Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up

OBJECTIVE: To construct an ultrasonography-based gestation-specific amniotic fluid index (AFI) curve in a Chinese population. METHODS: Routine obstetric ultrasonography examinations were performed in 5496 normal pregnancies (more than 95% first births) in five obstetric ultrasound laboratories in Central-South China from January 1, 1992, to December 31, 1993. A gestation-specific AFI curve was constructed and compared with previous studies. RESULTS: The gestational ages of the patients included in this study ranged from 16 to 40 weeks. The gestation-specific AFI showed patterns similar to those observed previously, with the median being 72 mm at 16 weeks, increasing to 119 mm at 26 weeks, and then gradually declining to a median of 91 mm at 40 weeks. However, the absolute value of AFI in this Chinese population was consistently and substantially lower than values reported in previous studies in populations with mixed parities. CONCLUSION: Different standards of AFI are needed for different populations.     

A case of successful hypospadias repair without infection using recombinant human granulocyte-colony stimulating factor (rhG-CSF) for idiopathic neutropenia

OBJECTIVES: To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages. SUBJECTS AND METHODS: A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter. RESULTS: The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter. CONCLUSIONS: The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus.     

Gentamicin dosage intervals in neonates: longer dosage interval--less toxicity

Our objective was to construct a nomogram of the fetal lingual size early pregnancy and to assess the size of the tongue in abnormal fetuses. The lingual width was measured by using transvaginal ultrasonography in 80 normal fetuses at 13 and 18 weeks' gestation. In addition the tongue was measured in 22 fetuses at these gestational ages who had an abnormal karyotype or oro-facial malformations. A linear relationship was found between the lingual width and gestational age in normal fetuses. The lingual size was within the normal range in cases of trisomy 13, trisomy 21 and Turner syndrome. A small tongue was observed in fetuses with micrognathia. Correlation between lingual width and gestational age was observed in early pregnancy. The relationship between the size of the tongue and oro-facial malformation needs further evaluation.     

Birth weight, gestational age and perinatal mortality: biological heterogeneity and measurement error

At low birth weight the variance of last menstrual period based gestational age is wide and the distribution is positively skewed toward higher values. In this study the variance of gestational age decreases rapidly as birth weight increases, skewness decreases and kurtosis increases in approaching the mean of the birth weight distribution. Some of the wider variance and positive skewness of gestational age at low birth weight appears to reflect heterogeneity of intrauterine growth, in which infants with high values of gestational age are growth retarded. We show by partitioning each birth weight group into two groups of infants with different gestational age distributions, that at low birth weight, infants with low gestational ages have higher neonatal mortality rates but lower fetal mortality rates than infants with a higher gestational age for birth weight. The differences in mortality described between small infants at different gestational ages suggest that infants with a high LMP-based gestational age have experienced a slower rate of intrauterine growth. Some authors interpret the distributional characteristics as indications of systematic error in last menstrual period based assessment of gestational age. It appears from this study that the extent of systematic error in the estimation of LMP based gestational age may have been overstated in the past.     

Ultrasound evaluation of the width of the fetal nose

The aim of the study was to construct a normal range for the width of the fetal nose during gestation. The study group included 229 healthy pregnant women with normal singleton pregnancies at 15-42 weeks of gestation. The ultrasound measurements were taken at the level of the lower border of the ala nasi, using the modified coronal view. Routine biometric measurements were obtained from the participants, including biparietal diameter, head and abdominal circumferences, cerebellum and femur lengths. Our results were used to construct objective measurements of the fetal nasal width across all gestational ages. We conclude that the nasal width can be easily measured from 15 weeks of gestation using the modified coronal view. A linear growth relationship was found between nasal width and gestational age, biparietal diameter, head and abdominal circumferences, and transcerebellar and femoral lengths. We feel that such measurements may prove useful in the diagnosis of cases at high risk for fetal facial abnormalities.     

Experience with the Ultrex and Ultrex Plus inflatable penile prosthesis: new implantation techniques and surgical outcome

OBJECTIVE: To construct nomograms of the size of the fetal orbit and lens during gestation. SUBJECTS: The study group included 349 normal pregnant women at 14-36 weeks' gestation. METHODS: Routine biometric measurements were obtained in all the participants; these included biparietal diameter, head and abdominal circumferences, measurements of the long bones and the diameters of the fetal orbit and lens. The orbital and lens circumference measurements were also related to gestational ages. RESULTS: A linear growth function was observed between gestational age (GA) and orbital diameter (r = 0.94; p < 0.00001; y = -0.66 + 0.5 x GA), orbital circumference (r = 0.94; p < 0.00001; y = -2.1 + 1.5 x GA) and orbital area (r = 0.94; p < 0.00001; y = -98.1 + 8.3 x GA). Significant correlation was also found between femoral length (FL) and orbital diameter (r = 0.95; p < 0.00001; y = 3.3 + 1.9 x FL), orbital circumference (r = 0.95; p < 0.00001; y = 10.3 + 5.9 x FL) and orbital area (r = 0.93; p < 0.00001; y = -28.2 + 32.2 x FL). A linear growth function was observed between orbital circumference and biparietal diameter (r = 0.94; p < 0.00001) and head circumference (r = 0.95; p < 0.00001). A linear growth function was also observed between gestational age and the diameter of the lens (r = 0.89; p < 0.00001; y = 0.88 + 1.4 x GA) the circumference of the lens (r = 0.89; p < 0.00001; y = 2.78 + 0.4 x GA) and the area of the lens (r = 0.89; p < 0.00001; y = -7.95 + 1.0 x GA). The correlation was found between the ratios of the diameters, circumferences and areas of the lens and the orbit. CONCLUSIONS: These results provide normative data of the growth of the fetal orbit and lens and may aid future studies relating to fetal eye anomalies.     

Study of intrauterine growth from birthweight at Maharaj Nakhon Chiang Mai Hospital

Intrauterine growth curve and normogram for newborns at Maharaj Nakhon Chiang Mai Hospital are constructed. Birthweight at various gestational weeks of deliveries were determined within 24 hrs after birth. All 1,311 Thai pregnant women selected, fitted the criteria of inclusion deliveries at Maharaj Nakhon Chiang Mai Hospital from May 1983 to April 1991 (8 yrs). Their gestational age distribution was between 28 wks to 42 wks. Clinical status at birth was satisfactory. There were no obstetric or medical complications during pregnancy. Mean birthweight and standard deviation of newborns for each gestational age at delivery were calculated and presented in tabular and graphic form. Mean birthweight for 40 wks of gestation was 3.144 +/- 382 g. In addition, normogram of 10th, 50th, 90th percentile ranks of birthweight for each gestational age was constructed. These values may be useful as baseline data of intrauterine growth curve to evaluate fetal growth in our population.     

Measurement of fetal nasal width by ultrasonography

OBJECTIVE: This study was designed to determine the range of normal fetal nasal width by ultrasonography, which may be beneficial for detection of trisomy 21 and other chromosomal abnormalities. We hypothesize that a wide, saddle-shaped nose, which is one of the clinical neonatal anatomic features of trisomy 21, can be diagnosed prenatally. STUDY DESIGN: Fetal nasal width diameter was measured on 782 normal white fetuses by ultrasonography. Gestational ages ranged from 13.8 to 40.4 weeks. Mean and SD of fetal width diameter was calculated weekly by gestational age to establish normal values. RESULTS: The fetal nasal width increased as a function of gestational age, showing a polynomial curve during pregnancy (r = 0.912, p = 0.002). With use of mean +/- 1 SD as a cutoff value, the results showed a sensitivity of 80% with a specificity of 67% and a positive predictive value of 2.2% with a negative predictive value of 99.7% for the diagnosis of trisomy 21. CONCLUSION: The fetal nasal width diameter may be used as a biometric measurement and may be useful to identify trisomy 21 or other chromosomal abnormalities in conjunction with other already defined parameters used in a genetic ultrasonographic screen.     

Conservative management of post-operative peritoneal cysts associated with endometriosis

BACKGROUND: Early amniocentesis has been claimed to confer a higher risk of fetal loss than standard amniocentesis after the 15th gestational week. Our experience of early amniocentesis in single and twin gestations from 1990 - 1995 is presented with 99.3% follow-up. METHODS: Amniocentesis was performed between 11 gestational weeks + 5 days and 14 gestational weeks + 6 days. RESULTS: In 1646 pregnancies 1678 amniocenteses were performed. Thirty-two reamniocenteses were done, 17 due to amniocyte culture failure and 15 due to failure to obtain sufficient amount of amniotic fluid on the first occasion. After puncture 1.49% (25/1678) suffered a spontaneous abortion. Twenty twin pregnancies were included. One spontaneous abortion was noted in this group, as well as three cases where one fetus was normal and the other had a severe defect. Selective abortions were performed without complications. CONCLUSIONS: The difference of postprocedure fetal loss in our population between early and standard amniocentesis is 0.8%. A comparison of postprocedure losses is not appropriate when amniocenteses are performed at a different gestational age, as spontaneous loss decreases with increased gestational age. Our results compare well with the only randomized study between early and standard amniocentesis where the fetal loss after early amniocentesis is similar to that in standard amniocentesis.     

Single and repetitive maternal glucocorticoid exposures reduce fetal growth in sheep

OBJECTIVE: We evaluated the effects of single or three repeated doses of maternal betamethasone on fetal growth at preterm and term delivery in sheep. STUDY DESIGN: Pregnant ewes were randomly assigned to receive one dose of 0.5 mg/kg betamethasone at 104 days' gestational age; three doses of betamethasone at 104, 111, and 118 days' gestational age; or saline for controls. Lambs were delivered at 125 days' (preterm) or at 145 days' (term) gestational age for assessments of fetal growth. RESULTS: The single betamethasone exposure at 104 days' gestational age caused symmetric growth retardation of 11% at 125 days' gestational age and 14% at term. The three-dose exposures decreased body weights by 25% in preterm lambs and by 19% at term. Organ protein and deoxyribonucleic acid per kilogram of body weight were selectively decreased in preterm lambs. At term the decreases in organ weight, protein, and deoxyribonucleic acid were proportionate to the decreased birth weight. CONCLUSION: One or three doses of maternal glucocorticoids begun at an early gestational age caused symmetric growth retardation in lambs delivered prematurely, and the decreased fetal size persisted to term.     

Etiology and outcome of acute renal failure in elderly patients

OBJECTIVE: To test the usefulness of the fetal transverse cerebellar diameter/abdominal circumference (TCD/AC) ratio in predicting known small-for-gestational-age (SGA) infants. METHOD: The relationship between fetal TCD and AC throughout the second half of pregnancy was investigated in 635 well-dated, normal pregnancies and examined with regard to gestational age and infant birth weight percentiles. RESULTS: One hundred eighteen (19%) fetuses were excluded due to inadequate visualization of the fetal cerebellum. A strong correlation was noted between gestational age determined by the last menstrual period and both fetal TCD (r2 = 0.91338) and AC (r2 = 0.89361) in fetuses with birth weights between the 10th and 90th percentiles (n = 407; mean 14.4, S.D. 1.2). Although the TCD/AC ratio showed a poor correlation with gestational age (r2 = 0.15788), a slight increase was noted during gestation. A TCD/AC ratio greater than 15.5 was present in 80% of SGA infants when measurements were performed within 1 week of delivery. CONCLUSION: Fetal TCD/AC ratio as a gestational age-independent method could improve diagnostic sensitivity and specificity in the early detection of fetal growth abnormalities.     

How accurate is fetal biometry in the assessment of fetal age?

OBJECTIVE: The purpose of the study was to assess the accuracy of fetal biometry in the midtrimester of pregnancy in the assignment of fetal age. STUDY DESIGN: A total of 152 singleton, 67 twin, and 19 triplet gestations resulting from in vitro fertilization with ultrasonographic fetal biometry from 14 to 22 weeks made up the study population. A gestational age prediction equation was derived from singletons with the use of stepwise linear regression. This equation was compared with 38 previously published equations and then applied to the twin and triplet populations. RESULTS: Head circumference was the best predictor of gestational age (random error [SD] 3.77 days). Addition of abdominal circumference and femur length to head circumference improved the accuracy of the dating equation (random error 3.35 days). Most dating formulas had systematic errors of <1 week. The systematic error was -0.32 day for averaging the singleton-based predictions for twins and -1.26 days for triplets. CONCLUSIONS: Gestational age assessment with the use of fetal biometry from 14 to 22 weeks is accurate for singleton, twin, and triplet gestations.     

The relationship of pretreatment serum hemoglobin level to the survival of epithelial ovarian carcinoma patients: a prospective review

OBJECTIVE: Our purpose was to examine the impact of gestational age and fetal growth restriction on fetal and neonatal mortality rates in the postterm pregnancy. STUDY DESIGN: All deliveries occurring in Sweden between Jan. 1, 1987, and Dec. 31, 1992, were evaluated for participation in this study. Data were derived from the National Swedish Medical Birth Registry. Pregnancies were selected for inclusion in the study on the basis of the following criteria: (1) singleton pregnancy, (2) reliable dates, (3) gestational age > or = 40 weeks, and (4) maternal age 15 to 44 years. Fetal growth restriction was defined as birth weight <2 SD below the mean for gestational age. A total of 181,524 pregnancies met the inclusion criteria and formed the study population. Fetal and neonatal mortalities at 40 weeks' gestation were used as reference levels. Logistic regression analysis was used to estimate the independent effects of gestational age and fetal growth restriction on fetal and neonatal mortality rates. RESULTS: A significant rise in the odds ratio for fetal death was detected from 41 weeks' gestation and on (odds ratios 1.5, 1.8, and 2.9 at 41, 42, and 43 weeks, respectively). Odds ratios for neonatal mortality did not demonstrate a significant gestational age dependency. Fetal growth restriction was associated with significantly higher odds ratios for both fetal and neonatal mortality rates at every gestational age examined (with odds ratios ranging from 7.1 to 10.0 for fetal death and from 3.4 to 9.4 for neonatal death). CONCLUSIONS: Postterm pregnancies have long been considered to be at high risk for adverse perinatal outcome. This study documents a small but significant increase in fetal mortality in accurately dated pregnancies that extend beyond 41 weeks of gestation. This study also demonstrates that fetal growth restriction is independently associated with increased perinatal mortality in these pregnancies.     

Simplified method of determining fetal brain weight in utero

Analysis of autopsy data shows that, from the 26th through the 38th gestational weeks, fetal brain weight (BrW) is a function of the 3.124 power of the largest head circumference (HC). Because there is excellent correlation between prenatal ultrasound measurement and postnatal tape measurement of the HC, it is possible to determine fetal BrW in utero. An alteration of the BrW:somatic weight (SW) relationship is an important physical stigma of asymmetric intrauterine growth retardation (IUGR). The value of longitudinal studies of fetal BrW and SW as a means of discriminating between normal and asymmetric growth is tested in a population at risk for IUGR.     

Suspected skeletal dysplasias: femur length to abdominal circumference ratio can be used in ultrasonographic prediction of fetal outcome

OBJECTIVES: Skeletal dysplasias are a group of bone growth disorders, some of which can be recognized prenatally. Certain types of skeletal dysplasias result in a lethal fetal outcome. The ability to predict this outcome prenatally would be important in counseling parents. This study evaluated the ratio of femur length to abdominal circumference as a predictor of fetal outcome in cases of suspected skeletal dysplasia. STUDY DESIGN: This 3-year retrospective study identified 18 cases of prenatally suspected skeletal dysplasia from a population of approximately 35,000 fetuses undergoing prenatal ultrasonography. The femur length/abdominal circumference ratio was calculated and compared with fetal-neonatal outcomes and diagnoses. RESULTS: Eighteen cases of suspected skeletal dysplasia were identified, and the femur length/abdominal circumference ratio was found to be a good predictor of fetal outcome independent of gestational age. A ratio < 0.16 resulted in a lethal outcome in nine of nine cases. Conversely, a ratio > or = 0.16 resulted in a diagnosis of a nonlethal form of skeletal dysplasia or a diagnosis that ruled out any form of skeletal dysplasia in nine of nine cases. CONCLUSIONS: The femur length/abdominal circumference ratio may be useful to predict a lethal fetal outcome when ultrasonography indicates a possible skeletal dysplasia.     

Randomised study of risk of fetal loss related to early amniocentesis versus chorionic villus sampling

BACKGROUND: Several cohort studies have shown the feasibility of early amniocentesis (between 11 and 13 weeks of gestation) as an alternative to chorionic villus sampling (CVS) for karyotyping, but the only completed randomised study of fetal safety showed a significant fetal-loss risk related to first-trimester amniocentesis. We assessed fetal safety in early amniocentesis and CVS. METHODS: We assessed early amniocentesis at 11-13 weeks gestational age compared with the fetal risk associated with CVS at 10-12 weeks. 1160 pregnant women were randomly assigned one procedure (581 early amniocentesis, 579 CVS) after a baseline ultrasound examination at 10 weeks' gestation and were followed up until birth. Total fetal loss and neonatal morbidity were the primary outcome measures. Sampling success and pregnancy complications were secondary outcomes. We used a filter to increase the cell yield in the early amniotic-fluid samples. CVS was transabdominal. FINDINGS: We found a significantly increased occurrence of talipes equinovarus in the early amniocentesis group (p < 0.01), the risk of which was associated with sampling at the earliest gestational ages and with temporary leakage of amniotic fluid after sampling. Therefore, the trial was stopped early, which reduced the power of the safety study. 4.8% (27) of fetuses in the CVS group and 5.4% (30) in the early amniocentesis group were lost after randomisation (p = 0.66). More detailed survival analysis did not show any significant differences in fetal loss rates. Leakage of amniotic fluid after sampling occurred significantly more frequently after early amniocentesis than after CVS (p < 0.001), but we found no other major differences in pregnancy complications. Significantly more CVS than early amniocentesis procedures were repeated or failed to produce a karyotype (p < 0.01). INTERPRETATION: Even though the numbers were small, we found an association between early amniocentesis and talipes equinovarus. We believe this association to be true, since it supports a trend in a similar randomised study. Our results show that early amniocentesis, when done with the filter technique, is associated with an abortion risk similar to CVS, although the limited size of our study population reduced the strength of this conclusion.     

Cerebral palsy: effects of twinning, birthweight, and gestational age

AIMS: To determine the effects of birthweight and gestational age on the risk of cerebral palsy for multiple and singleton births. METHODS: Children on the North East Thames Regional Health Authority Interactive Child Health System, born between 1 January 1980 and 31 December 1986, and notified as having cerebral palsy, were included. Cases of postneonatal onset, of known progressive, or non-cerebral pathology and with only mild signs were excluded. Rates and relative risks were calculated using the most complete data, which related to 1985-86, and comprised 102,059 singletons and 2367 twins. Logistic regression was used to examine the associations between being a twin, gestational age, and birthweight. RESULTS: The crude rate per 1000 survivors at 1 year of age was 1.0 in singletons and 7.4 in twins. The relative risk was greatest in twins weighing more than 2499 g (4.5). However, after adjusting for reduced birthweight of twins it was the relative risk of twins weighing less than 1400 g that was significantly increased. Logistic regression confirmed that lower fetal growth, lower gestational age, and being a twin are all independent risk factors for cerebral palsy. CONCLUSION: The increased risk to twins of cerebral palsy is not entirely explained by their increased risk of prematurity and low birthweight.     

Growth graphs for the clinical assessment of infants of varying gestational age

Two graphs are presented showing means and 1 and 2 SD for growth in weight, length, and head circumference: (1) a fetal-infant graph with lines of growth from 26 weeks of gestational age until one year of age after "term' has been reached: and (2) a similarly constructed graph for children ages one through ten years. The standards of growth were obtained from published data in which the subjects received optimal health care. The graphs allow comparisons of infants of varying gestational age with standards for that age. Normal and abnormal deviations in growth are easily identified. Some examples of common variations in physical growth are described.     

Diagnosis of phenylketonuria in a 35-year-old mother in relation to prenatal diagnosis of intrauterine growth retardation with microcephaly

BACKGROUND: Some French pregnant women with phenylketonuria (PKU), born before 1978, have not been tested with the Guthrie method during the neonatal period. They have a risk of spontaneous abortion and their infants are often mentally retarded with microcephaly and/or congenital heart anomaly. CASE REPORT: A woman with a moderate mental retardation became pregnant at the age of 31 years. Her newborn had a severe intrauterine growth retardation with microcephaly and developed mental retardation. This mother became pregnant again 4 years later. Repeated fetal ultrasonography showed progressive growth retardation. Maternal blood phenylalanine concentration was 18 mg/100 mL. Therapeutic abortion at 27 weeks of gestational age showed a fetus with several abnormalities, particularly cardiovascular and cerebral. CONCLUSION: It is still possible to meet women with unrecognized atypical PKU. Fetus or infant born with unexplained growth retardation and microcephaly requires search for maternal PKU.     

A biometric study of the eye, orbit, and face in 205 normal human fetuses

PURPOSE: To develop models for assessing the differential growth of the fetal face along its horizontal and vertical axes, as well as of the orbit and the eye. METHODS: Normal human fetuses (n = 205), whose gestational ages ranged from 15.5 to 41 weeks of amenorrhea, were examined. Orbitofacial parameters were as follows: outer canthal distance, inner canthal distance, palpebral fissure length, and oropalpebral distance. Ocular parameters were corneal diameter and axial length. Correlations were tested among all parameters. Linear and polynomial regression analyses of gestational age and the orbitofacial and ocular parameters were used to develop models of growth. Differential patterns of growth in the face were investigated. RESULTS: The best correlation was found between palpebral fissure length and oropalpebral distance. The increase of each of the parameters studied could be accurately described by a linear model. Sex had no detectable effect on these parameters. Compared with the skull, the face had a more rapid growth along the vertical axis. The palpebral fissure developed more rapidly than the eye. CONCLUSIONS: The parameters that were studied in the fetal face, orbit, and eye follow a roughly linear growth curve.