While only a small fraction of SSA/SSB-positive pregnancies are complicated by complete heart block (HB), substantial fetal and infant morbidity and mortality, as well as reports of successful treatment of incomplete HB with maternally administered steroids, make early diagnosis of conduction abnormalities desirable. In this study we investigated whether prospective Doppler interrogation of the mechanical PR interval could identify fetuses with incomplete HB who might benefit from in utero treatment. Maternal histories and fetal echocardiograms performed secondary to maternal SSA/SSB antibodies at two large maternity services between 1997 and 2003 were reviewed. The mechanical PR interval .was measured from onset of mitral A wave to onset of aortic outflow for three beats. The mean (±SD) mechanical PR intervals of study patients were compared to fetuses with known autoimmune first- and second-degree HB on fetal magnetocardiography (controls). Differences were determined by Mann-Whitney test. 128 fetal echocardiograms were performed on 68 women at 23.7±5.1 (range 16-32 weeks) during their 1st (36), 2nd (18), 1st and 2nd (4), or >2nd (10) pregnancies. One previous child had incomplete fetal HB that did not progress after maternally administered dexamethasone. Sixty-four mothers had SSA, and 4 had SSA/SSB antibodies. Mechanical PR intervals ranged from 97-142 (121.3±11.8) msec in the study group and were significantly different from the 4 controls (191.5±22.4 msec, P = 000). All study infants were liveborn with no HB or dilated cardiomyopathy. Mechanical PR intervals can be successfully measured in fetuses from 16-32 weeks of gestation. The incidence of conduction abnormalities in fetuses with maternal SSA/SSB and a negative family history is extremely low (0/68). The mechanical PR is an effective discriminant and should be evaluated prospectively.

Objective: The study’s aims were to compare neonatal outcomes and to describe maternal complications in patients who underwent delayed delivery of twins or triplets in a preterm gestation. Study Design: A retrospective review was performed on 5 sets of twins and 2 sets of triplets. Maternal morbidity was described. Neonatal outcomes were compared in the initial and subsequent delivery groups. Results: The percentage of surviving firstborns was 57%, compared with 78% among latter-born infants. The average gestational age of the initial delivery group was 22.6 weeks (18.9-24.7 weeks); gestational age was 27.4 weeks (19.3-37.9 weeks) for the subsequent group (P < .05), a difference of 32.6 days. The average weight gain was 556.1 g. Serious neonatal complications were less frequent among the subsequently delivered siblings (P < .05), and the mean difference in neonatal hospital stay was 77.3 days, with a range of 62.5 to 139.8 (P < .5). Adverse maternal outcomes were represented by 3 patients with abruptio placentae and 3 patients with intra-amniotic infection, 2 of whom had positive blood culture results. Conclusion: On the basis of our experience with 7 multifetal pregnancies, delayed delivery has been demonstrated to increase the likelihood of survival and decrease morbidity among the latter-born siblings. Despite the risk of complications, these data support therapeutic interventions aimed at delayed delivery of subsequent fetuses in cases with the potential for significant morbidity and mortality. (Am J Obstet Gynecol 1998;179:1145-9.)

Indomethacin was utilized in 24 pregnancies (31 exposed fetuses) in preterm labor who labored despite intravenous tocolysis. The mean gestational age at the start of indomethacin therapy was 25.1 weeks (+/- 4.4), mean duration of indomethacin therapy was 43.9 days (+/- 31.4), mean gestational age at delivery 33.1 weeks (+/- 3.7). Neonatal follow-up revealed the same incidence of complications in these indomethacin-exposed infants, when they were compared with all other infants born in the same time period and exposed to intravenous tocolytics only when matched for gestational age at delivery.

Journal of Clinical UltrasoundVolume 15, Issue 1 p. 59-63 Case Report Prenatal ultrasound diagnosis of thoracopagus conjoined twins Mark Kalchbrenner DO, Mark Kalchbrenner DO Department of Obstetrics and Gynecology, Flint Osteopathic Hospital, Flint, Michigan 48502Search for more papers by this authorStuart Weiner MD, Corresponding Author Stuart Weiner MD Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA 19107Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania 19107Search for more papers by this authorJohn Templeton MD, John Templeton MD Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104Search for more papers by this authorThomas A. Losure MD, Thomas A. Losure MD Chicago Osteopathic Hospital, Chicago, Illinois 60615Search for more papers by this author Mark Kalchbrenner DO, Mark Kalchbrenner DO Department of Obstetrics and Gynecology, Flint Osteopathic Hospital, Flint, Michigan 48502Search for more papers by this authorStuart Weiner MD, Corresponding Author Stuart Weiner MD Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA 19107Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania 19107Search for more papers by this authorJohn Templeton MD, John Templeton MD Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104Search for more papers by this authorThomas A. Losure MD, Thomas A. Losure MD Chicago Osteopathic Hospital, Chicago, Illinois 60615Search for more papers by this author First published: January 1987 https://doi.org/10.1002/jcu.1870150112Citations: 15AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume15, Issue1January 1987Pages 59-63 RelatedInformation