The goniomaxillar length/goniomandibular length ratio in normal newborn infants: A clinical tool for defining chin position abnormalities.

Retrognathia (recessed chin) and prognathism (prominent chin) often present as signs of an underlying condition. Accurate clinical definitions are important. Yet their definitions were according to "clinical impression", or to seldom used X-ray criteria. We propose a statistical and anthropometric definition of retrognathia and prognathism based upon the ratio between the goniomaxillar length (distance between the gonion at the mandible angle and the subnasale and the goniomandibular length (distance between the mandible angle and the most anterior point of the bony chin). We assumed that an increase in the ratio indicates retrognathia and a decrease reflects prognathism. We conducted a prospective, observational, anthropometric study in 204 consecutive healthy term infants. Measurements took place on the second day of life, using sliding calipers. Mean ± SD of goniomandibular length (5.1 ± 0.3 cm), goniomaxillar length (5.4 ± 0.3 cm), were calculated. All measurements correlated significantly with gestational age, and with infant birthweight. The mean ± SD goniomaxillar length/goniomandibular length ratio was 1.06 ± 0.05. We defined a normal ratio as being within 2 SD of the mean, that is, between 0.96 and and 1.16. This ratio correlated with neither gestational age nor with birthweight. We conclude that the goniomaxillar length/goniomandibular length ratio can be calculated whenever retro - or prognathism is suspected. A ratio outside of the 95% confidence interval should help in making this diagnosis. An increase in this ratio beyond 2 SD above the mean (1.16) could be interpreted as retrognathia and a decrease beyond 2 SD below the mean (0.96) as prognathism.

Nipple/Areola Dimensions in Early Breastfeeding.

Background: Nipple dimensions may be an important factor in breastfeeding (BF) initiation success. Objective: To establish standards of nipple/areola dimensions in early BF and to determine whether maternal age, gestational age (GA), parity, cup size, previous BF experience, and early (<2 hours) BF affect nipple dimensions (assessed on the second day of BF). Design/Methods: A total of 205 consecutive BF women were enrolled. They were all Caucasians, and had uncomplicated pregnancies, labors, and vertex vaginal deliveries. Measurements (immediately before and after BF) of nipple length and diameter and of prefeeding areolas were by sliding calipers. Results: In average, there were no significant differences between right (R) and left (L) side dimensions, except for post-BF nipple length, and post-BF horizontal nipple diameter (significantly higher on the L side). Both R and L nipple length correlated positively with maternal age, gravidity, parity, number of previously breastfed infants, and cumulative number of BF months. Early (<2 hours) first BF did not correlate with increased nipple length. Pre-BF nipple length correlated significantly with post-BF nipple length on both sides. There were significant differences between pre- and post- BF values in terms of nipple length (longer length post-BF), but not in terms of nipple diameter. In stepwise regression analysis, where pre-BF nipple length was the dependent variable, and parity (or maternal age, or previous BF), early first BF, and GA were independent variables, parity, maternal age, gravidity, or previous BF experience were positively and significantly associated with nipple length (p < 0.001). The correlation maternal age-nipple length remained significant in primigravida mothers. Conclusions: This study provided a set of standards for nipple and areola dimensions on day 2 of BF in Caucasian women. The only areola/nipple dimension significantly affected by BF is the nipple length. Increasing parity, maternal age, or previous BF experience is significantly associated with increased nipple length.

The effect of prolonged rupture of membranes on circulating neonatal nucleated red blood cells.

OBJECTIVES: To test the hypothesis that absolute nucleated red blood cells (ANRBC) counts are higher at birth in infants who were born after prolonged rupture of membranes (PROM, >24 hours). STUDY DESIGN: Retrospective study of 31 infants admitted to the neonatal intensive care unit who were born after PROM, and pair matched for gestational age and Apgar scores with 31 no PROM controls. Venous ANRBC counts were obtained within 1 hour of life. RESULTS: Groups did not differ in birthweight, gestational age, Apgar scores, and platelets counts. The ANRBC counts and hematocrit were significantly higher in infants who were born after PROM than in controls. CONCLUSIONS: Infants born after PROM have higher ANRBC counts at birth than control infants. We suggest that increased fetal erythropoiesis exists in infants who are delivered after PROM. If correct, our interpretation supports the theory that fetal hypoxia and/or ischemia may result from PROM.

Ectopic pregnancies following emergency levonorgestrel contraception.

There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.

Non-classical 21-hydroxylase deficiency: prevalence in males with unexplained abnormal sperm analysis.

OBJECTIVE: To evaluate the prevalence of nonclassical 21-hydroxylase deficiency (NC-21OHD) in men with abnormal sperm parameters of unexplained etiology compared with males with normal sperm analysis. DESIGN: Case control study. SETTING: Major tertiary medical center. PATIENT(S): Of 484 healthy men being followed at a fertility clinic, 222 (mean age 33.8 +/- 6.1 [+/-SD] years) presented with abnormal findings on sperm analysis (1999 WHO criteria) of unknown cause and 262 (mean age 34.8 +/- 6.5 [+/-SD] years) with a normal sperm analysis. INTERVENTION(S): Random mid-morning blood sampling to test for 17-hydroxyprogesterone (17-OHP) levels. Subjects with levels of >or= 6 nmol/L underwent a standard adrenocorticotropic hormone (ACTH) stimulation test. MAIN OUTCOME MEASURE(S): NC-21-OHD, defined as a stimulated ACTH level of >or=45 nmol/L. RESULT(S): A serum 17-OHP level of >or=6 nmol/L was detected in 11 study patients (5.0%) and 14 control subjects (5.3%). Seven study patients and 8 controls subsequently underwent ACTH stimulation test, and none had levels compatible with a diagnosis of NC-21OHD. Mean 17-OHP levels were similar in the two groups (3.3 +/- 1.4 [+/-SD] nmol/L and 3.3 +/- 1.5 [+/-SD] nmol/L, respectively). There was no correlation between sperm parameters and serum 17-OHP levels. CONCLUSION(S): Until larger studies are performed, the routine measurement of 17-OHP in the evaluation of male infertility is not recommended.

Neonatal nucleated red blood cells in infants of overweight and obese mothers.

OBJECTIVE: The perinatal outcome of the infant of obese mother is adversely affected and in theory, may involve fetal hypoxia. We hypothesized that an index of fetal hypoxia, the neonatal nucleated red blood cell (NRBC) count, is elevated in infants of overweight and obese mothers. STUDY DESIGN: Absolute NRBC counts taken during the first 12 hours of life in 41 infants of overweight and obese mothers were compared to 28 controls. RESULTS: Maternal body mass index and infant birthweight were significantly higher in the overweight and obese group (P < 0.01). Hematocrit, corrected white blood cell and lymphocyte counts did not differ between groups. The absolute NRBC count was higher (P = 0.01), and the platelet count lower (P = 0.05) in infants of overweight and obese mothers than in controls. In stepwise regression analysis, the absolute NRBC count in infants of overweight and obese mothers remained significantly higher even after taking into account birthweight or gestational age and Apgar scores (P < 0.02). CONCLUSION: Infants of overweight and obese mothers have increased nucleated red blood cells at birth compared with controls. We speculate that even apparently healthy fetuses of overweight and obese mothers are exposed to a subtle hypoxemic environment.

Accuracy of diagnosis of retained products of conception after dilation and evacuation.

OBJECTIVE: Uterine re-evacuation samples taken in cases of suspected residua after curettage are occasionally negative for gestational tissue. We aimed at evaluating the occurrence of such postcurettage re-evacuation-negative samples and at exploring factors that may influence their occurrence. METHODS: This was a cross-sectional comparative retrospective study of 69 consecutive women who underwent uterine re-evacuation for suspected postcurettage gestational remnants. Pathologic reports of samples drawn during re-evacuations were reviewed to determine whether the extracted tissue contained gestational tissue. The presence of factors that may influence the rate of a positive or negative sample (eg, sonographic findings, gestational age at initial procedure, and presenting symptom) was noted and compared between women with and without histologically verified remnants. RESULTS: Twenty-eight (41%) of the re-evacuation samples were histopathologically positive for gestational remnants. Residual tissue was more commonly found when the initial evacuation was performed at a more advanced gestational age (> 15 weeks). Women referred by emergency department attendants had significantly fewer positive samples. Normal expert sonographic examination practically excluded yielding samples. Conversely, no negative samples were preceded by sonographic reports mentioning residua. CONCLUSIONS: Most re-evacuation samples taken during a re-evacuation procedure for suspected residua are negative for gestational tissue. Parameters that are likely related to histologically confirmed gestational residual tissue are advanced gestational age at initial evacuation, level of the sonographer's skill, persistent bleeding as the presenting symptom, and a sonographic report specifically mentioning retained gestational tissue.

Nucleated red blood cells in concordant, appropriate-for-gestational age twins.

OBJECTIVES: The purpose of this study was to test the hypothesis that neonatal nucleated red blood cell (RBC) counts are elevated in nondiscordant twins compared with singletons. STUDY DESIGN: We compared absolute nucleated RBC counts taken after birth in 2 groups of term, appropriate-for-gestational age infants; 74 concordant twins, and 29 singleton control infants. We excluded infants with factors associated with a potential increase in absolute nucleated RBC counts. RESULTS: Birth weight and gestational age were significantly lower in twins than in singletons (P < .01). Hematocrit, absolute nucleated RBC count, and corrected lymphocyte counts were significantly higher in twins (P < .01). In multiple regression, the significantly higher absolute nucleated RBC count in twins remained significantly higher even after taking into account gestational age and Apgar scores. CONCLUSION: Concordant, appropriate-for-gestational age twins have increased nucleated RBCs at birth compared with singleton control infants.

Nucleated red blood cells in infants of mothers with asthma.

OBJECTIVE: The purpose of this study was to evaluate whether the absolute nucleated red blood cell and lymphocyte count is elevated in term, appropriate-for-gestational-age infants born to women with asthma. STUDY DESIGN: We compared absolute nucleated red blood cell counts taken during the first 12 hours of life in two groups of term, vaginally delivered, appropriate-for-gestational-age infants; one group was born to mothers with active asthma during pregnancy (n = 28 infants), and the other group was born to control mothers (n = 29 infants). Asthma severity was classified according to the National Asthma Education and Prevention Program. We excluded infants of women with diabetes mellitus, hypertension, alcohol, and tobacco or drug abuse and infants with fetal heart rate abnormalities, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no differences between groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, and infant sex. The hematocrit level, red blood cell count, absolute nucleated red blood cell count, and corrected leukocyte and lymphocyte counts were significantly higher in the asthma group than in the control group. The platelet count was not significantly different between groups. The absolute nucleated red blood cell count correlated significantly with the asthma severity score (r (2) = 28%, P <.001). Backward stepwise multiple regression that included Apgar scores and gestational age showed a significant correlation of absolute nucleated red blood cell count with the presence of asthma and its severity (P <.001). CONCLUSION: At birth, term appropriate-for-gestational-age infants born to mothers with asthma have increased circulating absolute nucleated red blood cell and lymphocyte counts compared with control infants.

Factors influencing the obstetric and perinatal outcome after oocyte donation.

BACKGROUND: We evaluated interactions between perinatal outcome after oocyte donation and various maternal factors. METHODS: The study included 134 parturients after oocyte donation. Data were collected from medical files and personal interviews. Stepwise logistic regression analyses were used to evaluate associations between perinatal outcomes and selected maternal variables. RESULTS: Fifty percent of the women were >43 years old, 30.6% were >45 years and 67.9% were nulliparous. The rates of pregnancy induced hypertension (PIH), gestational diabetes and first and second trimester vaginal bleeding (STB) were 27.6, 23.9, 43.3 and 6% respectively, while 72% had Caesarean deliveries. The rates of preterm (PD), low birth weight (LBW), small for gestational age (SGA) deliveries and major malformations were respectively 14.9, 14.9, 7.6 and 2.2%. Using a logistic regression, PD was significantly associated with PIH, STB and maternal smoking. LBW deliveries were significantly associated with PIH, STB, nulliparity and maternal smoking. SGA babies were significantly associated with PIH. These perinatal outcomes were not associated with advanced maternal age or ovarian failure. CONCLUSIONS: There is a high risk of obstetric complications in singleton oocyte donation pregnancies, but the perinatal outcomes are favourable. Patients should be counselled about these risks and monitored for these complications during pregnancy.

Labor does not affect the neonatal absolute nucleated red blood cell count.

We investigated whether the presence or absence of physiologic labor may affect the neonatal nucleated red blood cell (RBC) count. We compared absolute nucleated RBC counts taken at approximately 6 hours of life in term infants born by elective cesarean delivery without trial of labor ( n = 32) and in vaginally delivered infants ( n = 28). Venous blood samples were analyzed and differential cell counts were performed manually; absolute nucleated RBC were counted and expressed as an absolute number. There were no significant differences between groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, and infant sex. There was a significantly higher hematocrit and RBC count in the vaginally delivered group as compared with the cesarean group. The absolute nucleated RBC, corrected leukocyte and lymphocyte, and platelet counts were strikingly similar in both groups. We conclude that labor does not affect the neonatal nucleated RBC count. This finding supports the speculation that physiologic labor does not induce a fetal hypoxemia severe or prolonged enough to produce hematological evidence of increased erythropoiesis.