Familial abdominal wall defects.

We report 2 families, each having multiple sibs with abdominal wall defects. In family 1, normal parents gave birth to identical (monochorionic, diamniotic) twins. This is the first reported case of gastroschisis occurring in monozygotic twins. In family 2, a normal mother gave birth to a son with omphalocele. Two subsequent pregnancies with a different husband resulted in a stillborn girl with partial atresia of the colon and a liveborn girl with gastroschisis. In neither case were there any associated anomalies. In neither of the 2 families was there consanguinity or history of other abdominal wall defects. The familial occurrence of these defects suggests that 1) multifactorial determination should be considered in at least some cases of abdominal wall defects, 2) the bowel atresias that occasionally accompany gastroschisis may also have a genetic (multifactorial) cause, and 3) some cases of gastroschisis and omphalocele may have the same genetic cause.

Relationship of maternal weight status to selected pregnancy events.

The relationship of maternal weight status to the probability of appearance of one or a combination of three or more undesirable pregnancy events ( UPE ) was analyzed. A total of 711 women presenting for prenatal care before 16 weeks estimated gestational age were categorized according to early pregnancy body mass ( EPBM ) and subsequent weight gain. Statistical analysis revealed weight gain related to the appearance of one UPE only in women with an EPBM less than 120 pounds. In gestations complicated by three or more UPEs , a relationship to weight gain was shown only in women with an EPBM of 120-199 pounds.

Thrombotic thrombocytopenic purpura: report of fourteen cases--occurrence during pregnancy and response to plasma exchange.

Thrombotic thrombocytopenic purpura (TTP), a syndrome of diverse etiology probably related to factors regulating platelet-vessel wall interaction, is predominantly a disorder of women. We report our experience with 14 patients in an 11-year period. Thirteen were female and aged between 25-69 years. Four were postmenopausal, and of the nine premenopausal women three were pregnant, one was immediately postpartum, and three were taking estrogen-containing oral contraceptives. A review of the literature confirms the two to one female/male preponderance and that TTP is reported in 56 women who are pregnant or recently postpartum. While this association with possible hormonal events has been noted, it has previously received little comment. We stress the similarity between TTP and some occurrences of preeclamptic toxemia, and that this may suggest not only a common etiology but that therapeutic attempts should be similar. While no single therapeutic modality is universally successful, our experience is that plasma exchange is the most effective, with five of seven patients so-treated obtaining prolonged remission; four of five patients responded to splenectomy and corticosteroids, but one died of infection postoperatively. Five patients, including two treated exclusively with antiplatelet aggregating agents, died without achieving remission. The frequency of successful therapy is not changed by the concurrent pregnancy, but the fetal loss is high. There does seem to be an increased risk of recurrence of TTP in a subsequent pregnancy, and this might be considered when counseling premenopausal patients who have achieved remission of TTP.

Fetal distress in term pregnancies.

A diagnosis of fetal distress was made in 75 term obstetrical patients from a population of 3,972 term deliveries. Twenty-three percent of the infants were scored 6 or less on the 5-minute Apgar rating. One or more determinations of fetal scalp pH were available in 27 of these patients. The scalp pH improved the accuracy of the diagnosis of fetal distress modestly. Follow-up evaluation to at least 1 month of age was available in 75% of the infants. Six infants were not neurologically normal; in four of them this was of major importance, and in the other two it was of minor importance. In one, the condition was almost certainly unrelated to prenatal or perintal factors, whereas in the other five, evidence of chronic fetal asphyxia as well as perinatal asphyxia was elicited. An additional 10 term infants with a 5-minute Apgar score of 6 or less had entirely normal electronic fetal monitoring tracings.

Extraperitoneal cesarean section revisited.

A retrospective analysis was made of 186 consecutive primary cesarean sections performed on patients at high risk for infection to determine whether extraperitoneal cesarean section would have decreased the incidence of infections and other complications. Women who theoretically would have benefited most from extraperitoneal cesarean section were not candidates for the procedure because of technical reasons, while those who would have been candidates for the procedure did very well despite the fact that the procedure was not done. Except for somen with severe toxemia, prophylactic antibiotics markedly reduced febrile morbidity. A number of significant unsuspected pathologic conditions also would not have been diagnosed if the extraperitoneal cesarean section technique had been used. It is concluded that prophylactic antibiotics and intraperitoneal cesarean sections are the preferred techniques even for those women with apparent amnionitis.

Delivery of the tiny newborn.

Obstetric factors related to the survival of 100 newborn infants weighing between 800 and 1,350 grams were analyzed. Available data suggest that maternal intrapartum antibiotic and steroid administration and delivery by classical cesarean section are associated with increased newborn survival.

Severe edema-proteinuria-hypertension gestosis.

Severe edema-proteinuria-hypertension (EPH) gestosis (pre-eclampsia) appears in at least two forms (A and B). The A type is mostly complicated by fits, while the B type is characterized by multiple organ failure. The perinatal mortality rate is especially high in the B group. All gravid women with severe EPH gestosis benefit from blood volume expansion therapy.

Effects of x-ray on a gravida with severe hemoconcentration: a case report.

A gravida with severe hemoconcentration was studied with intravenous urography because of right upper quadrant pain. She subsequently developed renal failure. The potential hazard of urography in the presence of a severe blood volume contraction state is noted.

Fetal reacting bradycardia.

Acute and abrupt fetal bradycardia are considered to be vagal in origin. In addition to head compression and funis compression bradycardias, we will report on those acute fetal bradycardias occurring during maternal seizures and maternal voiding, during aortocaval compression, during terminal labor, and during the immediate postpartum period. While certain mechanisms are known which can explain some or parts of these bradycardias, we conclude that in the clinical setting information is insufficient to determine their etiology with precision. Instead of labeling abrupt fetal heart rate pattern as resulting from either head or funis compression, it is suggested that the patterns be described according to their severity and duration. Such acute fetal bradycardias can be detrimental in terms of reduced umbilical flow. Administration of atropine may be indicated in the otherwise healthy fetus with acute bradycardia.

Post--paracervical block bradycardia: its prediction and preventability.

The fetal heart rate recordings of 100 parturients given PCB with less than 200 mg. of lidocaine were reviewed. No PCB bradycardia occurred if there were no pre-PCB FHR decelerations (92 per cent accuracy). In an effort to prevent post-PCB bradycardia, atropine was given in the maternal paracervical area and also intravenously. The most effective dose was 1.0 mg. intravenously, but the prophylactic efficiency of atropine was uncertain in preventing the post-PCB bradycardia.

Pituitary tumors in patients with secondary amenorrhea.

This study was undertaken to determine the prevalence of radiologically detectable pituitary tumors among patients seen initially in a gynecology clinic for a complaint of secondary amenorrhea. In a group of 144 women with secondary amenorrhea of more than 6 months' duration, 13 had radiologic abnormalities of the sella turcica detectable with standard skull films without tomography. These gynecologic patients composed more than half of the women in the reproductive age group who were diagnosed at this medical center as having a pituitary tumor. Only one patient with oligomenorrhea or secondary amenorrhea of less than 2 years' duration had a detectable tumor. Thus, for patients with short-term amenorrhea, the risk of having a pituitary tumor is small, especially in the absence of galactorrhea, headache, or changes in vision. However, 12 of 71 patients with amenorrhea longer than 2 years (17%) had detectable tumors and the risk appears to increase progressively with time. Assay of adrenal and thyroid hormones did not discriminate between patients with and without pituitary tumors. Early detection of these tumors is aided by serial sella x-rays, tomograms, prolactin assays, and newer pituitary function tests. Patients presenting with postpill amenorrhea and postpartum amenorrhea illustrate the hazard of interpreting a temporal relationship as a causal one.

Fetal cardiac interval recorder.

A recorder is described which is capable of continuously measuring intervals between two events of the fetal cardiac cycle, as well as functioning as a routine intrapartum monitor. We have primarily measured the interval between the R wave of the fetal ECG and the second fetal heart sound (R-S2), but the recorder is also capable of measuring R-R, R-A0 (opening of aortic valve), R-Pl (placenta), and R-Sc (scalp) intervals. In the discussion, we endeavor to show that these intervals reflect fetal cardiac performance, which is altered by drugs and acidemia.

Intrapartum hypertension and intravenous saline.

Four hundred women in labor were given, on a random basis, either 5 per cent dextrose in water or 5 per cent dextrose in normal saline infusions. Normotensive parturients receiving saline showed an increased incidence of elevated blood pressure during labor or postpartum while hypertensive parturients showed no significant increase in mean arterial blood pressure. Fetal serum sodium levels were not affected by whether the mother had received either the dextrose or saline intravenous solution.