Treatment of premature labor with subcutaneous terbutaline.

Terbutaline was administered subcutaneously to treat premature labor for several years. As ritodrine has been approved by the Food and Drug Administration for this purpose, the authors considered it necessary to determine the efficacy of their terbutaline protocol. The hospital records were reviewed for all patients treated for premature labor with subcutaneous and oral terbutaline sulfate during a recent 4-month period. The regimen was highly effective in prolonging pregnancy for the 44 patients with intact fetal membranes, 88.6% of whom delivered 72 hours or more after start of therapy and 79.5% of whom had delivery delayed by 1 week or more. These results are comparable with those reported for intravenous administration of terbutaline or ritodrine hydrochloride. Efficacy was much less among the 19 patients in whom terbutaline was used to delay delivery after labor with premature rupture of the membranes. Of this group, 52.6% had delivery delayed to 72 hours or more, but only 10.5% had a delay of 1 week or more. Maternal side effects and neonatal complications were minimal. Successful tocolysis with beta2-sympathomimetic drugs appears to be possible without the need for intravenous therapy and at lower doses than customarily used.

Maternal serum screening for aneuploid pregnancy by alpha-fetoprotein, hCG, and unconjugated estriol.

A number of serum screening protocols are either currently in use or proposed to identify pregnant women under 35 years of age who are at increased risk for a Down syndrome fetus. It has been suggested that these same screening methods be applied to gravidas over 35 years of age to identify those women who should be offered amniocentesis. To evaluate the efficacy of screening for detection of aneuploid pregnancy in this age group, the serum samples of 34 women who underwent amniocentesis and who had confirmed fetal aneuploidy were assayed for alpha-fetoprotein (AFP), hCG, and unconjugated estriol (E3). These concentrations were compared with those of 85 women with known euploid pregnancy who underwent amniocentesis for advanced maternal age. The mean multiple of the median (MoM) for each of the three markers was significantly different from control values in cases of trisomy 21 (AFP median MoM = 0.82; unconjugated E3 median MoM = 0.77; and hCG median MoM = 1.89). These differences were not found when other aneuploidies were considered. Likelihood ratios were calculated for cases and controls and examined for their ability to predict the need for amniocentesis, based on currently recommended risk levels. There was a significant difference between the mean likelihood ratio for cases of trisomy 21 compared with that of controls (mean likelihood ratio = 13.48); there was no significant difference for other aneuploidies (mean likelihood ratio = 1.08). Of the 16 cases of trisomy 21 analyzed, four would not have been diagnosed antenatally if recommendation against amniocentesis had been made based on each woman's individual age-specific risk as modified by her likelihood ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent inversion of the puerperal uterus managed with 15(s)-15-methyl prostaglandin F2 alpha and uterine packing.

The present report describes an unusual case of recurrent puerperal uterine inversion causing major postpartum hemorrhage. Blood replacement, oxytocin, and ergot therapy along with manual reduction failed to prevent immediate recurrence, but treatment with 15(S)-15-methyl prostaglandin F2 alpha (Prostin 15M) and uterine packing were successful. It is recommended that 15(S)-15-methyl prostaglandin F2 alpha be available in all obstetric suites for the management of similar emergencies.

Familial recurrence of pulmonary sequestration.

BACKGROUND: Pulmonary sequestration is not believed to be familial. We report two male infants with this anomaly who were born to the same parents. CASES: The prenatal diagnosis of pulmonary sequestration was made in a woman's two consecutive pregnancies by demonstrating systemic arterial supply to an echogenic mass located in the left lower lung of each fetus. Postnatal radiographic evaluation confirmed the prenatal diagnoses. CONCLUSION: Recurrent pulmonary sequestration in two male offspring from the same parents raises the possibility of a genetic predisposition for this condition.

Maternal and perinatal morbidity resulting from placenta previa.

One hundred forty-seven cases of partial or complete placenta previa from 1975 to 1982 were reviewed. A history of prior cesarean section was associated with a significant increase in maternal morbidity, including massive hemorrhage, placenta accreta, and hysterectomy. Despite tocolysis and transfusions to delay delivery, nearly two-thirds of the patients were delivered before 36 weeks' gestation. Onset of bleeding before 20 weeks' gestation was associated with a very poor fetal prognosis. The perinatal mortality rate was 81 of 1000. The overall incidence of respiratory distress syndrome was 22%; this was a major cause of neonatal mortality and morbidity. There was a statistically significant correlation between antepartum maternal hemorrhage and the need for neonatal transfusion, and between the neonatal anemia and the amount of intrapartum maternal blood loss.

Antenatal ultrasonographic diagnosis of fetal seizure activity.

A case is reported in which fetal seizure activity was observed ultrasonographically but the growth-retarded fetus was chromosomally normal.