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Spontaneous septostomy in a monochorionic diamniotic twin pregnancy is a rare phenomenon. We present a case of monochorionic diamniotic twin pregnancy with an intact dividing membrane seen in the 1st half of the pregnancy. At 26 weeks, when she was assessed for preterm contractions, the dividing membrane was not documented, which suggested spontaneous septostomy. There had been no invasive procedures during the pregnancy. She subsequently delivered at 29 weeks, secondary to preterm labor. No dividing membrane was noticed at the time of caesarian section. Spontaneous septostomy can complicate the management of monochorionic diamniotic twins by creating a pseudomonoamniotic environment resulting in cord entanglement, and difficulty in the diagnosis and management of twin-twin transfusion syndrome. We believe that such a case should be managed as monochorionic monoamniotic twin gestation.

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c Intraventricular hemorrhage with congenital cytomegalovirus (CMV) infection is rare and has been reported only in extremely premature infants or in association with thrombocytopenia. We report the first case of a full-term male infant with congenital CMV infection and intraventricular hemorrhage with a normal platelet count and coagulation profile. The infant also had a left subependymal cyst and bilateral occipital cysts without any other manifestations of CMV infection. CASE REPORTT he mother of our patient was a 31-year-old woman (gravida 2, para 1) who was rubella and varicella immune, and all of her other serologic findings were negative. The parents were nonconsanguineous, and there was no family history of any bleeding disorder. Ultrasound examinations done at 12, 19, and 30 weeks of gestation showed normal fetal anatomy with a fetus appropriate for its gestational age.The pregnancy was uneventful until 38 weeks of gestation, when the mother felt that fetal movement had decreased. An ultrasound examination revealed asymmetric intracranial ventriculomegaly with the left lateral ventricle larger than the right and strands visible across both ventricles. The occipital horn of the right ventricle was also dilated, and there was echogenicity of the left choroid plexus suggestive of a blood clot (Fig. 1A). Fetal biometry was appropriate for the gestational age, the amniotic fluid index was normal, and the biophysical profile was 8/8.As an intraventricular hemorrhage was suspected, delivery was by cesarean section at 39 weeks of gestation with Apgar scores of 9 and 9 at 1 and 5 min, respectively. His birth weight was 2,790 g, his head circumference was 34 cm, and his length was 48 cm, all of which were appropriate for his gestational age. Except for mild hypotonia, the infant was normal upon examination.Magnetic resonance imaging (MRI) done on day 2 of life showed a moderately dilated left lateral ventricle with a subependymal cyst at the left foramen of Munro extending along the caudothalamic notch, consistent with a previous intraventricular hemorrhage. There were bilateral occipital cysts compressing the occipital horns with a thin intervening septation (Fig. 1B). A small-volume intraventricular hemorrhage was visible in the dependent portion of the left lateral ventricle (Fig. 1C). Myelination was appropriate for a term infant, and magnetic resonance spectroscopy was noncontributory.Given his history and neuroimaging findings, the infant was investigated for a bleeding disorder and bacterial and viral infections. Complete blood counts showed a platelet count of 190 ϫ 10 9 /liter (normal range, 150 ϫ 10 9 to 400 ϫ 10 9 /liter) with normal hemoglobin and white cell counts. The partial thromboplastin time was 46.6 s, and the international normalized ratio was 1.4, both of which were within the normal range for a term infant. Bacterial cultures and tests for parvovirus B19-specific IgM and IgG and toxoplasma-specific IgM and IgG were negative. Both the rapid plasma reagin assay and a line immunoassay (Innogene...

We evaluated the relationship between duration of labor induction and successful vaginal delivery (VD) in nulliparous women at term. Nulliparous women with singleton pregnancies > or = 37 weeks who underwent labor induction at a single institution were studied. Exclusion criteria were nonvertex presentation, stillbirth, fetal chromosomal/structural abnormalities, spontaneous labor, and spontaneous rupture of membranes. VD rates and maternal/neonatal outcomes were evaluated and compared with respect to the duration from induction to delivery. Over the 1-year study period, 340 women met all criteria. Seventy-five percent achieved VD (n = 255), 40.6% of whom had rate of cervical dilation in active labor < 1.0 cm/hour. Women requiring cesarean delivery were more likely to have fetal acidemia, admission to the neonatal intensive care unit, chorioamnionitis, and endometritis. There was no association with prolonged induction to delivery intervals and adverse maternal/neonatal outcomes. In our population, only 5.7% of nulliparous women undergoing labor induction at term remain undelivered at 48 hours. Of women achieving VD, > 40% had rate of cervical dilation in active labor < 1.0 cm/hour.