Ronald J. Bolognese

Ultrasonic ratio of fetal thoracic to abdominal circumference: An association with fetal pulmonary hypoplasia

Real time ultrasound was used in pregnant women who were considered to be at risk for development of pulmonary hypoplasia (n = 26). The population consisted of women who had either premature rupture of membranes (n = 16) or oligohydramnios (n = 10). The ratio calculated by comparing the fetal thoracic circumference to abdominal circumference was obtained in all cases within 10 days of delivery. This ratio correlated strongly with neonatal outcome. Multivariate regression models of neonatal outcome were developed to analyze the relationship of gestational age at which premature membrane rupture occurred, the duration of premature rupture, date of birth, and prenatal diagnosis. The addition of the thoracic circumference to the abdominal circumference ratio increased significantly the proportion of explained variability. Application of this ratio should be considered in evaluating fetal status in oligohydramnios and in the expectant management of premature rupture of membranes.

Postpartum uterine atony treated with prostaglandins

This brief case history documents the usefulness of administering prostaglandins (PGs) postpartum for treating uterine atony after cesarean section. The patient was a 29-year-old gravida 2, para 0. After cesarian section, the atony of the uterus was noted, and the patient did not respond to intravenous ergotrate or brisk uterine massage with warm sponges. PGF2 alpha was injected superficially into the myometrium; about 1 mg of a 5 mg/ml solution was administered. Uterine contraction began almost immediately. However it was limited to the local area of injection and sustained for less than 2 minutes. After 6 such injections failed to produce the desired effect, the patient was given 250 mcg of PGF2 alpha 15-methyl ester Tham salt intramuscularly. After 8 minutes, the uterus increased tone in a tetanic-like contraction which sustained. No further atony occurred. Nor did side effects present a problem. Estimated blood loss during this time was 850 ml, and the postoperative hemoglobin was 8.5 gm/100 ml.

Gestational age and amniotic fluid protein patterns

Abstract Analysis of amniotic fluid protein electrophoretic patterns in 60 patients studied showed 6 discrete protein bands. The pre-albumin fraction increased with gestational age with a peak at 38 weeks followed by a sharp decline after the fortieth week. Correlation of gestational age with this finding is possible.

Increased risk of aneuploidy in women having unsuccessful chorionic villus sampling procedures

Objective To determine the incidence of fetal aneuploidy in women who had unsuccessful chorionic villus sampling (CVS) procedures.

The Intrauterine Device: Three Years of Clinical Experience

A report of experiences with the intrauterine device (IUD) in 1000 patients over a 3-year period is presented. The Birnberg Bow and the Lippes Loop were used in 995 primary insertions. The Saf-T-Coil was used in 5 cases. 718 patients (72%) retained the device from 1 to 3 years. The pregnancy rate for the Loop was 3.2 per 100 women or 2.2 per 100 women-years for the Bow 6.9 per 100 women and 3.9 per 100 women-years. Side effects encountered included intermenstrual spotting menorrhagia dysmenorrhea and especially with the Loop expulsions.

Bilateral Salpingovaginal Fistula

PROLAPSE OF a fallopian tube into the vagina following vaginal or abdominal hysterectomy is an unusual complication which often is mistaken for chronic granulation tissue. Although ectopic pregnancies have been reported, more commonly the patient is asymptomatic or complains of persistent or cyclic watery discharge and pelvic discomfort. The following case is unique in that both fallopian tubes were involved in a fistula communicating with the vagina.

The shell loop — A new IUD

Abstract A modified loop D — the Shell loop — was inserted in 500 patients. Improvement in decreased expulsion and lowered pregnancy rate was noted compared with other devices. The Shell Loop differs from the standard Loop D in that it is of a more rigid copolymer construction. The following report concerns the 500 primary and 20 secondary insertions of this device.

BIRTHWEIGHT|[sol]|GESTATIONAL AGE PROFILES FOR METROPOLITAN PHILADELPHIA

Birthweight (BW) as a function of gestational age (GA) was evaluated for a broad spectrum of both urban and suburban population, in Philadelphia and the Delaware Valley, who delivered at Penna. Hosp. A total of 13467 live-births occurred at this institution during the years 1977 to 1981. The racial spectrum was 62% Black (49.7% females); 30% White (47.8% females); and 8% Hispanics, Orientals, Asians, etc. GA was calculated on the mothers dates, obstetrical evaluation and then, the clinical estimation of GA. The data was analyzed by a UNIVAC computer programmed to calculate the percentiles of BW for each week of GA (26 to 42 weeks) for the total population and ethnic subcategories. BW curves were developed for all data. Total population BW exhibited different values of central tendency and were statistically different from known curves (Fig 1). Statistically different curves were also developed on the basis of race and sex. Differences in geographic location, altitude and composition of ethnic populations probably account for these observations. These data emphasize the need to utilize local regional standards classification of neonates according to their GA, and thus predict the risk of their morbidity and mortality.

PRENATAL HEMATOLOGICAL INDICES DURING GESTATIONAL DEVELOPMENT AS DETERMINED BY PERCUTANEOUS UMBILICAL BLOOD SAMPLING

Direct access to fetal blood by an ultrasonographically guided needle is now feasible and overcomes the limitations of earlier sampling techniques such as placentocentesis, fetoscopy and scalp sampling. Percutaneous umbilical blood sampling (PUBS) of 92 fetuses were performed for a variety of fetal indications: suspected prenatal hematological diseases, rapid chromosomal evaluation, etc. Of these, 50 fetuses (17 to 37 wks gestation) were deemed normal at birth and postnatal evaluation and were evaluated retrospectively for the hematological indices. Values of hemoglobin (HGB), red blood cells (RBC), mean corpuscular volume (MCV), white blood cells (WBC) and platelet (Plt) counts were correlated to gestational age (GA). Linear regression equations are listed:Fetal values indicate a relative neutropenia (WBC: 3.0-6.0 ×103). Values of both WBC and Plt counts (150-250,000) did not change significantly during gestation. These data define an increase in both HGB and RBC and concommitant decrease in MCV with advancing GA. This study describes and demonstrates the normative changes in hematological indices during fetal development prior to the onset of labor and delivery.

AMNIOTIC FLUID GAS TENSIONS

Ninety-eight amniotic fluid (AF) samples, collected at amniocentesis over a gestational age (GA) range of 16-40 wks, were analyzed for CO2 and O2 gas tensions. Of these, 21 samples were obtained at Cesarean section and matched with both umbilical vein (UV) and arterial (UA) gas tensions. The cord and expelled placental vessels were catheterized for blood gas tensions. All samples were collected under anaerobic conditions and gas tensions measured by an IL 1301/1303 analyzer. AF gas tension values were analyzed as a function of gestational age and grouped: I = 16-20 wks GA, II: 21-30 wks, and III = 31-40 wks GA. Mean ± SEM values were: Gr. I, 17.5 ± 1 wk GA (n = 38); pH, 7.11 ± 0.01; PO2, 59.1 ± 1.9 mmHg and PCO2 42.3 ± 2.6 mmHg. Gr. II, 26.0 ± 1.0 wks GA (n = 7): pH = 7.16 ± 0.01; PO2 = 64.3 ± 3.1 mmHg; PCO2 = 44.3 ± 1.1 mmHg. Gr. III, 36.0 ± 1.0 wks (n = 53): pH 7.11 ± 0.01, PO2 = 58.1 ± 3.8 mmHg, PCO2 = 47.5 ± 1.2 mmHg. At delivery, the mean ± SEM values of AF and blood gas tensions were correlated as below:These data suggest that there is an equilibrium of gases, especially PCO2, between the fetus, chorioamnion and maternal circulation. AF gas tensions need to be evaluated as an alternative and, presently, a less invasive means of assessing fetal gas tensions and thus of fetal well being.