Abstract: Plasma lipoprotein, cholesterol and triglycerides were determined in 34 hypertensive pregnant patients and in 17 healthy full term pregnant women. Pregnancy induced hypertension was diagnosed in 21 patients and chronic hypertension in the remaining 13 women. Serum triglyceride levels were significantly elevated in the hypertensive patients. This elevation was not influenced by either the severity or the etiology of the hypertension. The total cholesterol/HDL and the LDL/HDL ratios were significantly elevated in the severely hypertensive patients, and furthermore the LDL/HDL ratio was elevated in patients receiving anti-hypertensive treatment. The lipid profiles found in hypertensive pregnant patients could be associated with enhancement of pathological lipid deposition in predisposed vessels such as the uterine spiral arteries. Furthermore, the hypertriglyceridemia found in the hypertensive patients may be associated with the hypercoagulability reported in pregnancy induced hypertension.

Abstract: Transvaginal color Doppler of luteal flow was performed on 58 patients with normal early pregnancy before artificial abortion, 73 patients with proven ectopic pregnancy and 75 non-gravid patients in luteal part of menstrual cycle. The equipment used were Aloka Color Doppler SSD-350 and SSD-680 with a 5 MHz transvaginal probe. Obtained color flow from ovarian tissue was explored with pulsed Doppler and the Pourcelot resistance index was calculated. Typical luteal low-impedance flow was detected in 82.8% cases of early pregnancy, 80.8% cases of ectopic pregnancy and 69.3% cases of non-pregnant women. The lowest resistance index (RI = 0.42 +/- 9.12) of luteal flow was found in cases of non-pregnant women, and the highest resistance index (RI = 0.53 +/- 0.09) was obtained in cases of early normotopic pregnancy. RI in cases of ectopic pregnancy was 0.48 +/- 0.07. Statistical analysis has shown significantly different RI in each of 3 groups of patients (P greater than 0.001). Corpus luteum was seen as early as a few days after ovulation in non-pregnant women and was present until about the 11th week of amenorrhea in pregnant women. In 86.4% patients with proven ectopic pregnancy, luteal flow was detected on the same side as the ectopic pregnancy. Our results have shown different RI value of corpus luteum flow in different groups of patients. Such findings could help to exclude pregnancy, specially with non-specific B-mode ultrasound features. Corpus luteum flow could be used as a guide for searching for ectopic pregnancy.

Abstract: Fetal heart rate (FHR) and fetal electrocardiogram (ECG) recordings were obtained from a scalp electrode with maternal thigh as reference and used for ST waveform analysis in 201 patients in labour. Nearly 45% had suspicious or abnormal FHR traces whilst only 27% had T/QRS ratio greater than 0.25 (mean +/- 2 SD). A normal T/QRS ratio identified 99.3% of fetuses with normal buffering capacity in cord artery blood. Of 13 infants with a cord artery blood pH less than 7.15, standard bicarbonate was less than 15.0 mmol/l in five who had an average T/QRS ratio less than 0.25 throughout labour. Of the eight with respiratory acidosis, five had an increase in T/QRS ratio greater than 0.25 for longer than 20 minutes prior to delivery, in two the ratio increased during the last few minutes and one had no change (pH 7.14). Persistent elevation of T/QRS in the first stage of labour identified those with decrease in buffer capacity in cord arterial blood (sensitivity of 94.1%). Acute hypoxia was recognized by the rapid rise in T/QRS. The specificity of T/QRS to identify fetuses at risk increased by combining the ST waveform analysis with FHR changes.

Abstract: Recurrent respiratory symptoms in the first year of life following preterm delivery were documented in two studies. In the first study a questionnaire was sent to all parents of preterm very low birth weight (VLBW) infants who had been admitted during a six-month period to the Neonatal Intensive Care Unit (NICU) at King's College Hospital (KCH) and who lived within the local district. Questionnaires were also sent to parents of a control group of infants who were recruited by random selection. All the controls lived locally and were delivered at KCH in the same six-month period as the study group, but were born at 37-41 weeks of gestation and had had no neonatal problems. The questionnaire documented frequency of cough and wheeze, medication and hospital admissions. Recurrent respiratory symptoms (wheeze or wheeze and cough) occurred in 65% of the preterm VLBW infants but only 33% of the controls p less than 0.001. Less than 10% of infants in either group had received bronchodilator therapy. Admission to hospital in both groups was more common amongst children who had recurrent wheeze (p less than 0.01). In the second study all preterm VLBW infants admitted to the NICU in a six-month period were followed prospectively over the first year of life. The nature and frequency of respiratory symptoms and frequency and length of re-admission was documented and related to the duration of neonatal ventilation. Twenty-three of the 44 preterm VLBW infants (53%) followed prospectively had recurrent wheeze and/or cough.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract: Cases of congenital varicella syndrome have been published, to date, a single case reports. Isolation attempts of Varicella-Zoster virus from fetal tissues have, thus far, been unsuccessful. This is a first report of detection of Varicella-Zoster virus in fetal tissue by means of DNA hybridization technique in a typical case of congenital varicella syndrome in a premature delivery of the 27th gestational week. The case is documented anamnestically, sonographically, pathologically and virologically. In women with primary varicella infection during pregnancy good sonographical controls are recommended. In cases with sonographically characteristical signs prenatal diagnosis with puncture of the umbilical vein cord and placentocentesis may be considered. The varicella DNA detection should be supplemented, however, by the polymerase chain reaction.

Abstract: In 38 women with uncomplicated vaginal delivery at term, the different pain intensities during spontaneous labor were correlated to the plasma beta-endorphin and cortisol concentrations simultaneously examined. The pain intensities subjectively assessed were numerically categorized. The women in labor categorized to pain intensities 0 to III were in comparable stages of cervical dilatation. The hormone concentrations were measured by means of radioimmunoassay. The lowest hormone levels were found after abolition of pains of labor by epidural anesthesia: beta-endorphin 42 pg/ml, cortisol 318 ng/ml (mean values). The hormone concentrations rose progressively with increasing intensities of labor pain. The highest concentrations were observed in the first few minutes after delivery i.e. immediately after cessation of the extreme pains of expulsive labor: beta-endorphin 118 pg/ml, cortisol 449 ng/ml. Statistically significant, positive correlations were calculated between beta-endorphin and cortisol concentrations in plasma and the self-reported pain intensities (p less than 0.001 and p less than 0.01 resp.). Thus, highly elevated beta-endorphin levels in plasma do not abolish pain, probably they modulate it. Within the first four hours postpartum the concentrations of the two stress-stimulated hormones dropped rapidly. The endorphin level fell from 118 pg/ml immediately after delivery to 38 pg/ml in the above mentioned period, the cortisol level from 449 ng/ml to 302 ng/ml. One to three days after delivery the beta-endorphin and cortisol concentrations in maternal plasma were largely normalized, this means they then approximately corresponded to the values being found in nonpregnant women under normal conditions.

Abstract: We investigated the impact of a long interval between the birth of the first and the second twin on second twin perinatal mortality (PNM). National data in the Swedish Medical Birth Registry were used on 7533 second twins born in Sweden between 1973 and 1985. PNM as a function of the time interval between the births of the twins was studied in data from two time periods: during 1973-78 (n = 4008) and 1979-85 (n = 3525). During the first period, PNM was significantly higher at intervals of 30 min or more between the births of the twins than at shorter intervals (chi 2 = 11.1, p less than 0.001). When studied within broad birth weight classes, a significant trend was seen for twins weighing 1500-2499 g with an increasing interval (chi 2 = 8.1: p less than 0.01). A non-significant trend was also found for twins weighing less than 1500 g but none for twins weighing greater than or equal to 2500 g. During the second period, abdominal delivery of the second twin after vaginal delivery of the first twin was significantly more common than during the first period (2.0% vs 0.3%, chi 2 = 52.7, p less than 0.001). During the second period, the interdelivery interval had little impact on second twin PNM. The results of this study seem to indicate that with modern management of labor and delivery, as seen in Sweden since 1979, the interdelivery interval has little impact on second twin PNM.

Abstract: This report summarizes the essential findings of seven cases of pneumococcal septicemia in the newborn and compares the data with those reported in the literature. It is emphasized that pneumococcal septicemia is a rare but highly lethal disease of the newborn. The clinical course strongly resembles early onset group B streptococcal disease. Epidemiological data suggest that the majority of infants are colonized near birth. Analogous to group B streptococcal sepsis, it seems rational to administer penicillin prophylaxis during labor to women with S. pneumoniae isolated from their genital tract to prevent vertical transmission and neonatal pneumococcal septicemia.

Abstract: The value of transvaginal colour and pulse wave Doppler in the diagnosis of pathologic early intrauterine and tubal pregnancy was assessed. Forty-one normal pregnancies, 6 blighted ovum, 6 missed abortions, and 22 suspected ectopic pregnancies (13 proven tubal pregnancies) were examined. Single 5 MHz transvaginal colour and pulse wave Doppler probe was used and once clear signals from uterine vessels, umbilical artery or trophoblastic vessels were obtained. Resistance Index (peak systole--end diastole/peak systole, RI) from the corresponding waveforms was calculated. In 41 normal pregnancies (examined before termination of pregnancy) with gestational age ranged from 6 to 10 weeks mean RI in uterine artery was 0.81 (SD 0.06), in the umbilical artery 1 (SD 0), and 0.48 (0.08) in the trophoblastic vessels. Mean RI from uterine arteries in six pregnancies with blighted ovum and six with missed abortion were 0.77 (SD 0.11) and 0.69 (SD 0.13) respectively. In 2 out of 6 cases of blighted ovum and 4 out of 6 cases of missed abortion flow in trophoblastic vessels could not be detected. These findings suggest ineffective early placentation in pathologic pregnancy. Twenty-two patients with suspected ectopic pregnancy (raised serum beta HCG with empty uterus, amenorrhoea with abdominal pain and/or palpable abdominal mass) were examined. In 13 cases tubal pregnancy was confirmed by laparoscopy and/or laparotomy. In the remaining nine cases the diagnosis was excluded by means of laparoscopy or subsequent negative beta HCG. Doppler diagnosis of ectopic pregnancy was made when colour flow in adnexa with RI less than 0.56 was revealed.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract: The purpose of this population based study on twins born in Sweden between 1961 and 1987 was to estimate the risk to the fetuses of becoming entangled during birth, and to identify those pregnancies with an increased risk for this rare complication. By using 3 separate questionnaires, 41 of 26,428 twin pregnancies with entanglement were identified. Twins in breech-vertex presentation (group A; 29 cases) were at significantly greater risk of entanglement (chi 2 = 168.3, p less than 0.001) than twins not in breech-vertex presentation (group B; 8 in vertex-vertex, 3 in breech-breech, and 1 in vertex-breech presentation). Known risk factors for entanglement in group A were intra-uterine growth retardation, a birth weight less than 2000 g, and antenatal fetal death. Intrapartum-neonatal mortality reached 38.9% in group A (median gestational week 36); and for group B, 8.3% (median gestational week 38). Entanglement during the study period occurred in 1 of 645 twin deliveries, on average. A vaginal delivery is proposed for women with twins in breech-vertex presentation, unless other risk factors leading to an increased risk for entanglement warrant abdominal delivery.

Abstract: All current methods of fetal karyotyping are invasive and carry a definite, albeit small, procedure-related risk. Because of this and testing costs, only women older than 35 years who have a greater risk for fetal aneuploidy are currently offered prenatal testing. But this detects only 20% to 25% of fetuses with Down syndrome. It would be a tremendous advance to find a noninvasive technique for prenatal diagnosis that carries no procedure-related risk and could be offered to all pregnant women. We describe a possible technique for noninvasive prenatal diagnosis that aims to identify fetal cells in the peripheral maternal circulation and successfully garner them for prenatal testing. Early attempts at fetal karyotyping were hampered by inaccurate diagnostic methods and cumbersome cell-counting techniques. Today, improved capabilities of identifying and enriching for fetal cells, coupled with sensitive methods of analysis such as the polymerase chain reaction, bring renewed enthusiasm to this task. Many technical issues, as well as serious questions regarding the test's utility, still exist, however, and must be explored and answered before the capture of fetal cells in the maternal circulation translates into reality for noninvasive prenatal diagnosis.

Abstract: C. reactive protein (CRP) estimations were performed prospectively on 30 consecutive admissions of very low birth weight infants to a Regional neonatal intensive care unit. The samples were analysed by a recently described, rapid intralipid agglutination assay and by a reference turbidimetric technique. Two hundred and ninety samples were assayed by both techniques. The intralipid agglutination was positive on two occasions when the reference method found normal levels. No false negative reactions occurred. Bacterial micro-organisms were isolated on 32 occasions but 19 of the organisms were considered to represent bacterial colonisation or contamination. The CRP remained negative in 17 cases. There were 13 episodes of clinical deterioration associated with positive bacterial cultures. In each of the six infants with severe systemic infections (septicaemia (4), meningitis (1), and osteomyelitis (1)), the levels were raised. In five of these infants the CRP was elevated before, or at the time of, the clinical deterioration. The CRP remained normal during seven (54%) of the culture positive events. We believe that the CRP estimations provide additional information in the evaluation of the infant with suspected sepsis. Serial measurements are helpful in distinguishing bacterial contamination from invasive infection but are not helpful in predicting infection during the pre-clinical phase. The intralipid agglutination technique is a rapid and reliable test and could be performed on the neonatal unit outside normal laboratory hours.

Abstract: The purpose of this study was to clarify the role of the intestinal anaerobe bacteria colonizing the intestine of the newborn delivered by cesarean section. The intestinal bacterial colonization of 18 newborns delivered by cesarean section was assessed sequentially over the first 14 days of life. Emphasis is placed on C. perfringens and upon interaction to other bacteria. Correlation was made with the infant feeding mode. Microbial studies were realized in anaerobic conditions using Columbia blood agar simple and supplemented with antibiotics. Artificial alimentation seemed to favour C. perfringens installation, in contrast to the maternal one which promote B. bifidum proliferation. Antagonism between these bacteria seems to be established in the newborn intestine, via the alimentation.

Abstract: The placenta secretes large amounts of the hypothelamic hormone, corticotropin releasing hormone (CRH) into the maternal and fetal circulation during pregnancy. We and other investigators have shown that during normal pregnancy, maternal plasma CRH levels begin to rise in the second trimester with a dramatic increase in CRH levels during the 5-6 weeks preceding the onset of labor. This rise in maternal plasma CRH is parallel to the rise of placental CRH mRNA which has been reported to occur with gestational maturation. Mechanisms underlying the control of CRH secretion by the placenta have not yet been determined. In twin gestation, increased fetal-placental mass has been shown to be associated with elevated maternal levels of several placental hormones as compared to singleton gestation. We measured maternal plasma CRH in both twin and singleton gestation to investigate whether the larger size of the fetal-placental unit in twin gestation is associated with elevated maternal CRH levels. Seventy-six serial venous blood samples were collected from 20 women with twin gestation and 40 samples were obtained from 27 women with uncomplicated singleton gestation. Gestational age was determined by history of a known last menstrual period and first trimester clinical examination and confirmed by ultrasound examination. CRH was extracted from 1-2 ml plasma with SEP-Pak C18 cartridges and eluted with triethylamine-formic-acid propranolol. CRH was measured by radioimmunoassay (RIA) with human CRH standard and antiserum to human CRH raised in our laboratory. Mean CRH levels were calculated for four week intervals. In both singleton and twin gestation, the maternal plasma CRH levels increased with advancing gestational age. After 29 weeks of gestation, maternal plasma CRH levels in twin gestation were significantly higher than those in singleton gestation (p less than 0.01). At 37 to 40 weeks of gestation, mean maternal CRH was 1167 +/- 237 pg/ml in singleton gestation as compared to 6927 +/- 1725 pg/ml in twin gestation (p less than 0.05). In addition, the rapid rise in plasma CRH levels which occurs near term in singleton gestation, occurred earlier in twin gestation. This early rise in maternal CRH levels persisted when the data from twin pregnancies complicated by preterm labor were removed from the analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract: Reflectance probes are being developed for neonatal use and obstetricians are beginning to use reflectance pulse oximetry to monitor the fetus. When a reflectance probe was used to monitor the arterial oxygen saturation of a baby whose skin was stained with meconium an artificially low result was obtained. This is because meconium absorbs more red than infra-red light and acts as a red light filter between the vascular bed and the probe. This effect may be reproduced by interposing a red filter between a reflectance pulse oximetry probe and the skin. Obstetricians who use a pulse oximeter to assess the fetus through intact membranes will record an erroneously low result if they are stained with meconium. Similarly neonatologists should avoid placing a reflectance pulse oximetry probe on babies skin which is stained with meconium.

Abstract: A prospective study was performed in order to determine vaginal and cervical pH in pregnancy. In normal pregnancy vaginal pH (using a pH meter with connected glass electrode) was found to be between 3.8 and 4.0 (1 SD +/- 0.3) at the introitus, mid-vaginal, and at the anterior and posterior fornix. In patients with preterm labor (n = 50) or prolonged rupture of the membranes (PROM, n = 35) pH was increased significantly to 4.2-4.5 (1 SD +/- 0.7) resp. to 5.2-6.1 (1 SD +/- 0.8). Cervical pH ranges between 6.5 and 7.0 in all groups studied. Elevated pH values are due to disturbed vaginal flora. We recommend vaginal pH measurement for an quick detection of infection in cases with preterm labor and for clarifying PROM in suspicious cases.

Abstract: Six hundred and six low income women were studied postpartum to assess the relationship among medical risk factors, use of alcohol and drugs, race, content/amount of prenatal care and birth weight. Content of prenatal care was defined by the number of medical procedures performed and amount of care was determined by the Kessner Index. Women received prenatal care in 1-4 different sites. Those remaining in or transferring to sites performing the least number of routine prenatal procedures delivered babies with lower birth weights than those selecting sites performing more procedures. A path analysis (LISREL) constructed a priori to model the relationships among medical risk factors, use of alcohol and drugs, race, content/amount of prenatal care received and birth weight, revealed that women at high medical risk were more likely to receive care at sites offering more medical procedures while those who abused drugs and alcohol were significantly less likely to receive such care. Medical risk factors and the use of alcohol and drugs had significant negative effects on birth weight, while content and amount of prenatal care contributed to improved birth weight. These findings are discussed relative to issues of access to high quality prenatal care by patients at greatest risk and to the prevention of low birth weight infants.

Abstract: The circumstances which cause the ripening of the cervix during the initial phase of parturition are still unexplored. In addition, complications during labour such as cervical dystocia still necessitate cesarian section. Therefore we examined the biomechanical alterations of the cervix during the last trimester of pregnancy. We developed a special method to measure dilatation and resistance of the rat cervix. After testing several substances, the antigestagen Mifepristone turned out to be most effective in causing cervical softening. Further investigations with light and scanning electron microscopy showed an increase of collagen and a possible loosening of collagen fibers after antigestagen treatment. Therefore it might be possible to use Mifepristone, perhaps in combination with a prostaglandin to promote cervical ripening when certain obstetric problems arise.

Abstract: Acid phosphatase (ACP1) is an enzyme found in the cytoplasm of many tissues and probably functions as a flavin mononucleotide-phosphatase. Therefore the highest concentration of flavin-mononucleotide cofactors is expected in ACP1 phenotypes with the lowest enzymatic activity (A and BA) and the lowest concentration of these cofactors is expected in phenotypes with the highest activity (CB and C). Accordingly, metabolic activities related to flavoenzymes should attain maximal levels in A and BA phenotypes and minimal levels in CB and C phenotypes. In the present study we have analyzed possible effects of ACP1 genetic variability on intrauterine growth in a sample of 609 newborns collected from three consecutive series in Rome. An association between ACP1 and birth weight is observed. The association is present only among male infants. ACP1 phenotypes with low enzymatic activity (A and BA) show a clear tendency to higher rates of intrauterine growth. A linear negative correlation is also observed between enzymatic activity and quartile class. The relation is significant only in male infants. The data suggest that in fetuses with low ACP1 activity, metabolic activity may be regulated at a level allowing a full response to specific genetic stimuli maximizing fetal growth.

Abstract: Fifteen out of 24 risk neonates from the premature baby ward (= 63%) and 36 of 79 healthy neonates from the infant nursery (= 46%) at a Zurich hospital were infected within a period of 29 days during a nosocomial epidemic human rotavirus (HRV) outbreak. Forty-two out of 51 of all HRV-infected babies (=82%) manifested clinical symptoms, but these could not all be attributed to an HRV infection. On average, rotavirus could be detected in infected risk neonates five days after their admission to the premature baby ward. Eleven of the 15 risk neonates were infected within 10 days after the admission of the index case. Immediately after detection of the epidemic process, specific detailed countermeasures were instituted, including hand protection and hand disinfection, individual nursing set and cohorting of already infected babies. Early institution of such measures and information of all persons responsible for treatment and care of the babies concerned are crucial for success.

Abstract: Ovarian cysts can be demonstrated in the ovaries of fetuses and full term infants at birth. Small cysts involute spontaneously during fetal life or within the first few months of life. Large cysts may cause mechanical complications or respiratory distress. Sonographic detection of fetal ovarian cysts has been reported, as well as intrauterine surgical treatment. The sonographic findings and the outcome of the smaller and the complicated cysts were studied in 25 pregnant women. Uncomplicated fetal ovarian cysts should be monitored by weekly examination until delivery. Huge ovarian cysts may be an indication for cesarean section; or, intrauterine aspiration may be the alternative. Complicated fetal ovarian cysts represent an indication for neonatal surgery.

Abstract: In twelve twin pregnancies with normal amniotic fluid volume, the urine output of each twin was lower than in fetuses from singleton pregnancies, and the combined urine output of both twins was between the 50th and 95th centile for singletons. In three twin pregnancies at 21-24 weeks of gestation with acute polyhydramnios, presumed to be due to the twin-twin transfusion syndrome, the urine output of the smaller fetus was zero and that of the larger was above the 95th centile for normal singleton pregnancies. These three pregnancies were managed by repeated amniocenteses and rapid drainage of large volumes of amniotic fluid. With advancing gestation, there was a tendency for normalization of urine output in the twins.

Abstract: Hydrops developing in fetuses with lupus-associated heart block has usually been assumed to result from congestive heart failure. We present a case in which fetal ascites associated with complete heart block resolved promptly after administration of betamethasone and prednisone to the mother, who had anti-SSA and who developed clinical lupus erythematosus. This resolution occurred with no demonstrable change in fetal cardiac function. We conclude that an immune mechanism, rather than congestive heart failure, was responsible for the fetal ascites.

Abstract: The materno-fetal transfer of methionine in the Rhesus monkey was investigated using positron emission tomography, a non-invasive in vivo tracer technique based on short-lived radionuclides. A bolus dose of [11CH3]-l-methionine was administered intravenously and the radioactivity concentrations in the placenta, the fetus and the maternal arterial blood were measured as functions of time and fitted to an equation derived from a four compartment model of the feto-placental complex. Rate constants were calculated describing maternal placental blood flow, the transfer of [11CH3]-l-methionine to the placental tissue and the fetus. The transfer rate of methionine to the fetus was estimated as 0.8-1.5 nmol/min/g placenta and was similar to the transfer to the placental tissue. An approximate blood flow through the intervillous space of 128 ml/min was found. The correlation between placental transfer to the fetus and the maternal blood flow in the intervillous space was low.

Abstract: We studied 374 pregnant diabetic women to determine the value of various ultrasound parameters in the prediction of fetal macrosomia. The correlation between ultrasonographic signs and maternal glycaemia in the development of fetal macrosomia was also studied. Significant correlation was observed between the accurence of hydramnios and future macrosomia during the second-trimester (p less than 0.001). Serum fructosamine levels as an index of maternal glycaemia in patients of macrosomic fetuses were significantly higher throughout the pregnancy as compared with mothers of infants with normal birth weight (p less than 0.001). These data suggest: 1. The presence of hydramnios in the second trimester is a useful predictor of macrosomia in diabetic patients (specificity: 86%, negative predictive value: 88%). 2. Maternal diabetic control during pregnancy has a significant influence on fetal growth and contributes to the development of fetal macrosomia. 3. The lack of correlation between the frequency of hydramnios and fructosamine levels suggests that a mechanism other than carbohydrate metabolism also plays an important role in the development of fetal macrosomia.

Abstract: The purpose of this population-based study on twins whose birth weight was discordant by 1.0 kg or more, was to evaluate the impact of abdominal delivery on the "corrected perinatal mortality" (fetal death prior to delivery being excluded), and also on childhood morbidity. Between 1973 and 1983, 277 such discordant twin pairs were identified in Sweden, using the Medical Birth Registry, Stockholm. The original medical records were retrieved for 267 pairs. The presence of childhood morbidity of 437 twins born between 1973 and 1980 was determined by means of questionnaires sent to rehabilitation centers for handicapped children, offices for the Provision of Care to the Mentally Retarded throughout Sweden, as well as to local Boards of Education. No association was found between corrected perinatal mortality figures and a more than 4-fold increase in cesarean section rate, from 11.4% during 1973-75 to 45.9% during 1980-83. The 10 perinatal deaths (1.9%) could be correlated with birth weight (9 small and 1 large twin; p = 0.01), but not to the mode of delivery of the smaller twins (6 born vaginally and 3 abdominally; p greater than 0.05). At follow-up, at the age of 8 years or more, 5 smaller and 4 larger twins had cerebral palsy and/or mental retardation; no correlation was found with mode of delivery. The results of this study show that perinatal death (twins with lethal malformation included) or residual major handicap occurred in one of ten pregnancies of twins with discordant birth weights. Abdominal delivery seemed to have little impact on either short or long-term outcome.

Abstract: A retrospective study of maternity records from 1977-1985 (38,000 deliveries) was conducted to determine the number of stillbirths that might have been prevented by a new method of antenatal assessment. During this period there were 240 stillbirths, 154 of which involved a normally formed fetus who died prior to the onset of labour. After a review of the literature, a set of risk factors were selected relevant to stillbirth. Such factors were found in 60% of the study group, compared with 38% of control patients. Seventy-five of the normally formed 'antepartum stillbirths' occurred in the high-risk group after 31 weeks gestation, so that a perfect method of prediction and treatment, applied from 31 weeks onwards, would potentially have prevented half of the 154 deaths in this study. Since intensive monitoring and the subsequent intervention cannot attain such perfection, an assessment was made, using realistic sensitivity and specificity values and other reasonable assumptions, to show that approximately one third of antepartum stillbirths might have been prevented by a new method for monitoring of all high-risk pregnancies. A sensitivity analysis was used to test this conclusion over a range of possible test performance values. The implications of these findings for clinical trials and cost-utility analysis are discussed.

Abstract: The fetal intrapartum condition as well as maternal and immediate neonatal outcome of 274 consecutive midforceps rotations (head in transverse or posterior position and below + 1 station but without reaching the perineum) were compared with 106 cesarean sections done for arrest of progress for more than two hours and cervical dilatation of at lest 7 cm. It was found that there were more nulliparous among cesarean section patients, that their fetuses weighed near 400 gm more on the average, and that their time in labor was 200 minutes longer. On the other hand, the midforceps group had a higher incidence of spontaneous labor, conduction anesthesia, and intraprtum fetal distress (37%). There were no differences in fetal outcome, other than admission to NIC and/or NIM among C-section infants. This latter group had a higher postdelivery maternal complication rate (hemorrhage and infection), as well as longer than expected hospital stay. These findings are discussed. It appears that midforceps rotation, properly indicated and executed, offers a safe alternative to C-section for delivery of the infant.

Abstract: Fetal acardia is a rare abnormality of multiple pregnancies, which is lethal for the affected fetus and can cause death in 50% of normal co-twins. Antenatal recognition with early ultrasound is essential to institute a prospective management to improve the outcome. Our communication outline the difficulties which may be encountered in ultrasound diagnosis. In particular the problem of distinguishing a fetal heart from large pulsating mediastinal vessels, which can be present in these fetuses, and the difficulty of diagnosing death in an acardiac fetus. Our report confirms that the co-twin remains at increased risk of sudden death, even without ultrasound evidence of cardiac failure or biochemical compromise. The finding in this fetus of intravascular fibrin deposits suggests the possibility of acute disseminated intravascular coagulation, not previously reported in association with an acardiac twin.