Respiratory distress syndrome of the newborn and complications of pregnancy.

A group of 412 infants with birthweights between 501 and 2,500 gm and gestational ages of 36 weeks or less were studied for the influence of both prolonged ruputre of amniotic membranes and maternal hypertension on the incidence of idiopathic respiratory distress syndrome (IRDS). The occurrence of these complications was associated with a significant decrease in the incidence of IRDS only in infants with birthweights between 1,501 and 2,500 gm (37.4% in the no complications group versus 12.8% in the complications group; P less than .01) or gestational ages of 33 to 36 weeks (35.2% in the no complications group versus 13.1% in the complications group; P less than .01). In infants with birthweights of 1,500 gm or less or gestational ages of 32 weeks or less, the specific antecedent complications of pregnancy did not alter the incidence of IRDS. Rupture of the membranes for more than 72 hours had no greater effect on the incidence of IRDS than those lasting 24 to 72 hours.

Clinical experience with the oxytocin challenge test. II. An ominous atypical pattern.

Three cases have been observed over the past 3 years at Los Angeles County-USC Medical Center, Women's Hospital, which have shown an unusual fetal heart rate response to induced uterine contractions during the antepartum period. All 3 cases resulted in perinatal death apparently due to asphyxia. This report describes this unusual pattern and presents a discussion of its possible significance.

Risk indicators of reduction limb defects.

The birth of a child with a reduction limb defect (RLD) was evaluated in relation to vaginal bleeding, threatened abortion, and other complications of pregnancy, placental weight, birth weight, family history, parental age, and the outcome of previous pregnancies. The material consisted of 453 cases of reduction limb defect and an equal number of non-malformed controls matched for time and place. The children were born in Finland during 1964-77. The cases with reduction limb defect without additional malformations were analysed separately. Statistically significant associations were found between the occurrence of reduction limb defect and the following risk indicators: vaginal bleeding, threatened abortion, duration of gestation under 37 weeks, placental weight 400 g or less, birth weight 2500 g or less, and any type of malformation in the relatives. Vaginal bleeding indicated the risk of reduction limb defect to be increased about fourfold; short gestation indicated about twofold risk of reduction limb defect as an isolated malformation. Both low placental weight and low birth weight were associated to a threefold risk of an isolated reduction limb defect. These factors of an abnormal pregnancy indicated even higher risk of reduction limb defect with additional malformations. Preliminary genetic analysis suggests that hereditary factors play no major part in the aetiology of reduction limb defects.

Clinical and experimental studies of the congenital constriction band syndrome, with an emphasis on its etiology.

The findings in fifty-nine patients with congenital constriction band syndrome and in experiments in which limb malformations resembling those of the human constriction band syndrome were successfully reproduced in rat fetuses by amniocentesis indicated that these malformations arise from excessive contraction of the uterine muscle during pregnancy, with resulting hemorrhages from the marginal blood sinuses of the digital rays. Such malformations in humans may arise during the fifth and sixth weeks counted from ovulation. It therefore was concluded that this syndrome is not hereditary but is produced by prenatal environmental factors.

Pulmonary edema and wheezing after pulmonary embolism.

A young, pregnant woman with angiographically proved pulmonary emboli developed pulmonary edema and wheezing without evidence of left ventricular failure. This cast study points out the unusual association of pulmonary embolism with pulmonary edema, wheezing, and hyper-reactive airways in a patient with a positive family history of allergy, but no antecedent history of bronchospasm. Mechanisms for the occurrence of noncardiogenic pulmonary edema and wheezing after pulmonary embolism are reviewed.

[Risk of prematurity and reported bleeding in pregnancy (author's transl)]. / Frühgeburtsrisiko bei rezidivierenden Schwangerschaftsblutungen

The analysis of 5.139 cases from the prospective study "Pregnancy and Childdevelopment" (supported by the Deutsche Forschungsgemeinschaft) showns that time and frequency of bleeding in pregnancy influence the risk of premature delivery. Every additional bleeding will increase the risk, especially if bleeding occurs in the second trimester. For example the risk of prematurity exceedes 25%, if bleeding occurs four times or more. After bleeding in early pregnancy the frequency of small for gestational age infants is not increased.