Intrapartum bimanual tocolytic-assisted reversal of face presentation: preliminary report.

OBJECTIVE: To design and conduct a mode of vaginal delivery for mentoposterior-presenting fetuses when cesarean delivery is not possible. METHODS: Eleven orthodox Jewish parturients who refused cesarean delivery had intrapartum bimanual conversion of mentoposterior to occipitoanterior presentation, concomitant with ritodrine infusion in ten. RESULTS: Excluding the first case, in which ritodrine was not administered, the maneuver was successful and vaginal delivery was achieved. CONCLUSION: This maneuver, performed with intravenous ritodrine tocolysis, might be an alternative mode of delivery in the presence of mentoposterior presentation when cesarean delivery is not possible. More experience is needed with this technique before it is performed routinely.

Anti-PP1Pk (anti-Tja) and habitual abortion.

Blood group incompatibility as a cause of early or habitual abortion has been a matter of much debate. However, the abortion rate in such cases is much higher than that found in the general population. Two sisters having the rare genotype pp and anti-PP1Pk (anti-Tja) in their serum were reported as having habitual abortions; a third sister, with a normal P group, had a normal obstetric history. The relationship of anti-PP1Pk (anti-Tja) to the high rate of habitual abortion was discussed and added support was given to the existing evidence that certain maternal blood group antibodies can affect embryos early in uterine life.

The effect of intrauterine devices containing zinc and copper on their levels in serum.

Serum levels of copper and zinc were determined in 11 health women in whom Latex Leaf intrauterine devices (IUDs) containing copper and zinc had been inserted. Patients with low levels of serum copper or zinc before insertion usually had increased levels of either of these metals while using the device, but they did not exceed the upper limits of normal values. When the group was considered as a whole, the serum levels of zinc showed a slight tendency to increase with duration of IUD use, whereas there was no statistical difference between the serum levels of copper before and after insertion of the IUD.

PIP: Serum levels of copper and zinc were measured in 111 healthy women in whom Latex Leaf IUDs containing copper and zinc had been inserted. The women ranged from 21 to 41 years of age. Months of use ranged from 1 to 23 with an average of 14.6. The 1st blood sample was obtained before insertion and the 2nd from 1 to 19 months after insertion. Mean level of serum copper in the 1st sample was 1.42 mcg/ml. Age and parity had no effect; a slight tendency for higher levels was observed only in multigravidas. There were no significant changes in mean copper levels even when the levels were correlated with duration of usage. Mean serum zinc level before insertion was 1.1 mcg/ml with no correlation to age, gravidity, or parity. The 2nd sample showed a slight increase, 109% + or -3.25% standard error p .005. This increase correlated with the time the device was in situ. In general, patients with low levels of serum copper or zinc before insertion usually had increased levels after use but these levels did not exceed the upper limits of normal values. This may be due to an initially low level of the copper fraction bound to serum albumin and indicates the existence of some equilibrium between free and bound metal in the system.

Bell palsy complicating pregnancy: a review.

UNLABELLED: The aim of the present work was to review the published evidence on the association of Bell palsy (BP), an acute idiopathic peripheral facial paralysis of unknown etiology, with pregnancy. Reports have shown that women of reproductive age are affected two to four times more often than men of the same age, and pregnant women 3.3 times more often than nonpregnant women. The apparent predisposition of pregnant women to Bell palsy has been attributed to the high extracellular fluid content, viral inflammation, and immunosuppression characteristic of pregnancy, but findings are controversial. Most cases of Bell palsy occur in the third trimester or the puerperium. Onset is acute and painful. Some authors suggest that Bell palsy increases the risk of hypertension and toxemia of pregnancy, whereas the pregnant state, in turn, may affect the course and severity of disease. Recovery is usually good; poor prognostic markers are recurrence in subsequent pregnancy and bilateral disease, both of which are rare. Neonatal outcome is apparently unaffected, although this has been studied rarely. The preferred mode of management remains undecided; it is usually confined to supportive care. Corticosteroids in pregnancy are controversial. We think clinicians should be aware of these findings to avoid unnecessary testing and treatment and to help the patient cope with this acute, painful disease. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to identify the potential etiologies of Bell palsy associated with pregnancy and to describe the clinical presentation of this condition in pregnancy and its likelihood for recovery.

Decreased fetal activity in complications of pregnancy.

Fetal activity expresses the fetal condition in utero. Absence of fetal movements may signify fetal distress. The reduction in fetal movements (FM) to 3 or less or their cessation for at least 12 h with audible heart beats was referred to by us as movement alarm signal (MAS). The rate of MAS in 662 complicated pregnancies was studied. There were 43 patients (6.5%) with MAS mainly in cases of fetal malformations and conditions associated with reduced uteroplacental blood flow. In 13 cases a nonintervention approach was undertaken and all the fetuses died in utero. The remaining 30 cases with MAS were delivered promptly, mainly by Cesarean section and live births resulted. Eight of these died neonatally. It is suggested that in cases of MAS the diagnosis of fetal distress should be verified by additional tests. Should fetal distress be confirmed, especially in cases of polyhydramnios, oligohydramnios and symmetrical growth retardation, every effort should be made to exclude fetal malformations before delivery is undertaken especially by Cesarean section.

Ossification centers as evidence of fetal lung maturity.

Fetal pulmonary maturity based on visualization of one or both fetal knee secondary centers of ossification was assessed in 84 gravidas. Amniotic fluid lecithin/sphingomyelin ration of 2:1 or greater was the criterion of fetal lung maturity. It was concluded that when antenatal radiographs reveal the presence of both centers of ossification, fetal lung maturity can be assured in 100% of the fetuses. When the distal femoral center along is seen, only 60% of the fetuses will have mature lungs.

Can breech presentation at birth be predicted from ultrasound examinations during the second or third trimesters?

OBJECTIVES: To determine at which gestational age the ultrasound finding of a breech presentation should compel us to follow the pregnancy more closely with repeat ultrasound examinations. METHODS: A retrospective longitudinal investigation of ultrasound examinations in the second and third trimesters is reported. The study group consisted of 157 breech deliveries and a control group of 1325 vertex deliveries. RESULTS: In the study population (breech delivery) 63.2% were presenting as breech during the 15th-19th weeks of pregnancy--almost the same percentage as in the vertex-born group (of which 55.2% were breech presentation). In the interval between 20 and 24 weeks the same relationship was observed (50.8% and 42.9%, respectively). From 25 weeks until delivery a statistically significant difference appeared between the breech-delivered group and the vertex-delivered group: during weeks 25-29 in the breech-delivered group, 70.6% were breech presentation compared with 28.9% in the vertex-born group (P < 0.0001). That difference increased as the pregnancy progressed. CONCLUSIONS: Patients found sonographically to be a breech presentation at 25 weeks' gestation or later are at high risk for malpresentation at delivery.

Prerupture ultrasound diagnosis of interstitial and rudimentary uterine horn pregnancy in the second trimester. A report of two cases.

Pregnancies in an interstitial and rudimentary uterine horn are rare and often fatal varieties of ectopic gestation. Ruptures tend to occur in the second trimester, resulting in maternal morbidity and mortality. Only a few cases of the ultrasonographic diagnosis of unruptured second-trimester interstitial and rudimentary uterine horn pregnancy have been reported. In two such cases second-trimester ultrasonographic examination revealed an unusual pregnancy location, thin uterine wall, incomplete myometrial layer and empty uterus.

Predicting first-trimester spontaneous abortion. Ratio of mean sac diameter to crown-rump length compared to embryonic heart rate.

First-trimester spontaneous abortions have been predicted from alterations in the gestational sac size and embryonic heart rate. To evaluate which parameter or combination of parameters has the greatest predictive value, a prospective study was carried out during the first trimester of pregnancy. Pregnancy sac size, crown-rump length and heart rate were measured in 603 embryos, of which 580 continued beyond 13 weeks' gestation and 23 ended in first-trimester spontaneous abortions. Based on the continuing pregnancies, we constructed nomograms relating the ratio of mean sac diameter to crown-rump length (S/CR) to gestational age (last menstrual period [LMP]), to crown-rump length (CRL) and to embryonic heart rate (EHR). The S/CR ratios of the 23 embryos that spontaneously aborted in the first trimester were plotted on these nomograms to determine the significance of values falling outside the 95% confidence limits. Plotting the S/CR ratios of the aborted fetuses on the S/CR versus LMP nomogram gave a sensitivity of 78.3%, a specificity of 97.8% and a false-positive rate of 2.2%. The same population was evaluated for abortion risk using EHR nomograms, giving a sensitivity of 65.2%, specificity of 98.2% and false-positive rate of 1.8%. Our findings suggest that S/CR measurement in early pregnancy may be a simple and reliable method of predicting first-trimester abortions.