Improved detection of fetal cells from maternal blood with polymerase chain reaction.

OBJECTIVE: The objective was to test the reliability of new deoxyribonucleic acid primers that have previously been used very efficiently by this laboratory with amniolysate samples to amplify a 248 bp Y-specific, repeated sequence from maternal blood during pregnancy. STUDY DESIGN: Blood samples were obtained from 50 women during weeks 11 and 16 of pregnancy and were analyzed for the presence of the Y chromosome-specific sequences. RESULTS: Y-specific fragments were identified in 19 of 24 (79.2%) women after one complete amplification. A second amplification of these samples negative for Y-specific fragments revealed three additional samples positive for the Y chromosome-specific fragment. Only two male fetuses remained unidentified. Overall, 91.7% male fetuses and 96% of all fetuses (48/50) in these women were correctly identified. CONCLUSIONS: The primers described in this study provide an additional or alternative tool for the determination, by means of the polymerase chain reaction, of Y chromosome-bearing cells in maternal circulation.

The effect of pretreatment with magnesium sulfate on the initiation of seizure foci in anesthetized cats.

The therapeutic effect of magnesium sulfate remains unknown. Its role as an anticonvulsant is controversial. The effect of pretreatment with parenteral magnesium sulfate on the ability to initiate penicillin-induced seizure foci in anesthetized cats was studied. All animals in the experimental group achieved serum magnesium levels of greater than 10 mg/dl. No significant difference in epileptic spike frequency between the experimental and control groups was demonstrated.

Sonographic evaluation of the adnexa during early pregnancy.

Of 3,918 obstetric patients who underwent scanning during the first 20 weeks of gestation, 94 had sonolucent adnexal masses identified. These represented predominantly the corpus luteum of pregnancy. The incidence of such a mass significantly declined after the tenth gestational week. This pattern of degeneration is physiologic and represents the normal course of events for the ovary in the first half of pregnancy. Characteristics of these masses and indications for operative intervention are discussed. The obstetric outcome for eight patients who underwent surgical treatment was uncomplicated. Guidelines for management of significant adnexal masses in pregnancy is similar to that of the nonpregnant state.

Mezlocillin prophylaxis against infection after cesarean section: a comparison of techniques.

We studied 212 patients undergoing emergency cesarean section at an urban hospital. Four techniques of antibiotic prophylaxis were used, including single-dose and triple-dose parenteral therapy, parenteral and lavage therapy, and lavage therapy alone. One agent, mezlocillin, was used for all patients. There was no significant difference in surgically related infectious morbidity among the groups. This antibiotic proved efficacious when related to historical controls, and was the most economical of the modalities of administration studied.

Immunologic thrombocytopenia in pregnancy; use of antenatal immunoglobulin therapy: case report and review.

Steroid therapy remains the treatment of choice for immunologic thrombocytopenia in pregnancy. However, for cases refractory to steroid therapy, alternate forms of treatment must be used. This case report and review discusses a successful technique for acute, short-term correction of thrombocytopenia. In limited experience the administration of high-dose immunoglobulin appears to be effective for antepartum use in patients with immunologic thrombocytopenia. The concomitant or subsequent performance of splenectomy appears to be a valuable adjunct in long-term treatment of this condition.

Antenatal sonographic diagnosis of conjoined twins in a triplet pregnancy.

Presented is the case of a triplet pregnancy with conjoined twins diagnosed antenatally with sonography. Prenatal diagnosis has the potential to improve outcome for the normal infant.

Effect of parenteral magnesium sulfate on penicillin-induced seizure foci in anesthetized cats.

The use of magnesium sulfate as an anticonvulsant remains controversial. The effect of parenteral magnesium sulfate on established penicillin-induced seizure foci in anesthetized cats was studied. After induction of an epileptic focus by application of penicillin to the cerebral cortex, experimental animals were infused intravenously with magnesium sulfate, whereas control animals received normal saline solution at an equivalent rate. Experimental animals achieved a mean serum magnesium level of 11.73 +/- 2.00 mg/dl. Analysis of the electroencephalogram recordings demonstrated no significant difference in epileptic spike activity between the experimental and control groups. The critical importance of adequate controls in studies of this type is stressed.

Early prenatal sonographic appearance of rare thoraco-abdominal eventration.

Fetal ventral wall malformations may be diagnosed prenatally with ultrasound. These include omphalocele, gastroschisis, or even thoracic defects with or without ectopia cordis. It is important whenever such a defect is found to carefully define the full extent of the lesion prior to parental counselling. Described and illustrated here is the prenatal diagnosis with real-time ultrasound at 17 weeks gestation of a rare thoraco-abdominal ventral wall defect including omphalocele, bifid sternum, diaphragmatic aplasia, and pericardial aplasia with incomplete ectopia cordis. The technique is described and the importance of the complete, accurate delineation of anatomic malformations is emphasized.

Perinatal management of conjoined twins.

Thorough evaluation of all twin pregnancies is necessary if prenatal diagnosis of conjoined twins is to be made more often. Application of sonography, amniography, and amniocentesis is helpful in formulating prognosis, details of delivery, and subsequent assessment. Two-dimensional echocardiography, radionuclide scanning, computed tomography, and sonography are recently developed techniques for evaluation of the neonates. Detailed planning at all stages of care is essential. Interaction among medical personnel and the family is extremely important.

Elevated maternal serum alpha-fetoprotein, second-trimester oligohydramnios, and pregnancy outcome.

Although the primary purpose of maternal serum alpha-fetoprotein (AFP) screening is to detect open neural tube defects, the technique is of value in the diagnosis of other fetal abnormalities. Six patients from the Alpha-Fetoprotein Screening Program, Perinatal Region IV, were found to have twice elevated maternal serum AFP levels associated with severe early second-trimester oligohydramnios. Five of the fetuses were found to have urinary tract abnormalities. The source of the elevated maternal serum AFP is not clear. Pregnancy prognosis appears poor. These cases should be thoroughly studied so that patients may be accurately informed of the recurrence risk.

Pseudotumor cerebri in pregnancy.

Pseudotumor cerebri is an enigmatic neurologic disorder markedly more common in women of childbearing age. Diagnosis, management, and pregnancy outcome of nine women with active disease are described. Pregnancy is not contraindicated in women with pseudotumor cerebri, and termination of pregnancy is seldom required.

Ultrasonography in the antepartum diagnosis of conjoined twins. A report of two cases.

The advent of new and effective methods for the neonatal evaluation and treatment of conjoined twins has greatly increased the importance of prenatal diagnosis of this complication. Ultrasonography has become the method used most commonly to diagnose and evaluate multiple pregnancies. All ultrasonographers should be familiar with the signs associated with conjoined twins. We treated two patients in whom the antenatal diagnosis of conjoined twins was made by ultrasonography alone. One is the first reported case of the antenatal ultrasonographic diagnosis of conjoined twins in different presentations. The findings associated with conjoined twins are: (1) lack of a separating membrane, (2) inability to separate the fetal bodies, (3) presence of fetal anomalies, (4) identification of more than three vessels in a single umbilical cord, and (5) sonographic detection of any of the classic radiologic signs.

Rocky Mountain spotted fever in pregnancy: differential diagnosis and treatment.

Rocky Mountain spotted fever (RMSF) presents both diagnostic and therapeutic difficulties in the pregnant patient. Early clinical manifestations may be mistaken for normal pregnancy changes. Accurate diagnosis is essential, since several of the disorders in the differential diagnosis may have important obstetric implications. Antibiotics generally used to treat serious infections during pregnancy are ineffective in treating RMSF. Chloramphenicol is the antibiotic of choice. Specific recommendations for evaluating pregnant patients with suspected RMSF are given.

Management of the latent phase of labor.

1. Iatrogenic causes of prolonged latent phase such as sedation, narcotic analgesia, and epidural anesthesia should be avoided during the latent phase. 2. Cesarean delivery is not appropriate management solely for failure to progress in latent phase. 3. Multiparas in latent phase with favorable cervices should be treated with oxytocin stimulation. 4. Multiparas with unfavorable cervices and most nulliparas should be treated with therapeutic rest when they become exhausted during a long latent phase, without regard to an arbitrary time table. 5. Characteristics of latent phase in induced labors are undefined. 6. Management of latent phase in the presence of ruptured membranes should take into consideration the total clinical picture, including gestational age, presentation, and risk of infection and other pertinent factors.