Faculty Bibliography

When cesarean section is not warranted because of extreme prematurity, continuous electronic fetal heart rate monitoring during the intrapartum period and in utero resuscitation of the distressed fetus are indicated, especially in cases of borderline fetal viability. Two cases are presented to illustrate the benefit of such measures when fetal distress occurs and the fetus is judged to be too small for operative intervention.

A pregnancy, complicated by hypophosphatemic familial rickets (vitamin D-resistant rickets) of a female fetus, associated with atrial flutter and congestive heart failure is presented. Upon review of the literature, only 22 cases of fetal atrial flutter have been reported. The association between hypophosphatemic familial rickets and atrial flutter has not yet been described.

A linear relationship between the ultrasound fetal femur length and the crown-heel length of the fetus is described. The formula for calculating the fetal length in centimeters was found to be 6.18 + 0.59 x femur length in millimeters. The value and potential uses of the calculated length of the fetus are discussed.

A pregnancy complicated by cyanotic heart disease due to single ventricle was recently managed at the authors's institution. Review of the literature showed only five previous case reports. The management of this uncommon disorder is presented along with a review of the literature. The presence of pulmonary hypertension appears to be a major determinant in assessing maternal risk.

A review of the literature on congenital hydrocephalus was used to develop a protocol for management. Specific emphasis is given to early diagnosis, evaluation of associated anomalies, and prognosis based on etiology.

Six fetal biophysical variables--the nonstress test, fetal movements, fetal breathing movements, fetal tone, amniotic fluid volume, and placental grading (biophysical profile)--were assessed in 150 high-risk pregnancies during a 30-minute observation period. The predictive value of the nonstress test alone, biophysical scoring, and contraction stress test alone in the identification of the healthy fetus as well as the fetus in jeopardy are discussed. The relationships between individual variables and combinations of variables to the outcome of pregnancy, as reflected by abnormal intrapartum fetal heart rate patterns, meconium during labor, fetal distress, and perinatal mortality rate were determined. The biophysical profile of all hypoxic fetuses was analyzed. These data suggest that the biophysical profile is more accurate in the identification of the hypoxic fetus than any other single method; therefore, a new protocol including the biophysical profile for antepartum fetal evaluation is presented.