that obtained in the newborn infant. The positive fetal evoked response to sound in labor is used to confirm the origin of these brain potentials. The technique is offered as a method of studying the fetal brain during birth.

Simulated marihuana smoking in the maternal and fetal guinea pig

Abstract Maternal and fetal heart rate and brain wave (electroencephalogram [EEG]) changes were observed during simulated maternal marihuana smoking. The maternal heart rate change consisted of a delay in onset of an elevated heart rate, while the fetuses and newborn infants studied revealed a decrease in heart rate during the smoking period. The maternal EEG remained essentially unchanged during the smoking period. Following marihuana exposure, the maternal EEG changed to a pattern of low frequency and high-amplitude activity and in a few instances was similar to the “recovery spike-discharges” reported in other animal experiments with marihuana. The fetal EEG changed to a slow-frequency, high-voltage activity pattern during the smoking period. Following exposure to the marihuana, it changed to a lower voltage and higher frequency activity.

Temporal parameters in the acquisition of a free- operant avoidance response in human subjects

Male, medical and graduate students were subjected to a nondiscriminated avoidance regimen under different combinations of SS and RS intervals. Acquisition of the avoidance response was found to be a function of the RS/SS ratio; the most rapid acquisition occurring at ratios of 2:1 or greater.

On correlating the fetal heart and brain in the sheep. I. Following recovery from operation. II. Following maternal hemorrhage.

Abstract Fetal sheep brain wave changes during recovery from operations and fetal heart rate and brain wave changes during acute maternal hemorrhage are described. During the first 24 hours after operation, there was a change in fetal brain wave with increasing amplitudes and faster frequencies of brain waves. A fully recovered EEG was not present for at least 24 hours. During acute maternal hemorrhage the heart changes were primarily those of heart rate irregularity with bradycardia being the most common pattern. Brain wave changes occurred early and progressed through a pattern of slower frequencies and decreasing amplitudes to an isoelectric state which always preceded terminal bradycardia.

Preoperative Endovaginal Sonographic Diagnosis of an Unruptured Interstitial Pregnancy

Interstitial pregnancies carry a higher maternal morbidity and mortality rate, due to the abundant ovarian and uterine arterial supply of this region, than do other tubal pregnancies. Prerupture diagnosis is crucial, inasmuch as rupture (which usually occurs at a later stage than in tubal gestations) may be followed by rapid exsanguination. Precise early diagnosis may permit conservative nonsurgical treatment with methotrexate. A case is presented in which preoperative diagnosis of an unruptured interstitial pregnancy was aided by endovaginal sonographic examination. Considerations of subsequent management are discussed.