Faculty Bibliography

With the increasing survival rates of the extremely premature infants, counseling patients as to the potential outcome of the pregnancy is difficult. Traditional methods of basing survival rates on gestational age and actual birthweights have limitations. This study compares survival rates based on ultrasonically estimated fetal weights to those of actual birthweights and demonstrates an excellent correlation at this institution. It is suggested that individual institutions should construct their own neonatal survival rates based on estimated fetal weights for the extremely premature fetus to counsel better patients at risk for early delivery.

The presence or absence of cyclic variation (cyclicity) of fetal heart rate patterns was prospectively investigated in fetuses between 25 and 32 weeks' gestation. All fetuses were delivered by cesarean section before the onset of labor. The relationship between the presence or absence of fetal heart rate cyclicity and fetal acidosis, as determined by cord pH measurements, was investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of this method in predicting fetal acidosis were: 100, 90, 50, and 100%, respectively. All fetuses with reactive nonstress tests also had fetal heart rate cyclicity present and none were acidotic at birth. The majority of fetuses (68.8%) with nonreactive nonstress tests had fetal heart rate cyclicity present and none were acidotic; fetuses with nonreactive nonstress tests and absence of fetal heart rate cyclicity were acidotic in 50% of the cases. These preliminary data suggest that the presence or absence of fetal heart rate cyclicity may help to select the healthy preterm fetuses with nonreactive nonstress testing who are in good condition and therefore in no need for further testing.

The sonographic characteristics and the frequency of the presence or absence of fetal hair in the occipital region was determined from 16 weeks to 42 weeks of menstrual age. Our results suggest that the ultrasonic appearance of occipital hair is first noted at approximately 24 weeks of menstrual age and there is a progressive increase in frequency of hair presence as pregnancy approaches term. The normal ultrasonic characteristics of occipital fetal hair are described, and the differential diagnoses between normal fetal hair and malformations such as meningocele, encephaloceles, or cystic hygromas is discussed

A protocol of expectant management using daily fetal biophysical assessment was applied to 23 consecutive women with severe oligohydramnios after preterm premature rupture of the membranes. A persistently low biophysical score (less than or equal to 6 on two examinations two hours apart) in the presence of a nonreactive nonstress test and absence of fetal breathing was used as an indication for delivery. The pregnancy outcome in this group was compared to that in a historic control group managed similarly except that an abnormal biophysical assessment was not an indication for delivery. The results suggest that the management of women with severe oligohydramnios after preterm premature rupture of the membranes with daily fetal biophysical profiles decreases the incidence of low five-minute Apgar scores as well as that of maternal and neonatal infection.

Thrombocytopenia complicating pregnancy occurs with four major nonmalignant conditions found in the reproductive age group: thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, pregnancy-induced hypertension, and immune thrombocytopenic purpura. A case of thrombotic thrombocytopenic purpura occurring in a pregnant patient is presented, along with a review of the literature.

A prospective study was conducted to evaluate the estimation of fetal weight in preterm pregnancies by use of ultrasound measurements. Two equations for estimating fetal weight, one proposed by Shepard and associates and the other by Hadlock and associates, were evaluated. The ability to estimate fetal weight accurately was evaluated with respect to birth weight and menstrual age. Shepard's equation is associated with a lower mean signed percent error than Hadlock's, when the birth weight is less than 1500 g (4% vs 12%) or when the menstrual age is between 23 weeks to 30 weeks (2% vs 10%). However when the birth weight is between 1500 g and 3500 g, or the menstrual age is between 31 weeks to 36 weeks, Hadlock's equation has a lower mean signed percent error: 1% vs -4% for the birth weight category and 2% vs -3% for the menstrual age category. In preterm gestations both equations estimate fetal age weight with a low mean signed percent error--Shephard's -0.4% versus Hadlock's 6.0%.

We describe a case of spontaneous resolution of a cystic hygroma between 14-16 weeks' gestation in a fetus with trisomy 21 who, at termination at 19 weeks, revealed only mild webbing of the neck. Redundant nuchal skin folds are among the most common features of trisomy 21. Our case supports the hypothesis that this redundant skin of the fetal neck represents early cystic hygromas, which resolve in utero before 16 weeks' gestation.

A case of fetal jejunoileal atresia in association with persistent omphalomesenteric duct is presented. The dilated stomach and proximal and distal duodenum produced a multiple bubble sign on the prenatal sonogram. The neonate underwent exploratory laparotomy, excision of the persistent omphalomesenteric duct, gastrotomy, and colostomy. Possible causes of jejunoileal atresia are presented

Double survival of monoamniotic twins is rare. Three consecutive cases in which double survival occurred are presented. Accurate antenatal diagnosis, intensive fetal surveillance, and operative delivery should improve neonatal outcome.