>Objective: Administration of purified human IgG from antiphospholipid syndrome patients has not consistently caused murine pregnancy loss despite the presence of significant anticardiolipin antibody (ACA) activity. We evaluated whether a correlation exists between ACA activity and the degree of fetal resorption in murine pregnancy and also determined whether pooled IgG from multiple ACA-positive patients increases the likelihood of fetal resorption compared with injection of single-donor IgG.Methods: Affinity chromatography followed by anisotropic ultrafiltration was used to extract and concentrate IgG from individual serum samples with and without ACA activity (ACA-positive IgG activity, 35-85 GPL versus ACA-negative IgG activity, <1 GPL) and from pooled aliquots derived from the same sera. On Day 8 of gestation, pregnant mice randomly received intraperitoneal injections of ACA-positive or ACA-negative, purified IgG (15 mg/mouse) or saline (1 ml). Laparotomies were performed on day 15, and uteri were harvested for gross evaluation and histologic study. Rates of fetal resorption were derived for each murine pregnancy (resorbed fetuses/resorbed fetuses + live pups) and compared between experimental groups.Results: A significant increase in fetal resorption rate was observed in ACA-positive IgG-treated animals (n = 19, 19.3%) compared with either ACA-negative (n = 5, 6.4%; P = 0.008) or saline-treated pregnancies (n = 8, 4.6%; P = 0.004). However, differences in resorption rates among the ACA-positive IgG-treated pregnancies did not correlate with initial ACA activity of the whole serum or with antibody activity measured in the purified, concentrated IgG preparations. A comparison of fetal resorption between single donor ACA-positive IgG and pooled ACA-positive IgG revealed similar rates of fetal resorption (20.5 versus 17.9%, respectively) but a lower mean birth weight among non-resorbed pups in the single-donor IgG-treated pregnancies (340 versus 430 mg; P = 0.05).Conclusions: Although greater murine fetal resorption resulted from ACA-positive IgG administration compared with ACA-negative IgG or saline injection, marked variability in pregnancy outcome was observed among ACA-positive animals. These differences were not attributable to initial antibody activity in whole serum or to activity associated with the purified immunoglobulins. Combining multiple ACA-positive sera did not augment the rate of fetal resorption.
> Objective: To investigate the hemodynamics of uteroplacental circulation in normal and preeclamptic pregnancies using the biomagnetometer SQUID. Methods: Fifteen pregnancies complicated with preeclampsia and 37 normal pregnancies were included in this study. All women were near term. The biomagnetic signals (waveforms) were recorded with the SQUID from the uterine arteries in normal and preeclamptic pregnancies. Using nonlinear analysis we attempted to differentiate these two types of magnetic activity. Results: Applying nonlinear analysis to the biomagnetic activity recorded from the uterine arteries in preeclamptic pregnancies and using dimensionality calculations we observed a clear saturation value for the preeclamptic pregnancies and nonsaturation for the normal pregnancies. These findings were statistically significant and were correlated with fetal heart rate monitoring, pH, and the Apgar score at 1 and 5 min. High amplitude cases were related to normal fetal heart rate patterns, pH > 7.25, and an Apgar score > 7; low amplitude recordings correlated with abnormal fetal heart rate patterns, pH < 7.25, and an Apgar score < 7. Conclusions: It is suggested that biomagnetic measurements with the SQUID in the uterine artery flow and the application of nonlinear analysis are promising procedures in assessing fetal health, especially in high risk pregnancies.
Frequent fetal premature ventricular contractions were diagnosed at 39 weeks of gestation. To avoid unnecessary cesarean section, the mother was administered propranolol hydrochloride orally. The tococardiography became feasible and permitted us to evaluate fetal well-being. The patient successfully delivered transvaginally a male infant at 40 weeks of gestation.
> Objective: A nonsubjective evaluation of intrapartum fetal heart rate (FHR) with a neural network (NNW) computer system and its clinical application. Methods: Eight simple FHR data were input into the NNW computer after 16-step normalizations. The computer was composed of 40 units in the input layer, 30 in intermediate layer, and 3 in the output layer, and the probabilities to be normal, suspicious, and pathological were obtained at the output. Before use, the computer was trained 10,000 times by 50-min teacher FHR data of 20 cases with known outcomes. The trained NNW computer was tested by FHRs of another 29 cases. The outcome probabilities in 15 min were calculated every 5 min in another 10 cases, and the bar graphs of the probabilities were displayed in sequence in the trendgrams. Results: The trained NNW computer was 100% accurate in the internal check; in the external check 86% of the results were evaluated correctly with the cardiotocogram, Apgar score, and umbilical arterial pH of the 29 test cases. The FHR scores of our conventional computer FHR analysis were higher in the suspicious and pathological groups than the normal group, and the fetal distress index was high in the pathological group. The trendgrams were simply accurate in typically normal or abnormal cases, transitory abnormal probabilities were shown in intermediate cases, and mixed suspicious and pathological probabilities suggested pathological outcome. Conclusions: The outcome probabilities and their trendgrams in the NNW FHR analysis are promising in objective decision making in the intrapartum stage.
Objective: To assess the influence of diabetes mellitus on the mechanical wall properties of large maternal and fetal arteries in pregnant women.Methods: Prospective serial monitoring of arterial wall characteristics, using ultrasonic phase-locked tracking of vessel diameters and oscillometric brachial blood pressure measurements. Ten pregnant women with insulin-dependent diabetes mellitus and 15 with gestational diabetes were studied and compared with 20 women in uncomplicated gestation.Results: In women with uncomplicated pregnancy, the stiffness index and the elastic modulus of the maternal aorta were lower (both P < 0.05), whereas the pulse amplitude and the strain were higher (both P < 0.05) in the 12th gestational week than in the 6th week postpartum. These differences did not appear in pregnancy complicated by insulin-dependent diabetes. In early gestation, higher aortic stiffness index and elastic modulus (both P < 0.05) and lower pulse amplitude and strain (both P < 0.05) were recorded in gravidae with insulin-dependent diabetes compared with nondiabetic pregnant women; those with gestational diabetes were not detected in early pregnancy. No intergroup or intragroup differences of stiffness index and pulse amplitude were found in the carotid artery in corresponding gestational ages. In the fetal aorta, the pulse wave velocity increased during the third trimester of normal gestation (P < 0.05) but not in insulin-dependent diabetic pregnancy.Conclusion: The difference found concerning the aortic stiffness between women with insulin-dependent diabetes during pregnancy and those with uncomplicated pregnancy might be interpreted as an altered cardiovascular adaptation to pregnancy in women with diabetes.
Objective: For more than 20 years, vibroacoustic stimulation testing (VAST) using an artificial larynx has been used worldwide when fetal heart rate monitoring produced patterns with absent or very low variability. In addition to the artificial larynx many other appliances have been used to stimulate a seemingly dormant fetus, but these have rarely been evaluated properly. In this study we tried to evaluate the use of standard mechanical wind-up alarm clocks for VAST.Methods: VAST with an alarm clock was performed successfully in 80 women with normal pregnancies from 36 weeks to term. It was tested by placing the alarm clock on the maternal abdomen just above the fetal head or on the controlateral side of the maternal abdomen to see whether position made any difference and whether coupling with ultrasound gel applied between the alarm clock and the maternal abdomen would affect the degree of fetal reaction to VAST as expressed in heart rate acceleration. Similarly, the effect of the alarm clock VAST on subjective and objective fetal movement patterns as registered by kinetocardiotocotraphy (K-CTG) in addition to heart rate patterns was investigated.Results: All fetuses showed heart rate acceleration, an increase in heart variability, and increase in movement patterns in the 6 min after the application of alarm clock VAST. No statistically significant difference was found which would favor a particular placement of the alarm clock on the maternal abdomen or the use of ultrasound coupling gel. When K-CTG was performed, patient-perceived fetal movements as expressed with an event marker showed agreement with the machine-registered movements only when patients could see the tracing during registration and no accordance when the K-CTG was turned toward the wall during registation.Conclusion: In keeping with the ALARA principle a conventional wind-up alarm clock appears to be an inexpensive and effective alternative to the electrolarynx.
Objective: To investigate the perinatal management and outcome of fetuses diagnosed prenatally with single umbilical artery.Methods: Sixty-one consecutive fetuses with single umbilical artery diagnosed prenatally by ultrasonography were included. Thorough prenatal ultrasonographic screening was carried out to detect associated congenital anomalies. Chromosome study by either amniocentesis or cordocentesis was performed for all 61 of the fetuses with single umbilical artery. Thorough physical examination or autopsy was per formed after delivery.Results: All 61 fetuses were confirmed to have single umbilical artery after delivery. Ten (16.4%) of the 61 fetuses with single umbilical artery had abnormal karyotypes. In the single umbilical artery group with abnormal karyotyping, 8 had detectable structural abnormalities, 1 had symmetrical intrauterine growth retardation, and 1 had no apparent congenital anomalies. For the 51 fetuses with normal karyotyping, 28 had abnormal ultrasonographic findings. In 23 fetuses with single umbilical artery without chromosomal or structural anomalies diagnosed in utero, 7 (30.4%) were found to have structural anomalies (3 with congenital heart disease, 3 with congenital renal disease, and 1 with limb deformity) after birth.Conclusion: Prenatal diagnosis of single umbilical artery should be made with caution to avoid false positive cases. When single umbilical artery is diagnosed prenatally, we suggest 1) targeted ultrasonography for detection of anomalies with cardiovascular, genitorenal, and limb-skeletal systems; 2) chromosome study for those with intrauterine growth retardation or other associated defects; and 3) thorough investigation after birth.
> At present preterm delivery is the leading cause of perinatal morbidity and mortality and its incidence is remained stable during the past 10 years. Conventional methods of identifying patients at risk of preterm delivery such as obstetrics history, demographic factors or evaluation of uterine contractions and cervix by digital examination show disappointintly low sensitivity and positive predictive value. In this review we describe new ultrasonographic and biochemical approaches that have been recently proposed to screen for preterm labor both in patients with intact and with premature rupture of the membranes. The ultrasonographic detection of a short uterine cervix and/or of a dilation of the internal os, expression of weakening of the lower uterine segment or cervical ripening, seems to efficiently predict patients at risk of preterm delivery. The efficiency of this marker may be improved by the association with the assay of fetal fibronectin or pro inflammatory cytokines (interleukin-6 and interleukin-8) in cervical secretions. Further by the concentrations of interleukin-6 and interleukin-8 in cervical secretions seems to be possible to predict among patients in preterm labor those secondary to subclinical endoamniotic infection or chorioamnionitis. The use of these new markers in the future may allow a better identification of patients at risk of preterm labor and a proper selection of the treatment (medical or surgical) required for such patients.
> Objective: To evaluate the efficacy and safety of two different methods, intravenous prostaglandin E2 and extraamniotic prostaglandin F2alpha instillation, in second-trimester pregnancy termination. Methods: We designed a prospective randomized longitudinal study. 130 consecutive patients with various indications for second-trimester pregnancy termination were recruited. Patients were managed randomly with either intravenous continuous prostaglandin E2 infusion or extraamniotic prostaglandin F2alpha instillation. Laminaria were inserted in patients with unfavorable cervixes. The instillation-abortion time, success rate within 24 hours, dosage of both medications, and side effects were recorded and analyzed. Results: There was a significantly shorter instillation-abortion time (11.85 +/- 9.65 versus 22.18 +/- 16.83 hours, P < 0.001), higher complete abortion rate (71.91% versus 41.5%, P = 0.013), and a higher rate of successful abortion within 24 hours (87.6% versus 56.1%, P < 0.001) in patients treated with intravenous prostaglandin E2 than in those with extraamniotic prostaglandin F2alpha. Conclusions: Prostaglandin E2 had a higher rate of successful abortion and fewer side effects than prostaglandin F2alpha. This implies that intravenous prostaglandin E2 might be a better choice for second-trimester pregnancy termination compared with extraamniotic prostaglandin F2alpha.
Objective: To determine the effects of ketanserin given from early in the midtrimester of pregnancy on fetal heart rate parameters later in pregnancy. Methods: Patients with diastolic blood pressure persistently higher than 80 mm Hg between 12 and 20 weeks' gestational age were randomized to receive either ketanserin or placebo. Both groups also got 75 mg of aspirin per day. The fetal heart rate was monitored once every fortnight from 28 weeks' gestation and weekly from 36 weeks onward. Recordings were made with the Sonicaid System 8000 and continued until the Dawes and Redman criteria were met. Results: The Dawes and Redman criteria were met within 10 min in 54% of recordings in both study groups, whereas they were not met in 4.5 and 3.3% of recordings in the ketanserin group and placebo group, respectively (P = 0.58). The mean time to meet these criteria duration per recording was 16.9 min in the ketanserin group and 16.2 min in the placebo group (P = 0.83). There were no significant differences between the two study groups in fetal heart rate variability, accelerations, or decelerations before 38 weeks' gestation. Thereafter the mean minute range and short-term and baseline variability were significantly higher in the ketanserin group, and significantly more accelerations of the fetal heart were recorded in the ketanserin group. Conclusions. Ketanserin does not influence the fetal heart rate adversely and may even be associated with improved recordings late in pregnancy.
Spondyloepiphyseal dysplasia is a skeletal disorder in which the vertebrae are flattened, thus making the spine shorter and greatly deformed, with marked thoracic kyphoscoliosis, lumbar lordosis, and a shortened trunk. The pelvis is also severely deformed and contracted. The patient was a 40-year-old nulligravida. At the 33rd week of pregnancy, respiratory distress gradually worsened, and cesarean section under spinal anesthesia had to be done. In women with spondyloepiphyseal dysplasia, uterine expansion is limited. As respiratory difficulties increase, an early delivery may have to be done.
> Objective: To investigate the relationship between amniotic fluid interleukin-6 levels and the development of periventricular leukomalacia and intraventricular hemorrhage in the preterm neonate and to compare the value of amniotic fluid interleukin-6 with amniotic fluid culture and histologic chorioamnionitis in the prediction of periventricular leukomalacia and intraventricular hemorrhage. Methods: 119 women, between 20 and 34 weeks gestation, in preterm labor with intact membranes, underwent transabdominal amniocentesis. Amniotic fluid was cultured for aerobic and anaerobic bacteria, Ureaplasma urealyticum and Mycoplasma hominis. Amniotic fluid interleukin-6 levels were determined by enzyme-linked immunosorbent assay. The placentas were examined for histopathologic evidence of inflammation. Where the birth weight was <2,000 g, transfontanelle cranial sonography was performed on the 3rd and 7th days of life for diagnosis of periventricular leukomalacia and intraventricular hemorrhage. Student's t test, the Mann-Whitney U test, likelihood ratio chi2, logistic regression, and receiver-operator characteristic curve were used for analysis. Results: 33 women were excluded from the analysis because they delivered at other institutions. The neonates of 33 women did not have sonography because they weighed >2,000 g at birth. Two neonates died before sonography was performed; four neonates who weighed <2,000 g at birth did not have sonography. In the definitive study group of 47 women, those with neonates who developed periventricular leukomalacia and intraventricular hemorrhage (n = 14) had higher median amniotic fluid interleukin-6 levels (42,795 pg/ml versus 8,020 pg/ml; P = 0.009), more positive amniotic fluid cultures (64% vesus 21%; P < 0.003), and a shorter median amniocentesis-to-delivery interval (16 h versus 24 h; P = 0.045) than women (n = 33) who delivered neonates without periventricular leukomalacia or intraventricular hemorrhage. The groups did not differ in gestational age at admission (P = 0.15), birth weight (P = 0.09), or histologic chorioamnionitis (P = 0.37). An amniotic fluid interleukin-6 level >/=20,000 pg/ml had a sensitivity of 71% and a specificity of 70% compared with a sensitivity of 69% and specificity of 79% for amniotic fluid culture, and a sensitivity of 71% and specificity of 42% for histologic chorioamnionitis in the prediction of periventricular leukomalacia and intraventricular hemorrhage. Women with amniotic fluid interleukin-6 levels >/=20,000 pg/ml (n = 20) had more neonates with periventricular leukomalacia or intraventricular hemorrhage than women with amniotic fluid interleukin-6 levels <20,000 pg/ml (n = 27) (50% versus 15%; P = 0.009). They also were of lower birth weight (P = 0.02), had more neonatal morbidity (P = 0.01), had more positive amniotic fluid cultures (P = 0.01), and more histologic chorioamnionitis (P = 0.02). Logistic regression analysis demonstrated that amniotic fluid interleukin-6 was an independent risk factor for the development of periventricular leukomalacia and intraventricular hemorrhage (odds ratio, 5.81; 95% confidence interval, 1.02-33.16; P = 0.05) after controlling for gestational age, birth weight, histologic chorioamnionitis, and amniotic fluid culture (odds ratio, 7.94; 95% confidence interval 1.22-51.77; P = 0.03). Conclusions: In women in preterm labor with intact membranes amniotic fluid interleukin-6 is useful in predicting neonatal periventricular leukomalacia and intraventricular hemorrhage.
> Objective: The purpose of this study was to assess the direct effects of cocaine on cerebral blood flow and oxygenation in newborn piglets using optical spectroscopy. Optical spectroscopy is capable of monitoring changes in cerebral oxyhemoglobin, deoxyhemoglobin, and total hemoglobin continuously, noninvasively, and in real time. Methods: Five anesthetized and ventilated newborn piglets were injected intravenously with 1 mg/kg cocaine through a central venous catheter over 60 seconds. Cerebral blood flow and oxygenation were assessed by optical spectroscopy and standard physiologic monitoring: mean arterial pressure, carotid blood flow, cerebrovascular resistance, and arterial hemoglobin oxygen saturation (by pulse oximetry). Results: Cocaine induced a profound increase in cerebrovascular resistance, a decrease in carotid blood flow, and a decrease in mean arterial pressure and heart rate. Cerebrovascular changes were detected readily by optical spectroscopy (i.e. a decrease in cerebral oxyhemoglobin was associated with an increase in deoxyhemoglobin). The hypotensive response augmented the cerebral vasoconstriction effect on carotid blood flow. A good correlation existed between the changes in carotid Doppler blood flow and total hemoglobin in each animal and for all animals combined. Peripheral arterial hemoglobin oxygen saturation measured by pulse oximetry remained normal throughout the experiment. Conclusions: The cause for the apparent idiosyncratic hypotensive response to intravenous injections of cocaine is uncertain and requires further investigation. Our study clearly demonstrates that optical spectroscopy might become an extremely useful tool for monitoring cerebral hemodynamics and oxygenation in cocaine-exposed fetuses and infants.
Objective: To compare the technique of immunofluorescence flow cytometry against traditional Kleihauer testing with respect to the sensitivity and specificity of clinical detection of fetomaternal hemorrhage. Methods: Blood samples from D-negative unsensitized postpartum women were analyzed by flow cytometry (customized, directly conjugated monoclonal anti-D) and Kleihauer testing using commercial kits as well as a manual technique. Results: Both flow cytometry and manual Kleihauer tests performed well in vitro against known standards, giving similar results with detectable fetal cells in the range of 2-10%. Correlation of in vivo results obtained by flow cytometry and either Kleihauer method was poor. The percentage of fetal red cells detected by flow cytometry was approximately twice that of the manual Kleihauer. Commercial Kleihauer testing proved unreliable in the in vivo setting. Conclusions: Flow cytometry offers a reliable alternative to traditional Kleihauer testing for detecting fetomaternal hemorrhage and may, with standardized methodology, help optimize immunoprophylaxis against erythroblastosis fetalis.
Objective: The purpose of this study was to determine the type of nitric oxide synthase isoform and to measure the quantities of nitric oxide synthase mRNA in the human placenta.Methods: The isoforms of nitric oxide synthase were determined in ten placentas of normal pregnant women using information regarding calcium dependence and inhibition by arginine analogs and findings from Western blot analyses and reverse transcriptase-polymerase chain reaction.Results: The activity of nitric oxide synthase was largely calcium dependent, although a small element of calcium-independent activity was observed. A stronger inhibition was shown with N-omega-nitro-L-arginine than with N-omega-monomethyl-L-arginine. On Western blots endothelial nitric oxide synthase was detected as a band of 140 kilodaltons, without evidence of inducible nitric oxide synthase. Messenger RNA of endothelial nitric oxide synthase was readily detected by reverse transcriptase-polymerase chain reaction, but that of inducible nitric oxide synthase was barely detected. The quantity of mRNA of inducible nitric oxide synthase was about 100-fold less than that of endothelial nitric oxide synthase.Conclusions: These results point to the constitutive endothelial type as the predominant isoform of nitric oxide synthase in human placenta from 37 to 41 weeks gestation, although protein and mRNA of inducible nitric oxide synthase may exist.
> Objective: The aim of our study was to evaluate sonographic and Doppler detectable differences in umbilical coiling index and fetoplacental circulation of discordant twins. Study Design: Doppler blood flow studies in 13 pairs of concordant and 20 pairs of discordant twins were performed from umbilical artery, middle cerebral artery, inferior vena cava, and ductus venosus. Flow studies were compared and correlated with the antenatal sonographic coiling index and the actual umbilical cord length, number of vascular helices, and birth weight. All studies were performed within 72 h before delivery. Pulsatility index (PI) values were calculated for the arteries and preload index (PLI) values for the veins. The umbilical coiling index (CI) was calculated using sonographic longitudinal views of cord vessels from several segments antenatally and by dividing the total number of helices by cord length (cm) postnatally. Discordancy was defined as a more than 20% intrapair actual birth weight difference. For all these index values the intertwin differences (Delta values) were calculated by subtracting the values obtained in the larger twin with those of the smaller twin. Results: The mean +/- SD intertwin difference in umbilical coiling index was 27.4 +/- 10.5% in the antepartum period and 28.9 +/- 10.0% after birth. Regression analysis showed a significant linear trend (r = 0.77, P < 0.001) between intertwin birth weight difference (DeltaBW) and intertwin coiling index difference (DeltaCI). A good correlation was found between DeltaCI and DeltaPLI in the ductus venosus (r = 0.63, P < 0.05), DeltaPLI in the inferior vena cava (r = 0.51, P < 0.005), and DeltaPI in the middle cerebral artery (r = 0.44, P < 0.05). Conclusions: Intertwin difference in antepartum umbilical coiling index can be determined by ultrasound and correlates well with: 1) the actual difference in coiling indices at birth, 2) the intertwin birth weight difference and 3) the intertwin Doppler flow characteristics in the fetal cerebral and venous circulation.
Gitelman's syndrome is primary renal tubular hypokalemic metabolic alkalosis with hypocalciuria and magnesium deficiency. We present the prenatal course and outcome of two pregnancies in a patient with Gitelman's syndrome. The complication encountered was oligohydramnios. Close monitoring of serum magnesium and potassium, amniotic fluid volume, and fetal growth is required.
> Objective: A pilot study was designed to investigate whether maternal brachial arterial Doppler shift waveforms analyzed using a Laplace transform analysis technique could distinguish women with gestational hypertension and preeclampsia from women who remained normotensive during their pregnancy. Methods: We examined 50 pregnant women in total. They were divided into two groups. The first was a group of 21 normotensive women, and the second was a group of 29 women with gestational hypertension or preeclampsia, not on medication at the time of study. A Doppler shift waveform of the right and left brachial artery was obtained and analyzed using the conventional parameters of resistance index (RI) and pulsatility index (PI) and Laplace transform analysis. Results: The systolic and diastolic blood pressures and the mean arterial blood pressure at presentation were significantly higher in group 2 as expected. The results of the Laplace transform parameters showed significant differences in the resonant frequency, real pole, c coefficient, and alpha between the two groups. There was no difference in the PI between the two groups, but the differences in RI just reached significance. The Laplace transform parameters in the group with gestational hypertension were consistent with peripheral vasoconstriction, which has been suggested as part of the hemodynamic abnormalities in this condition. Conclusion: Analysis of maternal brachial arterial Doppler shift waveforms by Laplace transform analysis detects differences between normotensive and hypertensive patients. These differences may also reflect some of the hemodynamic changes occurring in gestational hypertension.
> Objective: To investigate the relationship between maternal weight and serum alpha-fetoprotein (AFP) and free beta-human chorionic gonadotropin (beta-hCG) levels and to determine the methodology of correction formulas for influencing the results of Down syndrome screening in an Asian population. Methods: 8,194 normal singleton pregnancies without any congenital anomalies were screened using AFP and free beta-hCG between 14 and 22 weeks of gestation. Down syndrome risk was calculated by bivariate gaussian algorithm that combined information from the two biochemical measurements and maternal age. The all points regression method and median regression method were used to approach the study cases. Linear and quadratic regression correction formulas for AFP and free beta-hCG, either in analyte multiples of the median (MoM) or log analyte MoM, against maternal weight have been proposed in this study. Results: The mean maternal weight is 54.95 +/- 7.36 kg in Taiwanese pregnant women during the second trimester. There is a distinctly inverse relationship between maternal weight and serum marker levels. The log quadratic regression correction formula was the most satisfactory equation fit to the distribution of both AFP and free beta-hCG levels with a wide weight range. Routine weight correction may have the small benefit of reducing the screen-positive rate 0.36% at the risk cut-off level of 1:270. Conclusions: Maternal weight may affect the AFP and free beta-hCG levels. Although there is no discernible effect in maternal weight adjustment, it is worth making weight corrections for serum marker levels in order to reduce individual variance.
At week 32 of a pregnancy complicated by maternal seizures, fetal ultrasonography showed hydrocephalus and an intracranial hyperechoic mass identified by magnetic resonance imaging as subacute right thalamic hemorrhage, with aqueductal obstruction. Fetal intracranial bleeding may be a cause factor of perinatal death complicating maternal epilepsy.
