Clinical chorioamnionitis is not predicted by umbilical artery Doppler velocimetry in patients with premature rupture of membranes

Chorioamnionitis substantially increases fetal and neonatal morbidity. Infants born to women with chorioamnionitis have a fourfold increase in neonatal morbidity. If this condition could be predicted before the clinical manifestation and thereby treated earlier, an improved perinatal outcome might reasonably be expected. Based on the in vitro model of bacteria-induced vasoconstriction and pulmonary hypertension noted in sheep and lambs after exposure to the spent medium of a bacterial culture, we theorized that infected amniotic fluid may produce vasospasm of umbilical and placental vessels, reduce fetal perfusion, and increase perinatal asphyxia, morbidity, and mortality. Umbilical vessel vasospasm may be detected by measuring the systolic-diastolic ratio (S/D) of the umbilical artery. Continuous Doppler flow studies of the umbilical artery S/D were performed prospectively on 51 patients with premature rupture of membranes who were not in labor. The most recent test, done within 1 day of delivery, was compared with pregnancy outcome. Ten subjects developed clinical chorioamnionitis, of whom none had an abnormal S/D. Six of 41 women without clinical chorioamnionitis had abnormal S/Ds. These data do not support the use of Doppler measurement of the S/D as a predictor of clinical chorioamnionitis.

Prenatal ultrasonographic fetal iliac bone measurement. Correlation with gestational age

The variety of circumstances under which ultrasound examinations are performed makes fetal iliac bone measurement an important indicator of gestational age. We studied 322 well-dated pregnancies from 13 to 40 weeks' gestation with sonogram measurements of the fetal iliac bone in order to examine the relationship between gestational age and bone length. The results indicate a linear relationship, as described by the equation iliac length = -0.376 + (0.0887) (gestational age). The fit of the data to a straight line was quite close (R2 = .877, P = .0001). The data were used to obtain a nomogram for growth of the fetal iliac bone.

Crouzon syndrome: prenatal ultrasound diagnosis by binocular diameters

This is a report of second-trimester prenatal diagnosis of Crouzon syndrome suggested by binocular and interorbital diameter measurement and family history. Early prenatal diagnosis provides the option of termination or optimal postnatal management for families who choose to continue the pregnancy.

Factors affecting perinatal mortality in an urban center

In the Division of Obstetrics of the Statewide Perinatal Center, Newark, NJ, the rate of perinatal mortality fell from 51 in 1000, to 15 in 1000, between 1971 and 1986, and increased thereafter to 28 in 1000 by 1988. This development is analyzed against the background of changes in the environment and inside the Center. It is noted that during 2 study years (1983 and 1986) in our extremely high-risk patient population, the perinatal mortality rate was kept at, or under, the national average. It appears, therefore, that with well-coordinated management and optimum use of resources, marked nationwide differences in mortality rates between white and non-white populations can be greatly reduced or eliminated. An inverse relationship between the rates of caesarean section and perinatal mortality was documented, as the former increased from 4.5% to 17%. Paradoxically, a further increase of caesarean section rates was accompanied by a parallel increase of intrauterine fetal and neonatal losses.

[Current trends in perinatal mortality statistics at the New Jersey Obstetric Center]

The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.

Prenatal diagnosis of fetal renal mesoblastic nephroma

A rare case of fetal renal mesoblastic nephroma diagnosed prenatally by ultrasonography is presented.

Prenatal diagnosis of occipital encephalocele

Two cases of occipital encephalocele diagnosed late in pregnancy are presented. Early diagnosis of this problem is possible. Parents might elect to terminate pregnancy as the outcome is invariably dismal.