Amniotic fluid particles: Are they related to a mature amniotic fluid phospholipid profile?

Citations from the Literature same period, we identified 21 cocaine-abusing parturients at our institution who were not enrolled in the Perinatal Center for Chemical Dependence and who received little or no prenatal care (group 2). Control subjects were selected from the general obstetric population for comparison. Data from these two groups were compared with each other and with matched control pregnancies. Group 2 pregnancies had lower mean gestational age at delivery, lower mean birth weight, and a higher incidence of preterm delivery than group 1 pregnancies. Furthermore, groups 1 and 2 were significantly different from control pregnancies for these parameters. We conclude that comprehensive prenatal care may improve outcome in pregnancies complicated by cocaine abuse; however, the perinatal morbidity associated with cocaine abuse cannot be eliminated solely by improved prenatal care. Bias against the null hypothests: The reproductive hazards of cocaine Koren G.; Shear H.; Graham K.; Einarson T. Motherbk Programme, Department of Pediatrics, Divkion of CIinical Pharmacology, Hospitai for Sick Children, 555 University Avenue, Toronto, M5G IX8 Ont., CAN LANCET 1989,2/8677 (1440-1442) To examine whether studies showing no adverse effects of cocaine in pregnancy have a different likelihood of being accepted for presentation by a large scientific meeting, all abstracts submitted to the Society of Pediatric Research between 1980 and 1989 were analysed. There were 58 abstracts on fetal outcome after gestational exposure to cocaine. Of the 9 negative abstracts (showing no adverse effect) only 1 (llolo) was accepted, whereas 28 of the 49 positive abstracts were accepted (57%). This difference was significant. Negative studies tended to verify cocaine use more often and to have more cocaine and control cases. Of the 8 rejected negative studies and the 21 rejected positive studies, significantly more negative studies verified cocaine use, and predominantly reported cocaine use rather than use of other drugs. This bias against the null hypothesis may lead to distorted estimation of the teratogenie risk of cocaine and thus cause women to terminate their pregnancy unjustifiably Maternal

phenylketonuria and hyperphenylalaninemia: for medical practice in the United States Luder AS.; Green C.L. Inherited Metabolic Diseases Clinic, University of Colorado Health Sciences Center, Box CZ33, 4200 E. 9th Ave., Denver, CO 80262, USA AM. J. OBSTET. GYNECOL. 1989, 161/5 (1102-1105) The risk of maternal phenylketonuria and hyperphenylalaninemia syndrome, a preventable cause of severe birth defects and retardation with a near 100% recurrence risk if untreated, is increasing in the United States. The reasons for this are reviewed. Women with hyperphenylalaninemia and those with phenylketonuria diagnosed and treated at birth are intellectually normal, as are some women with undiagnosed phenylketonuria. Both groups are at risk for maternal phenylketonuria syndrome in their offspring if blood Implications

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phenylalanine levels are not controlled by diet during pregnancy. The problems and pitfalls of suspecting, diagnosing, and managing the condition are discussed. Suggested strategies for reversing the increasing trend include the greater use of genetic registers, increased clinical awareness, and some form of rescreening. The advantages and costs of rescreening a subset of pregnant women or all pregnant women at or before their first registration are examined. Amniotic fhdd particles: Are they related to a mature amniotic flnid phospholipid profile? Helewa M.; Manning F.; Harman C. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Man., CAN OBSTET. GYNECOL. 1989,74/6 (893-896) In a prospective, blinded clinical study, the relationship between amniotic fltid free-floating particles measured by a dynamic ultrasound imaging method and phospholipid profile was studied in 82 women undergoing amniocentesis between 26 -42 weeks’ gestation. None of 11 patients with sonographitally clear amniotic fluid had a mature phospholipid profile (lecithin-sphingomyelin ratio greater than 2 and detectable phosphatidylglycerol). Thirty-eight of 71 women (53W) with turbid or markedly turbid amniotic fluid had a mature phospholipid profile. The sensitivity of this method was lOO%, specificity 25%, positive predictive value 53%, and negative predictive value 1OOolo.Although the Ending of sonographitally clear amniotic fluid may eliminate unnecessary amniocentesis, markedly turbid amniotic fluid is not a reliable indicator or a mature amniotic fluid phospholipid profile. Examination of amniotic fluid in diagnosing congenital syphilis with fetal death Wendel G.D.; Maberry M.C.; Christmas J.T.; Goldberg M.S.; Norgard M.V. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dollas, TX 75235, USA OBSTET. GYNECOL. 1989,74/6 (967-970) The diagnosis of congenital syphilis is difficult, particularly in stillborn fetuses, who are often macerated and have undergone autolysis. These changes can obscure both syphilitic histology findings and special stains for spirochetes in tissue specimens used to confirm the diagnosis of congenital syphilis. Five gravidas with untreated syphilis and fetal deaths underwent sonographic examination and amniocentesis. In all five cases, dark-field microscopic examination of the amniotic fluid showed spirochetes with morphology and motility characteristics of Treponema pallidum. Organisms were infrequent, but easily identified at 400 x magnification and confirmed using an oil-immersion objective yielding a 900 x magnification. After delivery, fetal-placental examination and autopsy showed clinical findings typical of congenital syphilis in all five cases. Histologic changes compatible with syphilis were found in all four autopsied fetuses. Silver impregnation stains were positive in two of five tissue specimens, and anti-treponemalmonoclonal antibody immunofluorescence assays were positive Int J Gynecol Obstet 32