Maternal serum alpha-fetoprotein in twin pregnancy.

Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 138 twin pregnancies. All patients had at least one ultrasonographic examination (86% before 20 weeks' gestation). Two pregnancies were discordant for open fetal defects (one anencephaly, one gastroschisis). The median serum alpha-fetoprotein value in the remaining 136 twin pregnancies paralleled a curve 2.5 times the median curve for singleton pregnancies over the gestational range studied. Higher serum alpha-fetoprotein values correlated significantly with increasing incidence of fetal and neonatal death, premature delivery (less than 35 weeks' gestation), and twin-to-twin birth discordance (greater than 20%), most pronounced at greater than 4 multiples of the singleton median level. A significant negative correlation between alpha-fetoprotein and birth weight was observed (p less than 0.001), but was related more to prematurity than to poor fetal growth. Theoretically, serum alpha-fetoprotein screening detected 56.5% of the twins in this study when a cutoff level of 2.5 multiples of the median was used, enhancing twin detection in the study population by 40%. These data indicate that maternal serum alpha-fetoprotein screening has a valuable role in the management of twin pregnancy, both in the detection of twins and in the prediction of perinatal outcome in twin pregnancy.     

Severe anti-C hemolytic disease of the newborn.

OBJECTIVE: Because of referral of a C-alloimmunized pregnant woman with a previous hydropic death whose fetus survived after four intraperitoneal transfusions, prevalence and severity of anti-C hemolytic disease of the newborn were investigated. STUDY DESIGN: The numbers of C- or Ce-alloimmunized pregnancies in Manitoban women and their outcome for the 28-year period ending Oct. 31, 1990, were reviewed. The literature relating to C or Ce alloimmunization from 1944 to 1990 was surveyed. RESULTS: In Manitoba for the period reviewed there were 120 pregnancies in 80 C- or Ce-alloimmunized women. Twenty-two ended in abortion and two in fetal death unrelated to anti-C or anti-Ce. Of the remaining 96, 33 fetuses of 32 pregnancies were affected but only eight (6.7%) required treatment after birth. None were severely affected. In the literature there are only three other reported deaths from C or Ce hemolytic disease; two of the three may have been the same patient. The prevalence of C or Ce alloimmunization reported in various series, including our own, ranged from 8.7 to 185 per 100,000 pregnancies. CONCLUSIONS: Because on rare occasions, C or Ce alloimmunization can cause severe hemolytic disease, criteria for investigative measures such as amniocentesis or cordocentesis do not differ from the criteria for instituting these measures in Rho (D)-alloimmunized pregnancies.     

Postnatal development of enzyme activities associated with protection against oxidative stress in the mouse

A number of enzyme systems are important in the protection of cells from chemical-induced oxidative damage. Little is known of the relative importance of these enzymes during postnatal development and its is possible that changes in their activity during this period may alter the susceptibility to toxic agents. This study investigated the activities of glutathione peroxidase, glutathione reductase, catalase, superoxide dismutase, gamma-glutamyl-cysteine synthetase and glutathione synthetase in the liver, lung and kidney of postnatal and adult mice. The first 3 postnatal weeks are characterized by marked changes in the activities of enzymes that protect against oxidative stress (glutathione peroxidase/reductase, catalase and superoxide dismutase). Overall, the activity of these enzymes suggests that the mouse has a higher level of protection against peroxides at various stages during this period but lower capacity to detoxify superoxide anions. The activities of the glutathione-synthetic enzymes (gamma-glutamylcysteine synthetase and glutathione synthetase) were significantly lower in the kidney of the postnatal mice, but the liver and lung had levels similar to those in the adult. Glutathione turnover in the liver of 2-week-old mice was not different from that in adults. The results indicate a complex pattern of development in the activities of detoxification enzyme systems during postnatal development.     

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.     

Fetal assessment based on fetal biophysical profile scoring. III. Positive predictive accuracy of the very abnormal test (biophysical profile score = 0)

The relationship between complete absence of all components of the fetal biophysical profile score (biophysical profile score = 0) and adverse perinatal outcome was examined. Twenty-nine of 28,655 fetuses studied (0.092%) had a last biophysical profile score of 0; 48.3% of these perinates died (14 of 29 fetuses), the majority of whom (11 of 14) were stillborn, with death occurring as early as 30 minutes to as long as 11 days after the last test. Three asphyxia-related neonatal deaths occurred despite aggressive and immediate intervention. All survivors exhibited at least one of the five discrete markers used to assess perinatal morbidity. The positive predictive accuracy of a biophysical profile score of 0, with mortality and morbidity used as end points, was 100%. These data indicate the very abnormal fetal biophysical profile score to be a perinatal emergency.     

Biophysical profile scoring in the management of the postterm pregnancy: an analysis of 307 patients

Management and outcome were reviewed in 307 consecutive postterm pregnancies assessed by biophysical profile scoring. Twice-weekly scores accurately differentiated normal fetuses from those at risk for intrauterine hypoxia. When the profile score is normal, waiting for spontaneous labor results in healthy neonates and a much lower cesarean section rate (15% versus 42% for "prophylactic" induction). Confident conservative management of postterm pregnancy is possible.     

A randomized,double-blind comparison of single-dose and divided multiple-dose dolasetron for cisplatin-induced emesis

 Purpose: Intravenous dolasetron has been shown to be an effective antiemetic agent in patients receiving high-dose cisplatin-containing chemotherapy. Previous studies have suggested that 1.8 mg/kg is an optimal dose for achieving control of emesis and nausea. The objective of this study was to compare the efficacy and safety of a single intravenous (IV) dose of dolasetron with an equal divided multiple dose. Methods: In this randomized, double-blind, parallel-group, multicenter study, the efficacy and safety of a single 1.8-mg/kg dose of dolasetron given 30 min prior to high-dose cisplatin (≥80 mg/m²) chemotherapy was compared with the same total amount of dolasetron administered in three separate doses (0.6 mg/kg each) over a 12-h interval commencing 30 min prior to beginning chemotherapy and ending 11.5 h later. Antiemetic efficacy, safety, and tolerability were compared in 55 patients with various malignancies during the 24 h following the initiation of chemotherapy. The number of emetic episodes was the primary efficacy parameter. Results: A single IV dose of dolasetron was generally more effective than a multiple-dose regimen in all measures of efficacy. There was a larger proportion of complete responders in the single-dose group compared with the multiple-dose group (48% vs 23%), although this difference did not reach statistical significance. Compared with the multiple-dose group, patients who received a single dose of dolasetron had a significantly (P=0.034) longer median time to the first emetic episode (10.1 h vs >24 h, respectively). Overall, 53% of patients had either a complete response or a major response to dolasetron, and only 40% of the total patient population received escape antiemetic medication in the 24 h after cisplatin administration. Except for headache, adverse events were similar with both regimens and were generally of mild or moderate intensity; no serious adverse events occurred. Neither dolasetron treatment regimen was associated with any clinically important events, trends in laboratory variables, or differences in safety profile. Conclusions: single-dose dolasetron was well tolerated and effectively controlled emesis and nausea in patients who received highly emetogenic, high-dose cisplatin chemotherapy. The greater antiemetic efficacy of a single prophylactic dose of dolasetron offers both convenience and potential cost savings, compared with a multiple-dose schedule of administration. Received: 31 March 1995/Accepted: 20 October 1995     

Successful pregnancy in an ovulating recipient following the transfer of two frozen-thawed embryos obtained from anonymously donated oocytes

A fertile woman suffering from mild dystrophia myotonica had undergone sterilization because of the 50% genetic risk of this disease developing in her offspring. In her second treatment cycle on the donor oocyte program, four anonymously donated oocytes were inseminated with frozen-thawed sperm of her husband. Three embryos were obtained and two surviving embryos were deep-frozen at the eight-cell stage and kept in storage for 9 months. These embryos were successfully thawed and transferred to the recipient 97 hr after the onset of her luteinizing hormone surge. A normal singleton pregnancy developed and a healthy male infant was delivered by cesarean section at 36 weeks of gestation.