Antenatal sonographic diagnosis of dacryocystocele.

Dacryocystocele is an uncommon condition presenting at birth as a bluish swelling approximately 1 cm in diameter located below and nasal to the medial canthus. It represents a cystic swelling of the lacrimal sac due to obstruction of the lacrimal drainage system both above and below the sac. The average age when the lacrimal duct becomes patent is the eighth intrauterine month. If this does not occur, a dacryocystocele can result. Dacryocystocele is also referred to in the literature as mucocele, dacryocele, and amniocele of the lacrimal sac. We report a case of a dacryocystocele detected sonographically during pregnancy.

Elevated serum group II phospholipase A2 levels are associated with decreased blood flow velocity in the umbilical artery.

Twenty-two hospitalized patients, diagnosed as having hypertensive disorder of pregnancy, were selected from two University Clinics. Maternal serum samples were analyzed for serum group II phospholipase A2 (PLA2-II) by time-resolved fluoroimmunoassay. At the same time, umbilical artery blood flow velocities were measured with color Doppler sonography for orientation and pulsatile Doppler sonography for recording waveforms. Nineteen normotensive third-trimester pregnant patients served as a control group. Maternal serum PLA2-II was elevated in 8 cases with preeclampsia. This elevation was invariably associated with decreased blood flow velocity in the umbilical artery. In 1 case, the clinical condition allowed simultaneous follow-up of serum enzyme and blood flow velocity: a further rise of serum PLA2-II was linked to a further decrease in the blood flow velocity of the umbilical artery. A large spillover of the elevated PLA2-II content from the preeclamptic placenta into the maternal serum is associated with a decrease in blood flow velocity in the umbilical artery. The enzyme might serve as a link between local proximal (placenta) and systemic distal (umbilical arterial blood flow) effectors.

Group I and group II phospholipase A2 in serum during normal and pathological pregnancy.

Phospholipase A2 groups I (pancreatic) and II (synovial) could be a link between local and systemic changes in pregnancy, reflected in catalytic activity. We studied whether normal pregnancy, preeclampsia, preterm labor and four other diseases have processes involving serum phospholipase A2s. Pancreatic and synovial-type phospholipase A2 were measured in the serum of 59 normal pregnant women and 89 patients with pathological pregnancy by newly developed time-resolved fluoroimmunoassays, and the catalytic activity by a radiochemical method using micellar phosphatidylcholine as substrate. During pregnancy weeks 6-14, synovial-type phospholipase A2 and catalytic activity were elevated 2- to 4-fold, but at 37 weeks values were normal. Pregnancy-induced hypertensive diseases increased by 4- to 10-fold the concentration of synovial-type phospholipase A2, reflected in catalytic activity. In 8 out of 14 cases, the enzyme was increased if the fetus was to be delivered prematurely. The enzymes studied remained within the reference interval in cases of hepatogestosis, fetal asphyxia, diabetes and twin pregnancy. Newly developed specific immunoassays for measuring different types of phospholipase A2 in serum can provide insights for clinical follow-up.

Transabdominal and transvaginal ultrasonography in the diagnosis of ectopic pregnancy: a comparative study.

Thirty-four patients believed to have ectopic pregnancies were examined by transabdominal and transvaginal ultrasonography. Twenty-five patients had tubal pregnancy confirmed operatively within 24 hours after ultrasonographic examination. In these cases adnexal findings highly suspicious for ectopic pregnancy were found in 68% of cases by transabdominal ultrasonography and in 84% by transvaginal ultrasonography. A distinct adnexal gestational sac was apparent in 32% of cases by transabdominal ultrasonography and in 64% of cases by transvaginal ultrasonography. Transvaginal ultrasonography was significantly more accurate (p less than 0.01) in identifying an adnexal gestational sac and allows more detailed adnexal imaging.

Combined pregnancy: how common is it?

Three cases of combined intrauterine and ectopic pregnancy, treated in the same hospital over a 39-day period, are presented. This condition has been acknowledged to be a rare phenomenon with delayed diagnosis and treatment. Two of the cases were diagnosed by ultrasound upon arrival at the hospital, and all three were treated within 24 h of arrival. These cases highlight the importance of ultrasound in diagnostics and indicate a possible higher incidence of this phenomenon than was previously estimated.

Effect of third-trimester premature rupture of membranes on fetal breathing movements: a prospective case-control study.

Fetal breathing movements were examined in 44 women with premature rupture of membranes. All had previously uncomplicated singleton pregnancies (28 to 41 weeks). Of these 44 women, 13 had complications based on later amnionitis/neonatal infection or antepartum fetal distress. Thirty-one normal antepartum patients, matched for gestational age, served as a normal control group. These women had intact membranes and were without any known or suspected maternal, fetal, or neonatal complications. Fetal breathing movements were found in 90% of cases in the control group, compared with 65% in the 31 women with premature rupture of membranes (p less than 0.05). In the group of 13 women with premature rupture of membranes and complications, the incidence of fetal breathing movements was 38%. Therefore, it is possible that the absence of fetal breathing movements can be due to premature rupture of membranes alone. There was a statistically higher incidence of low-birth-weight infants and low Apgar scores in the group of 13 women with premature rupture of membranes and complications compared with the group of 31 women with premature rupture of membranes.

Angiographic arterial embolization to control hemorrhage in abdominal pregnancy: a case report.

A case is described in which heavy postoperative bleeding from the placental bed after removal of the fetus in an abdominal pregnancy was managed by selective arterial embolization of the placental vascular bed. Selective angiographic embolization is a useful tool in both obstetric and gynecologic complications when hemorrhage fails to respond to other modes of therapy.

Sulprostone in the control of postpartum haemorrhage.

A PGE2 analogue, Sulprostone was administered to control the postpartum haemorrhage, immediately after the baby was born, to 74 healthy patients, who had normal pregnancy and delivery. Divided into three groups they received 50 or 100 micrograms intravenously, or 200 micrograms intramuscularly. The results were compared with those of a group of 54 patients, which received 0.2 mg methylergometrine i.m. and 5 IU oxytocin i.v. respectively. The blood loss was measured during the third stage of labour and during two hours thereafter. The pilot dose of 50 micrograms was not effective enough. The blood loss in the group of 100 micrograms i.v. was 386 +/- 175 ml, in the group of 200 micrograms i.m. 325 +/- 197 ml, and in the methylergometrine-oxytocin group 302 +/- 202 ml. Sulprostone 200 micrograms i.m. seems to be effective treatment to control the postpartum haemorrhage. Only four patients had mild side-effects after Sulprostone administration.