Fetal micrognathia and short, bowed femora were found on a routine prenatal ultrasonogram. At birth, a cleft palate and the characteristic facial appearance confirmed the diagnosis of the femoral-facial syndrome. (The femoral-facial syndrome [McKusick 137840] was first delineated by Daentl et al. [1975: J Pediatr 86:197-211] and called the "femoral hypoplasia-unusual facies syndrome." We prefer the "femoral-facial syndrome" because it is shorter, more easily translated, and because the McKusick catalog is the most widely recognized standard of nomenclature.) A paternal great uncle, deceased at age 4 years, seems to have had the same condition.
A 27-year-old gravida 4, para 3 was found to have anhydramnios at 14 weeks' gestation following a size/date discrepancy noted at her routine prenatal visit. A detailed ultrasound revealed multiple fetal anomalies including congenital heart defect, chest hypoplasia, and bilateral dysplastic kidneys. Karyotype revealed trisomy 16 in 15/15 cells from a tissue specimen obtained from the fetal cord insertion site following elective pregnancy termination.
A retrospective study of vaginal birth after cesarean (VBAC) was conducted over 24 months. Of 152 women who had a previous cesarean, 141 were offered VBAC. Sixty-eight had an elective repeat cesarean, and 73 agreed to VBAC. These groups were similar with respect to age, race, parity, and weight. Fifty-nine of the VBAC patients delivered vaginally (80.8%). The two groups were compared for the incidence of febrile morbidity, endomyometritis, uterine dehiscence and estimated blood loss at delivery. There were no significant differences between the two groups or when each was compared with a control group of 69 routine vaginal deliveries except for the estimated blood loss and the number of days hospitalized (p less than 0.05). Neonatal morbidity was examined between the two groups by comparing the incidence of transient tachypnea and the number of newborns with suspected sepsis, as well as those requiring antibiotics or admission to the Neonatal Intensive Care Unit. The repeat cesarean group had a higher overall incidence of neonatal morbidity than the VBAC group, but this was not statistically significant. However, there was statistical significance (p less than 0.05) when comparing the number of days hospitalized between the infants in the VBAC group versus the repeat cesarean group. This study supports VBAC as a safe alternative to elective repeat cesarean for the patient and neonate. Data analysis was performed using Student's t test or chi-square analysis with a p less than 0.05 regarded as being statistically significant.
OBJECTIVE:To describe the use of subcutaneous (s.c.) metoclopramide in the outpatient treatment of hyperemesis gravidarum. STUDY DESIGN:In a retrospective design, women who received continuous s.c. metoclopramide for treatment of hyperemesis gravidarum were identified from a national database. Data analysis included weight at start and stop of treatment, frequency of resolution of symptoms, and side effects of medication. In addition, data were collected on adjuvant therapies. RESULTS:Between January and December of 1997, there were 646 women with hyperemesis gravidarum who received continuous s.c. metoclopramide on an outpatient basis. A total of 413 patients (63.9%) had complete resolution of symptoms. Seventy-five percent of patients had received one or more antiemetic medications before initiation of s.c. metoclopramide. A total of 192 patients (30.5%) reported at least one side effect related to treatment. The majority of reported side effects were considered mild and did not require discontinuation of s.c. metoclopramide. CONCLUSION:S.c. metoclopramide appears to be a safe, effective treatment for hyperemesis gravidarum. Outpatient treatment may result in decreased costs compared with inpatient hospitalization. Journal of Perinatology 2000; 20:359-362.Hyperemesis gravidarum is characterized by intractable nausea and vomiting during pregnancy with concurrent disturbances of nutrition and fluid balances. While nausea and vomiting afflicts 60% to 70% of pregnant women, hyperemesis gravidarum is relatively uncommon, occurring in ϳ5 per 1000 pregnancies.1 Ultimately, hyperemesis gravidarum accounts for ϳ4% to 7% of all antenatal hospital admissions and 30% of admissions before 20 weeks' gestation. 2When patients experience hyperemesis gravidarum, there is significant disruption in their lives, and there is a high cost to society. In a review of hyperemesis gravidarum by Cowan, 3 women reported curtailing social contacts. They also reported that relationships with spouses and families were altered. Vellacott et al. 4 reported that 183 of 243 pregnant women experienced nausea and vomiting in pregnancy, and 47% of these women felt that their job efficiency was reduced. Gadsby et al.1 have estimated that in England, some 8.6 million hours of paid employment and 5.8 million hours of housework are being lost through nausea and vomiting in pregnancy of all severities each year.Traditionally, this condition has resulted in costly management and loss of productivity due to prolonged and/or recurrent hospital admissions, as well as physical and emotional sequela. According to the Healthcare Cost and Utilization Project (HCUP), the average charge for patients treated for ICD-9-CM 643.13 (Hyperemesis with Metabolic Disturbances-Antepartum) in the hospital is $1291.33 per day.5 Studies looking at patients with hyperemesis gravidarum have reported frequent hospital admissions. 2,6,7 In one such study, 28% (39 of 140) of patients with hyperemesis gravidarum were admitted to the hospital 2.9 times on average (range 2 to 6 time...
Pre-induction intracervical deposition of 1 mg PGE2 gel decreased the amount of oxytocin required to induce progressive labor and decreased the cesarean rate in patients who had medical or obstetric indications for delivery before 41 completed weeks. This was accomplished without negative effect on Apgar score or umbilical artery pH.
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