Vaginal myxoma presenting as acute urinary retention.

Vaginal myxoma is an extremely rare tumor. We report a case in which the initial complaint was acute urinary retention. The tumor had grown quite rapidly over a 4-month period. It was resected easily and did not recur over the next 5 years.

Intrauterine fetal demise after negative oxytocin challenge tests.

The oxytocin challenge test was used to evaluate the fetoplacental unit in 572 patients over a 5-year period. Four fetuses died in utero within 7 days of a negative test. None had periodic fetal heart rate decelerations of any type. All 4 showed periodic accelerations of the fetal heart rate (FHR) in association with fetal movement. Two had baseline changes in the fetal heart rate during the oxytocin challenge test.

Prefascial marsupialization of the pregnant uterus.

A case report is presented of a white woman, gravida 4, para 2, abortus 1, who experienced protrusion of a gravid uterus through the anterior rectus fascia. The uterus subsequently became entrapped and was reduced only after cesarean section at 34 weeks' gestation.

Single-probe spectrophotometry in the assessment of fetal oxygenation.

Six sheep fetuses were monitored with a single-probe tissue spectrophotometer. This spectrophotometer provides continuous digital output of the index of hemoglobin that is saturated with oxygen. To vary the fetal pO2, each maternal ewe was given room air, 100% oxygen, 12% oxygen, and 100% nitrogen via rebreathing bag. Fetal venous (N = 4) or arterial (N = 2) blood was analyzed for pO2. There was excellent correlation between the index of hemoglobin saturated with oxygen and the fetal pO2. The single-probe spectrophotometer overcomes two of the technical problems encountered when a double-probe spectrophotometer is used.

Outcome of pregnancy during imprisonment.

The scant available information on pregnancies in women in prison suggests that the outcome is poor. We studied a cohort of 69 incarcerated pregnant women cared for over a one-year period. They were compared with 69 controls who were matched for age, parity, race and date on which they entered prenatal care. Thirty-six percent of the prisoners acknowledged using illicit drugs, primarily cocaine, during their pregnancies as compared to 3% of the controls. Sixty-eight percent of the incarcerated women smoked cigarettes as compared with 20% of the controls. In spite of those facts, there was a tendency toward better pregnancy outcomes among the prisoners. They were less likely to deliver prematurely (10% vs. 22%) and significantly less likely to experience premature rupture of the membranes (2.8% vs. 2.6%, P less than .001).

Acute Haemophilus influenzae chorioamnionitis associated with intact amniotic membranes.

While Haemophilus influenzae infection commonly occurs in the age group 6 to 48 months, it uncommonly affects adults. A case of acute chorioamnionitis due to Haemophilus influenzae in the presence of intact fetal membranes is presented. The low incidence of maternal urogenital carriage, the high attack rate, and the virulence are discussed.

Cyclic neutropenia and pregnancy.

We have described a case of cyclic neutropenia and pregnancy. Although many such cases exist, we believe this is the first time the association has been documented. In this patient, pregnancy had a mitigating effect on the symptoms caused by cyclic neutropenia.

Sinusoidal fetal heart rate pattern during labor.

Of 1280 consecutive fetuses monitored internally with a scalp electrode for at least 10 minutes during labor, 54 (4.2%) demonstrated the sinusoidal heart rate (SHR) pattern. Seven of these demonstrated the SHR pattern for more than 90 minutes. In six of these seven cases, the SHR pattern occurred during oxytocin administration. The SHR group did not differ from the 1226 fetuses not demonstrating the SHR pattern (NSHR group) in Apgar scores, incidence of other fetal heart rate abnormalities, or passage of meconium. The scalp pH was obtained from three fetuses in the SHR group and was above 7.30 in each. Alphaprodine administration during labor was associated with development of the SHR pattern, whereas other narcotic administration was not. The significance of "atypical" SHR pattern with increased amplitude is discussed, along with the need to adhere to strict definition of the SHR pattern.

Severe hypoglycemia associated with HELLP syndrome.

Presented is a case of the syndrome of hemolysis, elevated liver enzymes, and low platelet counts, in which severe maternal hypoglycemia occurred 8 hours after delivery. It is proposed that the hepatic pathologic features in this case were severe enough to interfere with glycogenolysis and glyconeogenesis.

Leukocyte esterase: a simple bedside test for the detection of bacterial colonization of amniotic fluid.

Chorioamnionitis is a major cause of neonatal mortality, neonatal morbidity, and maternal morbidity. Clinical signs of acute chorioamnionitis occur relatively late, and laboratory tests for acute chorioamnionitis lack the desired sensitivity and specificity. Early antibiotic treatment may have important neonatal implications. The leukocyte esterase test is both rapid and simple. Because of the specificity (100%) and sensitivity (81%) of the test in predicting bacterial colonization of the amniotic fluid, we conclude that it has the potential to become an invaluable tool in assessing the intrauterine environment.

Femur length versus biparietal diameter for estimating gestational age in the third trimester.

It is well established that ultrasound measurement of femur length and biparietal diameter are comparably accurate estimators of gestational age when obtained in the first half of pregnancy. Both estimators, however, become less accurate later in pregnancy. The present study compares the relative accuracy of these estimators when obtained in the third trimester. It is concluded from linear regression analysis that the correlation between gestational age estimated from femur length and the actual gestational age is stronger than that between gestational age estimated from biparietal diameter and actual gestational age. Furthermore, gestational age calculated from femur length is significantly more likely to be within 2 weeks (P less than or equal to .01) and 3 weeks (P less than or equal to .05) of actual gestational age than is gestational age calculated from biparietal diameter. Estimating gestational age from the mean of the gestational age based on biparietal diameter and that based on femur length is less accurate than estimating gestational age from femur length alone.

The cardiorespiratory effects of perfluorochemicals on acute carbon monoxide poisoning in the pregnant ewe.

Studies in nonpregnant animal models of carbon monoxide poisoning have demonstrated the protective effect of perfluorochemicals. Anesthetized pregnant ewes were exposed to carbon monoxide. After symptoms of toxicity were demonstrated, group 1 animals were respired with room air. Group 2 animals respired room air and were given intravenous perfluorochemicals. Group 3 animals were administered 100% oxygen. Group 4 animals were given intravenous perfluorochemicals and respired 100% oxygen. In all ewes exposure to carbon monoxide resulted in increased cardiac output, heart rate, and carboxyhemoglobin level without a significant change in arterial oxygen tension. After carbon monoxide exposure, there was no significant difference in the carboxyhemoglobin to oxyhemoglobin conversion between groups 1 and 2 although the conversion rates were more rapid in groups 3 and 4. Fetal oxygenation was improved in groups 3 and 4. All fetal lambs exhibited a progressive increase in carboxyhemoglobin and a decrease in venous pH regardless of the maternal postexposure treatment. There was no significant increase in the fetal venous oxygen content of group 4 as compared with that of group 3, suggesting that the adjunctive administration of limited quantities of perfluorochemicals to the mother offers no apparent advantage over 100% oxygen alone for acute fetal resuscitation.

The relationship between mean abdominal diameter and femur length in normal and impaired fetal growth.

The relationship of fetal mean abdominal diameter (MAD) to fetal femur length (FL) in clinically normal pregnancies and 37 cases of intrauterine growth retardation (IUGR) was studied. The normal relationship of FL to MAD is closely described by the equation: log (MAD) = 3.326 + (0.185 X FL). r = .953, P less than .001. In the growth retarded infants, 59% of the abdominal measurements fell below the lower 75% confidence limit. Of the abdominal measurements derived from infants with birthweight greater than 2 SD below the mean for gestational age, 86% fell below the lower 75% confidence limit. These data show the MAD is selectively depressed in many, but not all cases of IUGR and particularly in the more severely affected infant, but the technique is not sufficiently discriminant to be used by itself for the detection of IUGR. Detection of an anomaly of this relationship would be strong supportive evidence of IUGR independent of gestational age and possibly identifies infants growth retarded specifically due to chronic deprivation.