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Investigating trends in Down syndrome live births in the US from 1989 to 2001 using birth certificate data. Down syndrome live births declined in the US despite an expected increase caused by delayed or extended childbearing.

Most maternal-fetal medicine specialists perform Down syndrome screening, according to a survey of 543 specialists. Most offer second-trimester screening and about half offer first-trimester screening. Amniocentesis was the most common prenatal test, but many specialists also used blood tests and ultrasound scans.

Combining blood tests with ultrasound scans for fetal anatomic abnormalities can improve the prenatal diagnosis of Down syndrome in women 35 years old or older. The combined screen detects 97% of fetuses with Down syndrome with a 22% false-positive test.

A group of doctors from the University of Connecticut Health Center has created tables and graphs of fetal growth measurements in triplet pregnancies. The data are based on 443 ultrasound scans of 33 triplet pregnancies between 16 and 35 weeks' gestation. Each woman had between 3 and 6 scans during this time period.

Infection with parvovirus during pregnancy can contribute to hydrops in the fetus, a potentially fatal massive accumulation of fluid. In a survey of members of the Society of Perinatal obstetricians, 541 respondents confirmed parvovirus-induced hydrops. In 34% of the cases, there was spontaneous resolution; in 30% of the cases there was death without uterine tranfusion. After uterine transfusion, 29% cases resolved, while 6% died. Almost all of the cases appeared between 16 and 32 weeks.

Survival rates of monoamniotic twins may be significantly improved with early diagnosis, intense monitoring of the fetal heart rate, and judiciously timed cesarean delivery. Monoamniotic twins, sharing a single amniotic sac, are a rare occurrence. Thirteen monoamniotic twins diagnosed in early pregnancy were meticulously supervised. Eight sets of twins were delivered in response to an abnormal fetal heart rate. The survival rate of the closely monitored infants was 92%, compared to a 66% survival rate seen in historical accounts of 77 monoamniotic twins undiagnosed before birth.

The use of several electronic calipers for on-screen ultrasonic measurement of the axis of the fetal heart may enable doctors to detect fetal heart defects. Abnormal heart axis has been associated with congenital heart defects. Researchers performed ultrasound examinations of two hundred low-risk fetuses using several electronic calipers to measure the placement of the heart axis. This measurement was compared to that obtained by a manual method using a protractor. Both methods yielded similar results. All 200 infants were found to have heart axes in a normal position of 43 degrees, which was confirmed by examining infants after birth. The use of electronic calipers may be more convenient for ultrasonic measurement of fetal heart axis. Three to five sets of calipers should be used.

A second trimester ultrasound scan may help determine whether a pregnant woman is at high or low risk for a fetus with Down syndrome. The medical literature was searched for second trimester ultrasound studies of physical markers of Down syndrome. A table was generated of the association of the presence or absence of these factors with Down syndrome. The results showed an average detection rate for physicial abnormalities in the fetus of 28%. Scan results can be combined with maternal age and a maternal blood test to help women determine whether to have an amniocentesis. Women of any age may wish to consider amniocentesis if an ultrasound scan is positive for one or more these factors. Reducing the number of amniocenteses would reduce the number of normal fetuses exposed to its risks, which include a pregnancy loss rate of about one per 270 scans. Some preliminary data suggest that the number of women age 35 or more having an amniocentesis can be reduced to 20% of this group without missing any cases of Down syndrome, although this cannot be guaranteed.

Magnesium sulfate, a medication given to stop preterm labor, had no effect on the biophysical profiles of healthy preterm fetuses. Previous reports found adverse effects on this test of fetal well-being among full-term fetuses. Thirty-one fetuses between 24 and 35 weeks gestation had a biophysical profile just before their mothers were administered magnesium sulfate to stop labor. The fetuses were evaluated again at two and twelve hours after administration of magnesium sulfate. No differences in total score or in the score components were found. Possible explanations for the difference from other studies include lower dosages used, failure to rule out infection in other studies, adaptation over time, or normal differences in physiology between the preterm and the mature fetus. Longer studies should be carried out because duration of magnesium sulfate therapy may extend to one or two days.

Variation in placental weight may cause significant differences in the birth weight of dichorionic twins. Dichorionic twins have two distinct chorions, the outer extraembryonic membrane. The lighter twin may also have a larger number of placental lesions that the heavier twin. Researchers examined the placentas of 91 dichorionic twin pairs and 40 monochorionic twin pairs. Monochorionic twins share the same chorion. Among the dichorionic twin pairs, the lighter twin was more likely to belong to the lighter placenta than the heavier twin. The lighter dichorionic twin was more likely to have the largest number of placental lesions than the heavier twin. No association between placental abnormalities and differences in birth weight was found in the monochorionic twin pairs.

Lung function of patients with heart failure is characterized by a variety of changes proposed as being due to passive congestion, secondary pulmonary fibrosis, and/or recurrent pulmonary emboli. A diffusion [...]

The formation of gap junctions in the smooth muscle of the uterus (myometrium) may play an important role in the onset of both preterm labor and labor at term. Gap junctions are pathways for intercellular communication that are formed between muscle cells. Among 27 samples of myometrium, six were from patients who delivered preterm with no labor, six were from patients with preterm labor, six were from patients who delivered at term with no labor, six were from patients who delivered at term with labor and three were from patients who had a hysterectomy. Gap junction formation occurred in myometrium samples from patients who had term or preterm labor, but not in samples from patients who had not had labor. Interference with gap junction activity may be a potential treatment for preterm labor.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.05.042 Byline: Alan D. Bolnick (a), Carolyn M. Zelop (a), Beth Milewski (a), Elisa A. Gianferrari (b), Adam F. Borgida (a), James F.X. Egan (a)(b) Keywords: Mitral valve-tricuspid valve distance; Endocardial cushion defect; Echocardiography Abstract: The purpose of this study was to compare the mitral valve-tricuspid valve distance in second-trimester fetuses with normal cardiac anatomy versus those fetuses with endocardial cushion defects. Author Affiliation: (a) Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Connecticut School of Medicine, Farmington, Conn (b) Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Francis Hospital and Medical Center, Hartford, Conn Article Note: (footnote) Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal Medicine, February 2-7, 2004, New Orleans, La. Reprints will not be available from the authors.

Babies born to women who have a premature membrane rupture after amniocentesis will have a good prognosis provided they are not born too prematurely. In a study of 11 such women, the pregnancy continued for several months after the membranes ruptured, and 91% of the babies survived.

Determination of dextroposition, when a fetus' heart is on the right side of its chest, is important and routine echocardiograms should be done to identify this problem. When a fetus' heart is on the right side of its chest, there are usually other abnormalities present. In examining 2,882 echocardiograms done over a period of six years, 297 had abnormalities. Of these, 14 had dextroposition, more than half of which included abnormal development of organs.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.02.029 Byline: Yu Ming Victor Fang (a), Peter Benn (b), Winston Campbell (a), Jay Bolnick (a), Anne Marie Prabulos (a), James F.X. Egan (a) Keywords: amniocentesis; chorionic villous sampling; Down syndrome; first-trimester screening; quad screen Abstract: The purpose of this study was to determine changes in screening and performance of invasive diagnostic procedures for Down syndrome between 2001 and 2007. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT (b) Department of Genetics and Developmental Biology, University of Connecticut School of Medicine, Farmington, CT Article History: Received 22 October 2008; Revised 20 December 2008; Accepted 26 February 2009 Article Note: (footnote) Cite this article as: Fang YMV, Benn P, Campbell W, et al. Down syndrome screening in the United States in 2001 and 2007: a survey of maternal-fetal medicine specialists. Am J Obstet Gynecol 2009;201:97.e1-5. , Reprints not available from the authors., Authorship and contribution to the manuscript is limited to the 6 authors indicated. There was no outside funding or technical assistance with the production of this article.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.06.054 Byline: Peter A. Benn, Winston A. Campbell, Carolyn M. Zelop, Charles Ingardia, James F.X. Egan Keywords: amniocentesis; chorionic villus sampling; Down syndrome; prenatal screening; trisomy 18 Abstract: The purpose of this study was to evaluate stepwise sequential screening for fetal aneuploidy. Author Affiliation: Division of Human Genetics, Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, CT. Article Note: (footnote) Cite this article as: Benn PA, Campbell WA, Zelop CM, Ingardia C, Egan JFX. Stepwise sequential screening for fetal aneuploidy. Am J Obstet Gynecol 2007;197:312.e1-312.e5. Reprints not available from the authors.

Study objective: Low bone mineral density is a common complication of cystic fibrosis (CF), and recent studies have implicated vitamin D insufficiency as a significant etiologic factor. The aim of [...]

A Lesson From Single-Lung Transplantation Idiopathic pulmonary fibrosis (IPF) has a poor prognosis and therapeutic options are limited with a 5-year survival of less than 50%. This report includes a [...]