Menstrual Weeks Research Articles

Tocolytic therapy in conservative management of symptomatic placenta previa

Objectives: To study the effect of ritodrine therapy on maternal and perinatal outcome in cases of symptomatic placenta previa being managed conservatively. Methods: A prospective, randomized controlled clinical trial was made of a total of 60 women whose pregnancies ranged from 28 through 34 menstrual weeks who were randomly allocated to the two study groups using Tippet's random number table. Of these women, 30 were included in the study group where tocolysis with ritodrine was given whereas the other 30 in the control group did not receive tocolysis. Prolongation of pregnancy and birth weight of the newborn were evaluated. The unpaired t-test and chi-square test were used for statistical analysis. Results: Use of tocolysis in symptomatic placenta previa was associated with significant prolongation of pregnancy (25.33 vs. 14.47 days, P<0.05) and difference in birth weight (2270 g vs. 1950 g, P<0.05). There was no observed statistical difference between the two groups with regard to number of episodes of hemorrhage after admission, total amount of blood loss during stay in hospital, number of blood transfusions and maternal complications due to tocolysis in the study group. Conclusions: The present prospective study suggests that ritodrine hydrochloride in patients with symptomatic placenta previa tends to prolong the pregnancy and result in an increase in birth weight of the babies without causing any adverse effect on the mother and fetus.

P197: Fractional thigh volume: a new soft tissue parameter for fetal growth assessment

Previous attempts to quantify fetal soft tissue by conventional sonography have been difficult. Fractional thigh volume measurements, obtained by three-dimensional ultrasonography (3DUS) were evaluated for this purpose, using Individualized Growth Assessment (IGA). Longitudinal sonographic studies of normal fetuses were performed to obtain standard biometry and fractional thigh volumes. Fractional thigh volumes were based on 50 percent of the femoral diaphysis length. Start points, the theoretical age at which an anatomical parameter can first be identified, were calculated from linear functions relating the cube root of fractional limb volume to menstrual age prior to 28.5 weeks'. Regression analysis was used to fit Rossavik functions (P = c(t) k + s(t), where P is the anatomic parameter, t is menstrual minus start point, and c, k, s are model coefficients) to individual growth trajectory data. Rossavik models specified from the linear slopes of growth curves before 28.5 weeks were used to predict TVol during the third trimester and at birth. Neonatal growth status was determined from anatomic measurements and 3DUS within 48 hours of delivery. 22 fetuses (14 females, 8 males) were prospectively studied between 17.4 and 39.3 weeks, menstrual age. The mean birthweight was 3296 ± 253 (SD) grams. All neonates had normal modified Neonatal Growth Assessment Scores. The mean start point (9.0 ± 1.4 weeks') was consistent with completion of thigh development at 8.5 weeks', determined from embryological studies. Rossavik models fit the TVol trajectories very well (mean R2 = 99.8 ± 0.2). By fixing the k coefficient at its mean (2.976), the fit did not change and the variabilities of coefficients c and s were reduced. The mean percent deviation between observed and predicted TVol measurements was − 0.048 ± 7.5% (n = 72) during the third trimester. Neonatal TVol measurements in 12 infants, corrected for systematic error (− 16.7%) led to an averaged signed deviation of − 1.8 ± 9.2% from predicted values. IGA standards for fractional thigh volume provide a new approach for characterizing soft tissue growth. Normal growth trajectories and neonatal soft tissue volume can be accurately predicted from growth models specified by fractional thigh volume data obtained before 28.5 menstrual weeks. The normal variability for these predicted TVol measurements is about one-third of what has been reported for fetal thigh circumference. This parameter may allow earlier detection and improved monitoring of fetuses with soft tissue abnormalities such as IUGR and macrosomia.

Early surgical abortion: Efficacy and safety

Objective: Because of concern over the higher rates of failed abortion, many clinicians defer surgical abortion until 7 menstrual weeks or later. We conducted this study to evaluate the efficacy and safety of early surgical abortions that are performed by numerous physicians in a community-based setting. Study Design: We prospectively gathered data on all eligible patients who had surgical abortions at <6 weeks of gestation at 3 Planned Parenthood clinics from January 1, 1998, to August 31, 2000. Outcomes were evaluated with the use of proportions with 95% CI and χ2 analysis. Results: A total of 1132 women had early surgical abortions during the study interval, and follow-up was available for 750 of those women (66%). Seventeen women (2.3%; 95% CI, 1.4%, 3.7%) had failed attempted abortions. Other complications occurred in 13 women. Conclusion: Early surgical abortion is safe and effective. In this series, the frequency of complications that required curettage was similar to that reported with mifepristone and vaginal misoprostol. (Am J Obstet Gynecol 2002;187:407-11.)

A diagnostic approach for the evaluation of spina bifida by three-dimensional ultrasonography.

To describe a prenatal diagnostic method for evaluating spina bifida by three-dimensional ultrasonography. Two- and three-dimensional ultrasonography were used to determine the extent of vertebral defects among fetuses with spina bifida. Spinal levels were independently counted from the most caudal thoracic vertebra with a rib (e.g., 12th thoracic rib). A virtual cutting plane was manipulated through a volume-rendered spine to generate optimal multiplanar views for this blinded analysis. Prenatal diagnosis was compared with a postnatal analysis of bony spine defects derived from radiographic films or magnetic resonance imaging. Nine fetuses were examined by two-dimensional ultrasonography (21.8 +/- 3.4 menstrual weeks) and three-dimensional ultrasonography (22.8 +/- 4.4 menstrual weeks). For two-dimensional ultrasonography, the spinal level agreed to within 1 vertebral segment in 6 of 9 infants. In contrast, three-dimensional ultrasonography agreed to within 1 vertebral segment in 8 of 9 infants. Three fetuses had vertebral defect levels on two-dimensional ultrasonography that were 1.5 to 2 segments away from postnatal findings. The same fetuses had results that were within 1 vertebral segment on three-dimensional ultrasonography. Volume rendering showed splayed vertebral pedicles and disrupted vertebrae. An intact meningeal sac was easily rendered in 5 of 9 subjects. Multiplanar views are generally more informative than rendered views for localizing bony defects of the fetal spine. The level of the defect on three-dimensional ultrasonography correlates well with those on two-dimensional ultrasonography and postnatal imaging studies. This approach may improve characterization of spina bifida by adding diagnostic information that is complementary to the initial assessment by two-dimensional ultrasonography.

Uterine artery hemodynamic adaptations through the menstrual cycle into early pregnancy

OBJECTIVE: To estimate the time course of human uterine artery vascular adaptation through the menstrual cycle into early pregnancy. METHODS: We prospectively measured the uterine artery pulsatility index, peak systolic velocity, and volumetric blood flow during the menstrual cycle and at 4, 6, and 12 weeks of pregnancy in women who conceived. Upper extremity radial artery hemodynamic changes were examined as a control vessel. Ten subjects conceived within 12 months of menstrual cycle studies. Analyses were performed using repeated measures analysis of variance with P < .05 accepted for significance. RESULTS: In women who conceived, uterine artery peak systolic velocity demonstrated a significant increase during the period of observation, which began after cycle day 10 (0.36 × 0.02 meters per second) of the menstrual cycle and continued though 12 menstrual weeks (1.05 ± 0.10 meters per second, P < .001). Uterine artery pulsatility index decreased significantly during the observation window from 3.0 ± 0.2 in the follicular phase to 1.6 ± 0.2 at 12 menstrual weeks ( P < .001). Blood flow in the uterine artery increased significantly from cycle day 10 (22.2 ± 1.8 mL per minute) to 12 menstrual weeks’ gestation (150.2 ± 40.3 mL per minute, P < .001). These patterns were significantly different from the patterns observed for the radial artery. CONCLUSION: Uterine artery hemodynamic adaptation in early pregnancy follows a continuum established during the menstrual cycle. These adaptations result in decreased uterine artery impedance and increased blood flow. These changes differ from those observed in the upper extremity radial artery (control vessel) suggesting independence of regional pelvic and systemic hemodynamic adaptations.

Predictors of Subsequent Surgery for Uterine Leiomyomata After Abdominal Myomectomy

In Brief OBJECTIVE To study factors associated with an increased risk of subsequent surgery in a cohort of women undergoing abdominal myomectomy. METHODS We followed 65 women undergoing abdominal myomectomy performed by the same experienced surgeon for a mean of 83.6 ± 35.0 months to assess the occurrence of both laparotomies and minimally invasive surgeries for uterine leiomyomas. Surgical and pathologic variables from the initial myomectomy as well as information on sociodemographic and anthropometric variables collected during a subsequent survey were correlated with the need for further surgery. RESULTS Women with uterine size greater than 12 menstrual weeks had a substantially reduced risk of undergoing a second surgery (multivariate hazard ratio 0.1, 95% confidence interval 0.01, 0.4) compared with women having smaller uteri. Weight gain in excess of 30 pounds since age 18, relative to weight gain of 10 or fewer pounds is also associated with an increased risk of recurrent surgery (multivariate hazard ratio 4.8, 95% confidence interval 1.2, 18.5). CONCLUSION Women with uterine size less than 12 menstrual weeks at the time of abdominal myomectomy may be at increased risk of second surgery. Weight gain after age 18 may also modify the risk of recurrent surgery. These changes may be related to the pathogenic mechanisms underlying myoma formation and growth. The risk of subsequent surgery is significantly decreased in women with larger uteri or a larger dominant fibroid at the time of initial abdominal myomectomy.

Predictors of subsequent surgery for uterine leiomyomata after abdominal myomectomy.

To study factors associated with an increased risk of subsequent surgery in a cohort of women undergoing abdominal myomectomy. We followed 65 women undergoing abdominal myomectomy performed by the same experienced surgeon for a mean of 83.6 +/- 35.0 months to assess the occurrence of both laparotomies and minimally invasive surgeries for uterine leiomyomas. Surgical and pathologic variables from the initial myomectomy as well as information on sociodemographic and anthropometric variables collected during a subsequent survey were correlated with the need for further surgery. Women with uterine size greater than 12 menstrual weeks had a substantially reduced risk of undergoing a second surgery (multivariate hazard ratio 0.1, 95% confidence interval 0.01, 0.4) compared with women having smaller uteri. Weight gain in excess of 30 pounds since age 18, relative to weight gain of 10 or fewer pounds is also associated with an increased risk of recurrent surgery (multivariate hazard ratio 4.8, 95% confidence interval 1.2, 18.5). Women with uterine size less than 12 menstrual weeks at the time of abdominal myomectomy may be at increased risk of second surgery. Weight gain after age 18 may also modify the risk of recurrent surgery. These changes may be related to the pathogenic mechanisms underlying myoma formation and growth.

Laminaria, induced fetal demise and misoprostol in late abortion

Objectives: To analyze and determine the safety and effectiveness of induced fetal demise as an adjunctive method in outpatient abortion for patients with advanced pregnancies and to evaluate the independent effect of intrauterine misoprostol administered after amniotomy in late abortion. Methods: During a 9-year period, 1677 abortions were performed for patients whose pregnancies ranged from 18 through 34 menstrual weeks in an outpatient facility. Of these, 832 were performed by one physician. Techniques for performing all the abortions included induction of fetal demise by intrauterine fetal injection of digoxin and/or hyperosmolar urea, serial multiple laminaria treatment of the cervix, amniotomy, oxytocin induction of labor, and assisted delivery or surgical evacuation of the fetus and placenta. In the last 411 of the 832 patients whose abortions were performed by one physician, misoprostol was placed in the lower uterine segment following amniotomy in order to enhance labor induction, cervical ripening, and fetal expulsion. Results: Of the entire group of 1677 cases, the median gestational age was 22 menstrual weeks. The median procedure time for all cases was 10 min. Measured median blood loss was 125 ml. Blood loss and procedure time increased with length of gestation, but these were not affected by misoprostol. There were three major complications (0.2%) in the overall series. Among patients seen by one physician ( N=832), amniotomy-to-procedure time was shorter by 26 min for patients receiving misoprostol, and there was 27% more variability in amniotomy-to-procedure time among patients not receiving misoprostol. Complication rates for patients receiving misoprostol were the same as for those not receiving misoprostol. There were no major complications in the 832 patients seen by one physician, no uterine rupture or perforations, and no cervical lacerations. Conclusions: Outpatient abortion may be performed safely from 18 through 34 menstrual weeks using combined surgical and medical procedures. Use of intrauterine post-amniotomy misoprostol was associated with reduced amniotomy-to-procedure time and reduced variability in the amniotomy-to-procedure time.

Plasma volume expansion in early pregnancy

Objective: To determine the time course of plasma volume expansion in early pregnancy. Methods: We prospectively measured plasma volume by Evans blue dye dilution during the menstrual (cycle day 2–3), follicular (cycle day 9–10), and luteal phases (cycle day urinary leutinizing hormone [LH] surge plus 9–10) of the menstrual cycle and at three additional time points (LH surge + 16 days, LH surge + 28 days, and LH surge + 70 days) in women achieving pregnancy. Twenty-one subjects were examined during 38 menstrual cycles to establish baseline menstrual cycle data. Ten subjects conceived within 1 year of menstrual cycle studies. All ten pregnancies were viable and reached the third trimester. Analyses used repeated-measures analysis of variance with P < .05 accepted for significance. Results: Mean plasma volume was found to change significantly across the period of observation ( P < .008) in those who conceived. Plasma volume at LH surge + 70 days (12 menstrual weeks, 2320 ± 280 mL) was greater than either menstrual cycle estimates or early pregnancy estimates of plasma volume. There was no difference in plasma volume at LH surge + 16 days (2077 ± 288 mL) or LH surge + 28 days (2010 ± 271 mL) compared with menstrual cycle measurements during the menstrual phase (2156 ± 292 mL), follicular phase (2036 ± 280 mL), and luteal phase (2120 ± 425 mL). There was no significant difference between those who conceived and those who did not in their mean menstrual cycle plasma volume. Conclusion: Plasma volume expansion in early human pregnancy cannot be identified until after the sixth menstrual week. By 12 menstrual weeks, plasma volume has expanded by approximately 14% ± 12% (mean ± SD) over follicular phase measurements.

Plasma Volume Expansion in Early Pregnancy

In Brief Objective To determine the time course of plasma volume expansion in early pregnancy. Methods We prospectively measured plasma volume by Evans blue dye dilution during the menstrual (cycle day 2–3), follicular (cycle day 9–10), and luteal phases (cycle day urinary leutinizing hormone [LH] surge plus 9–10) of the menstrual cycle and at three additional time points (LH surge + 16 days, LH surge + 28 days, and LH surge + 70 days) in women achieving pregnancy. Twenty-one subjects were examined during 38 menstrual cycles to establish baseline menstrual cycle data. Ten subjects conceived within 1 year of menstrual cycle studies. All ten pregnancies were viable and reached the third trimester. Analyses used repeated-measures analysis of variance with P < .05 accepted for significance. Results Mean plasma volume was found to change significantly across the period of observation (P < .008) in those who conceived. Plasma volume at LH surge + 70 days (12 menstrual weeks, 2320 ± 280 mL) was greater than either menstrual cycle estimates or early pregnancy estimates of plasma volume. There was no difference in plasma volume at LH surge + 16 days (2077 ± 288 mL) or LH surge + 28 days (2010 ± 271 mL) compared with menstrual cycle measurements during the menstrual phase (2156 ± 292 mL), follicular phase (2036 ± 280 mL), and luteal phase (2120 ± 425 mL). There was no significant difference between those who conceived and those who did not in their mean menstrual cycle plasma volume. Conclusion Plasma volume expansion in early human pregnancy cannot be identified until after the sixth menstrual week. By 12 menstrual weeks, plasma volume has expanded by approximately 14% ± 12% (mean ± SD) over follicular phase measurements. Plasma volume expansion in pregnancy can be detected 12 weeks after the last menstrual period but not at 6 weeks.

F117Hystero‐embryoscopic findings in early nonviable pregnancies

BackgroundA high proportion of early pregnancy losses are associated to abnormal embryo development. However, chromosomal analysis of routine curettage samples are of limited value; and histopathological examinations of the embryos are rarely performed in clinical practice.MethodA transcervical hystero‐embryoscopy was performed prior to the curettage in 31 nonviable first‐trimester pregnancies and a control group of 5 early terminations of pregnancy. In the study group, the estimated gestational age according to the ultrasound findings was 6.7 (4–9) menstrual weeks. Direct biopsies of different gestational structures were taken during the endoscopic procedure.ResultsIn nonviable pregnancies, focal haemorrhagic/necrotic changes were present in the decidua capsularis. The collapse of the gestational sac was variable. Most chorionic villi had an oedematous appearance. Degenerative changes of the embryo and yolk sac were not uniform. The following gestational anomalies were identified: partial moles (n = 2), structural abnormal embryos (n = 4), umbilical cord cysts (n = 3) and abnormal yolk sacs (n = 2). Chromosomal analysis of selective chorionic and embryo biopsies identified a misdiagnosis of the curettage sample result in 8 cases.ConclusionHystero‐embryoscopy offers great potential for evaluating early nonviable pregnancies. Accurate karyotypes can be obtained from direct chorionic and embryo biopsies.

Prenatal ages and stages-measures and errors.

The confusing term "gestational age" is generally either not defined or is used for menstrual "age," postovulatory age, or postfertilizational age. The designation (post)menstrual weeks and/or days is very useful in obstetrics but, because prenatal age extends from fertilization to birth, menstrual "age" is a misnomer. The term "stage" has a specific morphological meaning in embryology and should not be used either for ages or for lengths. Embryonic age is best assessed, when possible, from the 23 internationally recognized morphological stages. A morphological staging system is not available for the fetal period, and fetal age is assessed mainly from measurements. Among these, the unsatisfactory designation crown-rump length (CRL) should be replaced, in ultrasonic biometry as well as in embryology, by the greatest length (GL), exclusive of the lower limbs. These points are discussed in detail, and justification for the views expressed is provided. The continuing confusion concerning prenatal age is shown to be unnecessary once the ambiguous and superfluous term "gestational age" is abandoned.

Diamnionic monochorionic twin gestations: An overview

Monochorionic (MC) twins account for about 20–30% of all twins, but contribute disproportionately to mortality, intrauterine growth restriction, and preterm delivery compared with dichorionic (DC) twins. This higher mortality in MC twins is likely due to the effects of placental morphologic characteristics, which include complex vascular communications between the twins associated with twin–twin transfusion syndrome (TTTS), and the tendency for the common placenta to be shared either symmetrically or asymmetrically. In assessment of clinical outcomes for TTTS, artery to vein anastomoses in the absence of artery to artery or vein to vein, especially if present with placental asymmetry, carry the worse prognosis. Chorion status in twins forms the basis for clinical risk assessment and can be determined by 7 menstrual weeks using transvaginal sonography. The variable results reported in the literature for intertwin umbilical artery Doppler findings in MC twins may be explained by differences between sonographic and clinical criteria (including differential hemoglobin concentrations) reported by various investigators. Antenatal fetal Doppler assessment of the umbilical artery and cerebral arteries can help distinguish between TTTS and placental insufficiency in MC twins. Significant restriction of fetal growth occurs in about 25% of multiple gestations, accounting for about 17% of all growth-retarded infants. Redistribution of fetal blood (brain-sparing effect), as determined by Doppler interrogation of fetal cerebral and umbilical arteries, occurs more commonly in MC twins compared to DC twins and in growth-restricted MC twins compared to nongrowth-restricted MC twins. Overall, the prognosis is poorer for the donor twins in TTTS and there is a greater prenatal death rate for the donor (18–35%), and a higher overall survival rate for recipients following fetoscopic laser treatment. Finally, the clinical and sonographic findings suggest that the polyhydramnios/oligohydramnios sequence seen in MC twins likely represents a spectrum strongly linked to placental variables. J. Matern.-Fetal Med. 2000;9:89–96. © 2000 Wiley-Liss, Inc.

Diamnionic monochorionic twin gestations: an overview.

Monochorionic (MC) twins account for about 20-30% of all twins, but contribute disproportionately to mortality, intrauterine growth restriction, and preterm delivery compared with dichorionic (DC) twins. This higher mortality in MC twins is likely due to the effects of placental morphologic characteristics, which include complex vascular communications between the twins associated with twin-twin transfusion syndrome (TTTS), and the tendency for the common placenta to be shared either symmetrically or asymmetrically. In assessment of clinical outcomes for TTTS, artery to vein anastomoses in the absence of artery to artery or vein to vein, especially if present with placental asymmetry, carry the worse prognosis. Chorion status in twins forms the basis for clinical risk assessment and can be determined by 7 menstrual weeks using transvaginal sonography. The variable results reported in the literature for intertwin umbilical artery Doppler findings in MC twins may be explained by differences between sonographic and clinical criteria (including differential hemoglobin concentrations) reported by various investigators. Antenatal fetal Doppler assessment of the umbilical artery and cerebral arteries can help distinguish between TTTS and placental insufficiency in MC twins. Significant restriction of fetal growth occurs in about 25% of multiple gestations, accounting for about 17% of all growth-retarded infants. Redistribution of fetal blood (brain-sparing effect), as determined by Doppler interrogation of fetal cerebral and umbilical arteries, occurs more commonly in MC twins compared to DC twins and in growth-restricted MC twins compared to nongrowth-restricted MC twins. Overall, the prognosis is poorer for the donor twins in TTTS and there is a greater prenatal death rate for the donor (18-35%), and a higher overall survival rate for recipients following fetoscopic laser treatment. Finally, the clinical and sonographic findings suggest that the polyhydramnios/oligohydramnios sequence seen in MC twins likely represents a spectrum strongly linked to placental variables.

Diamnionic Monochorionic Twin Gestations: An Overview

Monochorionic (MC) twins account for about 20-30% of all twins, but contribute disproportionately to mortality, intrauterine growth restriction, and preterm delivery compared with dichorionic (DC) twins. This higher mortality in MC twins is likely due to the effects of placental morphologic characteristics, which include complex vascular communications between the twins associated with twin-twin transfusion syndrome (TTTS), and the tendency for the common placenta to be shared either symmetrically or asymmetrically. In assessment of clinical outcomes for TTTS, artery to vein anastomoses in the absence of artery to artery or vein to vein, especially if present with placental asymmetry, carry the worse prognosis. Chorion status in twins forms the basis for clinical risk assessment and can be determined by 7 menstrual weeks using transvaginal sonography. The variable results reported in the literature for intertwin umbilical artery Doppler findings in MC twins may be explained by differences between sonographic and clinical criteria (including differential hemoglobin concentrations) reported by various investigators. Antenatal fetal Doppler assessment of the umbilical artery and cerebral arteries can help distinguish between TTTS and placental insufficiency in MC twins. Significant restriction of fetal growth occurs in about 25% of multiple gestations, accounting for about 17% of all growth-retarded infants. Redistribution of fetal blood (brain-sparing effect), as determined by Doppler interrogation of fetal cerebral and umbilical arteries, occurs more commonly in MC twins compared to DC twins and in growth-restricted MC twins compared to nongrowth-restricted MC twins. Overall, the prognosis is poorer for the donor twins in TTTS and there is a greater prenatal death rate for the donor (18-35%), and a higher overall survival rate for recipients following fetoscopic laser treatment. Finally, the clinical and sonographic findings suggest that the polyhydramnios/oligohydramnios sequence seen in MC twins likely represents a spectrum strongly linked to placental variables.

Menstrual-Linked Asthma

This study was conducted to determine the occurrence of menstrual-linked asthma (MLA) in India in 100 consecutive female asthmatics in the reproductive age group. The patients were required to respond to a questionnaire concerning the relationship between their asthma and the menstrual cycle. Twenty-three patients had subjective perception of deterioration in symptoms of asthma in relation to the menstrual cycle. Ten patients from both groups were also required to maintain a daily peak expiratory flow rate (PEFR) diary for 2 consecutive menstrual cycles. The mean total duration of illness in patients with MLA was significantly longer than in patients without cyclic exacerbation. Cough and breathlessness were also significantly more severe as was the disease. This was evidenced by the more frequent emergency room visits and hospitalizations in these patients. Menstrual-linked worsening of asthma was most common in the premenstrual week (17 patients). In 8 of these 17 patients, this phenomenon continued to occur during the menstrual week also. Interestingly, 1 patient complained of deterioration of asthma 2 days after menstruation was over. Such an observation is yet to be recorded. Fourteen patients reported an increase in symptoms with almost every cycle while 3 had worsening related to specific season only. Sixteen patients often required extra medication during the premenstrual and/or menstrual weeks. A significant association was also observed between severity of premenstrual syndrome and MLA. The mean PEFR values over 2 cycles revealed a significant fall in the morning as well as evening values in the premenstrual and menstrual weeks as compared to the midcycle week in patients with MLA. This fall was maximal in the premenstrual week. Such a fall was not observed in asthmatics without menstrual exacerbation of symptoms. MLA was detected in about a fourth of the female asthmatics in India and it appears to represent a more severe form of the disease. This study also documented that MLA was associated with an increase in airway resistance and was not simply due to an increased perception of symptoms during the premenstrual or menstrual weeks.

Prenatal diagnosis of cleft lip at 11 menstrual weeks using embryoscopy in the Van der Woude syndrome

On the basis of prenatal identification of a cleft lip by embryoscopy, a case of van der Woude syndrome was diagnosed at 11 menstrual weeks, allowing for early termination of pregnancy. The potential of embryoscopy to detect minor malformations in early pregnancy is discussed from both the technical and the ethical point of view.

46,XY,dup(10q) in direct CVS preparation and mosaic 48,XXXY,dup(10q) in CVS long‐term culture and fetal tissue

Chorionic villus sampling (CVS) was performed on a 40-year-old woman at 9 1/2 menstrual weeks because of advanced maternal age. The direct preparation showed 46,XY,dup(10)(q11.2q23.2). CVS long-term culture and fetal tissue revealed a rare additional abnormality: 48,XXXY,dup(10)(q11.2q23.2). This abnormality represented the major cell line (> 85 per cent in 691 cells) in an (XY)/XXY/XXXY/(XXXXY) mosaic (all cell lines presumably bearing the dup(10q); the presence of XY and XXXXY cell lines is uncertain). To our knowledge, this is the first report of trisomy 10q11-q23 and of prenatally detected 48,XXXY in chorionic villi. The mosaic could have resulted from early post-zygotic non-disjunctions in a 46,XY,dup(10q) or 47,XXY,dup(10q) zygote. The results from DNA studies of four polymorphisms, mapped to Xp and Xq, support this theory. The literature on prenatally detected cases with sex chromosome tetrasomy and pentasomy and those with additional autosomal abnormalities is reviewed. The reported case underlines the problem of false-negative findings when only direct CVS preparations are karyotyped.

Trisomy 13 syndrome: prenatal US findings in a review of 33 cases.

To determine the type and prevalence of prenatal ultrasound (US) findings in fetuses with trisomy 13. Prenatal US findings in 33 consecutive fetuses with trisomy 13 and in 200 karyotypically normal fetuses were reviewed and compared. One or more abnormalities were found in 30 fetuses (91%). Major anomalies detected by means of US included holoprosencephaly (13 [39%]) or other central nervous system anomalies (19 [58%]), facial anomalies (15 [48%]), and renal (11 [33%]) and cardiac (16 [48%]) defects. Growth retardation was also present in 16 (48%). Echogenic chordae tendineae were seen in 10 (30%), which includes seven (39%) of 18 fetuses examined before 20 menstrual weeks (compared with four [2%] of 200 fetuses in the reference group [P < .001]). Other findings not generally associated with trisomy 13 but present in this series included a large cisterna magna (six [18%]), mild cerebral ventricular dilatation (three [9%]), nuchal thickening or cystic hygroma (seven [21%]), and a hypoplastic left side of the heart (seven [21%]). Prenatal US can help detect one or more anomalies in most fetuses with trisomy 13; thus, US finding can indicate whether karyotype should be tested.

Teratogen exposure: lack of morphological abnormalities by detailed fetal sonography.

Teratogen exposures cause 1-2% of congenital abnormalities. Our anecdotal experience was that detailed fetal sonograms conducted for the indication of teratogen exposure failed to demonstrate significant morphological abnormalities. We reviewed our experience to see how often such examinations yielded positive results. Records from 11 September 1989 to 13 September 1993 were reviewed. All women referred for detailed fetal sonography for the sole indication of exposure to drugs, toxins, or infectious agents and with a sonographic age of 16-24 menstrual weeks were included. All exposures were included in the study, even those without known teratogenic potential. Patients previously diagnosed with a morphological abnormality or with an abnormal level of maternal serum alpha-fetoprotein were excluded.A total of 125 women with 126 singleton pregnancies comprised the study population. Ten women had multiple exposures. Including the multiple exposures, there was a total of 138 exposures, 104 to drugs and other toxins (45 of which were not known human teratogens), and 34 to infections. The only significant morphological abnormality found was a duplicated kidney in a woman with parvovirus exposure. While parvovirus is a cause of anemia and hydrops, it is not a known human teratogen. We therefore assume that this was a coincidental association. We conclude that teratogen exposure is a low-yield indication for detailed fetal sonography.