Owaidah M. Alsulyman

Clinical significance of prenatal ultrasonographic intestinal dilatation in fetuses with gastroschisis

OBJECTIVE Our purpose was to evaluate the clinical significance of intestinal dilatation detected by prenatal ultrasonographic examination in fetuses with gastroschisis. STUDY DESIGN A retrospective chart review was performed of all patients cared for at Los Angeles County/University of Southern California Womens and Childrens Hospital with the prenatal diagnosis of gastroschisis over a 7-year period (1988 through 1995). Patients were divided into two groups on the basis of the presence or absence of ultrasonographically measured fetal bowel diameter of > or = 17 mm. Neonatal outcomes of the two groups were compared. RESULTS Twenty-one patients met the entry criteria during the study period. Fetuses with maximal bowel diameter of > or = 17 mm did not have a longer time to full oral feeding, a longer initial hospital stay, or a greater need for bowel resection when compared with fetuses with a bowel diameter < 17 mm. Two newborns underwent bowel resection because of intestinal atresia. Prenatal ultrasonographic examination failed to show significant bowel dilatation in either infant. CONCLUSION Our data suggest that prenatal evidence of intestinal dilatation in fetuses with gastroschisis does not predict immediate neonatal outcome. Thus this finding is not an appropriate indication for preterm delivery in the absence of other evidence of fetal compromise.

The accuracy of intrapartum ultrasonographic fetal weight estimation in diabetic pregnancies

OBJECTIVE Our purpose was to compare the accuracy of ultrasonographic fetal weight estimation in pregnant diabetic women with that of matched nondiabetic controls. STUDY DESIGN We performed a case-control study of pregnant patients who underwent ultrasonographic fetal weight estimation within 3 days of delivery. The study group consisted of pregnant diabetic women and nondiabetic controls matched for maternal body mass index and neonatal birth weight. Fetal weight estimates were calculated with use of Hadlocks and Shepards formulas. The difference between ultrasonographic fetal weight estimation and actual birth weight (absolute percent error) was analyzed with respect to maternal diabetic status and actual birth weight. RESULTS A total of 450 patients were studied (225 patients in each group). The mean (+/- SD) gestational age at delivery was 39.0 +/- 1.5 weeks versus 39.9 +/- 1.7 weeks for the diabetic and nondiabetic patients, respectively. There was no statistically significant difference between the two groups with respect to the mean (+/- SD) time interval between the ultrasonographic examination and delivery (0.9 +/- 1.8 days vs 0.8 +/- 2.1 days) or the mean (+/- SD) absolute percent error (9.0% +/- 7.1% vs 8.4% +/- 6.3%). The mean (+/- SD) absolute percent error of fetal weight estimates among subjects with macrosomic fetuses (birth weight > or = 4500 gm) was significantly greater than that observed in fetuses with birth weights < 4500 gm (12.6% +/- 8.4% vs 8.4% +/- 6.5, p = 0.001). This difference was observed irrespective of maternal diabetic status. CONCLUSION When matched for maternal body mass index and birth weight, the accuracy of ultrasonographic fetal weight estimation was similar among diabetic and nondiabetic women. Birth weights > or = 4500 gm rather than maternal diabetes seem to be associated with less accurate ultrasonographic fetal weight estimates.

Experience with oral methylprednisolone in the treatment of refractory hyperemesis gravidarum.

OBJECTIVE Our purpose was to describe the effect of oral methylprednisolone on the course of refractory hyperemesis gravidarum. STUDY DESIGN Patients with intractable hyperemesis gravidarum were candidates for oral methylprednisolone. Forty-eight milligrams per day was given for 3 days followed by a tapering dose over 2 weeks. If vomiting recurred after 2 weeks of therapy or during tapering, the medication was restarted or extended but not longer than 1 month total. RESULTS Seventeen of 18 patients (94%) were free of vomiting and were able to tolerate a regular diet within 3 days. Seven did not have further symptoms during their pregnancies. Nine vomited during or after tapering, but 7 of these responded to extension or reinstitution of therapy. Four of 6 patients on total parenteral nutrition at the start of therapy had a complete response within 3 days. CONCLUSIONS A short course of oral methylprednisolone appears to be a reasonable therapeutic alternative for intractable hyperemesis.

The nonreactive nonstress test: predictive value for neonatal anemia in the isoimmunized pregnancy.

Objective To assess the value of the fetal nonstress test (NST) in predicting neonatal transfusion in pregnancies complicated by red cell isoimmunization. Methods We retrospectively reviewed the records of all patients evaluated for isoimmunization in pregnancy for the period January 1992 to December 1994. In addition to prenatal care, serial ultrasonography, and invasive testing when indicated, patients had NSTs two times per week. Nonstress tests were interpreted as either reactive or nonreactive using standard criteria. Results of the last NST before delivery were analyzed. Neonatal outcome data were obtained prospectively and by chart review. Results Sixty patients with isoimmunization were identified during the study period. Fifty-one patients (85%) had reactive NSTs until delivery, and nine (15%) had nonreactive NSTs that prompted delivery. Twelve of 51 (23.5%) patients with reactive NSTs and seven of nine (77.8%) patients with nonreactive NSTs required neonatal transfusion (P = .003, odds ratio 11.4 [95% confidence interval (CI) 1.7–120.21). The mean (standard error of the mean; range) hematocrit (%) at birth was 38.9 (3.0; 21.3–52.0) in patients with reactive NSTs and 28.3 (3.8; 14.5–45.0) in those with nonreactive NSTs (P < .05). A nonreactive NST had a 77.8% positive predictive value (95% CI 49.0–100) in identifying the need for neonatal transfusion. Conclusion These findings indicate that a nonreactive NST is predictive of subsequent neonatal transfusion in patients with isoimmunization. The antepartum fetal NST is a useful adjunct in the management of isoimmunized pregnancies.