Functional urinary tract obstruction developing in fetuses with isolated gastroschisis

OBJECTIVE

To evaluate the frequency and natural history of urinary tract abnormalities developing in fetuses presenting with initially isolated gastroschisis.

METHODS

Serial ultrasounds were performed prospectively on fetuses identified by our prenatal diagnosis program as having a gastroschisis. When abnormalities in the urinary tract were identified prenatally, newborns were evaluated by a pediatric urologist.

RESULTS

Over a 1-year period four out of 12 fetuses with gastroschisis developed deformations of the urinary tract. In three fetuses the bladder herniated through the abdominal wall defect. Two also had upper tract dilatation. A fourth fetus developed bilateral hydronephrosis with a normally situated bladder. Once the gastroschisis was repaired none of the newborns had evidence of structural obstruction of the urinary tract, however, hydronephrosis with or without reflux persisted for several months.

CONCLUSIONS

Deformations of the fetal urinary tract can develop secondary to gastroschisis. They do not appear to represent separate malformations and evaluation with fetal karyotyping may not be indicated. When hydronephrosis is present ongoing urologic evaluation of the neonate is indicated.

Counseling prenatal diagnosis patients: the role of the social worker

In the 1990s, new techniques and therapies for fetal problems continue to develop. Prenatal technology now provides information regarding unborn children which can sometimes be negative. This paper addresses the counseling techniques and therapeutic approaches perinatal social workers can use when dealing with parents who are confronted by hard choices regarding their pregnancies.

Ease and accuracy of evaluation of fetal hands during obstetrical ultrasonography: a prospective study

Hand malformations characterize many congenital syndromes, including mendelian disorders, skeletal dysplasias, and karyotype abnormalities. Although identification of a hand anomaly alters obstetrical management, evaluation of the fetal hands is not included in current ultrasonographic guidelines. We prospectively studied the utility of allotting up to 5 min to examine fetal hands during obstetrical ultrasonography. Both hands were visualized in 87% of patients (188 of 215). Eight hand abnormalities were present at delivery. Six had been identified antenatally, four during the study with ultrasonography. There were no false positives. Four fetuses with hand malformations were aneuploid. Fetal hands should be examined during a comprehensive obstetrical sonographic evaluation, especially when risk factors for aneuploidy are present.

The eighth-month fetus: classical sources for a modern superstition

Among obstetric patients from diverse backgrounds, we found a superstition that the prognosis for preterm infants born at eight months' gestation is poorer than for those born at seven months. After several women on a high-risk inpatient unit spontaneously expressed fears caused by this belief, we investigated its origin. A treatise attributed to Hippocrates is devoted to the idea, which appears to have been current in the Greek world by the fifth century BC. The doctrine was elaborately developed by subsequent Greek physicians and philosophers. It appears in the Talmud and in medieval texts, as well as in early modern medical writings. The unquestioning citation of a dogma of the Ancients until modern times is a common phenomenon in medical history. The persistence of this ancient scientific doctrine as an "old wives' tale" causing inappropriate patient anxiety makes it interesting to the modern obstetrician.

The blood pressure course in primiparous pregnancy. A prospective study of 383 women

Left lateral recumbent blood pressures were studied throughout pregnancy in all nulliparous women presenting for prenatal care at a single outpatient clinic. Six percent of these women developed preeclampsia. The incidence of preeclampsia was markedly higher among teens (13.6%). Diastolic blood pressure among normal women declined by less than 5 mm Hg from the first trimester to midgestation. During the third trimester the diastolic pressure returned to first-trimester levels. No significant difference was detected in the first- and early-second-trimester group mean blood pressure between normals and women later developing preeclampsia. However, by 25-28 weeks, before the onset of overt preeclampsia, blood pressures were significantly higher among preeclamptics.

Retrospective comparison of blood pressure course during preeclamptic and matched control pregnancies

A decrease in systemic blood pressure by midtrimester of normal pregnancy has been observed by many investigators. To examine the timing of onset of this decline and to study early behavior of blood pressure in pregnancies complicated by preeclampsia, we reviewed the outpatient charts of all patients with preeclampsia who received prenatal care at our clinics during the past 3 years. The 30 patients who met our criteria for preeclampsia were matched for age, race, and parity with normotensive control subjects. We found that in normal pregnancies, decline in blood pressure occurred before the second trimester and blood pressure remained low throughout gestation, rising insignificantly near term. Both systolic and diastolic blood pressures were significantly higher (p less than 0.05) for patients with preeclampsia than for normal control subjects beginning in the first trimester. This difference persisted throughout pregnancy and was also present at the 6-week postpartum visit (p less than 0.025).

Hermansky-Pudlak syndrome in pregnancy: two case studies

Pregnancies in two patients with Hermansky-Pudlak syndrome, oculocutaneous albinism with hemorrhagic diathesis, are presented. Outcomes were good despite prior reports of postpartum hemorrhage in patients with this syndrome. This autosomal recessive disease is relatively common in parts of Puerto Rico. Suspected patients should be screened with platelet aggregation studies.