Respiratory distress syndrome: differential effects of prenatal steroid therapy and prolonged rupture of the membranes

We studied the incidences of respiratory distress syndrome (RDS) and of severe RDS and the survival rate in premature newborns who received a complete prenatal course of betamethasone (N = 49) and in those who did not receive the steroid (N = 546). We also studied the same parameters in steroid-untreated prematures who had prolonged rupture of the membranes (greater than or equal to 24 h, N = 91), and in those who did not (N = 448). We found that the incidences of RDS and severe RDS were significantly lower and the survival rate significantly higher in steroid-treated babies than in untreated babies at 28-32 weeks of gestation (29% vs. 58%, P less than 0.01; 21% vs. 46%, P less than 0.03; and 83% vs. 49%, P less than 0.01, respectively). We also found that untreated babies born after prolonged rupture of the membranes at 28-32 weeks had significantly lower incidences of RDS and severe RDS than untreated babies without prolonged rupture (43% vs. 64%, P less than 0.02; 30% vs. 51% P less than 0.02, respectively). Between 28 and 32 weeks, steroid-treated babies did not have significantly lower incidences of RDS and severe RDS than untreated babies born after prolonged rupture of the membranes (29% vs. 43%, P greater than 0.2; 21% vs. 30%, P greater than 0.3, respectively). The data indicate that between 28 and 32 weeks gestation, the protection against RDS that is provided by prenatal treatment with betamethasone is not superior to that provided by prolonged rupture of the membranes alone.     

Maternal serum alpha-fetoprotein levels in low birth weight singleton pregnancies

Maternal serum alpha fetoprotein (MSAFP) measurement between 16 and 21 weeks gestation is used to define a group of women with an increased risk of fetal abnormality, particularly open neural tube defect. The test is strongly gestation dependent and women with high MSAFP levels require sonar scan examination to define gestation, exclude twins and examine the fetus for obvious malformation or death. It has been reported that women with no primary cause for raised MSAFP have an increased incidence of low birth weight babies. Conflicting reports have separately ascribed these to premature delivery and to intra-uterine growth retardation. We have studied the relationship between MSAFP and low birth weight infants with respect to both prematurity and retarded fetal growth. MSAFP values were expressed as multiples of the appropriate weekly median (MOM) values relating to normal pregnancies with normal outcomes at term. For our normal population an MSAFP value of 2 MOM is the 95% centile, i.e. 5% of normal outcome pregnancies of sure gestation will have MSAFP values in the second trimester which are at or above 2 MOM. Information was available on 389 women whose infants were liveborn singletons weighing 2.5 kg or less. 33 (8.5%) of these women had MSAFP greater than 2 MOM (p less than 0.005) and of the 145 women whose babies weighed less than 2 kg, 17 (11.7%) had MSAFP at this level (p less than 0.001) Tab. I).(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997

OBJECTIVE: The purpose of the study was to explore the associations of placenta previa with preterm delivery, growth restriction, and neonatal survival. STUDY DESIGN: A retrospective cohort study was performed of live births in the United States (1989-1991 and 1995-1997) that used the national linked birth/infant death records from 22,368,235 singleton pregnancies. The diagnosis of previa was restricted to those live births that were delivered (> or =24 weeks) by cesarean delivery. We evaluated gestational age and birth weight-specific risk of neonatal deaths (within the first 28 days) in relation to placenta previa. Fetal growth was assessed in centiles of birth weight (<3rd, 3rd-4th, 5th-9th, 10th-90th, and >90th centile), adjusted for gestational age. All analyses were adjusted for the confounding effects of the year of delivery, maternal age, gravidity, education, prenatal care, marital status, and race/ethnicity. RESULTS: Placenta previa was recorded in 2.8 per 1000 live births (n = 61,711). Neonatal mortality rate was 10.7 with previa, compared with 2.5 per 1,000 among other pregnancies (relative risk, 4.3; 95% confidence interval, 4.0,4.8). At 28 to 36 weeks, babies born to women with placenta previa weighed, on average, 210 g lower than babies born to women without placenta previa (P <.001). Compared with babies born to women without previa, the risk of death from placenta previa was lower among preterm babies (<37 weeks of gestation), with a crossover at 37 weeks where the mortality rate was higher for babies born to women with placenta previa than for babies born to women without placenta previa. This crossover also persisted in an analysis by birth weight and term births (delivered at > or =37 weeks of gestation). Mortality rates for term births were higher among babies born to women with placenta previa than among babies born women without placenta previa who were at the 10th to 90th centile (relative risk, 1.9; 95% confidence interval, 1.3, 2.8), and those at >90th centile (relative risk, 3.6; 95% confidence interval, 1.3, 9.6). Among preterm births, however, placenta previa was not associated with increased neonatal mortality by fetal growth centiles. CONCLUSION: The risk of neonatal mortality was higher for babies born to women with placenta previa than for babies born to women without placenta previa who were delivered at > or =37 weeks of gestation. Pregnancies that are diagnosed with placenta previa must be monitored carefully, especially as they approach term.     

Plasma and erythrocyte zinc concentrations in pre-eclampsia

Plasma and erythrocyte zinc concentrations were measured in 28 Chinese pre-eclamptic women and 28 controls matched for parity, race and gestation. There were no differences in either the plasma or erythrocyte zinc concentrations between pre-eclamptic and control groups, although the mean birth weight (p less than 0.001) and period of gestation (p less than 0.001) at delivery in the control group were significantly higher. In the pre-eclamptic patients, those delivering before 37 weeks or those who gave birth to low birth weight (less than 2500 g), babies had a significantly higher plasma urate concentration (p less than 0.02) compared to the pre-eclamptic patients with better fetal outcome. However, the plasma and erythrocyte zinc concentrations between these subgroups were not significantly different. Our results suggest that zinc deficiency is unlikely to play a significant role in pre-eclampsia in our patients, and that measurement of plasma and erythrocyte zinc concentrations is of doubtful clinical value in the management of pre-eclampsia.     

Factors associated with success of emergent second-trimester cerclage

OBJECTIVE: To assess the factors associated with delivery greater than or equal to 28 weeks' gestation after placement of an emergent cerclage in women with singleton gestations. METHODS: All women who underwent emergent cerclage, defined as any cerclage placed between 16 and 24 6/7 weeks' gestation in response to documented cervical change on physical examination, at Northwestern Memorial Hospital from 1980 to 2000 were identified. Univariable and multivariable analyses were used to determine the factors most associated with achieving at least 28 weeks' gestation. RESULTS: One hundred sixteen women were eligible for analysis. Maternal age, race, and operative variables such as suture type and use of antibiotics were not associated with differences in the frequency of delivery at or after 28 weeks. Cerclage placement at or after 22 weeks' gestation increased the likelihood of reaching 28 weeks, whereas several cervical examination findings (dilatation greater than 3 cm, cervical length less than 0.5 cm, and membranes prolapsing beyond the external cervical os) as well as need for placement in a nullipara significantly reduced the likelihood of reaching 28 weeks. In multivariable analysis, nulliparity (odds ratio 0.31, 95% confidence interval 0.1, 0.8) and membranes prolapsing beyond the external cervical os (odds ratio 0.24, 95% confidence interval 0.1, 0.4) continued to be associated with delivery before 28 weeks, whereas cerclage placement at or after 22 weeks (odds ratio 3.2, 95% confidence interval 1.2, 8.6) increased the chance of achieving at least 28 weeks' gestation. CONCLUSION: Nulliparity, the presence of membranes prolapsing beyond the external cervical os, and gestational age less than 22 weeks at cerclage placement are associated with decreased chance of delivery at or after 28 weeks after emergent cerclage; these factors may be used to help counsel patients considering the procedure.     

Amniocentesis prior to physical exam-indicated cerclage in women with midtrimester cervical dilation: results from the expectant management compared to Physical Exam-indicated Cerclage international cohort study

We evaluated whether the performance of an amniocentesis in women with a dilated cervix presenting at less than 26 weeks and subsequently managed by a physical exam-indicated cerclage increases the risk of spontaneous preterm birth (PTB) less than 28 weeks. Women between 15 (0)/ (7) to 25 (6)/ (7) weeks' gestation with a dilated cervix (1 to 4 cm) were identified. Multiple exclusion criteria were designated. The primary outcome was PTB less than 28 weeks. One hundred twenty-two women with a dilated cervix between 15 and 25 (6)/ (7) weeks gestational age were identified. Twenty-four (20%) of these had an amniocentesis performed. The unadjusted rate of PTB < 28 weeks differed between women who underwent amniocentesis compared with those who did not (58% versus 34%, respectively, P = 0.02), but after multivariate regression analysis, the performance of an amniocentesis was not an independent contributor to PTB < 28 weeks ( P = 0.90). The performance of an amniocentesis prior to cerclage did not independently contribute to PTB less than 28 weeks.     

Emergency cervical cerclage using a metreurynter in patients with bulging membranes.

Emergency cervical cerclage was performed in 26 women between 18 and 32 weeks of gestation who had fetal membranes bulging through a widely dilated cervix. A bulging bag was pushed into the uterine cavity by a new method, using a metreurynter. The average prolongation of pregnancy after the operation in the 26 women was 41 days (ranging from 2 to 115 days). All pregnancies resulted in the live birth of altogether 28 babies. The neonatal survival rates at gestational ages of less than or equal to 26 (including two sets of twins), 27-29, and greater than or equal to 30 weeks at the time of cervical cerclage were 80.0 (12/15), 85.7 (6/7), and 100% (6/6), respectively. Ten (83.3%) of the 12 infants who survived from patients receiving cerclage at a gestational age of less than or equal to 26 weeks are alive and well. The average duration of pregnancy after cerclage was 60 days when cervical dilation was less than or equal to 5 cm at operation, in contrast to 5.4 days in patients with cervical dilation of greater than or equal to 6 cm, suggesting that emergency cervical cerclage could be suitable in the presence of a cervical dilation of 5 cm or less.     

Emergency cervical cerclage.

OBJECTIVE--To assess the efficacy of emergency cervical cerclage. DESIGN--Retrospective review of patients who underwent emergency cervical cerclage between August 1986 and August 1989. SETTING--University College and the Middlesex Hospitals obstetric unit, a neonatal referral centre. SUBJECTS--19 women between 16 and 28 weeks gestation with a cervical dilatation between 3 and 10 cm. There were two twin pregnancies. INTERVENTIONS--Amniocentesis and bacteriological assessments were performed prior to cerclage and prophylactic antibiotics were given. Insertion of sutures was aided by a combination of techniques described previously. MAIN OUTCOME MEASURES--Prolongation of gestation and pregnancy outcome. Bacteriological findings at delivery and maternal and fetal morbidity were also recorded. RESULTS--Membranes remained intact in all the women after cerclage. Fifteen live babies were born and 13 of them survived (survival rate 63%). Gestation was prolonged from between 1 and 19 weeks in these patients and the gestational age at delivery ranged from 25 to 41 weeks. All eight intrauterine or neonatal deaths were associated with infection. Infecting organisms included Escherichia coli, Gardnerella vaginalis, Mycoplasma hominis, Trichomonas vaginalis and Fusobacterium spp. Pregnancy was prolonged for less than or equal to 5 weeks in these infected pregnancies. A cervical laceration occurred in a patient who had the suture inserted at full dilatation and subsequently laboured, but there were no other maternal complications. CONCLUSIONS--Emergency cervical cerclage can prolong pregnancy and influence the outcome favourably.     

Admission of Term Infants to Neonatal Intensive Care: A Population‐Based Study

ABSTRACT: Background: Neonatal intensive care and special care nurseries provide a level of care that is both high in cost and low in volume. The aim of our study was to determine the rate of admission of term babies to neonatal intensive care in association with each method of giving birth among low‐risk women. Methods: We examined the records of 1,001,249 women who gave birth in Australia during 1999 to 2002 using data from the National Perinatal Data Collection. Among low‐risk women, we calculated the adjusted odds of admission to neonatal intensive care at term separated for each week of gestational age between 37 and 41 completed weeks. We also calculated the odds of admission to neonatal intensive care in association with cesarean section before or after the onset of labor, and vacuum or instrumental birth compared with unassisted vaginal birth at 40 weeks’ gestation. Results: The overall rate of admission to neonatal intensive care of term babies was 8.9 percent for primiparas and 6.3 percent for multiparas. After a cesarean section before the onset of labor, the adjusted odds of admission among low‐risk primiparas at 37 weeks’ gestation were 12.08 (99% CI 8.64–16.89); at 38 weeks, 7.49 (99% CI 5.54–10.11); and at 39 weeks, 2.80 (99% CI 2.02–3.88). At 41 weeks, the adjusted odds were not significantly higher than those at 40 weeks’ gestation. Among low‐risk multiparas who had a cesarean section before the onset of labor, the adjusted odds of admission to neonatal intensive care at 37 weeks’ gestation were 15.40 (99% CI 12.87–18.43); at 38 weeks, 12.13 (99% CI 10.37–14.19); and at 39 weeks, 5.09 (99% CI 4.31–6.00). At 41 weeks’ gestation, the adjusted odds of admission were significantly lower than those at 40 weeks (AOR 0.64, 99% CI 0.47–0.88). Babies born after any operative method of birth were at increased odds of being admitted to neonatal intensive care compared with those born after unassisted vaginal birth at 40 weeks’ gestation. Conclusions: The adjusted odds of admission to neonatal intensive care for babies of low‐risk women were increased after birth at 37 weeks’ gestation. In a climate of rising cesarean sections, this information is important to women who may be considering elective procedures. (BIRTH 34:4 December 2007)     

Significance of the ultrasound location of placental site in early pregnancy

The placenta was located by routine ultrasound scanning before 24 weeks gestation in 615 consecutive obstetric patients. A 'low lying' placenta was present in 175 (28 per cent) of the total group; the incidence decreasing from 32 per cent at 16 weeks gestation to 18 per cent at 24 weeks. Of 94 women with an initial 'low lying' placenta who were selected for rescanning, only five had a placenta praevia persisting beyond the 34th week. Patients with an early 'low lying' placenta had a significantly higher incidence of small-for-dates babies than those in whom the placenta remained clear of the internal cervical os on ultrasound scanning.     

Poor maternal weight gain between 28 and 32 weeks gestation may predict small-for-gestational-age infants

In a retrospective analysis of 158 women considered to have had normal, low-risk pregnancies, 30 gave birth to infants with a birthweight less than the 10th centile for gestation. These 30 women had a significantly poorer mean increase in weight (0.99 kg) between 28 and 32 weeks gestation than the other 128 women (1.95 kg) who gave birth to infants with birthweights above the 10th centile for gestation. There was no statistically significant difference in booking weight, overall weight gain or other variables associated with low birthweight between the two groups of women which suggests that poor maternal weight gain specifically between 28 and 32 weeks gestation may predict small-for-gestational-age infants.     

Poor maternal weight gain between 28 and 32 weeks gestation may predict small-for-gestational-age infants

Summary. In a retrospective analysis of 158 women considered to have had normal, low-risk pregnancies, 30 gave birth to infants with a birth-weight less than the 10th centile for gestation. These 30 women had a significantly poorer mean increase in weight (0·99 kg) between 28 and 32 weeks gestation than the other 128 women (1·95 kg) who gave birth to infants with birthweights above the 10th centile for gestation. There was no statistically significant difference in booking weight, overall weight gain or other variables associated with low birthweight between the two groups of women which suggests that poor maternal weight gain specifically between 28 and 32 weeks gestation may predict small-for-gestational-age infants.     

Prolonged rupture of the fetal membranes and neonatal outcome

In order to establish the incidence of neonatal infection following prolonged (greater than 24 hours) rupture of the fetal membranes (PROM) and assess outcome of two year retrospective study was undertaken. The names of all babies born following PROM were obtained from the computerised obstetric record and the bacteriological results and outcome reviewed. Of 208 babies born following PROM only three had blood cultures containing pathogens--all of whom were of less than 1500 g birthweight and all of whom died. This represents a fivefold increased frequency of infection for premature babies but no increased risk for full term babies. The overall incidence of infection was much lower than in previous series and this may be due to performing amniocentesis as soon as possible following rupture and inducing labour where there was evidence of incipient chorioamnionitis. Meningitis was not associated with prolonged rupture of the membranes. The mortality for these babies was higher than those of babies without PROM in the 28-31 week gestation group. This was strongly associated with early onset of membrane rupture and none of the babies born following membrane rupture prior to 20 weeks gestation survived. Non-infective pulmonary disease was the main cause of increased mortality.     

Successful treatment of immunologic abortion with low-dose intravenous immunoglobulin

OBJECTIVE: To evaluate the efficacy of low-dose intravenous immunoglobulin (IVIG) treatment in older women with immunologic abnormalities and recurrent spontaneous abortion (RSA), a condition referred to as immunologic abortion. DESIGN: Prospective clinical trial. SETTING: Outpatient referral practice. PATIENT(s): Forty-seven women were enrolled in the study. The mean age of the women was 37 years (range, 28-45 years), and the mean number of prior miscarriages was 3.7. Immunologic abnormalities included antiphospholipid antibodies (32%), antithyroid antibodies (53%), antinuclear antibodies (28%), antiovarian antibodies (2%), increased natural killer cells (40%), increased immunoglobulin (Ig)M level (28%), and increased CD4/CD8 T-cell ratio (15%). One patient had IgA deficiency, and three women had endometriosis. Thirty-one of the 47 patients (66%) had more than one immunologic abnormality. INTERVENTION(s): Treatment with IVIG at a dose of 0.2 g/kg within 2 weeks of attempted conception. Once conception was achieved, IVIG treatment was continued on a monthly basis at the same dose through 26-30 weeks of gestation. MAIN OUTCOME MEASURE(s): Successful pregnancy or recurrent abortion.Result(s): Of the 47 women, 36 received initial IVIG treatment, and 24 subsequently became pregnant. Of these women, 20 continued IVIG treatment through 26-30 weeks of gestation, and 19 (95%) had a successful term pregnancy. Four women discontinued IVIG therapy after 10-12 weeks of gestation, and 3 (75%) had a successful pregnancy outcome. Of the 11 women who refused IVIG therapy, 7 became pregnant, and all 7 miscarried. The difference in pregnancy success rate between the IVIG-treated and untreated groups was significant (P=.001). Three women had adverse reactions during the low-dose IVIG infusion, and these reactions resolved when the IVIG brand was changed. Fetal abnormalities were not observed. CONCLUSION(s): Low-dose IVIG therapy is beneficial for older women with immunologic abortion. The optimum duration of IVIG treatment in these women requires further study.     

Long-term outcomes for mothers who have or have not held their stillborn baby

Objectives

to investigate long-term outcomes of mothers who have or have not held their stillborn baby, and predictors of having held the baby.

Design

postal questionnaires.

Setting

a nation-wide cohort study of mothers who gave birth to a singleton stillborn baby in Sweden in 1991.

Participants

314 out of 380 women answered the questionnaire and 309 reported whether or not they had held their baby.

Measurements

scales measuring anxiety, depression and well-being.

Findings

126 (68%) mothers of 185 babies stillborn after 37 gestational weeks had held their baby and 82 (68%) mothers of 120 babies stillborn at gestational weeks 28–37 had also done so. Compared with mothers who agreed completely with the statement that staff gave enough support to hold the baby, mothers who did not agree were less likely to have held their baby [relative risk (RR) 4.1; 95% confidence interval (CI) 2.7–6.1], and mothers with a low level of education were less likely to have held their baby than mothers with a higher level of education (RR 2.2; 95% CI 1.3–3.8). Mothers who had not held their babies born after 37 gestational weeks had an increased risk of headache (RR 4.3; 95% CI 1.1–16.5), and they were less satisfied with their sleep (RR 2.7; 95% CI 1.5–5.0). The increased risk of long-term outcomes associated with not holding, compared with holding, a stillborn baby were less pronounced for women who gave birth at gestational week 28–37 compared with women who gave birth after 37 gestational weeks.

Key conclusions

in this cohort, we found an overall beneficial effect of having held a stillborn baby born after 37 gestational weeks, whereas findings for having held a stillborn baby born at gestational weeks 28–37 are uncertain. The attitude of staff influenced whether or not the mother held her stillborn baby.

Implications for practice

if the mother is guided by staff in a sensitive way to hold her stillborn term baby, the experience will possibly be beneficial for her in the long term.     

Maternal azathioprine therapy and depressed haemopoiesis in the babies of renal allograft patients

Maternal immunosuppression with azathioprine during pregnancy can depress fetal haemopoiesis resulting in neonatal thrombocytopenia and leucopenia with the potential for serious sequelae. The effect on the infant of adjusting azathioprine dosage on the basis of maternal total leucocyte count has been studied in 10 pregnancies in eight renal allograft recipients. Throughout the first six pregnancies azathioprine dosage was unchanged and although the characteristic pregnancy leucocytosis was evident it was not maintained in four patients whose leucocyte counts by 32 weeks gestation were significantly less than our norm [10.3 (SD 1.7) X 10(9)/1] and who subsequently had babies with cord leucocyte counts less than or equal to 8.0 X 10(9)/l, again significantly less than our norm [13.7 (SD 3.9) X 10(9)/l]. A significant correlation existed between maternal leucocyte counts at 32 weeks gestation and at delivery and cord leucocyte count (r = 0.847; P less than 0.01 and r = 0.915; P less than 0.01 respectively). Three of these infants had platelet counts less than or equal to 100 X 10(9)/l but there was no correlation between maternal platelet counts at 32 weeks gestation or at delivery and cord platelet count. For the next four pregnancies policy changed: at 32 weeks gestation azathioprine dosage was halved if maternal leucocyte count was at or below the 1SD band (8.6 X 10(9)/l) for normal pregnancy. All of the infants were haemotologically normal and two patients whose first babies had leucopenia and thrombocytopenia had second babies without problems. Analysis of data from all 10 pregnancies still demonstrated a significant correlation between cord leucocyte count and maternal leucocyte count at delivery but no longer at 32 weeks gestation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of coitus on recurrent preterm birth

OBJECTIVE: To estimate the impact of sexual behavior on the risk of recurrent spontaneous preterm birth at less than 37 weeks of gestation. METHODS: This is a secondary analysis of a multicenter, blinded observational study of endovaginal sonographic examinations performed at 16-18 weeks of gestation on 187 women with singleton gestations who were at high risk for recurrent spontaneous preterm birth (prior spontaneous preterm birth at < 32 weeks of gestation). At the time of enrollment, each woman was interviewed by a research nurse with regard to her sexual history. The patient was asked about the number of sexual partners in her lifetime, the number of sexual partners since the start of her pregnancy, and, on average, the frequency of intercourse per week in the preceding month. RESULTS: A total of 165 pregnancies were available for this analysis. The population incidence of spontaneous preterm birth at less than 37 weeks of gestation in the study pregnancy was 36%. An increasing number of sexual partners in a woman's lifetime was associated with an increased risk of spontaneous preterm delivery (one partner 19%, 2-3 partners 29%, >or= 4 partners 44%, P = .007), whereas the number of sexual partners since the start of pregnancy was not (P = .42). Women who reported infrequent sexual intercourse during early pregnancy had an incidence of recurrent spontaneous preterm birth of 28% compared with 38% in those women who reported some intercourse (P = .35). CONCLUSION: Self-reported coitus during early pregnancy was not associated with an increased risk of recurrent preterm delivery. There was an association between increasing number of sexual partners in a woman's lifetime and recurrent preterm delivery. LEVEL OF EVIDENCE: II-2.     

Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth

OBJECTIVE: To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. DESIGN: Multicentre prospective cohort study. SETTING: Ten European centres offering prenatal screening for toxoplasmosis. POPULATION: Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks. METHODS: Comparison of infected and uninfected births, adjusted for parity and country of birth. MAIN OUTCOME MEASURES: Differences in gestational age at birth, birthweight and birthweight centile. RESULTS: Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was -5.4 days (95% CI: -1.4, -9.4), and at 20 weeks or more, -2.6 days (95% CI: -0.5, -4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile. CONCLUSION: Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth.     

Analysis of fetal loss after transcervical chorionic villus sampling--a review of 719 patients

Chorionic villus sampling was performed under real-time ultrasonographic direction on a study group of 719 patients from September 9, 1985, through May 5, 1988. Follow-up of 714 of these patients who would have reached 28 weeks' gestation on September 1, 1988, revealed "an unintended" abortion rate of 4.1% by 20 weeks' gestation. Nine patients had a fetal loss less than 4 weeks after the procedure; 19 had losses up to 12 weeks after the procedure and before 20 weeks' gestation. This study revealed a significantly increased risk of fetal loss with an increase in the number of catheter insertions (p less than 0.001). The risk of fetal loss after one sampling attempt was 3%, 7.8% after two attempts, and 14.3% after three attempts.