Biomedical subjects
Publications and source records attributed to V A Barss.
Ultrasound can be useful for fetal assessment in Kell-isoimmunized pregnancies. Because severe hydrops may develop within six days, ultrasound should be repeated more frequently than once per week even if the delta OD450 values are low.
The authors' experience with stillbirth within one week of a reactive nonstress test was reviewed to determine the reliability of this test in postdates patients and general high-risk patients. The corrected stillbirth rates were the same in both groups. Thirty-three percent of stillbirths in postdates patients occurred as early as 41.5 weeks' gestation. The cause of stillbirth in postdates patients was not clear even after careful autopsy. In the general high-risk group, 60% of stillbirths were due to an acute event with the remainder due to chronic fetal compromise that was not predicted by the nonstress test. Induction at 41.5 weeks' gestation or more comprehensive fetal surveillance than weekly nonstress testing are possible approaches to the management of postdates pregnancy, which need to be further studied.
Six patients requiring anticoagulation during pregnancy were managed with a continuous-infusion subcutaneous heparin pump. There were no cases of recurrent thrombosis; however, five of the six patients had major or minor bleeding complications despite therapeutic partial thromboplastin time levels.
Twelve cases of severe second trimester oligohydramnios are reported. The outcome of these pregnancies was uniformly poor, with no survivors in the present series. Four patients had therapeutic abortions, one woman had spontaneous labor at 22 weeks' gestation, and seven patients continued to viability. Of these, five patients had severe renal abnormalities incompatible with life. Two infants died at, or shortly after, birth from severe intrauterine growth retardation (IUGR), one of which had a triploid karyotype. Review of the literature shows a similar poor outcome for pregnancies with severe oligohydramnios in the second trimester.