Robert Debbs

Contemporary Use of Cerclage in Pregnancy

Second trimester pregnancy loss and preterm delivery may be considered an obstetrical syndrome. A multifactorial approach to the diagnosis of true cervical insufficiency is paramount. Surgical modification of the cervix benefits those with at least 3 second trimester losses or preterm deliveries, those with 2 early second trimester losses when no other cause for loss is identified, and those with a previous second trimester loss or preterm birth with ultrasound findings of a short cervix defined as less than 25 mm. Multifetal pregnancies do not benefit from cerclage and causes harm in those with ultrasound or physical examination identified cervical changes.

Echocardiography in intrauterine growth restriction.

Advances in fetal cardiac ultrasound have provided evidence of the natural history of the fetal cardiac response to many different stresses. Fetal echocardiography lends particular insight into the diverse etiologies of intrauterine growth restriction (IUGR). For example, structural malformation

Effect of Single Versus Serial Courses of Antenatal Steroids on Neonatal and Maternal Outcome. † 788

Our approach to the use of antenatal steroids is to treat all mothers in preterm labor, except those with insulin dependent diabetes mellitus, ≥ 34 weeks GA, or if delivery is imminent. Steroids are then repeated weekly until delivery. The objective of this study was to compare the impact of one full course (12 mg IM × 2 doses) of betamethasone with those who received an initial course plus serial doses of 12 mg IM weekly (2-12 doses) on incidence of RDS, BPD, PDA, Grade 3 & 4 IVH, sepsis, NEC, and ROP. 163 infants were born to mothers who received one course of steroids (BW = 2255 ± 871 gms, GA = 34.2 ± 4.4 weeks). 211 infants were exposed to serial antenatal steroid treatment (BW = 2087 ± 812 gms, GA = 33.6 ± 3.8 weeks). Chi square for linear trend was used to evaluate the dose response effect for all the infants, and for infants stratified by GA of 24 to 28 weeks(n = 48, BW 856 ± 235 gm SD & 894 ± 215 gm SD), 29 to 32 weeks (n = 77, BW 1688 ± 333 gm SD & 1558 ± 392 gm), and 32 to 36 wks (n = 138, BW 2221 ± 488 gm SD & 2222 ± 514 gm) for single and serial courses of steroids.