A cohort study of pregnancy outcome after amniocentesis in twin pregnancy.

We conducted a retrospective cohort study to assess the risk of amniocentesis in twin pregnancy for adverse outcomes. The study base consisted of women who had an amniocentesis performed during twin pregnancy and a comparison representative sample of women who carried a twin pregnancy, but did not have invasive prenatal diagnosis. The 227 women in each of the exposed and non-exposed groups were residents of the state of New South Wales, Australia, over the period 1980-92, and were matched on maternal age and period of the infant's birth. Nearly 10% of twin pregnancies among the women having an amniocentesis were affected by a stillbirth, and the stillbirth rate among exposed fetuses (5.3%) was nearly twice as high as among non-exposed fetuses (3.1%). After adjustment for confounding and excluding abnormalities, there was a non-significant elevated relative risk of stillbirth after exposure to amniocentesis. The analysis by type of amniocentesis (with and without methylene blue dye) was limited by small numbers, but the burden of risk was primarily among women who had dye exposure during amniocentesis (relative risk = 3.64, 95% confidence interval = 1.15, 11.48). This increase remained after adjusting for confounding, although the confidence interval was wide. In conclusion, we were unable to establish with certainty whether an increased risk of stillbirth could be ruled out among women who had any type of amniocentesis in twin pregnancy.

Fetal death after exposure to methylene blue dye during mid-trimester amniocentesis in twin pregnancy.

Methylene blue dye use during mid-trimester amniocentesis in twin pregnancy is associated with a high risk of small intestinal atresia. It is plausible that the effects of methylene blue as a fetotoxic agent may also lead to fetal death. We conducted a retrospective cohort study of all women who had an amniocentesis during twin pregnancy from 1980 through 1991 in New South Wales, Australia. Women who were exposed to methylene blue dye during the procedure were compared with women who had amniocentesis without dye exposure. Fetal death occurred in 31.8 per cent of pregnancies that had exposure to a high concentration of methylene blue, compared with 14.5 per cent of pregnancies exposed to a low concentration and 4.3 per cent of pregnancies with no exposure to dye. The unadjusted and adjusted risks and 95 per cent confidence intervals (CIs) for fetal death after any exposure to dye were 5.03 (2.12-11.91) and 8.52 (2.28-31.80), respectively. The adjusted odds ratio and 95 per cent CIs for the low and high concentration dye solutions were 4.63 (0.93-23.13) and 14.98 (3.40-66.08), respectively (chi-squared test for trend P < 0.001). Fetus papyraceous was significantly more likely among pregnancies exposed to a high concentration of methylene blue (P < 0.001) than among unexposed pregnancies. These results support the hypothesis that methylene blue dye use during mid-trimester amniocentesis in twin pregnancy increases the risk of fetal death.

Multilevel library instruction for emerging nursing roles.

As new nursing roles emerge that involve greater decision making than in the past, added responsibility for outcomes and cost control, and increased emphasis on primary care, the information-seeking skills needed by nurses change. A search of library and nursing literature indicates that there is little comprehensive library instruction covering all levels of nursing programs: undergraduate, returning registered nurses, and graduate students. The University of Florida is one of the few places that has such a multilevel, course-integrated curriculum in place for all entrants into the nursing program. Objectives have been developed for each stage of learning. The courses include instruction in the use of the online public access catalog, printed resources, and electronic databases. A library classroom equipped with the latest technology enables student interaction with electronic databases. This paper discusses the program and several methods used to evaluate it.

Continuous intrapartum fetal monitoring: a prospective randomized comparison of 2 types of fetal scalp electrode.

This trial was conducted to compare 2 commonly used fetal scalp electrodes with regard to ease of use, frequency and extent of neonatal injury and quality of cardiotocographic record. A randomized design was employed to study a group of 106 patients divided between a Surgicraft Copeland clip fetal scalp electrode (52 patients) and a Meditrace spiral single helix scalp electrode (54 patients). Patients were eligible for trial entry if they required an intrapartum fetal scalp electrode, at term with a singleton cephalic pregnancy. Ease of application was rated by the operator using a linear analogue score. Unidentified traces were reviewed independently for quality by 2 obstetricians and neonates were examined on day-2 postpartum for injury. The Meditrace spiral fetal scalp electrode was significantly easier to apply (unpaired t-test p < 0.02). It also obtained higher ratings for trace quality (unpaired t-test p < 0.02). There were no serious neonatal injuries and no difference was found between the 2 electrodes in this regard.

Maternal weight gain, smoking and other factors in pregnancy as predictors of infant birth-weight in Sydney women.

Two hundred and four (204) women attending a Sydney maternity hospital and their babies were followed throughout pregnancy in a study, which aimed: 1) to describe the distribution of maternal weight gain in present day Australian women and 2) to determine the effect of weight gain and other factors on birth-weight. Maternal weights and skinfold thicknesses were measured serially to give an indication of weight gain. Mean weight gain from conception to term was 14.2kg and mean birth-weight was 3,442g. Maternal predictors of birth-weight such as maternal weight gain, parity, age, education, height, public or private booking status, smoking, prepregnancy weight, and sex of the infant and gestational age were explored using simple and multiple regression analysis. Weight gain was predictive of birth-weight, each kg increase in total weight gain resulting in about a 30g increase in birthweight. Other strong predictors were gestational age, maternal smoking, sex of the infant and maternal parity. Maternal height was less strongly predictive and age and prepregnant weight were not predictive. Smoking mothers had infants who were 268g lighter than those of nonsmoking mothers. However, smokers were also younger, shorter, had less education and were more likely to book as public patients than nonsmokers. After adjusting for all other predictors, the birth-weight of infants whose mothers smoked, was still 224g less than that for nonsmoking mothers.

Cloverleaf skull with generalised bone dysplasia. Report of a case with short review of the literature.

A case of cloverleaf skull with generalised bone dysplasia is reported. The authors believe that bone dysplasia associated with cloverleaf is neither identical with thanatophoric dysplasia nor achondroplasia. Until identity of thanatophoric dysplasia and cloverleaf skull with generalised bone dysplasia is proved the diseases should be looked upon as separate entities and the wording "thanatophoric dysplasia with cloverleaf skull" should be abolished.

Ultrasound in the diagnosis and management of urinary tract disorders in the fetus.

Ultrasonic echography allows display of the fetal kidneys and urinary bladder from the 16th week of pregnancy, and the possibility of detection of a number of major congenital abnormalities of the urinary tract from that time. In the second half of pregnancy ultrasound has the key role in monitoring the progress of previously diagnosed abnormalities, particularly those of an obstructive nature. Sonologists thereby have an increasing responsibility in the obstetric care of the patient not only in the narrow field of diagnosis but in the wider field of management. Examples of conservative and surgical management of obstructive lesions are given.

Observations of fetal lung reflectivity using real-time ultrasound.

The ultrasonic appearance of the fetal lung alters as pregnancy progresses and this is expressed as increased reflectivity to ultrasound. Evidence is presented that demonstrates that these changes can be induced and that they may reflect increasing lung maturity.

Early diagnosis of Meckel's syndrome.

Meckel's syndrome is a disorder of polygenic origin inherited as an autosomal recessive. The main features are microcephaly, occipital encephalocoele with associated midline facial defects, renal and limb anomalies. The diagnosis has previously been made ultrasonically by the repeated demonstration of small head size. In this instance a renal anomaly was demonstrated and use to confirm the diagnosis.

Placental aging monitored by gray scale echography.

With gray scale ultrasonics echography, it is possible to identify changes in placental anatomy which formerly have been recognized only by examination of the placenta after delivery. By serial examinations these changes can be detected as they occur. The significance of the changes is discussed and an association between the premature appearance of aging of the placenta and a decline in placental function is noted.

Hydrocephaly, microcephaly and anencephaly diagnosed in pregnancy by ultrasonic echography.

The antenatal diagnosis of hydrocephaly, microcephaly and anencephaly is discussed and it is shown that ultrasonic echography is suited to the earliest diagnosis of these conditions. In hydrocephaly, demonstration of ventricular size and anatomy is used to assess the severity of the disease.