Myositis ossificans progressiva and pregnancy.

Myositis ossificans progressiva is a rare inherited ossifying condition of the striated muscle tissue. In the English language literature there is no reported association of this disease with an advanced state of pregnancy, nor is there any well-documented scientific data about the effect of pregnancy on this disease or of this disease on pregnancy. This report is about a patient with myositis ossificans progressiva carrying to 30 weeks' gestation and successfully delivering a viable female infant. The antenatal care and management problems of this case are discussed.

Spontaneous resolution of antenatally diagnosed adrenal masses.

Four infants had adrenal masses detected prenatally, through ultrasonography, between 18 and 30 weeks' gestation. Two were predominantly cystic, and two were solid. The sizes ranged from 0.8 to 1.5 cm. There were no associated prenatal maternal complications or stress factors. The urine vanillylmandelic acid levels at birth were normal in three infants. Two infants had a documented decrease in mass size at birth (compared with the last intrauterine study). All masses had a progressive decrease in size after birth, and ultrasound results were normal at 6 to 12 weeks of age. All four patients are well, with normal study results, at 2 to 5 years of age.

Level 2 hospital delivery of low birth weight infants 1970-1979.

We have reviewed the outcome for low birth weight infants in a designated Level 2 hospital. In New York City, hospitals are classified as Level 1, Level 2 and Level 3; the latter being the large tertiary center. St. Luke's-Roosevelt Hospital Center, Roosevelt Division is a Level 2 institution modified by components of Level 3 expertise. The data presented spans 10 years comparing results before (Level 2) and after (Level 2+) upgrading of services. The survival of very low birth weight infants improved as a result of the change and is comparable to the tertiary center. The factors are discussed. It is concluded that an institution can decide on the lowest gestational age and/or birth weight to be managed within its perinatal service.

Vaginal delivery following previous cesarean section in 1983.

In 1983 the question whether or not to perform vaginal delivery following previous cesarean section is again presented to the obstetrical community. Data are presented on 778 patients managed during the decade January 1, 1973 to December 31, 1982. Four hundred seventy-six had scheduled repeat cesarean section on an elective basis. One hundred sixty-five experienced normal vaginal delivery. One hundred thirty-seven failed the attempt and were delivered by cesarean section. The group that delivered vaginally and scheduled elective cesarean section did well. However, in the failed attempt the problems were awesome regardless of indication or number of previous cesarean sections.

Prenatal diagnosis of mosaic tetrasomy 21q confirmed by fluorescence in situ hybridization.

We describe the first case of a live-born neonate with mosaic tetrasomy 21q confirmed by fluorescence in situ hybridization (FISH). A 38-year-old Caucasian female presented for amniocentesis for maternal age. Initial chromosome analysis of the amniocytes using GTG-banding showed a mos47,XY, +?i(12p)/46,XY karyotype. Follow-up studies with FISH identified the isochromosome as an i(21q); mos47,XY, +i(21q)/46,XY. The patient was delivered at 38+ weeks gestation and umbilical cord blood samples were obtained. Chromosome analysis of 43 cord blood lymphocytes demonstrated a 46,XY karyotype in all cells. However, peripheral lymphocytes taken 1 day after birth showed 1 out of 120 lymphocytes to have an extra chromosome determined to be an i(21q). While initial clinical exam of the neonate revealed similarities to Down syndrome, long-term follow up of our patient will be required to provide the first definitive description of the mosaic tetrasomy 21 syndrome.

The efficacy of intramuscular 15 methyl prostaglandin E2 in second-trimester abortion. Coagulation and hormonal aspects.

Termination of pregnancy in the second trimester is sometimes associated with serious complications. This led to clinical investigation seeking methods superior to the traditional technique utilizing hypertonic saline. Intra-amniotic administration of naturally occurring prostaglandin F2-alpha has been developed and appears to be advantageous--especially in the area of coagulation stability. This study describes a technique for intramuscular administration of a prostaglandin analogue--15 methyl prostaglandin E2. This analogue is much more potent than the natural compound. Administration to 32 patients resulted in abortion in 28. The coagulation milieu remained completely intact and all other parameters were similar to previous published data for prostaglandin administration. There were no infections in this group of patients.

The efficacy of intravaginal 15 methyl prostaglandin F2alpha methyl ester in first and second trimester abortion.

Fifteen methyl prostaglandin F2alpha methyl ester prepared within a silastic device for intravaginal administration appears to be advantageous. This study describes the technique carried out and the results observed in 50 patients. The analogue is prepared in 1.0% and 0.5% delivery systems. Twenty-four patients received the 1.0% dosage schedule and all twenty-four patients aborted. Twenty-six patients received 0.5% and twenty-three patients aborted. The coagulation millieu and other parameters were similar to that reported for other prostaglandins.

A fetus with a chromosome 13 ring and placenta with chromosome 13 rod/ring mosaicism.

A fetus was identified by prenatal cytogenetic diagnosis as having a karyotype 46,XY,r(13) (p11q13). Termination of the pregnancy yielded a severely malformed fetus. Fetal abnormalities included anencephaly, imperforate anus and urethral meatus, severe talipes, syndactyly, cardiac defects and other anomalies. Confirmatory studies on cultured placental villi cells indicated a second cell line, 46,XY, -13,+13qter leads to cen::13q13 leads to qter. This cell line was not detectable in cells derived from the fetus despite extensive studies. It seems likely that the two cell lines arose simultaneously with selection favouring the 46,XY,r(13) line. How the chromosome rearrangements may have arisen is discussed. We are unaware of other cases where a cell line identifiable by a chromosome abnormality appeared to be confined to placental tissue. However, studies on placental tissue may be helpful in understanding the origin of other unbalanced de novo rearrangements.