Rs Smith

Need for urgent delivery after third-trimester amniocentesis.

Objective To estimate the risk of need for urgent delivery after third-trimester amniocentesis as currently done using ultrasound guidance to assess fetal lung maturity. Methods Ultrasound records of women scheduled for third-trimester amniocenteses to assess fetal lung maturity from February 1990 through October 1997 were reviewed for possible complications during or immediately after procedures. Collected data included gestational age, indication for the procedure, number of needle passes, transplacental passage, needle gauge, and fluid color. The primary outcome examined was procedure-related complications that required emergency delivery or the decision to deliver before completion of maturity studies. Infants who developed hyaline membrane disease leading to neonatal intensive care admission were also identified. Results During the 7½-year study period, 962 amniocenteses were done to assess lung maturity. Complete data were not available for 49 cases. Of the remaining 913 procedures, 15 (1.6%) were unsuccessful (needle pass without collecting fluid). Forty-one infants were delivered spontaneously or by cesarean on the same day as the procedure. However, complications that required delivery were identified in only six cases, an incidence of 0.7% (95% confidence interval = 0.16, 1.24). Complications included fetal heart rate abnormalities (n = 3), placental bleeding (n = 1), abruptio placentae (n = 1), and uterine rupture (n = 1). Only one of six complications had a single needle pass with clear fluid collected. Hyaline membrane disease occurred in 14 neonates, including two with mature indices. Conclusion Although complications that required urgent delivery after third-trimester amniocentesis are rare, the risks of the procedure should be carefully weighed against the benefits.

Maternal diabetes mellitus: Which views are essential for fetal echocardiography?

Objective To determine which fetal echocardiography views are essential to detect the majority of cardiac defects in fetuses of women with diabetes mellitus. Methods Fetal echocardiograms performed from February 1990 through May 1996 on insulin-requiring women with diabetes were reviewed. Individual component views of the examination were analyzed for the detection of fetal congenital heart defects. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Multiple gestations and patients with additional risk factors for congenital heart defects were excluded. Results A total of 223 patients were included in the study. There were 11 (4.9%) congenital heart defects, eight of which were conotruncal. When the four-chamber view and outflow tracts appeared normal, additional views such as the ductal and aortic arches did not detect a cardiac defect. The sensitivity of the four-chamber view for detecting an abnormal heart increased from 73% to 82% with the addition of the aortic outflow tract. There were two false-negative and no false-positive diagnoses. Conclusion the four-chamber and outflow tracts are the essential views that will detect most cardiac defects in fetuses of women with insulin-requiring diabetes mellitus.

The significance of ultrasonographically diagnosed fetal wrist position anomalies.

OBJECTIVE Our purpose was to determine the clinical significance of ultrasonographically diagnosed fetal wrist position anomalies. STUDY DESIGN The relationship of the fetal hand to the forearm was prospectively evaluated in all second- and third-trimester scans over a 5-year period. If an abnormal wrist position was detected, a targeted scan, including echocardiography, was performed. The outcomes of abnormal pregnancies were obtained. RESULTS An abnormal relationship of the hand to the forearm was found in 22 fetuses in 27,467 scans. Nine had a normal karyotype, and 13 had an abnormal karyotype. Among the nine with normal chromosomes, three had evidence of a movement disorder. Three with normal karyotypes are alive; two of these are the only normally functioning survivors. They had no other major anomalies and were shown prenatally to have normal movement of the limbs. CONCLUSIONS An abnormal fetal wrist position is associated with a high incidence of karyotype and movement abnormalities.

Benign teratoma of the omentum and ovary coexistent with an ovarian neoplasm

Benign cystic teratoma of the omentum is a rare abdominal tumor. Review of the literature describes seven reported cases of omental teratomas in association with ovarian teratomas. Our patient is a 68-year-old woman who presented with an asymptomatic abdominal mass and uterine prolapse. Ultrasound revealed a right-sided, cystic and solid pelvic mass. CT scan revealed a second mass with calcifications situated along the right iliac crest. This is the first description of an omental teratoma in association with a benign ovarian cystic teratoma coexistent with a malignant neoplasm. Possible etiologies of the present case are discussed and additional literature investigated.