Strategies for establishing a critical care obstetric service.

Critical care obstetrics is gaining increased recognition as a subspecialty of perinatal medicine. As the specialty continues to expand, many institutions may consider establishing a critical care obstetric service. However, implementing such a service is not feasible for every institution because of space limitations, budgetary constraints, lack of necessary resources, and/or a limited number of critically ill obstetric patients. This article explores strategies for examining the feasibility of establishing a critical care obstetric service, suggests methods of implementation, and offers an alternative when establishing a critical care obstetric service is not feasible.

Cook obstetrics and gynecology catheter multicenter chorionic villus sampling trial: comparison of birth defects with expected rates.

OBJECTIVE: The null hypothesis was that offspring of women undergoing first-trimester chorionic villus sampling do not experience a rate of birth defects exceeding background rates. STUDY DESIGN: Follow-up information regarding major malformations was prospectively sought on offspring of 4105 women undergoing first-trimester chorionic villus sampling from nine centers participating in a collaborative study with the Cook obstetrics and gynecology catheter. These data were compared with data from the Collaborative Perinatal Project and other registries. RESULTS: A total of 84 offspring with major malformations was identified (2.36%). Compared with background rates, there was no increase in the incidence of total malformations or specific malformations (including limb reduction defects) in the subjects. One institution experienced all three limb reduction defects in this series; the probability of this occurring by chance alone is < 1%. CONCLUSION: Chorionic villus sampling was not found to result in an increase in major birth defects or in specific categories of birth defects in this series.

Pre- and postnatal diagnosis of trisomy 4 mosaicism.

A liveborn girl with 46,XX/47,XX+4 mosaicism is reported for the first time. The diagnosis of true mosaicism was established initially in the assay of cultured amniotic fluid cells, although fetal blood obtained by percutaneous umbilical blood sampling showed a 46,XX chromosome constitution. The liveborn infant had manifestations previously reported in dup(4p) and dup(4q) syndromes. Cells in cord and arterial blood samples also were 46,XX, but cultures of placenta and bilateral forearm skin biopsies showed 46,XX/47,XX,+4 mosaicism. This case illustrates the disadvantage of chromosome analysis from blood alone when tissue-specific mosaicism is present.

Fetal intestinal obstruction: necessity for percutaneous umbilical blood sampling to assess the severity of Rh sensitization.

Investigation into the severity of hemolytic disease due to Rh isoimmunization may be complicated by concurrent amniotic fluid contamination with bile. We have presented a case in which a prenatal sonogram showed evidence of fetal intestinal obstruction, which was subsequently confirmed postpartum by exploratory laparotomy. Since intrauterine regurgitation of bile occurs with intestinal obstruction distal to the papilla of Vater, percutaneous umbilical blood sampling is necessary to discern the presence and severity of hemolytic disease as indicated by an abnormal spectrophotometric absorption pattern.

Recurrence rate of ABO hemolytic disease of the newborn.

ABO hemolytic disease of the newborn is a common and potentially severe disease. It can cause hyperbilirubinemia and anemia in the infant. A review of 230 primigravid mothers of affected offspring is presented. Evaluation of their subsequent pregnancies showed a recurrence rate of 88% in those infants at risk for the disease (of same blood type as their index sibling), with 62% of the affected infants requiring therapy. Guidelines for antenatal counseling are presented.