"Fetal heart rate patterns during repeated episodes of maternal clinical shock." Journal of Obstetrics and Gynaecology, 6(3), pp. 181–182

The survival rate of very low birthweight infants (weighing less than 1500 gm) has dramatically increased over the past two decades. Consequently, high-tech intensive care is offered to an increasing number of infants with borderline viability, previously considered as miscarriages. We reviewed the most recent literature on the results of intensive care used in the subgroup of extremely low birthweight infants, weighting less than 750 gm or 800 gm. Since definitions, management policies, and follow-up reports in this group of newborns are not consistent, the important statistical variables of incidence, mortality, and morbidity are incomplete and severely biased. In the past decade there was a growing tendency toward using a more active approach in caring for these infants. Most of the success is among the infants weighing 750 to 800 gm, with a survival rate in the range of 33 to 62%. However, the overall improvement in survival is small, with an extremely poor outlook for infants below 600 gm. The morbidity rate in the survivors is alarmingly high, reaching 70% and most common in infants with birthweight less than 600 gm. The available data show that virtually for every "healthy" surviving extremely low birthweight infant there is also at least one surviving child who is moderately to severely handicapped. The overall consequences and implications of high-tech care of these borderline viability infants, once considered as nonviable, are not necessarily improved over those of the former, less aggressive, approach. Since these results have grave consequences for the involved families and society, we urgently need to involve these parties more actively in decision making.

The incidence of triplet pregnancies has increased with the introduction of ovulation induction agents and is expected to further increase with the implementation of multiple embryo transfer in the in vitro fertilization programs. We review our experience with 29 triplet pregnancies in the last 10 years. Despite early sonographic diagnosis, close follow-up, increased use of tocolytics, and prophylactic cervical suture, we could not document prolongation of pregnancy, increased infants' weight, or a significantly decreased perinatal mortality, which still remains about 14%. Furthermore, the use of cesarean section as the delivery method of choice did not change the well-documented unfavorable relationship between birth order and fetal outcome. There is an urgent need for prospective assessment of the value of different treatment modalities, which nowadays becomes possible with the increasing incidence of triplet pregnancies. The prevention of triplet pregnancies or treatment by selective fetal reduction deserves a second thought.

Free digoxin-like immunoreactive factors) (DLIF) which may have a homeostatic role, as documented in different physiological conditions, but is generally undetectable in plasma from normal population. Total digoxin-like immunoreactive factor(s) (protein bound and free) can be estimated after plasma is heated. In this study, total digoxin-like immunoreactive factor(s) as measured in plasma in a well defined control population and compared to healthy term pregnant women and neonates, categories known to be associated with increased free digoxin-like. immunoreactive factors) concentrations. The mean level of this factors) in the control group was 706 ± 129 pg digoxin equivalent/ml (pg/ml) and was unaffected by age and sex. Significantly increased levels of total digoxin-like immunoreactive factor(s) were found in pregnant women and neonates (928 ± 127 and 1242 ± 367 pg/ml, respectively). We conclude that levels of total digoxin-like immunoreactive factor(s) are increased in term pregnancies and neonates, similarly to its free form. However total digoxin-like immunoreactive factor(s) is detected in the normal population as a plasma component, contrary to its free form, which is generally undetectable.

The objective of this study was to measure maternal total digoxin-like immunoreactive factor levels in singleton pregnancies with or without hypertension and in twin pregnancies. Plasma digoxin-like immunoreactive factor was measured in 113 third-trimester patients: 51 normotensives, 20 preeclamptics, 19 with latent or chronic hypertension, and 23 with twin pregnancies. The concentration of total digoxin-like immunoreactive factor in the twin gestations (1143 +/- 249 pg/mL) was significantly higher than that in either the normotensive pregnancies (890 +/- 161 pg/mL) (P less than .001) or in the hypertensive pregnancies (903 +/- 256 pg/mL) (P less than .01). However, there were no significant differences in digoxin-like immunoreactive factor levels between the normotensive and hypertensive groups. A trend of higher, although not statistically significant, levels of digoxin-like immunoreactive factor was noted in the chronic hypertensive group as compared with the preeclamptic patients (957 +/- 212 versus 852 +/- 288 pg/mL). We therefore conclude that digoxin-like immunoreactive factor does not contribute significantly to the pathogenesis or prediction of preeclampsia. The increased amount of digoxin-like immunoreactive factor in twin pregnancies may reflect a contribution from multifetal origin, or might be a physiologic adaptive mechanism allowing higher cardiac output by a possible cardiotropic effect.

Plasma digoxin-like immunoreactive factor(s) (DLIF) have been reported in various pathophysiological conditions associated with volume expansion and linked to the regulation of blood volume and pressure. We hypothesized that DLIF might be present in rapidly expanding gonadotropin-stimulated ovarian follicles. The mean total and free DLIF concentrations in the follicles (n = 9) studied were 4925 nmol/L and 1885 nmol/L, respectively. These concentrations were substantially higher than the plasma total and free DLIF levels in these women: 1216 nmol/L and 158 nmol/L, respectively (p less than 0.0001). The plasma DLIF levels in the gonadotropin-treated women were comparable to those in term pregnant women, which are known to be higher than those in non-pregnant women. The ovary thus may be a source of DLIF in the plasma of gonadotropin-treated women, and DLIF may have a role in ovarian follicular fluid homeostasis.

The effect of the delivery method on the short-term and long-term morbidity and mortality of the very low birthweight breech-presenting infants was evaluated. Although some previous studies question the benefit of cesarean section for the premature breech infants, the mortality rate and the incidence of birth injuries were significantly lower in the abdominally delivered group than in those delivered vaginally. The long-term follow-up clearly demonstrates that the vaginally delivered infants had a substantially higher incidence of cerebral palsy, visual damage, deafness, and severe developmental delay. It is concluded that cesarean section may be the preferred delivery method for the breech-presenting infants weighing 1000 to 1999 gm, offering a better quality of life.

Severe cyclic dysmenorrhoea in a young woman with a unilateral abdominopelvic mass terminating in a purpuric bulge in the lateral vaginal wall, and resulting in renal agenesis ipsilateral to the pelvic mass, suggests uterus didelphys with unilaterally imperforate vagina. A report of two cases, their diagnostic and therapeutic approach and review of the literature are presented.