Favorable results of neonatal intensive care for very low-birth-weight infants.

From 1961 to 1976, 229 infants with birth weights ranging from 751 to 1,000 gm were admitted to the Stanford University Hospital Intensive Care Nursery. The overall neonatal mortality for these infants was 63% (144/229), and there were ten late deaths. Before 1967, no infant in this group who required mechanical ventilation survived; thereafter, 30% (34/114) of the ventilated patients survived. Of the 75 long-term survivors 60 participated in a high-risk infant follow-up program; these included 23 infants who had received mechanical ventilation. The mean birth weight of these infants was 928 +/- 67 (SD) gm. Seventeen children (28%) had significant morbidity: seven (12%) with severe handicaps and ten (17%) with moderate handicaps. During this same period, seven infants weighing less than 750 gm at birth were also observed. The three infants who had not required ventilatory support thrived; the other four infants had required respirators and were significantly handicapped. More recently, neonatal mortality for infants with birth weights from 751 to 1,000 gm has improved: for 1977 to 1980, it was 28% (33/118). Furthermore, neonatal mortality for ventilated infants in this weight group was 27% (26/95). These data indicate an improved prognosis for very low-birth-weight infants, even with ventilatory support.

Polycythemia rubra vera and pregnancy.

Polycythemia rubra vera is a rare complication of pregnancy. Only 13 pregnancies occurring in eight women have been reported. The maternal outcome is uniformly good except for an apparent association of pregnancy-induced hypertension. The perinatal outcome is poor and is due to the frequent occurrence of abortion, preterm delivery, and stillbirth. The etiology of the disease is discussed along with symptoms and diagnostic criteria. A young woman who successfully negotiated two pregnancies is presented. Guidelines for hematologic monitoring and management during pregnancy and the early puerperium are proposed.

Oxytocin-induced labor characteristics and uterine activity after preinduction cervical priming with prostaglandin E2 intracervical gel.

Labor characteristics and quantitation of uterine activity resulting from oxytocin induction of labor after intracervical prostaglandin E2 (PGE2) gel priming have not been previously reported. Forty-seven women with modified Bishop scores of 5 or less received preinduction priming with 0.5 mg of intracervical PGE2 gel. Oxytocin was used to induce labor after priming, and uterine activity was quantitated. A matched group of control patients was managed identically but did not receive PGE2 gel. In the gel group, modified Bishop scores improved significantly and in two patients (4%), priming alone induced labor. No uterine hyperstimulation or fetal heart rate abnormalities occurred during priming. Cesarean sections for all indications and those for failed induction were less common in the gel group. The length of the active phase and the second stage of labor were significantly shorter in the gel group. Uterine activity was similar in both groups. The data suggest a primary cervical action of the gel.

Efficacy of Doppler echocardiography in the evaluation of aortic stenosis during pregnancy.

The recently developed technology of Doppler echocardiography was used to evaluate a pregnancy complicated by aortic stenosis. Given the lack of established norms for this test during pregnancy and the known cardiovascular changes during pregnancy, it is difficult to interpret this test. However, in the case presented, this test suggested the need for more conservative management, a plan that was justified postpartum.

Detection of feline immunodeficiency virus by a nested polymerase chain reaction.

A specific and sensitive polymerase chain reaction (PCR) procedure for the detection of feline immunodeficiency virus (FIV) in peripheral blood mononuclear cells (PBMC) was developed. PBMC from both blood samples and cultures were digested by proteinase K in a lysis buffer, and after heat inactivation of the proteinase, the resultant material was used in a two step amplification protocol using nested sets of primers. Two independent amplifications, from the gag and pol genes respectively, were performed in each tube. The PCR was positive for six of 14 samples from FIV seropositive adult cats, while all 36 samples from seronegative cats were negative. In comparison with an antigen-capturing ELISA procedure, the PCR detected FIV infection in PBMC cultures on average two days earlier.

No evidence of vertical transmission of naturally acquired feline immunodeficiency virus infection.

A naturally occurring feline immunodeficiency virus (FIV) infection in a closed breeding colony of cats, was studied for a period of 9 months. The colony consisted of 25 adult cats, of which six proved to be infected with FIV as judged by serological examination and virus isolation. In all, 48 kittens were monitored for levels of antibodies against FIV during their first 6 months of life. All the kittens (n = 30) born of FIV-infected queens showed maternal antibodies against FIV, although these declined to undetectable levels by the age of 5 months. Antibodies against FIV were not shown in any of 18 kittens born of FIV-negative queens. An attempt to isolate the virus from 12 kittens between 2 and 6 weeks of age did not succeed. None of the cats in the colony seroconverted during the observation period. In conclusion, neither vertical nor horizontal transmission of FIV infection were demonstrated in the colony during the 9-month investigation period.

Umbilical cord hematoma resulting in intrauterine fetal demise. A case report.

A 34-week male fetus experienced intrauterine death due to an umbilical cord hematoma. Rupture of the hematoma occurred at the time of delivery, but compression of the cord vessels and fetal blood loss into the hematoma, rather than the rupture itself, were the cause of death. Membranes had been ruptured for several days prior to the fetal demise, and both chorioamnionitis and funisitis were present. Inflammation of the umbilical cord, as well as a defect in the elastin and smooth muscle components of the vein, may have predisposed the cord to development of the hematoma.

Water intoxication and hyponatremic encephalopathy from the use of an oxytocin nasal spray. A case report.

Many nursing women returning to a full-time job and desiring to continue to breast feed are using oxytocin nasal sprays to facilitate breast emptying during the work day. Very few complications have been reported from its use, and the preparation has been assumed to be innocuous. However, we encountered a nursing mother whose life appears to have been jeopardized by the excessive and unmonitored application of such a spray. The patient was hospitalized for a viral illness and given a large quantity of intravenous fluid. In association with excessive self-administration of an oxytocin nasal spray, she developed severe water intoxication, with hyponatremic encephalopathy and convulsions. During the same hospitalization the patient subsequently developed a Guillain-Barré type of peripheral polyneuritis. The syndrome of inappropriate secretion of antidiuretic hormone has been reported to accompany the neurologic manifestations of the Guillain-Barré syndrome and may have been the cause of the convulsions. However, the temporal associations in this case strongly favor the unmonitored use of the oxytocin nasal spray as etiologic.

Serological, bacteriological and clinical observations on an outbreak of canine infectious tracheobronchitis in Norway.

During the autumn of 1988 an outbreak of canine infectious tracheobronchitis, which seemed to be more infectious than usual, occurred throughout Scandinavia. Paired serum samples and bacterial swabs were collected from 52 dogs with clinical signs of infectious tracheobronchitis in three districts of Norway. The results revealed a fourfold or greater rise in the titre of antibodies against canine parainfluenza virus in 79 per cent of the cases, strongly suggesting that the virus was of aetiological importance in the outbreak. Bordetella bronchiseptica was not isolated from the diseased dogs, and they showed no rise in the titres of antibodies against influenza virus, reovirus or adenovirus.

An audit of obstetric care in a university family medicine department and an obstetrics-gynecology department.

The care of obstetric patients in a university family medicine department was compared with that in the obstetrics-gynecology department of the same university. The obstetric service patients tended to be at higher risk due to a higher black population (24.2 percent vs 6.3 percent), greater prepregnancy weight (mean 154.0 lbs vs 113.9 lbs), and a greater number of patients referred from the community because of prenatal complications. However, the family medicine patients had a higher incidence of premature rupture of membranes (26 percent vs 11 percent), and were therefore at risk for several complications. Family medicine nulliparas had first stages of labor which lasted an average of 12.2 hours as opposed to obstetric service nulliparas whose first stages averaged only 9.2 hours. There were more family medicine than obstetric service patients who received no anesthesia (18.0 percent vs 10.2 percent). Elective low forceps were used more often by obstetric service physicians than by family physicians (28.2 percent vs 15.3 percent). Mothers on the family medicine service had more puerperal complications than those on the obstetric service (16.0 percent vs 5.6 percent). No serious discrepancies in quality of care could be found between the two services.

Maternal cardiovascular dynamics. VII. Intrapartum blood volume changes.

Blood volume was measured in 75 normal pregnant women at term and serially at 10 and 60 minutes and on Days 1 and 3 post partum in women delivered vaginally and on Days 1, 3, and 5 in women who underwent cesarean section. The mean blood volume at term was 5.95 L. and 83.3 c.c. per kilogram, an increase of 44 and 16%, respectively, over nonpregnant values. The increment appeared to be related to lean body mass and the weight of the neonate alone and to the combined weights of the neonate and placenta, but the wide range of values precluded statistical significance. The blood volume loss at 60 minutes post partum was 610 c.c. (10.2%) for patients delivered vaginally and 1,030 c.c. (17.4%) for those delivered by cesarean section. The blood volume showed a steady decline to Day 3 post partum in the vaginal delivery group, whereas it remained fairly stable from 60 minutes to Day 5 post partum in the surgically delivered group. Remarkably, the volume had declined by the amount, 16.2%, in both groups on the third postpartum day. On the other hand, the hematocrit showed a rise of 5.2% in the former group and a decline of 5.8% in the latter. A remarkable tolerance for blood loss at delivery was demonstrated. A more realistic definition of postpartum hemorrhage is strongly recommended.

Prevalence of feline leukemia virus and antibodies to feline immunodeficiency virus in cats in Norway.

Serum samples from 224 Norwegian cats were analyzed for the presence of feline leukemia virus (FeLV) p27 common core antigen, and for antibodies to feline immunodeficiency virus (FIV). Ninety specimens originated from the serum bank at the central referral clinic at the Norwegian College of Veterinary Medicine, which had been collected during the years 1983-1989; 67 sera were submitted from veterinarian practitioners; while 67 sera originated from cats presented for euthanasia. The cats were classified into one "healthy" and one "sick" group. Only 2.2% of sick cats and 1.2% of healthy cats showed FeLV antigenemia, a finding which is lower than which has been reported from many other countries. The prevalence of FIV antibodies was 10.1% in sick cats and 5.9% in healthy cats. Antibodies to FIV was most prevalent in male cats (14.7%) than in female cats (2.1%), and more prevalent among domestic cats (12.0%) compared to pedigree cats (2.4%). Antibodies to FIV in the cats demonstrated increasing prevalence with increasing age. It may be concluded that FeLV causes minor problems in Norwegian cats, while FIV is present in a similar prevalence to what is reported from other countries.

Physical characteristics of the cervix.

The cervix must remain closed during pregnancy to maintain the pregnancy yet open during parturition. It must perform at the right time and in the right sequence. The process that coordinates these activities is labor and it is an equal mixture of uterine contractions and cervical effacement/dilatation. Neither of these factors can be ignored if one is to understand parturition. Dilatation of the cervix depends upon the biochemical and physical processes that produce effacement. A better understanding of this active, ongoing process will enable one to manipulate them with new drugs that could produce effacement without uterine contractions. Conversely, the capacity to "stiffen" the cervix to ward off premature birth is another potential therapeutic approach that may be utilized. Research into the genesis and physical expression of the incompetent cervix is needed, as are studies of the cervix after forceable dilatation following a D and C. All of these possibilities and future advances are dependent upon our ability to quantitate the physical state of cervical tissue, both in situ and in vitro.