Diploidy in second trimester prostaglandin E2 induced abortuses

Second trimester abortuses induced by prostaglandin E₂ were karyotyped. Twenty (11.9%) had chromosomal aberrations. These were diploid aberrations except for one case of double Y male. Twelve, however, were genetically balanced chromosomal rearrangements, and two had deletions of acrocentric G group chromosome short arms which should have no phenotypic effects. Only 5 cases out of 20 or 2.98% of 168 karyotyped could be classified as having serious chromosomal defects. These were all structural lesions, suggesting a shift from aneuploidy in first trimester abortuses to diploidy in second trimester induced abortuses. The decline In fetal deaths In the second trimester of pregnancy might therefore be associated not so much with a decline in the frequency of chromosomal aberrations but apparently with a limitation of the more extreme variations through selection and greater maturity.     

Comparison of the vaginal flora in sexually abused and nonabused girls

The presence of sexually transmitted pathogens in the vagina of the sexually abused girl may provide direct evidence of sexual abuse; the presence of other abnormal vaginal organisms may provide indirect evidence of abuse. To identify abnormal vaginal organisms, we prospectively studied the flora of 209 sexually abused girls (cases) and compared it with that in a concurrent control group of 108 girls. Case and control subjects were from the same community, were predominantly white, and 71% of each group were 3 to 10 years of age. The sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex virus) were isolated exclusively from the case group at a low frequency (less than 1%). The isolation of Mycoplasma species exclusively in the case group (4%), and of Gardnerella vaginalis in 7% of the case group versus 1% of the control group, suggests that both these organisms may be sexually transmitted. Other bacteria also were collectively more frequent in the case group (16% vs 6%). There may be an association between sexual activity and colonization of the lower genital tract in young girls.     

Must Macrosomic Fetuses be Delivered by a Caesarean Section? A Review of Outcome for 786 Babies ≥ 4,500 g

Because difficult vaginal delivery is more frequent with macrosomic fetuses, some writers recommend routine Caesarean section for the delivery of fetuses greater than or equal to 4,500 g. The purpose of this study was to evaluate the appropriateness of this recommendation. A retrospective review was undertaken to determine how many fetuses born in our hospital weighing greater than or equal to 4,500 g died or were permanently damaged as a consequence of mechanical difficulties at delivery. During a 10-year period, 590 (75%) of 786 cephalic babies weighing greater than or equal to 4,500 g and alive at the start of labour were born vaginally. No baby died or was permanently damaged as a consequence of mechanical difficulties at delivery. Routine Caesarean section for macrosomic fetuses to prevent death or damage from difficult delivery is not warranted by our results.     

Prospective Study of the Quality of Survival of Infants with Critical Fetal Reserve Detected by Antenatal Cardiotocography

From 1981 to 1986 antenatal cardiotocographic monitoring was performed on 9,992 high-risk pregnancies selected from a total obstetrical population of 31,518 patients (31.7%). A critical fetal reserve pattern was detected in 89 patients (0.9%) whose pregnancies resulted in 68 surviving infants, 19 perinatal deaths and 2 sudden infant deaths. Since 47.4% of the infants who died in the perinatal period did so because of a related congenital malformation, such a defect should be excluded in the fetus with critical fetal reserve, by ultrasonography, before delivery (there is usually insufficient time for fetal karyotyping). Sixty-three (92.6%) of the surviving children were assessed at our Growth and Developmental Clinic and disabilities were detected in 16 (25.4%); however, the disability was major in only 5, including 2 children with Down syndrome. The quality of survival of infants born from pregnancies complicated by critical fetal reserve was satisfactory as 60 of 63 children (95.2%) had neither a major disability related to intrauterine hypoxia identified by the cardiotocographic pattern, or had one likely to significantly interfere with their quality of life. Our results suggest that pregnancies can be continued until the cardiotocographic pattern becomes critical in order to gain fetal maturity, without compromise to the fetal brain.     

The selenium status of children with phenylketonuria: Results of selenium supplementation

The selenium status of children with phenylketonuria on a synthetic low phenylalanine diet was assessed. Correlation between blood selenium and red cell glutathione peroxidase was unsatisfactory ( r = 0.65) due to the poor discrimination of red cell glutathione peroxidase with a low selenium diet. No symptoms of deficiency were observed. Supplementation with 50 μg per week of selenium as brewers yeast tablets over a period of 6 months significantly increased the blood selenium of the phenylketonuric children. Plasma Vitamin E levels were within normal limits. The supplementation effectively doubled their selenium intake to 15–17 μg per day, which is probably sufficient for this group with an adequate Vitamin E status, though considerably lower than the recommended minimum intake of 50 μg per day.     

Systemic candidiasis and pneumonia in preterm infants

Twenty-two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis-like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5-flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short- and long-term outcome.     

Maternal determinants of birthweight in normal pregnancy

Partial and multiple regression analysis was performed to find out the correlation between birthweight and maternal anthropometric variables. Pearson regression analysis revealed significant dependence of birthweight on gestation of pregnancy, maternal weight, symphysis-sternal distance and height, but not on armspan and skin thickness. However, the only maternal variable bearing significant influence on birthweight in partial regression analysis was bodyweight. The effects of maternal determinants on birthweight, though some of them were statistically significant, were clinically unimportant.     

Perinatal Infection with listeria Monocytogenes

Summary: Listeria monocytogenes has been increasingly recognized as a cause of intrauterine sepsis with associated perinatal wastage. The condition is mostly acquired through dietary intake and appropriate advice should be given to all pregnant women. The most common presentations in pregnancy include premature labour, an influenza-like illness and reduced fetal movements.
In this report, we present a series of 24 cases of perinatal listeria infection presenting to either our obstetric or neonatal units and confirmed by the microbiology department of the hospital. In particular, we wish to highlight 3 cases in which antenatal diagnosis and aggressive therapy was associated with a successful outcome. Amongst the remaining 21 cases in which an antenatal diagnosis was not made, there were 5 perinatal deaths and 1 mid-trimester loss at 18 weeks.
Clinicians must maintain a high index of suspicion for listeria, particularly in gravid patients who present with fever in the setting of a persistent 'flu-like' illness and premature labour. Once suspected, appropriate specimens for listeria culture should include blood, cervical swabs and midstream urine. Empirical antibiotic therapy with amoxicillin should be instituted while waiting for culture results in patients with possible Listeria monocytogenes sepsis.     

The Prevalence and Timing of Obstetric Ultrasound in Victoria 1991–1992: a Population-based Study

Summary: A statewide study to ascertain the number of ultrasound scans received by women in pregnancy, to identify the proportion having a scan at 16 to 20 weeks' gestation, and to establish where the scan at 16 to 20 weeks was performed was carried out between January, 1991 and June, 1992 in Victoria. Additional data were collected by midwives and entered on the perinatal morbidity statistics form routinely completed for all births. Of 52,319 women providing responses, 3.1% did not have a scan. Of the remaining 96.9% who had a scan, 73.5% were scanned at 16 to 20 weeks'gestation. Predictors of not having a scan were maternal birthplace and higher parity: previous perinatal death(s), and attendance at nonteaching hospitals predicted the opposite. Predictors of being scanned were location of hospital (country), maternal birthplace, higher parity and maternal age (< 20 years). Substantial differences in frequency and timing were found between hospitals attended. Factors associated with the pattern of scanning are not readily explicable in terms of risk of malformations or women's choices.