N.F.T. Arts

Prenatal ultrasonographic diagnosis of osteogenesis imperfecta

Between 1982 and 1986, osteogenesis imperfecta was diagnosed by ultrasound in seven fetuses. The known heterogeneity of osteogenesis imperfecta was confirmed by the prenatal ultrasonographic findings. Dependent on the type of osteogenesis imperfecta, the appearance of the limbs varied from severely shortened and broad, with very low echogeneity and absent acoustic shadow (type IIA), to only moderately shortened and thin, with almost normal echogeneity and acoustic shadow but clearly visible fractures causing angulation of the bone (types IIC and III). Ultrasonography offers the possibility to detect or exclude the lethal and severe forms of osteogenesis imperfecta early (type IIA) or halfway (types IIB, IIC, and III) through the second trimester. Prenatal diagnosis of the disease allows the option of elective abortion or may prevent unnecessary obstetric intervention.

Fetal heart rhythms during behavioural state 1F

Behavioural state 1F (quiet sleep) of the term fetus is defined on the basis of absence of eye and body movements, and the presence of a specific heart rate pattern (FHRP A), characterized by a stable heart rate with a small oscillation bandwidth. In the present paper the fetal heart rate pattern was studied in 39 enclosed periods with absence of fetal eye and body movements. In 37 periods the heart rate pattern met the criteria of FHRP A. Within FHRP A various distinct types of heart rhythm could be distinguished related to presence of breathing or regular mouthing and complete absence of movements. The bandwidth in the various heart rhythms differed significantly and was largest during breathing movements. During regular mouthing an oscillatory pattern was present with a frequency similar to the frequency of the clusters of mouthing movements. In 2 periods the heart rate deviated from the definition for FHRP A, i.e. a sinusoidal-like rhythm associated with sucking movements. These observations demonstrate the strong association between the fetal heart rate pattern and fetal movements during behavioural state 1F.

Validity of a selective policy for ultrasound examination of fetal congenital anomalies

The validity of the Stage II ultrasound examination for fetal congenital anomalies has been determined. Only pregnancies that fulfilled certain criteria, i.e. obstetric complications (IUGR, polyhydramnios, immature-premature uterus contractions), or women with a history of congenital anomalies qualified. Five hundred and fifteen pregnant women were examined. Follow-up evaluation was available on 481 pregnancies (494 neonates). Of these children 102 (21%) appeared to have one or more structural anomaly following birth. In 88 of them at least one congenital anomaly had been detected antenatally by the Stage II ultrasound examination. The sensitivity of the ultrasound scanning procedure was 86%, the specificity 100%. The validity of the applied selection criteria for the Stage II ultrasound examination was studied in 2059 women who had delivered consecutively in our hospital. One hundred and eighty-one had the Stage II ultrasound examination performed. Thirty-six of these 181 women delivered an infant with a structural anomaly (20.0%). The remaining 1878 did not qualify for the Stage II ultrasound examination. From these pregnancies 24 infants were born with a structural anomaly (1.3%). The sensitivity of the applied selection criteria was 60% and the specificity 93%. The incidence of congenital anomalies was strikingly higher in pregnancies scanned for reasons of obstetric complications than in the pregnancies scanned for a history of congenital anomalies. The necessity of the Stage II ultrasound examination in every pregnancy is questioned on the basis of the results.

Achondrogenesis…Hypochondrogenesis: the Spectrum of Chondrogenesis Imperfecta a Radiological, Ultrasonographic, and Histopathologic Study of 23 Cases

In the classification of lethal osteochondrodysplasias, achondrogenesis and hypochondrogenesis have recently received special attention. We describe 23 cases representing the different subtypes. Within the classical type I (Parenti-Fraccaro) two distinct disorders can be recognized: type IA (Houston-Harris) and type IB (Fraccaro). The classical type II (Langer-Saldino) and hypochondrogenesis represent phenotypic variants of one disorder in which type II is the most severe form and hypochondrogenesis the mildest form, while transitional forms exist. It is likely that a basic defect in cellular function of the chondrocyte results in a deficient cartilage matrix and in disorganized enchondral ossification.

Fetal behavioural states in epileptic pregnancies

Possible negative effects of maternal antiepileptic medication on fetal motility and heart rate patterns were examined at 32 and 38 wk of gestation. Fetal eye and body movements were recorded using 2 real-time ultrasound units. Comparison between pregnancies with antiepileptic medication and control pregnancies did not show marked differences in patterns of motility and heart rate. Duration of sleep states, occurrence and duration of body movements in state 2F and statistical parameters of heart rate level and heart rate variability were very similar for both groups. This preliminary study, limited to mostly combined treatment with antiepileptic drugs, could not demonstrate any obvious effect on fetal neuromuscular development from maternal antiepileptic medication.

Secretion of cefoxitin in breast milk following short-term prophylactic administration in caesarean section.

In this study we investigated whether cefoxitin administered prophylactically to the mother in caesarean section could be demonstrated in breast milk. For this purpose 25 samples of breast milk were obtained from 18 patients to whom either 2 or a total of 4 g of cefoxitin had been administered during and following caesarean section. Cefoxitin was determined by means of a modified HPLC method and appeared demonstrable in only one case in a concentration of 0.9 micrograms/ml. On these grounds nursing need not be advised against when prophylactic cefoxitin is briefly administered to the mother during and following caesarean section.

Single- versus three-dose cefoxitin prophylaxis in caesarean section: a randomized clinical trial

The present study was undertaken to determine the minimal effective antibiotic dosage in caesarean section prophylaxis. The study was conducted at the Academisch Ziekenhuis der Vrije Universiteit in Amsterdam (Amsterdam Free University Hospital) to compare the efficacy of one dose of cefoxitin (2 g) with three administrations of 2, 1 and 1 g respectively. In this prospective and double-blind study, 66 patients were given one dose and 72 patients received three doses. In terms of febrile morbidity, endometritis, wound infection, urinary tract infection and need for postoperative antibiotic therapy, the three-dose group showed fewer postoperative infections: as to wound infections (p less than 0.05) and therapeutic antibiotic use (p less than 0.025) these differences were statistically significant. The numbers of days of hospitalization after the caesarean section also showed differences: 10.6 +/- 2.6 versus 9.8 +/- 1.5 days in the one- and three-dose groups respectively (p less than 0.05). It is concluded that, contrary to several reports in the literature, prophylaxis consisting of three administrations of cefoxitin is to be preferred. No significant allergic or adverse reactions were observed in our patients.

An anatomic basis for ultrasound images of the human placenta

Placentas after uneventful pregnancies were perfused under physiologic pressure in the fetal vessels, expanded to their predelivery volume, fixated with 4% formaldehyde, and compared to their ultrasound images in pregnancy. The placentas showed a side arrangement of the fetal cotyledons in contact with the basal plate. The centers of the cotyledons showed an empty space in which the spiral arteries ended. These spaces in the placenta corresponded with transsonic areas of ultrasound. The central spaces were surrounded by a relatively dense shell of villi containing the more or less fibrotic stem villi. This explained the areas of increased echo-density, as seen by ultrasound during the last trimester of pregnancy. The fetal cotyledons, composed of a central cavity and a dense villous shell, were separated by a reticular area. The veins ended at the basal plate in these intercotyledonary areas.

Perinatal Lethal Osteogenesis Imperfecta: Radiologic and Pathologic Evaluation of Seven Prenatally Diagnosed Cases

The radiologic and pathologic characteristics of 7 cases of lethal osteogenesis imperfecta (OI), diagnosed prenatally by ultrasound in the 15th to 34th week, are described. They include four variants of the Sillence classification: types IIA, IIB, IIC, and type III. The radiologic criteria that differentiate these types of OI are described. The histopathology of the bones differed only slightly in types IIA, IIB, and III; OI type IIC, however, differed markedly from the other types.

Twin pregnancy: case reports illustrating variations in transfusion syndrome

The twin transfusion syndrome is diagnosed in 5.5% to 14.6% of monochorionic twins and the classical picture reveals a small anemic donor and a large plethoric recipient. Many other clinical discrepancies have been described. Today, by ultrasound it is possible to diagnose the syndrome in (early) pregnancy. In these case reports different clinical pictures and the importance of ultrasound are described. In twin pregnancies repeated ultrasound examinations should be considered with the consequences of vascular anastomoses.