Successful pregnancy after cardiac transplantation

Citations from the Literature each timester. Cervical HSV shedding concomitant with HSV culture-positive vulvar lesions did not change significantly with advancing gestation. The presence of an HSV culture-positive vulvar lesion indicated a significantly (P < 0.001) greater risk of concomitant cervical HSV shedding (44 of 333,13.2%) than in pregnant women with HSV culture-positive remote lesions (zero of 60) or in asymptomatic women (27 of 1460, 1.9%). Comparison of the characteristics among 43 pairs of pregnancies in 34 women revealed no consistent change over time. This study of the natural history of genital HSV recurrences in pregnant women demonstrated no proclivity for an increased rate of preterm delivery (1.3Yo) or congenital anomalies (2.2%) in a predominantly white, non-Hispanic middle-class population. S~~ccessfnlpregnancy after cardiac transplantation Key TC; Resnik R; D&rich HC; Reisner LS Department of Reproductive Medicine, University of California, San Diego, CA 92103; USA American Journal of Obstetrics and Gynecology/160/2 (367371)/1989/ A case report of a successful pregnancy after cardiac allotransplantation is presented. The patient underwent transplantation for an inoperable cardiac tumor 5 years before conception. Cardiac function before and during all stages of pregnancy was normal. Maintenance immunosuppressive therapy consisting of prednisone and azathioprine was continued through gestation. The pregnancy was complicated by a primary herpes virus infection requiring parenteral acyclovir treatment and a single episode of preterm labor that was successfully treated. The infant was born at term, weighed 3278 gm, and has developed normally during the first 3 years of life. The patient died 5 months after delivery as a result of acute immunologic rejection 5 months post partum caused by selfinitiated discontinuation of immunosuppressive therapy. Preconceptual counseling and pregnancy care guidelines are discussed. Sonographtc evaluation of fetal abdominal growth: Predictor of tbe large-for-gestational-age infant in pregnancies complicated by diabetes meUttus Landon MB; Mintz MC; Gabbe SG Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH 43210; USA American Journal of Obstetrics and Gynecology/l60/1 (115 121)/1989/ Serial ultrasound examinations were performed during the third trimester in 79 pregnant women with diabetes to establish the onset of accelerated fetal growth. At least three ultrasound examinations were performed, with a minimum scan interval of 2 weeks. Growth curves constructed for femur length and head circumference were similar for fetuses appropriate for gestational age (n = 48) and fetuses large for gestational age (n = 31). The mean changes in femur length and head circumferences (expressed as centimeters per week during the early and late third trimesters) did not differ statistically between these two groups. Abdominal circumference growth was clearly accelerated at 32 weeks’ gestation in the large for gesta-

83

tional age group (mean f SD, 1.36 f 0.16 cm/wk) compared with the appropriate for gestational age group (0.901 f 0.21 cm/wk, p < 0.001). With use of a receiver operator characteristic curve, a change in abdominal circumference of 1.2 cm/wk over the period of 32 to 39 weeks’ gestation was determined to be an optimal cutoff for detecting excessive fetal growth (sensitivity 84%, specificity 85%). A change in abdominal circumference 1.2 cm/wk was present in 414 large-for-gestational age fetuses (<4000 gm), in 17121 (81%) of fetuses with birth weights 4000 to 4499 gm, and in S/6 (83%) whose weight exceeded 4500 gm. It appears that improved detection of the fetus large for gestational age in diabetic pregnancies may be accomplished by the use of serial ultrasonography during the third trimester. Thyrotoxtcosts complicating pregnancy Davis LE; Lucas MJ; Hankins GDV; Roark ML; Cunningham FG Department of Obstetrics and Gynecology, University of Texas Southwestern Medicai School, Dallas, TX 75235-9032; USA American Journal of Obstetrics and Gynecology/l6O/1 (6370)/1989/ During the 12-year period from 1974 through 1985, nearly 120,000 women were delivered of infants at Parkland Hospital, and pregnancy was complicated by overt thyrotoxicosis in 60 of them (1 : 2000). Initial treatment was based on clinical assessment, and propylthiouracil was usually given in doses of 300 to 800 mg daily. In compliant women se-en by midpregnancy, euthyroidism was achieved by a mean of 8 weeks; however, the daily dose was decreased to (150 mg by delivery in only 101. Metabolic status at delivery correlated directly with pregnancy outcome, and women treated earlier in pregnancy were more likely to be euthyroid at delivery and to have good outcomes. Diagnosis of thyrotoxicosis antecedent to pregnancy was associated with earlier treatment, and 80% of 28 such women were euthyroid by delivery. Conversely, 32 women with a first diagnosis during pregnancy had the preponderance of morbidity, including five of six stillbirths and six of seven cases of heart failure. This group was characterized by a relative delay in gestational age at diagnosis. Preterm delivery, perinatal mortality, and maternal heart failure were more common in women who remained thyrotoxic despite treatment and in those who were never treated. Although we infrequently achieved maintenance doses recommended by most, because there were minimal adverse effects from therapy described here and because uncontrolled thyrotoxicosis caused significant maternal and perinatal morbidity, aggressive medical therapy seems appropriate, especially when pregnancy is advanced. Tuberculoos meningitis in pregnancy Kingdom JCP; Kennedy DH Department of Midwifery, The Queen Mother’s Hospital, Glasgow G3 SSH; United Kingdom British Journal of Obstetrics and Gynaecology/%/2 (233235)/1989/ Four women with tuberculous meningitis in association with pregnancy are described to illustrate both the serious Int J Gynecol Obstet 30