Early prenatal sonographic diagnosis of gastroschisis.

We report a case of gastroschisis that was suspected at sonography at 11 weeks + 3 days of amenorrhea. Although early detection does not alter prenatal management of this condition nor does it affect neonatal outcome, it allows early counseling of the parents.

Lamellar bodies: platelet channel particles as predictors of respiratory distress syndrome (RDS) and of transient tachypnea of the newborn.

OBJECTIVE: We aimed to find a single numeric cut-off point in order to predict respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN), through quantification of the lamellar bodies (LBs) count. MATERIALS AND METHODS: Two hundred and twenty-seven single pregnancies delivered within 48 h from amniocentesis in a III level university hospital in a period between 1996 and 2007. LBs counts were determined by amniotic fluid (AF) sampling and after centrifugation in a commercially available Coulter counter. LBs counts were performed in order to predict the risk of neonatal RDS and also evaluated against the risk of TTN by means of the most suitable receiver operator characteristic (ROC) curve in order to predict RDS and TTN. RESULTS: The best LBs cut-off to significantly predict TTN was ≤ 35,000/µL [sensitivity 86%, specificity 75%, positive predictive value (PPV) 22% and negative predictive value (NPV) at 96%]. An LBs count ≤ 32,000/µL was the best compromise between sensitivity and specificity in predicting RDS or TTN [sensitivity 86%, specificity 83%, PPV 37% and NPV at 97%]. CONCLUSIONS: The quantification of LBs is a reliable method, simple to execute, useful in predicting RDS, and may be useful in evaluating suspicion of TTN.

Maintenance immunotherapy in recurrent ovarian cancer: long term follow-up of a phase II study.

OBJECTIVES: Vascular endothelial growth factor (VEGF), a mediator of tumor-associated immunodeficiency, plays a key role in angiogenesis and is a prognostic factor in advanced ovarian cancer (AOC). Previously, we showed that low-dose interleukin-2 (IL-2) and 13-cis-retinoic acid (RA) improved the tumor-associated immunodeficiency and decreased VEGF in patients with AOC. Here, we report long term follow-up of a group of patients with platinum-sensitive AOC who were treated with IL-2 and RA. METHODS: Sixty-five patients with AOC who had a clinical benefit from second line chemotherapy and elevated serum levels of VEGF were entered into the study from 04/98 to 04/05. Therapy consisted of low-dose subcutaneous IL-2 and oral RA, administered on intermittent schedules for up to 5 years. RESULTS: A statistically significant improvement in lymphocyte and NK counts and a decrease in VEGF levels were observed with respect to baseline values among the 65 evaluable patients. Five-year progression-free survival and overall survival rate were 29% and 38%, respectively. CONCLUSIONS: These data show that patients treated with low-dose IL-2 and RA have a statistically significant improvement in their lymphocyte and NK counts, a decrease in VEGF, and seem to have an improved clinical outcome.

Liposomal pegylated doxorubicin and oxaliplatin as salvage chemotherapy in patients with metastatic gastric cancer treated earlier.

The aim of this study was to evaluate the activity and safety of pegylated liposomal doxorubicin (PLD) and oxaliplatin (LOHP) as salvage chemotherapy in patients with metastatic gastric cancer (MGC) who had earlier been treated with docetaxel, capecitabine, 5-fluorouracil, and leucovorin. Treatment consisted of PLD (40 mg/m(2)) and LOHP (120 mg/m(2)) administered over 2 days, every 3 weeks. Response to therapy was assessed using the Response Evaluation Criteria In Solid Tumors; toxicity was evaluated by the National Cancer Institute common toxicity criteria (version 2.0). Thirty-six patients with pretreated MGC and a mean age of 66 years were recruited for the study. After a median follow-up of 11 months and 202 courses of chemotherapy administered (median, five courses per patient), the overall response rate in the 36 evaluable patients was estimated to be 28%. Grades 3 and 4 hematological toxicities were neutropenia in 44% of patients, grade 2-3 diarrhea in 14% of patients, and grade 2 neuropathy in 12 patients. Median progression-free survival and overall survival were 5.8 and 9.2 months, respectively, with 1-year survival rate of 36%, [95% confidence interval (CI): 21-54%]. Median survival time from the diagnosis of metastatic disease was 31.5 months. Seventy-two percent of patients (n=26) (95% CI: 58-88%) obtained a clinical benefit from this chemotherapy regimen. PLD and LOHP is an active regimen, able to give palliation in a substantial percentage of MCG patients who have been pretreated with taxanes.

Oral contraceptives and clinical recurrence of human papillomavirus lesions and cervical intraepithelial neoplasia following treatment.

OBJECTIVE: To evaluate the effect of oral contraceptive use on the recurrence rate of human papillomavirus (HPV) lesions and cervical intraepithelial neoplasia (CIN) following ablative or excisional procedures in a long-term follow-up. METHOD: The study was conducted with 650 oral contraceptive users presenting with HPV lesions and/or CIN, and 670 women who had these lesions but did not use oral contraceptives acted as controls. The participants underwent cytologic evaluations, colposcopy, and direct biopsy, followed by either ablative treatment by laser carbon dioxide vaporization or excision by a loop electrosurgical excision procedure or cold knife conization. They were then followed up for a minimum of 5 years. RESULTS: The recurrence rates did not differ statistically between the case and control groups. CONCLUSION: Oral contraceptive use was not found to increase the recurrence rate of HPV lesions and/or CIN after ablative or surgical treatment.

Young women, cervical intraepithelial neoplasia and human papillomavirus: risk factors for persistence and recurrence.

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections (STIs) in young women. They can occur in one or multiple areas of the female genitalia. Usually, the vulva is the initial site of implantation for HPV. The purpose of our study is to evaluate the epidemiological aspects, incidence of single or multiple lesions in the lower genital tract, correlation between sexual behaviour and their localization and behaviour risk factors for persistence and recurrence of HPV lesions and cervical intraepithelial lesion (CIN) in a long-term follow-up among young women. We recruited 268 patients aged 11-21 years who previously had cytology and/or physical examination suspicious for HPV infection. The women were interviewed and asked information about lifestyle, sexual behaviour, work, personal or family history of genital warts and school attendance. We considered individuals to be 'smokers' if they smoked more than five cigarettes/day. No specific data were recorded about oral contraception, nevertheless, no woman had used oral contraceptives (OCs) for more than 2 years. Young women included in the study were between the age of 12 and 21 years who had HVP lesions after entry examinations and had undergone no treatment for HPV lesions prior to entry. Other exclusion criteria relevant to this study included cervical excisional treatment prior to entry or later. Two hundred and thirty-four young women were included in our study group. Our diagnostic schedule for a complete evaluation included exo- and endocervical cytology, colposcopy, directed biopsy and microcolpohysteroscopy. The treatment was performed with a LASER CO2 Coherent 400, model 451, with Zeiss photocolposcopy attachment. The finding that, among 126/234 (53.8%) adolescents using contraceptives, only 85 (36.3%) have used condom, the only barrier form of contraceptive effectively protecting against virus, shows a low awareness of the high risk for contracting HPV infection among young sexually active women. The sites most frequently affected in our study were vulva, perianus and perineum (194/234), 82.9% and the cervix (125/234), 53.4%. Vaginal lesions were detected only in 29/234 patients (12.3%). According to our data, in 161 patients, sexual habits, age at the first intercourse (P=0.68), frequency of intercourses (P=0.49) and number of lifetime partners (P=0.27) as well as age (P=0.26) play a role in transmission and incidence of HPV infection but not on the location of the lesions. This can be due to a coexistent clinical and subclinical multiple infection as well as a transmission via intercourse or from other sources, including tampons. Abnormal Pap test was related to HPV infection, but the low correlation with colposcopic and histological findings in this study justify the support of other examinations such as colposcopy and punch biopsy for diagnosis. Moreover, according to our data, cytology alone shows to be not suitable to exclude CIN (seven underestimated cases of CIN) and a closer correspondence were found between colposcopy and the result of histological sample after punch biopsy in CIN detection. More attention must be paid to psychological aspect of diagnoses and treatment among adolescents, more than older women as the high rate of patients lost shows in our study: 75/234 (32.05%) before LASER surgery and 55/159 (34.59%) during follow-up. International data shows that only 12-45% of sexually active adolescent girls have obtained Pap smear screening. In our study, we found no correlation between treatment failure and cigarette smoking or between the use of oral contraceptives and persistence/recurrence after LASER CO2 surgery. Because the small sample of our study group, further analyses were required.

Improvement in uterine artery doppler indices via hysteroscopic metroplasty.

OBJECTIVE: the objective of our research was to study uterine artery doppler indices and their evolution over time after metroplasty and subsequent pregnancy in patients whose septate uterus was the only explanation for infertility. MATERIALS AND METHODS: a retrospective study. The uterine arteries of 78 patients with septate uteri were evaluated using endovaginal color doppler ultrasound before and after metroplasty. Fifty-one patients became pregnant after metroplasty and were selected as study group, pregnancy occurred within 17 months. By comparing uterine artery doppler indices before and after metroplasty, we observed that the resistive index (RI) and pulsatility index (PI) post surgery were significantly lower compared to premetroplasty levels. RESULTS: all pregnant women in the study group showed uterine resistive indexes within normal ranges, they all underwent scheduled cesarean in-tervention. Gestational evolution was normal in all patients (mean score of Apgar and birth weight); no neonatal complications were observed. CONCLUSION: metroplastic intervention in women with septate uterus as the sole cause of infertility may be a plausible alternative for patients wishing to carry a pregnancy.

Betamethasone effects on umbilical arteries and ductus venosus Doppler velocity waveforms in growth-restricted fetuses.

UNLABELLED: We studied intrauterine-growth-restricted (IUGR) fetuses with absent or reversed umbilical artery end-diastolic flow (EDF) velocity in order to evaluate the benefit of antenatal steroid therapy. Perinatal outcomes after betamethasone were evaluated where end diastolic flow returned (group I), compared with data from fetuses with persistent absent-reverse end diastolic(ARED) flow (group II). OBJECTIVES/METHODS: We recruited sixty-four IUGR fetuses, 28-32 weeks' gestation, whose umbilical artery spectral tracings showed ARED flow and positive a-wave in the ductus venosus at admission. RESULTS: Group I, 21 cases of restored EDF after betamethasone: Significant, persistent return of umbilical artery EDF flow and persistent ductus venosus a-wave were documented. Group II, 43 cases of persistent ARED flow: Persistent ARED flow in umbilical arteries and deterioration of ductus venosus waveform with significant, increasing pulsatility index and/or a-wave disappearance were documented. In group I, cardiotocographic alterations were delayed contrasted with group II, (p = 0.03). Neonatal complications in group II were eight cases of intraventricular hemorrhage; two cases of retinopathy of prematurity; three neonatal deaths, one fetal demise; and a higher incidence of neonatal respiratory distress syndrome. CONCLUSIONS: Betamethasone treatment may have beneficial effects on restoring end-diastolic umbilical artery velocimetry and precordial waveforms. These spectral Doppler changes are related to delayed cardiotocographic alterations and to better perinatal outcomes.

Full-term-pregnancy effects of antenatal betamethasone administration on short-term variation as assessed by computerized cardiotocography.

OBJECTIVE: to verify whether there are other than transitory effects of antenatal betamethasone (administered for fetal lung maturity [FLM] enhancement) on fetal heart rate (FHR) variability detected by computerized cardiotocography (cCTG) in cases where formerly steroid-treated fetuses reached term. MATERIALS AND METHODS: cCTG of one hundred sixty-four women (study group) exposed to antenatal betamethasone for risk of preterm delivery in third trimester period were compared to controls (pregnancies who presented risk of preterm labour in the same period of cases, although with no steroids administration). cCTG was performed weekly as of standard schedule when pregnancies reach term from 37-40 weeks' gestation for cases and controls. RESULTS: regarding data concerning cCTG at term for cases and controls, no significant difference was found for FHR, Acc (accelerations) 10 min, and FM (fetal movements) between groups. LV (low variation)/min and LV/msec were absent in cCTG parameters of fetuses in the study group. Instead, for all weeks studied (37 to 40), cCTG parameters were higher for HV (high variation)/msec, STV(short term variation)/msec, and Acc 15 in cases with respect to controls. CONCLUSION: interestingly, maternal corticosteroid administration may be related to higher fetal reactivity when fetuses exposed to steroid therapy reach term. Our observation may help in the interpretation of a "more reactive" CTG trace in babies whose mothers previously received steroid therapy for FLM enhancement.

Conjoined twins: what ultrasound may add to management.

INTRODUCTION: Conjoined twins occur in approximately 0.2:10,000 births; the obstetrician and sonographer only rarely examine them. In Western countries, discovery of conjoined twins is often made by the end of the first trimester; however, in the third world, conjoined twins are often discovered only at birth. OBJECTIVE: To evaluate how ultrasound techniques, when possibly available, may improve management and counseling when conjoined twins are confirmed. MATERIAL AND METHODS: The authors report two different cases of union of two equal twins with sole umbilical cord. RESULTS: The two cases presented with non contributive medical history and no prior teratogen exposure and an unfavorable prognosis. Early discovery of viable conjoined twins permits assessment of the best route of delivery and a planning for serial sonography and fast MRI to plan eventual separation surgery or fetus after-birth surviving possibilities.

Unicornuate uteri associated with contralateral renal agenesis and ovarian anomalies.

Our findings regarding two cases of unicornuate uterus validate that conventional transvaginal ultrasound is helpful in diagnosing uterine anomalies. Moreover, anomalies of the urinary system and the contralateral ovary should always be considered.

Premenopausal hormone-responsive breast cancer with extensive axillary nodes involvement: total estrogen blockade and chemotherapy.

BACKGROUND: Poor prognosis is associated with estrogen- and/or progesterone receptor-positive (ER(+), PGR(+)) premenopausal breast cancer (PM-BC) with high Ki-67 labeling index and extensive axillary lymph node involvement. The role of adjuvant chemotherapy (CT) and hormonal therapy have not yet been established in these patients. PATIENTS AND METHODS: Twenty-five PM-BC patients received, in sequence, leuprorelin, taxane-anthracycline induction chemotherapy, radiation therapy, a platinum-based intensification high-dose CT, followed by leuprorelin and anastrazole for five years. Vascular endothelial growth factor (VEGF) levels were measured as the primary end-point; secondary end-points were 10-year relapse-free survival (RFS) and overall survival (OS) rates. RESULTS: The median patient age was 44 years, and the mean number of positive axillary nodes was 14. All patients were ER(+) and/or PGR(+), with a median Ki-67 index of 33%. Five patients were Cerb-B2 positive. Grade 4 hematologic toxicity was observed in all patients, no patient showed a decrease of cardiac ejection fraction and hot flashes and arthralgias were of moderate intensity. After a median follow-up of 70 months, VEGF levels significantly decreased (p<0.001); 10-year RFS and OS were 76% and 78%, respectively. CONCLUSION: Total estrogen blockade and high-dose CT in PM-BC patients is feasible, has moderate toxicity, significantly reduces VEGF levels, and seems to improve the expected RFS and OS.

First trimester PAPP-A levels associated with early prediction of pregnancy induced hypertension.

OBJECTIVE: Previous studies have suggested an association between low levels of first trimester serum Pregnancy Associated Plasma Protein-A (PAPP-A) and the occurrence of hypertension in pregnancy (PIH). The purpose of this study was to determine the predictive value of maternal PAPP-A levels in the identification of women at risk of PIH. METHODS: Maternal serum PAPP-A was measured between 11-13 + 6 wks' gestation, as part of the first trimester screening of aneuploidies. Our study included only singleton pregnancies (973 cases) over a three years period. PAPP-A levels were expressed as gestational age-specific multiples of the median (MoM). Hypertension in pregnancy was documented by standard criteria. RESULTS: One hundred and eleven pregnant women developed hypertension (8.9%). In these patients, PAPP-A levels ranged from 0.53 to 1.08 MoM. After performing a backward stepwise regression equation and a ROC curve procedure, a PAPP-A MoM value <0.8 was able to significantly predict PIH (p < 0.001, area under the ROC curve 83%, sensitivity 68%, specificity 86%, 95 degrees CI 0.57-0.94). CONCLUSION: Low levels of serum PAPP-A (?0.8 MoM) may be a potential resource in order to early screen pregnant women at increased risk of hypertension in pregnancy.

Validity of amniotic fluid index in preterm rupture of membranes.

BACKGROUND: Preterm premature rupture of membranes (pPROM) complicates up to one-third of preterm deliveries. We studied the Amniotic Fluid Index (AFI) in order to ascertain its validity as a predictive variable of maternal-fetal outcome in pregnancies complicated by pPROM. STUDY DESIGN: One hundred and fourteen pregnant women with gestational age between 24 and 34 weeks' gestation at the time of pPROM. Patients were categorized into two groups on the basis of AFI value (AFI <5 cm=63 or AFI >or=5 cm=51) performed at the time of admission. RESULTS: AFI numeric values were significantly related to the following maternal-neonatal variables: high maternal body temperature (P7 at 5 min (P

The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies.

AIMS: To evaluate the effect of antenatal betamethasone and ritodrine in third trimester low risk singleton pregnancies by Doppler technology. SUBJECTS AND METHODS: Eighty-four third trimester pregnant women who received a full course of betamethasone and delivering uneventfully were recruited. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI) and the middle cerebral artery (MCA PI) prior to treatment (baseline), and 48, 72 and 96 h after the second dose of betamethasone. RESULTS: No significant difference was found in UA PI and UA/MCA values following betamethasone therapy. In contrast, MCA PI decreased significantly 48 h from the last injection of betamethasone in the whole study group (P<0.001), and returned to basal values at 96 h. We also found that MCA PI was reduced significantly at 48 h in the subgroup under tocolysis (n=41) and in the subgroup not receiving tocolysis (n=43). We compared MCA PI values for both subgroups in the four timings, and found a non-significant difference comparing baseline and 96 h values. However, when comparing MCA PI values after 48 and 72 h, significantly lower differences in PI values in both subgroups were found. CONCLUSION: In low risk pregnancies, betamethasone therapy in the third trimester is related to a significant but transient reduction of MCA PI, which is more pronounced during tocolytic therapy. Although the physiological basis of this effect is currently unclear, it could be related to the local regulation of intracerebral blood flow.

Amniotic fluid lamellar body counts for the determination of fetal lung maturity: an update.

AIM: To reassess the cut-off value for lamellar body counts (LBs) for fetal lung maturity (FLM) over a 10-year study period. PATIENTS AND METHODS: 178 pregnancies were selected under strict inclusion criteria and delivered within 48 h from amniocentesis. FLM was determined by amniotic fluid LBs in centrifuged samples (300 x g for 10 min) in a commercially available Coulter Counter. Cases beyond 37 weeks were excluded. RESULTS: Mean gestational age was 33.5+/-3.0 weeks at amniocentesis and 33.7+/-3.0 weeks at birth. After reassessing the best compromise between sensitivity and specificity for all cases using the receiver operating characteristic (ROC) procedure, an FLM cut-off value of < or = 22,000/microL was obtained. Diagnostic accuracy (and confidence interval, CI) was: sensitivity, 73% (60.0-83.6%); specificity, 81.7% (CI 73.6-88.1%); positive predictive value, 66.2%; and negative predictive value, 86.0%. CONCLUSION: No significant change in FLM cut-off for LBs was found when comparing the value from this study and the results of our earlier report presented in 1996 (< or = 22,000 vs. < or = 20,000/microL), although the new value may be more accurate, since it is based on neonatal outcome with the exclusion of cases in which the diagnosis of FLM is seldom warranted, i.e., > 37 weeks' gestational age.

Structural-tridimensional study of yolk sac in pregnancies complicated by diabetes.

OBJECTIVES: To assess by two- and three-dimensional ultrasound the diameter and volume of the yolk sac in pregnant women affected by type 1 diabetes during the first trimester of pregnancy. METHODS: 18 women affected by insulin-dependent diabetes mellitus (IDDM) and 52 normoglycemic pregnant women (controls) were enrolled in this study. The women were evaluated once a week (5-12 weeks of pregnancy). Ultrasound examination in all pregnant women was initially performed in a bidimensional fashion with a transvaginal 6.5-MHz probe and subsequently using a three-dimensional technique. RESULTS: In the pregnant diabetic women the diameter of the yolk sac was significantly higher than that of controls in the first weeks of pregnancy, reaching a maximum diameter at 9 weeks, and decreasing thereafter, earlier than controls. The volume of the yolk sac increased in both groups from 5 weeks of pregnancy and reached maximum values at 10 weeks in both groups. The volumetric increase and decrease after reaching highest values were greater in IDDM patients. CONCLUSION: The clinical and diagnostic implications of the results of this study are still to be defined. Such a diagnostic technique may prove to be an additional element in monitoring diabetic women during early pregnancy.

Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus.

AIM: To evaluate whether computerized CTG (cCTG) is a reliable method of predicting neonatal outcome in pregnancies complicated by pregestational diabetes at term. PATIENTS AND METHODS: We considered 27 pregnant women affected by pregestational diabetes and 46 normal pregnancies as controls that fulfilled the following criteria: singleton, Caucasian, euglycemic pregnancies at term (>37 weeks gestational age). All women delivered by cesarean section (CS), with an antepartum cCTG performed within one hour before the CS and an UBGA available at birth. No patient was in labor during FHR monitoring. RESULTS: Among cCTG parameters, accelerations 15 bpm, HV min, HV ms and STV were significantly lower in comparison to controls. We observed that in the diabetic pregnant women the parameter STV was not able to predict or to linearly regress with the most important UBGA parameters: pH and pCO2. Contrarily, in normal pregnancies, the STV linearly regressed with both the pH (p < 0.03) and pCO2 (p<0.04). CONCLUSIONS: Computerized FHR criteria may not be applicable to fetuses in pregestational diabetic pregnancies at term. Therefore some criteria should perhaps be modified for a correct interpretation of cCTG in these pregnancies.

Validity of short term variation (STV) in detection of fetal acidemia.

AIMS: We aimed to establish a cut-off for short term variation (STV) in msec in electronic FHR tracings as a single parameter for the prediction of neonatal acidemia and hypercarbia at birth. METHODS: 195 consecutive cases of singleton pregnancies between 26 to 42 weeks' gestation delivered by cesarean section, with an antepartum tracing performed within 4 hours from birth and umbilical artery gas analysis (UBGA) available at birth. RESULTS: A positive correlation (r = 0.27, p < 0.0001) was found when STV was regressed against gestational age. We also found significant correlations between STV and UBGA parameters (pH [r = 0.12, p < 0.05] and pCO2 [r = -0.17, p < 0.01]). In order to evaluate the influence of gestational age on STV values, we subdivided patients into three subgroups (< 34 weeks: n = 31; 35-37 weeks: n = 37, and > 37 wks: n = 127). Only in the subgroup < 34 wks, STV < 5.1 msec was a significant predictor of acidemia (pH < 7.0), (sensitivity: 100%, specificity: 61%, p < 0.05); in the same subgroup STV < 4.9 msec predicted pCO2 > 60 mmHg with a sensitivity: 71.4% and a specificity: 62.5% (p < 0.02). CONCLUSION: In cases < 34 weeks' gestation, STV values below 4.9 msec and 5.1 msec are able to predict umbilical artery pH < 7.0 and PCO2 > 60 mmHg, respectively.

Preliminary report on a new and noninvasive method for the assessment of fetal lung maturity.

OBJECT: Several patterns of fetal breathing movements (FBMs), i.e. abdominal wall movements (AWm), thoracic wall movements (TWm) and nasal fluid flow velocity waveforms (NFFVW), were investigated by ultrasound (US) technology and related to fetal pulmonary maturity and immaturity, i.e. fetal lung maturity (FLM) tests, in order to validate the hypothesis that they may indicate whether the fetal lung is mature or immature, regardless of gender, weight and gestational age. MATERIAL AND METHODS: We prospectively enrolled 143 high-risk pregnancies in which a complete US study of FBMs and FLM tests was performed. Among them 43 women satisfied the inclusion criteria. US-FLM was defined as the presence of regular NFFVW detected by pulsed Doppler and spectral analysis, or irregular NF-FVW synchronous with TWm detected by M-mode. An US guided amniocentesis was performed in order to collect amniotic fluid (AF) and FLM was evaluated by L/S (lecithin/sphingomyelin) determination, presence of phosphatidylglycerol (PG) and lamellar bodies (LBs) count. At the end of the study the diagnostic accuracy of US-FLM was compared to that of FLM tests. RESULTS: Diagnostic accuracy for US evaluation of FLM was as follows: sensitivity: 89.6%; specificity: 85.7%; PPV: 92.8%; NPV: 80%. Diagnostic accuracy of FLM tests was as follows: sensitivity: 100%; specificity: 51.7%; PPV: 100%; NPV: 50%. L/S determination predicted lung maturity with a sensitivity of 100%; specificity of 93.1%; PPV of 100%; NPV of 87.5%. CONCLUSION: Presence of regular NFFVW or irregular NFFVW and TWm correlate accurately with conventional FLM tests. We suggest that this noninvasive procedure may be helpful for assessing FLM, particularly under certain circumstances, e.g., oligo-anhydramnios, laboratory logistic equipment difficulties or heavily stained AF samples, amniocentesis refusal, religious concerns.