Faculty Bibliography

Unilateral lung agenesis is a rare congenital condition of unknown etiology. A 33-year-old nullipara with right lung agenesis and scoliosis was admitted to the hospital at 30 weeks of gestation because of oligohydramnios. At 32 weeks she was treated for an upper respiratory tract infection with azithromycin. She went into premature labor at 34 weeks and was delivered by Cesarean for breech presentation. Both mother and infant did well.

BACKGROUND:The Arnold-Chiari malformation type I is characterized by the prolapse of the cerebellar tonsils below the foramen magnum. There is a lack of literature on the management of a pregnancy in a woman affected by an Arnold-Chiari malformation. CASE/METHODS:A young primipara with severe headaches underwent an elective primary cesarean delivery under general anesthesia successfully. Five years earlier, she had undergone neurosurgical resection for filum terminale syndrome shortly after her first pregnancy (term vaginal delivery) and decompression of a type I Arnold-Chiari malformation 4 months later. CONCLUSION/CONCLUSIONS:Careful selection of anesthetic technique for the delivery of a woman with an Arnold-Chiari malformation is of paramount importance.

A woman at 39 weeks' gestation with a previous Cesarean delivery had severe abdominal pains and rupture of membranes shortly after ingesting 5 ml of castor oil. Forty-five minutes later, repetitive variable decelerations prompted a Cesarean delivery. At surgery, a portion of the umbilical cord was protruding from a 2-cm rupture of the lower transverse scar.

Antepartum fetal surveillance constitutes an essential component of the standards of care in managing pregnancies complicated by pregestational diabetes mellitus. Fetal hyperglycemia is associated with increased oxidative metabolism, hypoxemia and increased brain and renal perfusion without any significant changes in fetoplacental perfusion. Human cordocentesis data show that fetal hypoxemia and acidemia are associated with changes in the umbilical arterial Doppler indices in maternal diabetes mellitus complicated by fetal growth restriction or pre-eclampsia. Consistent with this, observational studies suggest significant diagnostic efficacy of the Doppler method in diabetic pregnancies complicated by vasculopathy, and in the presence of fetal growth restriction or hypertension. However, the relationship between abnormal umbilical arterial Doppler indices and the quality of glycemic control remains unproved. Although there are no randomized trials specifically addressing this issue, existing evidence suggests that Doppler velocimetry of the umbilical artery may be beneficial for antepartum fetal surveillance in diabetic pregnancies complicated by vasculopathy, fetal growth restriction or hypertension.