Large fetal sacrococcygeal teratomas: could early delivery improve outcome?

OBJECTIVE: To determine if gestational age (GA) at delivery or tumor size impacts outcome in neonates with very large sacrococcygeal teratomas (SCTs). METHODS: Retrospective chart review from 1990 to 2006 of live-born infants with very large SCTs, defined as diameters exceeding 10 cm. Data analyzed using the independent t test and Fisher's exact test, with p values <0.05 considered significant. RESULTS: Nine infants with very large SCTs were identified. Six of the 9 infants survived, 4 of whom had evidence of early hydrops. Mean GA of survivors was 32.2 +/- 3.7 versus 31.7 +/- 0.6 weeks in nonsurvivors (p = 0.85). Infants with the largest SCTs did not survive. CONCLUSION: Risks of preterm delivery must be weighed against complications from further enlargement of very large SCTs and against the risks of in utero intervention.

Reproductive implications of bariatric surgery: pre- and postoperative considerations for extremely obese women of childbearing age.

Extreme obesity remains a frustrating and formidable disease, with most sufferers requiring surgical intervention in order to achieve long-term, sustained weight loss. Most bariatric procedures today are performed on women, many of whom are of reproductive age; yet minimal evidence exists to guide clinicians in the care of such women before, during, and after pregnancy. This review outlines the fundamental nutritional and surgical alterations of the most commonly performed bariatric procedures with the aim to elucidate a physiologically sound approach to counseling and management of extremely obese women of childbearing age who are either contemplating or have already undergone bariatric surgery. Preconception, pregnancy, and lactation guidelines are offered based on available evidence. Outstanding questions are highlighted for further investigation.

Maternal psychophysiological change during the second half of gestation.

This study investigated the trajectory of physiological and psychological functioning during the second half of pregnancy and compared responsiveness to a laboratory stressor between pregnant and non-pregnant women. Monitoring of 137 pregnant women at 20, 24, 28, 32, 36, and 38 weeks of pregnancy included measures of heart period (HP), heart period variability (HPV), skin conductance (SCL), respiratory period (RP), respiratory sinus arrhythmia (RSA), and self-report of mood disturbance. HP and RSA declined during this period; SCL and mood disturbance increased. Parity was a significant moderator. HP and SCL responsiveness to the Stroop color-word task was assessed twice in pregnant participants and compared to a sample of 27 non-pregnant women. Physiologic responsiveness was reduced in pregnant women. Pregnant women perceived the Stroop to be more difficult, but performance was unaffected. Despite buffered responsivity to stressful stimuli during pregnancy, advancing gestation is associated with escalating sympathetic tone and declining parasympathetic tone.

Measuring bioimpedance in the human uterine cervix: towards early detection of preterm labor.

We have created a bioimpedance probe designed to detect subtle changes in human cervical tissue composition in vivo, and thereby detect the onset of cervical remodeling in a noninvasive manner sooner than existing clinical methods allow. Our cervical bioimpedance measurement device, which can be used during a routine pelvic examination, is composed of a contoured probe with disposable tip and, within the probe's handle, a bioimpedance sensor equipped with an integrated chip capable of generating sinusoidal voltage of varying frequencies. A constant force spring assures consistent measurements through a range of contact forces applied. An activation switch allows the operator to control the application of current. The sensor can be synchronized with a computer data storage and analysis system, which interfaces with the device. With the probe placed in contact with a collagen gels of varying concentration, the relationship between measured bioimpedance and collagen concentration is verified to be positive exponential (R/sup 2/=0.94) and repeatability in saline solution showed that measurements varied by less than +/-10% over 20 trials. Finally, a variety of user-applied forces showed that impedance values plateau when forces exceed 1N.