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Failure of ultrasonographic parameters to predict the severity of fetal anemia in rhesus isoimmunization
Citations from the Literature purulent cervicitis and pelvic inflammatory disease. In addition, methods for the direct detection of chlamydial antigen in genital secretions have been developed. Although less sensitive than traditional cultural methods, these noncultural methods are more widely available than cultures and can facilitate the earlier recognition and more specific diagnosis of chlamydial genital infections. This article reviews these recent developments and outlines specific applications of tests for diagnostic purposes and for screening of high-risk populations.
PERINATOLOGY Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation
Berkowitz GS; Mehalek KE; Chitkara U; et al Department of Obstetrics, Gynecology and Reproductive Science, Mt Sinai Medical Center, New York, NY 10029, USA OBSTET. GYNECOL.; 71/5 (742-746)/1988/ Perinatal indicators of fetal compromise were assessed according to the results of continuous-wave Doppler umbilical velocimetry for 172 patients at risk for intrauterine growth retardation (IUGR). Forty-three (2SVo) of the patients delivered an infant with a birth weight below the tenth percentile for gestational age. The last Doppler study before delivery was abnormal in 48.8% of the growth-retarded infants but in only 13.2% of the infants without evidence of IUGR. Furthermore, in the growth-retarded group, early delivery, reduced birth weight, decrease amniotic fluid at birth, admission to neonatal intensive care unit, neonatal complications associated with IUGR, and a prolonged hospital stay were observed more frequently in those who had an abnormal ratio than in those with a normal ratio. The sensitivity of the systolic/diastolic ratio for an adverse perinatal outcome (operative delivery for fetal distress, neonatal morbidity associated with IUGR, and/or perinatal death) was significantly better for the infants with IUGR (66.7010)than for the infants without IUGR (27.8%; P < .05). The predictive value of an abnormal ratio was also higher for the pregnancies complicated with IUGR (57.1 Vo)than for those without IUGR (29.4%), but not to a statistically significant degree. These data suggest that Doppler umbilical velocimetry studies are valuable in identifying those growth-retarded fetuses at increased risk for an adverse perinatal outcome. Pulsed Doppler flow-velocity waveforms before and after intrauterine intravascular transfusion for severe erythroblastoski fetalis
Cope1 JA; Grannum PA; Belanger K; et al Department of Obstetrics and Gynecolow, Yale University School of Medicine, New Haven, CT 06510, USA AM. J. OBSTET. GYNECOL.; 158/4(768-774)/1988/ Pulsed Doppler studies of the fetal and maternal circulations were carried out before and after 64 intrauterine transfusions, performed on 24 fetuses. A model was derived for prediction of hematocrit before the first transfusion: Hematocrit = 7.778 - (0.088 x peak velocity in descending
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aorta) + (0.%8 + gestational age (weeks)) - (10.911 if hydrops present) (r = 0.876, p < 0.0001). An alternative formula, excluding hydrops, was slightly less predictive: Hematocrit = 45.312 - (56.261 x umbilicalcordPourcelotindex) (0.128 x peak velocity in descending aorta) + (1.042 X gestational age) (r = 0.822, p < 0.001). Neither model was accurate in the prediction of hematocrit before second or subsequent transfusions. A third model was derived from second-transfusion data: Hematocrit = 40.524 = 40.524 - (0.045 x peak velocity in descending aorta) - (10.693 x pulsatility index of maternal uterine artery) (r = 0.81, p < 0.003). However, this model was unable to predict hematocrit before third or later transfusions. No changes in Doppler ultrasound may be helpful in the evaluation of isoimmunized pregnancies, in differentiating anemic from normal fetuses. It does not appear to be useful in determining the timing of later transfusions. The lack of change before and after transfusions suggests that these vessels will not provide significant information concerning the effect of rapid volume and hematocrit changes in the fetus. Failure of ultrasonagraphic parameters to predict the severity of fetal anemia in rhesus isoimmunizntion
Nicolaides KH: Fontanarosa M; Gabbe SG; Rodcck CH Harris-Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, King’s College School of Medicine and Dent&try, London SE5 8RX. UK AM. J. OBSTET. GYNECOL.; 158/4 (920-926)/1988/ Ultrasonographic measurement of placental thickness, extrahepatic and intrahepatic umbilical vein diameters, abdominal circumference, head circumference, head/abdominal circumference ratio, and intraperitoneal volume were made in 50 rhesus-isoimmunized pregnancies at 18 to 26 weeks’ gestation. The severity of fetal anemia was assessed by fetal blood sampling. Results in the isoimmunized group were compared with a control population of 410 normal pregnancies at 17 to 32 weeks’ gestation. In the absence of fetal hydrops, none of the parameters studied could reliably distinguish mild from severe fetal hemolytic disease. Enterovirus in pregnant women and the perfused placenta
Amstey MS; Miller RK; Menegus MA; Di Sant ‘Agnese PA Department of Obstetrics-Gynecology, The University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America AM. J. OBSTET. GYNECOL.; 158/4 (775-782)/1988/ A survey of all nonpolio enterovirus infections in adults for a IO-year period revealed that most such infections will occur in the child-bearing age group during the third quarter of the year. Coxsackieviruses occurred more often than echovirus infection. Fourteen pregnant women, including four with meningitis, who had an enterovirus infection from 16 to 37 weeeks of gestation delivered uninfected, healthy infants. Attempts to demonstrate transplacental passage of Coxsackie B-3 or ECHO-11 viruses by use of the dual, recirculating, in vitro perfusion of an isolated placental lobule were unsuccessful even with a maternal virus input of 200,000 median tissue culture infectious doses. This suggests that transplacental passage of virus does not occur readily, and that most neonates of infected mothers will be unharmed. Int J Gynecol Obstet 28
PERINATOLOGY Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation
Berkowitz GS; Mehalek KE; Chitkara U; et al Department of Obstetrics, Gynecology and Reproductive Science, Mt Sinai Medical Center, New York, NY 10029, USA OBSTET. GYNECOL.; 71/5 (742-746)/1988/ Perinatal indicators of fetal compromise were assessed according to the results of continuous-wave Doppler umbilical velocimetry for 172 patients at risk for intrauterine growth retardation (IUGR). Forty-three (2SVo) of the patients delivered an infant with a birth weight below the tenth percentile for gestational age. The last Doppler study before delivery was abnormal in 48.8% of the growth-retarded infants but in only 13.2% of the infants without evidence of IUGR. Furthermore, in the growth-retarded group, early delivery, reduced birth weight, decrease amniotic fluid at birth, admission to neonatal intensive care unit, neonatal complications associated with IUGR, and a prolonged hospital stay were observed more frequently in those who had an abnormal ratio than in those with a normal ratio. The sensitivity of the systolic/diastolic ratio for an adverse perinatal outcome (operative delivery for fetal distress, neonatal morbidity associated with IUGR, and/or perinatal death) was significantly better for the infants with IUGR (66.7010)than for the infants without IUGR (27.8%; P < .05). The predictive value of an abnormal ratio was also higher for the pregnancies complicated with IUGR (57.1 Vo)than for those without IUGR (29.4%), but not to a statistically significant degree. These data suggest that Doppler umbilical velocimetry studies are valuable in identifying those growth-retarded fetuses at increased risk for an adverse perinatal outcome. Pulsed Doppler flow-velocity waveforms before and after intrauterine intravascular transfusion for severe erythroblastoski fetalis
Cope1 JA; Grannum PA; Belanger K; et al Department of Obstetrics and Gynecolow, Yale University School of Medicine, New Haven, CT 06510, USA AM. J. OBSTET. GYNECOL.; 158/4(768-774)/1988/ Pulsed Doppler studies of the fetal and maternal circulations were carried out before and after 64 intrauterine transfusions, performed on 24 fetuses. A model was derived for prediction of hematocrit before the first transfusion: Hematocrit = 7.778 - (0.088 x peak velocity in descending
191
aorta) + (0.%8 + gestational age (weeks)) - (10.911 if hydrops present) (r = 0.876, p < 0.0001). An alternative formula, excluding hydrops, was slightly less predictive: Hematocrit = 45.312 - (56.261 x umbilicalcordPourcelotindex) (0.128 x peak velocity in descending aorta) + (1.042 X gestational age) (r = 0.822, p < 0.001). Neither model was accurate in the prediction of hematocrit before second or subsequent transfusions. A third model was derived from second-transfusion data: Hematocrit = 40.524 = 40.524 - (0.045 x peak velocity in descending aorta) - (10.693 x pulsatility index of maternal uterine artery) (r = 0.81, p < 0.003). However, this model was unable to predict hematocrit before third or later transfusions. No changes in Doppler ultrasound may be helpful in the evaluation of isoimmunized pregnancies, in differentiating anemic from normal fetuses. It does not appear to be useful in determining the timing of later transfusions. The lack of change before and after transfusions suggests that these vessels will not provide significant information concerning the effect of rapid volume and hematocrit changes in the fetus. Failure of ultrasonagraphic parameters to predict the severity of fetal anemia in rhesus isoimmunizntion
Nicolaides KH: Fontanarosa M; Gabbe SG; Rodcck CH Harris-Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, King’s College School of Medicine and Dent&try, London SE5 8RX. UK AM. J. OBSTET. GYNECOL.; 158/4 (920-926)/1988/ Ultrasonographic measurement of placental thickness, extrahepatic and intrahepatic umbilical vein diameters, abdominal circumference, head circumference, head/abdominal circumference ratio, and intraperitoneal volume were made in 50 rhesus-isoimmunized pregnancies at 18 to 26 weeks’ gestation. The severity of fetal anemia was assessed by fetal blood sampling. Results in the isoimmunized group were compared with a control population of 410 normal pregnancies at 17 to 32 weeks’ gestation. In the absence of fetal hydrops, none of the parameters studied could reliably distinguish mild from severe fetal hemolytic disease. Enterovirus in pregnant women and the perfused placenta
Amstey MS; Miller RK; Menegus MA; Di Sant ‘Agnese PA Department of Obstetrics-Gynecology, The University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America AM. J. OBSTET. GYNECOL.; 158/4 (775-782)/1988/ A survey of all nonpolio enterovirus infections in adults for a IO-year period revealed that most such infections will occur in the child-bearing age group during the third quarter of the year. Coxsackieviruses occurred more often than echovirus infection. Fourteen pregnant women, including four with meningitis, who had an enterovirus infection from 16 to 37 weeeks of gestation delivered uninfected, healthy infants. Attempts to demonstrate transplacental passage of Coxsackie B-3 or ECHO-11 viruses by use of the dual, recirculating, in vitro perfusion of an isolated placental lobule were unsuccessful even with a maternal virus input of 200,000 median tissue culture infectious doses. This suggests that transplacental passage of virus does not occur readily, and that most neonates of infected mothers will be unharmed. Int J Gynecol Obstet 28