Luis A. Izquierdo

Diagnosis of cervical change in pregnancy by means of transvaginal ultrasonography

There are no absolute objective diagnostic criteria for cervical incompetence. Abdominal and endovaginal ultrasonographic assessment of endocervical length, both of which have been associated with technical problems, have been used to establish the diagnosis. Cervical cerclage may be useful in preventing silent cervical dilatation; however, no prospective trials with and without cerclage have been performed when endocervical shortening has been demonstrated by ultrasonography.

Does labetalol predispose to pulmonary edema in severe pregnancy-induced hypertensive disease?

We investigated whether use of labetalol, a beta adrenoreceptor blocking antihypertensive agent commonly employed as an alternative to hydralazine, is independently associated with pulmonary edema in women with severe preeclampsia. We retrospectively evaluated women with severe preeclampsia who were given labetalol by intravenous bolus for MAP > 120 mm Hg. Outcome variables included: achieving MAP < 120 mm Hg with < 300 mg of labetalol, incidence of adverse effects of the drug, including pulmonary edema, hypotension, and maternal bradycardia. Total intravenous fluid intake exceeding output (+ delta I/O) and presence or absence of preeclamptic liver involvement were noted. Statistical analysis included unpaired t-tests and Fishers exact test. Fifty-one women were studied, 7 (13.7%) of whom developed pulmonary edema. Demographic and pregnancy characteristics were not different between patients who did or did not develop pulmonary edema. No patient had detectable underlying heart disease. Patients with or without pulmonary edema did not differ as regards entry MAP (130 +/- 14 vs. 129 +/- 18 mm Hg), total dose of labetalol (209 +/- 83 vs. 193 +/- 39 mg/24 hours), incidence of bradycardia or hypotension (0/7 vs. 8/44), or presence of hepatic involvement (1/7 vs. 9/44). However, there was a significant difference in degree of positive fluid balance. Patients developing pulmonary edema had a net gain of 1,466 +/- 429 mL of fluid in the 24 hours in which they received labetalol than those who did not (659 +/- 1152 mL, P = .003). Initial central hemodynamic monitoring data revealed no impairment of cardiac performance (mean cardiac output 7.7 +/- 1.8 L/min, cardiac index 4.0 +/- 0.8 L/min/m2, left ventricular stroke work index 73 +/- 9 g.m.m-2) despite high pulmonary capillary wedge pressures (22 +/- 4 mm Hg). We conclude that the incidence of pulmonary edema in patients with severe preeclampsia who are treated with labetalol appears to be a result of an increase in third space fluid accumulation as a manifestation of the severity of their disease, not a direct effect of the drug on cardiac performance.

Acute posttraumatic fetal anemia treated with fetal intravascular transfusion

Fetal trauma resulting in acute anemia after maternal blunt abdominal trauma is a rare but potentially lethal condition. We recently managed such a case with the use of fetal intravascular transfusion.

Comparison of absorbable uterine staples and traditional hysterotomy during cesarean delivery

Objective To evaluate the use of the Auto Suture Poly CS-57 disposable surgical stapler to determine if the device offers any advantages over suture closure of the uterus. Methods A matched case-control study design was used. Operative time, estimated blood loss, change in hematocrit, incidence of postoperative endometritis, length of stay, and total patient costs were compared. Patients were recruited from a university hospital setting and a private practice. Results There were 288 patients in the study, 144 in the staple group and 144 matched patients in the standard hysterotomy control group. Patients did not differ in age, parity, gestational age, number of primary or repeat operations, anesthesia, infant weights, or outcomes. Comparing the patients in the staple group and the control group, there was no significant difference in operative time (63.7 ± 22.9 versus 62.0 ± 22.3 minutes, staple group versus controls, respectively), estimated blood loss (822 ± 338 versus 879 ± 318 mL), change in hematocrit (−5.9 versus −6.5 volume percent), incidence of postoperative endometritis (15 versus 20%), length of stay (4.1 ± 1.3 versus 4.0 ± 2.2 days), or total cost (

Recombinant 8 syndrome: the pool of Hispanic pericentric inversion 8 carriers expands numerically and geographically.

4490 ± 1544 versus

The Hadlock Method Is Superior to Newer Methods for the Prediction of the Birth Weight Percentile

3997 ± 1117). Comparing patients operated upon by residents in the university to those operated upon by the private attending physicians, there were no significant differences noted in the above-mentioned variables between stapled and sutured patients. Conclusion Compared with the usual suture technique for cesarean delivery, the uterine stapling device used in this study was not associated with a significant decrease in the incidence of postoperative anemia, infection, length of hospital stay, or cost. This device appears to offer no advantage over traditional hysterotomy and repair.

Enhancing 2D Cervical Length With 3D Cervix Imaging Emphasizing the Center Reference Point

Recombinant 8 syndrome is a well-established syndrome with mental and developmental retardation and usually severe cardiac anomalies. A carrier parent will produce affected offspring in 6% of pregnancies and carrier offspring in 53% of such pregnancies. Four New Mexican kindreds ascertained by the discovery of four apparently unrelated probands with cytogenetically confirmed recombinant 8 syndrome were studied. We found that (1) recombinant 8 syndrome will soon no longer be confined to New Mexico and southern Colorado, (2) the number of persons at risk may be higher than previously considered, and (3) through proper pedigree techniques and increased professional education, most carriers can be identified.

Pregnancy-Associated Hemolysis, Elevated Liver Functions, Low Platelets (HELLP) Syndrome: An Obstetric Disease in the Intensive Care Unit

To compare a traditional ultrasound (US) method for estimated fetal weight (EFW) calculation and fetal growth restriction diagnosis with 2 newer methods for the prediction of small for gestational age (SGA) at birth.

Coccidioidal Placentitis With Normal Umbilical Artery Velocimetry

Use of transvaginal ultrasonography for cervical length measurement at the 20-week anatomic examination has been suggested as a screening method to predict the risk of preterm birth. This article describes a three-dimensional ultrasonographic multiplanar imaging method of cervical length measurement by manipulating the center reference point and volume axes. This methodology should yield a more consistent, accurate measurement of the cervical length compared to conventional two-dimensional ultrasonographic methods. Also described are additional software image manipulation techniques to enhance visualization of the relational anatomy of the cervix. Precise utilization of the center reference point and available image reconstruction software augment current two-dimensional morphologic information of the lower genital tract.

Maternal Position and Its Effect on Doppler Velocimetry Studies of the Umbilical Artery

We reviewed the experience with hemolysis, elevated liver functions, low platelets (HELLP) syndrome at the University of New Mexico Hospital over the past 10 years to delineate the epidemiology and the clinical course of the disease. A retrospective chart review of a large, university-based, largely indigent, pregnant population was undertaken with attention to diagnostic features of the syndrome and maternal and infant outcomes of affected pregnancies. Comparisons were made with other large reported clinical series. Preeclampsia complicated 5.6% of deliveries in this study, and the HELLP syndrome occurred in 116 patients (0.3% of all deliveries). Epigastric pain, nausea, vomiting, and malaise usually heralded the syndrome. Signs and symptoms of preeclampsia (e.g., hypertension, proteinuria, and edema) were most often not striking at the time of presentation. The mean platelet count at diagnosis was 60 ± 25 × 103. Initial signs of hemolysis were usually minimal, although the hematocrit decreased a mean of 11.5 ± 5 vol% over the course of the disease. Moderate elevations of hepatic enzyme levels, specifically lactic dehydrogenase, were common; hyperbilirubinemia was usually mild and late. Maternal complications included disseminated intravascular coagulation, eclampsia, pulmonary edema, adult respiratory distress syndrome, and hepatic hematoma. Eight stillbirths and 7 neonatal deaths occurred (perinatal mortality, 126/1,000). HELLP syndrome is a relatively infrequent but serious development in the evolution of preeclampsia/eclampsia. Variations in onset and severity of hemolysis, hepatic dysfunction, and thrombocytopenia are common. Maternal complications and the perinatal mortality rate are high. Pregnant patients with right upper quadrant or epigastric pain and thrombocytopenia, even in the absence of significant hypertension and proteinuria, are most likely to have HELLP syndrome, rather than some other medical condition. Awareness of the variable presentations of this syndrome permit the prompt recognition and management necessary to optimize maternal and neonatal outcomes.