Faculty Bibliography

A case of a progressive virilizing solid granulosa-theca cell tumor producing high testosterone levels that were suppressed to normal by a course of oral contraceptives is presented. In vitro studies demonstrated significant specific follicle-stimulating hormone (FSH) receptors on the tumor. The studies of the biological response to gonadotropins in terms of cyclic AMP generation also indicate that the tumor is responsive to gonadotropic hormones in vitro, and are consistent with the in vivo clinical response. A discussion of the role of gonadotropins in the etiology or maintenance of ovarian tumors is also presented

Secondary hypergonadotropic, hypoestrogenic amenorrhea, or premature menopause, is usually considered an irreversible process. Four patients with this entity were observed to have evidence of ovulation. Three of these patients became pregnant while they were treated with estrogen replacement therapy (ERT) for their hypoestrogenic symptoms. Estrogen replacement may be effective in reversal of this process

Fifteen cases of fetal cardiac arrhythmia were detected by direct fetal electrocardiogram (FECG) during intrapartum fetal monitoring. The frequency of arrhythmia of 12.4/1000 monitored births. Thirteen of the arrhythmias were supraventricular. Atrial bigeminy was the most commonly observed arrhythmia, followed by atrial trigeminy. Two cases of ventricular arrhythmia were noted, one of which was a case of ventricular tachycardia. Arrhythmias were not related to drug treatment or to stage of labor. Variable decelerations occurred in association with arrhythmias in 73% of the cases. There were no nuchal cords seen at delivery, nor were there any instances of intrapartum fetal distress, fetal acidosis, or low Apgar scores associated with any arrhythmia. All arrhythmias resolved spontaneously without treatment. The neonatal course was uncomplicated in all cases. Intrapartum fetal arrhythmia is best detected by direct FECG. Appropriate management should include close observation for ominous fetal heart rate (FHR) patterns and fetal acid-base-studies. At present, there is no indication for drug treatment of intrapartum arrhythmia

A case of congenital mitral and aortic stenosis diagnosed from the fetal electrocardiogram (FECG) during labor is presented. Cardiologic work-up and autopsy findings in the neonate confirmed the diagnosis. This is the first case in which prenatal diagnosis of a specific anatomical lesion of the heart was made from the FECG and confirmed clinically as well as at autopsy

Eleven patients with moderate fetal bradycardia in labor were studied by fetal scalp blood pH, continuous tissue pH, and umbilical arterty pH at delivery. The neonatal outcomes and biochemical data demonstrated that moderate fetal brdycardia does not indicate fetal distress

The relationship between different FHR patterns and fetal tissue pH in 68 high-risk gravidas in labor was analyzed. A tissue pH electrode was placed in the fetal scalp and tissue pH recorded on a fetal monitor every 15 seconds along with uterine contractions and continuous fetal heart rate. The tissue pH changes correlated with the FHR patterns in a manner consistent with current concepts of fetal stress. Trend monitoring of fetal tissue pH in labor may prove useful in the management of high-risk patients in labor

Advanced polycystic renal disease associated with pregnancy is very rare. A severely uremic pregnant patient with Landesman's Group C disease was delivered by cesarean section at 33 weeks' gestation, after dexamethasone treatment for fetal lung maturation. This is the first surviving infant in a case of Group C polycystic kidney disease