Katherine Goetzinger

Operative Vaginal Delivery: Current Trends in Obstetrics:

After centuries of use in obstetrics, have forceps and vacuum deliveries become a dying art? Contemporary trends in operative vaginal delivery show increasing numbers of vacuum deliveries and decreasing numbers of forceps deliveries worldwide. Primary drivers of such trends include concerns over neonatal and maternal safety as well as fewer clinicians skilled in forcep use. Current literature reports a comparable efficacy rate for the two instruments, as well as a decrease in maternal morbidity compared with cesarean section. It has also been suggested that the neonatal morbidity once associated with operative vaginal delivery may actually be a function of an abnormal labor process itself, rather than a consequence of an operative vaginal intervention. Both the American College and the Royal College of Obstetricians and Gynecologists continue to support the use of both vacuum and forceps and strongly encourage residency programs to incorporate the teaching of these skills into their curricula.

Miller-Dieker Syndrome (17p13.3 Deletion Syndrome)

Abstract Miller-Dieker syndrome, or 17p13.3 deletion syndrome, is a rare, contiguous gene deletion syndrome characterized by type 1 lissencephaly, facial dysmorphism, seizures, and severe mental retardation. Impaired neuronal migration between 6 and 15 weeks gestation is the underlying mechanism for lissencephaly, leading to the absence of sulci and gyri on the surface of the brain as well as abnormal cortical thickness. Heterozygous deletions in the region of chromosome 17p13.3 result in the severe phenotype of Miller-Dieker syndrome. Suspicious sonographic findings include absent parietooccipital and calcarine fissures as well as a “smooth, shallow sylvian fissure.” Associated findings include ventriculomegaly, agenesis of the corpus callosum, fetal growth restriction, and polyhydramnios. Fetal MRI can be a useful adjunct for prenatal diagnosis, with the characteristic finding of a smooth brain surface with an abnormally shallow sylvian fissure. Miller-Dieker syndrome is incurable, with no known prenatal treatment options. Postnatal treatment consists largely of antiepileptic therapy for seizure control and supportive care. Suspicion for Miller-Dieker syndrome should be raised in patients with a family history and/or imaging findings relating to lissencephaly. Parental chromosomal analysis is indicated at the time of diagnosis, as 20% of deletions are inherited from a parent with a balanced chromosomal rearrangement.