Evaluation of gas-liquid chromatography for the rapid diagnosis of amniotic fluid infection: a preliminary report.

Gas-liquid chromatography has been proposed as a possible tool in the rapid diagnosis of amniotic fluid infections. The analysis is based on the identification of specific organic acids derived from bacterial metabolism when organisms are present within the amniotic fluid. We retrospectively subjected 69 samples of amniotic fluid which had been obtained by transabdominal amniocentesis to analysis by gas-liquid chromatography. Forty-seven samples were derived from patients who either were in premature labor or had premature rupture of membranes with associated premature labor. Twenty-two specimens which served as a comparison group were obtained from patients who underwent amniocentesis for assessment of fetal maturity. The results obtained from chromatographic analysis are presented, and the possible applications of this technique to the clinical situation are discussed.

C-reactive protein with premature rupture of membranes and premature labor.

C-reactive protein (CRP) was determined serially in 31 patients with premature rupture of the membranes, 41 patients in premature labor, and 18 pregnant patients with a variety of high-risk conditions. Elevated levels of CRP were not predictive of clinical amnionitis, histologic chorioamnionitis, or neonatal sepsis. No discernible relationship was found between serum CRP and peripheral white blood cell count. CRP was not elevated (false negative) in two patients in the premature labor group with culture-proved bacterial amnionitis. Elevated CRP in the absence of infection (false positive) likewise occurred. The results suggest that CRP be used in conjunction with other signs and symptoms suggestive of chorioamnionitis, rather than as a pathognomonic test.

Pregnancy complicated by concurrent primary hyperparathyroidism and pancreatitis.

The third case of pancreatitis and primary hyperparathyroidism during pregnancy is reported. The patient became gravely ill with "hypercalcemic crisis" in the third trimester, the condition was stabilized by medical therapy, and the fetus was delivered when mature. This combined diagnosis is difficult to make because of the changes in calcium metabolism that accompany pregnancy and because of the opposite effects the 2 diseases have on blood calcium levels. In early pregnancy, surgical management of the parathyroid disease seems warranted after the condition has stabilized, whereas in late pregnancy medical treatment may be used and definitive surgery may be postponed until after delivery.

Changing primary cesarean section patterns at a private hospital.

The primary cesarean section patterns for a two-year premonitoring period, 1967 and 1968, and a two-year postmonitoring period, 1977 and 1978, were determined and compared at a private hospital. The frequency of cesarean section deliveries increased from 5.0% to 14.6% during those times. Cephalopelvic disproportion as an indication for cesarean section was more common than the combined total of breech presentation and fetal distress. Cephalopelvic disproportion increased as a diagnosis from 0.8% to 4.1% (5 X ) of deliveries; breech presentation, from 0.4% to 2% (5 X ); and fetal distress from 0.1% to 0.8% (8 X ). A changing patient population was identified as one contributing factor to the rising cesarean section rate. Allowing patients an adequate trial of labor with or without oxytocin stimulation, applying strict criteria for attempting a vaginal breech delivery and utilizing fetal scalp blood sampling with abnormal fetal heart rate tracings are suggested ways to decrease the cesarean section rate without compromising perinatal morbidity and mortality.

Anencephaly, twins and HLA-B27.

A patient with a twin pregnancy where both infants were affected with anencephaly is reported, and the world's literature on anencephaly in twins is summarized. The anomalies were diagnosed by ultrasound during the prenatal period. Studies of the genetic histocompatible lymphocyte antigens (HLA) types of both parents were performed, and they failed to demonstrate the HLA-B27 locus in either. Anencephaly in twins is an unusual phenomenon, with concordance even more rare. The possibility that anencephaly is a heterogeneous entity, both morphologically and genetically, and its relationship to the HLA locus are discussed.