Lillie M. Padilla

Respiratory distress following elective repeat cesarean section

The clinical course and chest radiographs of 47 infants with respiratory distress after elective cesarean section were reviewed. The mean difference between the gestational age determined prenatally and that postnatally was 2.6 +/- 1.6 weeks. However, 14 of the infants were delivered at term. All 47 infants required more than 40% oxygen, and 18 infants required a respirator. Fifteen infants developed a pneumothorax; one, a pneumopericardium; one, bronchopulmonary dysplasia; and one infant died. Chest radiographs and the clinical course were consistent with hyaline membrane disease in 17 patients; respiratory distress syndrome type II in 24; and in three the radiographic findings were normal. These data suggest that some of the respiratory morbidity subsequent to elective repeat cesarean section is not secondary to iatrogenic delivery of a premature infant, and that much of it is not due to hyaline membrane disease. These data emphasize that respiratory distress in an infant delivered by elective cesarean section does not necessarily suggest poor prenatal care in regard to the timing of delivery.

Pregnancy-associated aplastic anemia--report of 3 cases.

Abstract:  3 patients with pregnancy‐associated aplastic anemia are reported. Management throughout most of the pregnancy consisted of supportive care. In 2 patients an improvement in blood counts occurred after delivery and, in 1 of these, the pancytopenia recurred during a subsequent pregnancy. In 1 case no improvement occurred after delivery and the patient ultimately required an allogeneic bone marrow transplantation. The outcome of these 3 cases demonstrates that pregnancy‐associated aplastic anemia can be managed successfully. The improvement that often occurs after delivery suggests a pathogenetic role for pregnancy in the development of this disease.

IN UTERO PERINEPHRIC URINOMA AND URINARY ASCITES WITH POSTERIOR URETHRAL VALVES: A PARADOXICAL POP-OFF VALVE?

Pressure pop-off mechanisms are generally protective of overall renal function in newborns with posterior urethral valves. We describe atypical upper tract preservation with massive in utero extravasation and posterior urethral valves. CASE REPORT A 29-year-old GIIIPII woman underwent ultrasound at 31 weeks of gestation to investigate a discrepancy between fundal height and estimated gestational age. No genitourinary or other anomalies were evident on a 21-week ultrasound. The second study revealed a male fetus with significant oligohydramnios, bladder distention, ascites and a “keyhole” deformity of the posterior urethra. The right kidney had multiple cysts, echogenic parenchyma and a large perinephric fluid collection (fig. 1). The left kidney had mild pelvic dilatation. Serial aspirations of the perinephric urinoma and bladder confirmed favorable electrolytes. After weighing the pulmonary ramifications of severe oligohydramnios and pre-term delivery, cesarean section was planned for 35 weeks of estimated gestational age. A vesicoamniotic shunt was not placed due to late gestational age and an anterior placenta. The day before delivery 600 ml. of ascites were aspirated. After delivery the child required jet ventilation for 9 days. A urethral catheter was placed, and percutaneous aspiration of the perinephric urinoma and ascites decompressed the abdomen. A cyclic voiding cystourethrogram confirmed posterior urethral valves and grade V reflux on the left side only

Fetal Tissue Derived From Spontaneous Pregnancy Losses Is Insufficient for Human Transplantation

Objective To determine if sufficient fetal tissue with desirable transplant characteristics can be obtained from spontaneous abortions. Methods A survey of fetal tissues collected from newly diagnosed spontaneous pregnancy losses from three Indianapolis hospitals was conducted from December 1992 to September 1993. Forty-nine of 356 mothers (13.8%) with spontaneous abortions or ectopic pregnancies consented to the evaluation of their products of conception by gross and microscopic pathologic examination, bacterial culture, cytogenetic analysis, cell culture, and maternal serologic tests. Results Forty-nine pregnancies (gestational age range 5–30 weeks) provided four identifiable embryos, 12 second-trimester fetuses, and one third-trimester fetus. Nine samples (18.4%) were of excellent or good quality on pathologic grading. Twenty-five of 38 samples tested (66%) grew pathogenic bacteria. Maternal serologic tests were negative for antibodies to human immunodeficiency virus, human T-cell lymphotropic virus, syphilis, and hepatitis B in all cases. One of 43 sera was reactive for hepatitis C, and 33 (77%) were positive for cytomegalovirus. Cytogenetic abnormalities were found in 25% of cultured samples. Five fetal brain samples had cell viabilities of 50% or more. Few viable fetal hepatocytes were found. Only two fetal brain samples (4.1%) were potential candidates for human transplantation. Conclusion Spontaneous pregnancy losses yield minimal usable tissue for human transplantation because of a lack of embryonic or fetal tissues, delayed collection, decomposition, genetic abnormality, and bacterial contamination.

Recurrent non‐immune hydrops fetalis with gracile bones and dysmorphic features in siblings

We report on two siblings with recurrent non‐immune hydrops fetalis of unknown etiology. The proposita was born at 32‐week gestation with hydrops fetalis. She died at less than 1 hr of age despite resuscitative efforts. Her brother was born

FETAL CRANIOFACIAL PATTERN VARIABILITY INDEX: THE MEASUREMENT OF FETAL CRANIOFACIAL DYSMORPHOLOGY 869

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A Morphometric Analysis of the Fetal Craniofacies by Ultrasound: Fetal Cephalometry

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Fetal craniofacial morphometrics: In utero evaluation at 16 weeks’ gestation

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Quantitation of craniofacial anomalies in utero: Fetal Alcohol and Crouzon Syndromes and Thanatophoric Dysplasia

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A morphometric analysis of the fetal craniofacies by ultrasound: fetal cephalometry.

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