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This article has essentially been a list of secondary factors for selecting an ultrasound machine. When a clinician narrows his/her choices for a new machine by viewing the image quality and features, the secondary factors in this article also should be studied. By doing so, a number of traps will be avoided and complaints from staff will be decreased. All sonographers and staff should have input to machine selection because all may have an impact on office operations. By anticipating problems before they occur, the selection of a new ultrasound machine becomes a smooth, well defined operation.

First-trimester fetal biometry using transvaginal sonography is now feasible and desirable due to improved imaging and probe maneuverability. A study of 144 early normal pregnancies with precise dates is presented. Regression models were constructed for the crown-rump length, biparietal diameter, head circumference and abdominal circumference. Error analysis of the technique and calculations was performed. First-trimester fetal biometry may be used for obtaining precise estimates of gestational age and may help to detect early fetal maldevelopment resulting in abnormal growth.

Recent developments in both laboratory measurements and ultrasound technology have revolutionized the management of early pregnancy. The discriminatory zone concept is a direct result of these developments. By correlating the serum beta-hCG values to the size of an intrauterine gestational sac, a value can be chosen that corresponds to the threshold of visualization of the sac. If the beta-hCG is above this value, a sac must be seen, and if it is not, aggressive steps should be taken to determine whether the pregnancy is abnormal or ectopic. The discriminatory zone may vary among institutions due to different equipment and assays. Thus, its value should be calculated individually at each institution. A proper discriminatory zone and a management protocol such as the one above can eliminate much of the uncertainty in the management of suspected ectopic and early pregnancies.

A multiple regression-based statistical model capable of quantitatively comparing two or more sonographic parameters for the effects of gestational age, variation in fetal growth and error in sonographic measurement is presented and then used to compare the biparietal diameter and femur length as estimators of gestational age in late pregnancy. A total of 311 patients were studied between 24 and 42 weeks' gestation. Variation in fetal growth was expressed as the birth weight percentile for gestational age. Biparietal diameter and femur length correlated equally well with gestational age. However, the biparietal diameter was more than twice as sensitive as the femur length to variation in fetal growth. Femur length had a larger error associated with its measurement. These results suggest that the biparietal diameter and femur length in late pregnancy are equal estimators of gestational age; that the femur length is a more stable estimator of gestational age when fetal growth deviates from normal; and that the femur length is technically more difficult to obtain.

The vaginal examination data (dilation, station, and time) were examined from 2845 consecutive uncomplicated patients who were admitted in early labor to Cleveland Metropolitan General Hospital between January 1, 1979 and December 31, 1982, using data from the computer database of the Perinatal Clinical Research Center. The length of the latent phase of labor was calculated in 2479 of these patients to form the study group. Individual effects of parity and the cervical dilation on the length of the latent phase of labor resembled Friedman's results from 20 years ago. Furthermore, the average and prolonged lengths of the latent phase confirmed that labors have not changed appreciably in 20 years. However, multivariable analysis and standard stepwise regression on all of the vaginal examination data revealed that the largest influence on the length of latent labor was the admitting cervical dilation. Parity had only a small effect when cervical dilation was controlled. Thus, a multiparous patient may progress as slowly as a primiparous patient if they both are admitted with a low cervical dilation.

An otherwise asymptomatic 17-year-old phenotypic female examined because of primary amenorrhea and hypoplastic reproductive organs was found to have a 45,XO karyotype. She had some of the stigmata of Turner syndrome. Laparoscopy revealed streak ovaries and an infantile uterus. Ovarian biopsy contained gonadoblastoma that was treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Rationale for laparoscopy and ovarian biopsy of this asymptomatic patient and the serendipitous discovery of a malignant neoplasm are discussed.

The transition from the latent to the active phase of labor, as defined by Friedman, was studied in all noncomplicated patients over a four-year period. Mothers studied were in spontaneous labor with a singleton fetus in the vertex position with intact membranes at admission. The independent variables were the parity and vaginal examination data, and the dependent variable was the rate of cervical dilation. The transition from latent to active labor was recorded and stratified by the cervical dilation where it occurred in a sample population consisting of 1060 nulliparous and 639 primiparous or multiparous women. There were no differences between nulliparous and multiparous patients. Less than 50% of labors became active by the time the cervixes had reached 4-cm dilation. By 5 cm, 74% of labors were active. However, when protracted and arrested labors were eliminated, 60% of the patients had reached the latent-active transition by 4 cm and 89% by 5 cm. We concluded that once a normal patient has reached 5 cm, she should be in the active phase of labor. If not, there is a high probability of labor dystocia.

Between January 1, 1979, and December 21, 1982, 2564 medically and obstetrically normal patients, admitted to the hospital with intact amniotic membranes during the latent phase of labor, were matched for spontaneous or artificial rupture of the membranes at similar cervical dilations. Spontaneous rupture of the membranes occurred earlier and was more likely in the latent phase of labor than was artificial rupture of membranes, which tended to occur nearer to or in the active phase of labor, and at lower pelvic stations. When matched by cervical dilation, spontaneous membrane rupture was associated with more rapid cervical dilation. Stepwise regression analysis confirmed that membrane rupture had a significant but small effect on labor length and rate of cervical dilation. Pelvic station and maternal parity had a smaller association with labor length than did membrane rupture. Cervical dilation at the time of membrane rupture appeared to be the most important factor associated with the length of labor.

A retrospective study of 165 Jehovah's Witnesses and 164 Jehovah's Witnesses and 164 control patients compared the morbidity and mortality associated with major obstetric and gynecologic surgery in the 2 groups. There were no deaths and few complications in either group. There were few differences in preoperative and postoperative hemoglobin values. Medicolegal implications of performing major surgery without blood transfusions are discussed. The study adds evidence that major operative procedures can be carried out on Jehovah's Witness patients without blood transfusions or blood products.