Objective To investigate the effects of maternal dexamethasone administration on umbilical and fetal Design Cross-sectional study.Setting Department of Obstetrics and Gynaecology, Robert Ballanger Hospital, Aulnay-sous-Bois, Sample Twenty-six pregnant women with singleton pregnancies considered at risk for preterm delivery.At baseline, all pregnancies had normal fetoplacental vascular resistance.Methods These women were given weekly six intravenous doses of 4 mg of dexamethasone eight hours apart.Main outcome measures Doppler studies were performed from both umbilical artery (UA) and fetal middle cerebral artery (MCA) before (day 0), during (day 2), immediately after (day 4) and shortly after (day 7) every steroid course.Results No significant variation was noted in both umbilical artery pulsatility index (PI) and fetal heart rate through dexamethasone therapy. Compared with mean initial values, we found on day 4 a significant decrease in MCA PI of 0.28 (F = 7.17, P c 0.001) and a significant increase in UA:MCA PI ratio of 0.08 (F = 3.85, P = 0.013); in contrast no significant change was documented on days 2 and 7 in both MCA pulsatility index and UA:MCA PI ratio. After multiple regression analysis, only the decrease in fetal middle cerebral artery pulsatility index on day 4 remained significant Conclusions The current study finds in healthy fetuses a transient, significant and unexplained decrease in fetal middle cerebral artery impedance on the fourth day following maternal dexamethasone administration. Further basic research and clinical studies including larger sample sizes or pregnancerebral artery flow velocity waveforms.France.(F=5.84, P = 0.001).cies with fetoplacental dysfunction are needed. that betamethasone and dexamethasone were associated with an increase in long term and short term variability and decreased fetal movements on the first day after steroid administration followed by a decline in fetal heart rate variability on the second day. Similarly, the trial of Mulder et aL6 reported a transient decrease in fetal heart rate variability and in fetal body and breathing movements after betamethasone; conversely, a rise in fetal heart rate variability was noted on the first day after dexamethasone. These effects are more obvious with betamethasone than dexamethas~ne~,~.'~. Evaluation of fetal wellbeing with Doppler waveform studies after maternal corticosteroid administration is therefore important. Knowledge of fetal haemodynamic effects of exogenous corticosteroids is limited. Little is known about the impact of antenatal 0 RCOG 2000 British Journal of Obstetrics and Gynaecology INTRODUCTION

No abstract

Objective: The aim of this study was to investigate the effect of cordocentesis on fetomaternal hemorrhage (FMH). Methods: One hundred and three diagnostic cordocenteses, without any other associated procedure, were performed at 23–40 weeks’ gestation. FMH was detected using the Kleihauer-Betke staining of maternal blood taken immediately before and after cordocentesis. Results: Significant FMH occurred after 40 (38.8%) of the 103 procedures. An increased risk of fetal bleeding was associated with both an anterior placenta (odds ratio (OR) 5.89; 95% confidence interval (CI) 2.27–15.3; p < 0.001) and a transplacental cordocentesis (OR 37.0; 95% CI 2.15–636; p < 0.001). The volume of FMH was greater after cordocentesis with an anterior placenta (90th percentile 6.20 ml) than after cordocentesis with a lateral (90th percentile 4.58 ml) or posterior placenta (90th percentile 1.35 ml) (p < 0.001). After fetal blood sampling, significant FMH occurred more frequently with a procedure duration of 3 min or more (OR 4.45; 95% CI 1.70–11.7; p = 0.002) and with two or more needle insertions (OR 4.65; 95% CI 1.80–12.1; p = 0.001). Conclusion: FMH following cordocentesis may be related to placental injuries. This event is influenced by placental location, procedure duration and the number of needle insertions.

No abstract

Objective To consider whether laparoscopic bilateral salpingotomy can be effective in the management of bilateral simultaneous tubal pregnancy. Design A case report. Subject A 24‐year‐old Indian woman, gravida 2 para 1, with pelvic pain at 5 weeks' gestation. Interventions The patient had conceived with an ovulation induction regimen. Pelvic examination and ultrasonography suggested an ectopic pregnancy. Laparoscopy revealed bilateral simultaneous tubal pregnancy. Conservative treatment through bilateral linear salpingotomy was carried out and pathological investigation confirmed the presence of chorionic villi in both tubes. Results The postoperative clinical course was uneventful and β‐human chorionic gonadotrophin levels dropped satisfactorily. The patient required no further treatment. Comment  Correctly performed laparoscopic bilateral salpingotomy can be effective in the management of bilateral simultaneous tubal pregnancy.