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Prenatal detection of neural tube defects: Comparison between alpha-fetoprotein and beta-trace protein assays

The prenatal diagnosis of neural tube defects is now possible in about 90 per cent of cases by assaying the amniotic fluid for alpha fetoprotein. The accuracy of beta-trace protein assays on amniotic fluid samples from defective fetuses was compared to alpha-fetoprotein studies. At present, alpha-fetoprotein studies provide more reliable results.

Fetal EEG sleep stages and physiologic variability

Abstract Acute and chronic observations of the fetal electroencephalogram (EEG) in a fetal sheep preparation revealed two distinct patterns of sleep activity consisting of high-voltage slow activity (HVSA) and low-voltage fast activity (LVFA). A decrease in fetal heart rate, cerebral perfusion pressure, and cerebral blood flow was observed consistently during LVFA when compared to HVSA. There was no significant difference in cerebral metabolism during the sleep stages.

ALG treatment of steroid-resistant rejection in patients receiving cyclosporine.

Thirty-one episodes of biopsy-proved acute rejection (R) in 28 patients maintained on cyclosporine did not respond to high-dose steroids and were treated with antilymphocyte globulin (ALG). Cyclosporine was discontinued in all but three during ALG administration. (A) Twenty-four patients received 26 courses of ALG within 90 days of transplant (11 1st R, 15 2nd or 3rd). Seven treatment courses were cut short due to infection (4), ongoing R (2) and a combination of infection and rejection (1). Only 1 of 7 has a functioning graft. Of the remaining 19 full ALG courses (17 patients) (8 1st R, 11 2nd or 3rd), 13 (11 patients) responded (7 1st R, 6 greater than 1st). The remaining 6 patients lost their grafts to ongoing acute rejection. (B) Five patients were treated after 6 months posttransplant; two responded but no grafts currently function

Antenatal diagnosis and management of the small-for-gestational age fetus

Abstract A new classification of small birth weight neonates (approximately 2,600 grams or less) has been developed. This classification is based on gestational age and birth weight determinations. With the use of physical, neurological, and electroencephalographic determinations, more accurate gestational age measurements can be made. From these measurements, fetal growth curves have been developed that present percentile distribution of birth weight at successive gestational periods. This report describes from an obstetric viewpoint the results of analysis of a group of 48 infants who were small for gestational ages.

Triple marker (α-fetoprotein, unconjugated estriol, human chorionic gonadotropin) versus α-fetoprotein plus free-β subunit in second-trimester maternal serum screening for fetal Down syndrome: A prospective comparison study

Abstract OBJECTIVE: Our purpose was to compare the efficacy of triple-marker screening (α-fetoprotein, unconjugated estriol, human chorionic gonadotropin) with α-fetoprotein plus free β-human chorionic gonadotropin. STUDY DESIGN: Free β-human chorionic gonadotropin was concurrently assayed in 2349 maternal serum samples. Trivariate and bivariate algorithms were used to calculate the risk for fetal Down syndrome by the two protocols. Free β-human chorionic gonadotropin from 12 cases of fetal Down syndrome previously screened with the triple marker was retrospectively assayed. RESULTS: Mean maternal age of our study was 29.8 years (range 14 to 51 years). The initial screen-positive rate with the triple marker was 8.0% compared with 12.8% for α-fetoprotein plus free β-human chorionic gonadotropin. All three cases of fetal Down syndrome ascertained in our prospective study were detected by the triple marker; in contrast, one of three was detected by α-fetoprotein plus free β-human chorionic gonadotropin. By adding 12 additional cases of fetal Down syndrome, 12 of 15 (80%) were screen positive with triple marker and nine of 15 (60%) were screen positive with α-fetoprotein plus free β-human chorionic gonadotropin. CONCLUSION: The detection rate of fetal Down syndrome was greater by use of a triple marker screen than when using α-fetoprotein plus free β-human chorionic gonadotropin. Our data do not support the claims of other studies that suggest that α-fetoprotein plus free β-human chorionic gonadotropin is superior to triple markers.

Erythrocyte 2,3-diphosphoglycerate in normal and hypertensive gravid women and their newborn infants

Red blood cell 2,3-diphosphoglycerate (2,3-DPG) levels were studied in 227 normal gravid women in all stages of pregnancy, active labor, and early post partum. An increase to peak levels was observed at 19 to 22 weeks followed by a gradual fall toward normal. During labor and early post partum, 2,3-DPG again rose significantly above levels observed at term. Serial 2,3-DPG values through the third trimester, labor, and postpartum period in 11 hypertensive mothers and 20 normal gravid control subjects and their newborn infants were studied. Maternal 2,3-DPG levels were significantly higher in the hypertensive mothers when compared to control mothers at similar gestational stages. However, no difference in 2,3-DPG levels was observed when newborn infants of hypertensive mothers were compared with those of normal control subjects.

Amniography in the Prenatal Diagnosis of Neural Tube Defects

Amniography for the visualization and confirmation of suspected neural tube defect was performed in 9 midtrimester gravidas. In all cases, amniotic fluid alpha-feto protein (AFP) was abnormally elevated. Four cases of anencephaly and one of spina bifida were demonstrated by amniography. These pregnancies were terminated and the defects were confirmed by gross pathologic examination. In 4 remaining cases, amniography was normal. Three of these pregnancies proceeded to term, culminating in the birth of a normal child. The fourth patient had spontaneous abortion of a normal fetus at 23 weeks of gestation. The experience reported here suggests that amniography is an important adjunctive diagnostic technique in the prenatal diagnosis of neural tube defect, and if used correctly, may significantly reduce the chance of false-positive diagnosis.

Prolactin and human placental lactogen changes in maternal serum and amniotic fluid in midtrimester induced abortions

Abstract Prolactin (hPRL) and human placental lactogen (hPL) concentrations in maternal serum and amniotic fluid were serially determined in 19 patients undergoing midtrimester elective abortion. Two subgroups were studied: Group 1 (10 patients) received 40 mg. of intra-amniotic prostaglandin F2α (PGF2α); in Group 2 (nine patients), 200 ml. of 20 per cent sodium chloride was instilled in the amniotic cavity. Maternal serum samples were serially obtained for 24 hours after induction of abortion by either abortifacient. Serial anmiotic fluid samples were obtained in Group 1 for the first seven hours after induction of abortion. The time from induction of abortion to fetal death (IDT) as well as the induction-abortion time (IAT) were recorded in all cases. Maternal serum hPL values declined significantly within one and one half hour from the induction of abortion. At six hours, a decline of more than 50 per cent of the original hPL value occurred in both groups. Prolactin in maternal serum did not show significant changes until six hours after induction. In Group 1, a significant drop of 40.5 per cent occurred at this time. In Group 2, a similiar declining trend was apparent, but this did not reach statistical significance until 12 hours after induction. In the amniotic fluid, no significant change in the hPRL values was noticed throughout the observation time. Amniotic fluid hPL did show a rising trend, ranging to between 41.1 and 79.4 per cent above the base-line value. However, this change was not statistically significant. The decrease in maternal serum hPRL following the more rapid fall in hPL in both study groups indicates a close dependency of hPRL levels on the intact functions of the fetoplacental unit. Changes in the amniotic content of these lactogenic hormones appear to be independent of the respective changes of these hormones in maternal serum.

Prolonged fetal bradycardia with recovery--its significance and outcome.

bradycardia lasting more than 21/2 minutes with a decrease in FHR of more than 30 b.p.m. were observed in the course of 15 monitored labors. The mean fetal pH during the 20 minutes following the bradycardia (early recovery) was significantly less than the mean pH obtained 30 minutes or more after the bradycardia (late recovery). Various types of periodic heart rate changes were observed during the early recovery period but few persisted into late recovery. Vaginal delivery occurred in 13 of 15 patients. Two cesarean sections were performed for indications unrelated to the prolonged bradycardia. The 5 minute Apgar score of all 15 neonates was 7 or greater.

Interlocking Twins: Experience With Four Cases and Suggested Management

Experience with the management of 4 pairs of locked twins is described and analyzed. In view of the high morbidity figures a proposed preemptive management is suggested.