Group B streptococcal sepsis and death in utero following funipuncture.

The technique of umbilical cord puncture for diagnosis and therapy, which has been shown to be feasible and relatively safe for both mother and fetus, is being used increasingly. The fetal loss rate with this technique has been estimated to be approximately 1%. A case is presented of fetal death from group B beta-streptococcal sepsis after funipuncture, the first report of this complication.

Uterine activity among a diverse group of patients at high risk for preterm delivery.

In this study, 98 patients with early premature rupture of membranes (PROM), postoperative recuperation, placenta previa, or blunt abdominal trauma were assessed for uterine contractions with an ambulatory uterine activity monitor. Uterine irritability manifested by low-amplitude, high-frequency contractions of 30 seconds' duration or less was prevalent in all groups but decreased as the patients were stabilized and diminished or disappeared in those who did not develop preterm labor. In the 18 women who developed preterm labor, daily uterine activity monitoring detected contractions 24-48 hours before clinical symptoms of preterm labor and/or vaginal bleeding occurred. A number of patients with early PROM and placenta previa had low-amplitude, high-frequency contractions, and the majority occurred in those who subsequently developed preterm labor.

Stripping membranes at term: can it safely reduce the incidence of post-term pregnancies?

Membrane stripping has been used clinically for many years but has not been well studied. An investigation was undertaken to determine whether weekly membrane stripping beginning at 38 weeks could safely reduce post-term pregnancies. One hundred eighty patients with firm gestational dates were randomized to either a treatment or control group. Control subjects received a gentle cervicovaginal examination each week to assess Bishop scores, whereas the treatment group also underwent weekly stripping of membranes. Women who received treatment had earlier delivery (mean +/- SEM 8.60 +/- 0.74 versus 15.14 +/- 0.83 days; P less than .0001) and fewer post-term deliveries than those in the control group (three versus 14; P less than .004). The reduction of post-term pregnancies was most notable in nulliparous women with unfavorable Bishop scores. Complications were similar in both groups. Membrane stripping was safe and was associated with earlier delivery and a decreased incidence of post-term gestation.

Pulmonary disorders complicating pregnancy.

The pulmonary physiologic changes associated with pregnancy increase oxygen transport to the developing fetus. Because of these changes, the fetus is allowed an extra measure of protection against insults that would decrease blood or oxygen flow to the uteroplacental unit. The goal of treating a patient with pulmonary disease in pregnancy should be to maximize pulmonary function throughout gestation. Experts in pulmonary disease should be readily available for patients with significant pulmonary disorders or worsening disease during pregnancy. Pregnancy affords all providers the opportunity to address the major respiratory health problem in the United States, which is smoking. This concerns not only the patient's personal health, but also that of her unborn offspring.

Stripping the fetal membranes at term. Is the procedure safe and efficacious?

A prospective, randomized investigation was undertaken in a low-risk group of pregnant women at term (38-42 weeks' gestation) to determine if stripping the fetal membranes would safely result in earlier delivery. Ninety-nine patients entered the study; 51 underwent stripping of the membranes, and 48 controls did not. Fifty-nine percent of the patients in the stripped group delivered within one week as compared to 21% in the nonstripped group (P less than .0003). Two pregnancies in the stripped group advanced beyond 42 weeks' gestation as compared to six pregnancies in the control group (P = .12). A single gravida in the control group developed chorioamnionitis during labor. There were no other infections or other complications. Stripping the membranes was associated with earlier delivery and was not associated with any complications.

Pregnant women with prosthetic heart valves.

Pregnant women with prosthetic heart valves present the same myriad of problems and challenges inherent in other patients with severe cardiac disease. Care for these patients should involve counseling to determine the advisability of attempting or continuing pregnancy. Combined team care with several specialists is necessary for the optimal management of these patients. Family planning is very important for these patients.

Hemoperitoneum as a result of coital injury without associated vaginal injury.

Hemoperitoneum as a result of coital injury without associated vaginal injury is an extremely rare entity, and evidence by only five cases that have been reported in the medical literature to date. We report five additional cases encountered in two medical centers. Two of these were ruptured corpus luteum cysts, one was a laceration of the round ligament, another was a laceration of an ovary, and the fifth was rupture of a serous cystadenoma. This diagnosis should be considered in patients with hemoperitoneum after coitus.

Parturitional factors associated with membrane stripping.

OBJECTIVE: Our purpose was to determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated. STUDY DESIGN: Thirty patients were randomly divided among a study population and two control groups to assess uterine contractions and microbiologic, histologic, and biochemical markers associated with parturitional events over a 7-hour time frame. RESULTS: Clinically, an increased frequency of uterine contractile activity was observed among patients in the membrane-stripped group (p < 0.03). There was a significant increase in plasma 13,14-dihydro-15-keto-prostaglandin F2 alpha (p < 0.001) and endocervical phospholipase A2 activity (p < 0.04) among those who underwent membrane stripping. Blood leukocyte counts, sedimentation rates, prostaglandin E2 metabolite concentrations, and fibronectin levels revealed no significant change during the 7-hour study session. CONCLUSION: Membrane stripping was associated with increases in phospholipase A2 activity and prostaglandin F2 alpha concentrations, indicating a possible correlation with initiation of the cascade of parturitional events.

Pregnancy after Fontan repair of tricuspid atresia.

We have described a patient who had a cyanotic congenital heart disease (type Ib tricuspid atresia), with initial palliation accomplished in childhood via a Glenn procedure. In 1985, she had a Fontan repair with the Bjork modification; 3 years later she achieved her first pregnancy at age 27. Maternal Doppler echocardiography in early pregnancy showed good flow through the constructed conduit, with normal left ventricular size and function. Fetal echocardiography at 22 weeks' gestation via two-dimensional, M-mode, pulsed Doppler, and color flow mapping revealed no evidence of fetal cardiac disease. At 25 weeks' gestation recalcitrant preterm labor developed, and the infant was delivered spontaneously. Labor, delivery, and puerperium were uncomplicated, and the newborn (though too premature to survive) was of appropriate weight for gestational age, without evidence of congenital heart disease or other anomalies. We believe this is the first report of pregnancy and spontaneous delivery in a patient who has had Fontan repair of a congenital heart defect.