Fifty-three patients with twin gestation were seen at the University of California, Los Angeles, between January 1, 1977 and June 30, 1983 for antenatal genetic studies. The diagnosis of twins was successfully made in 52 patients using ultrasound. Forty-eight patients with viable fetuses requested sampling of both sacs. Amniotic fluid was successfully obtained from both sacs in 47 patients. There was only one spontaneous abortion six weeks after the amniocentesis. In five patients, one of the fetuses was delivered alive, whereas another was delivered as a stillborn without any apparent reason. Eleven sets were delivered prematurely at less than 36 weeks. There were two neonatal deaths, one from prematurity and one with multiple congenital anomalies. This study showed that differential amniocentesis can be used safely to obtain reliable information about each fetus in twin gestation.
To evaluate multifetal pregnancy reduction as a treatment for patients seeking to reduce the risks of multiple gestation.One hundred thirty-one women had transabdominal multifetal pregnancy reduction performed by a single practitioner; 103 have delivered.Multifetal pregnancy reduction was associated with a 7% pregnancy loss rate and no losses within the first 4 weeks after the procedure. The mean gestational age at delivery overall was 35.5 weeks. The mean gestational age at delivery for singletons was 37.5 weeks, for twins 35.5 weeks, and for triplets 35 weeks. The incidence of maternal and fetal complications was no more than that previously reported for nonreduced multiple gestations.Multifetal pregnancy reduction is a safe option for patients who desire to reduce the risks of multiple gestation. The ultimate successful outcome of reduced pregnancies may be enhanced by extensive experience with the procedure.
Ossification centers about the fetal knee were identified and measured by ultrasound in 133 nondiabetic patients who underwent amniocentesis for determination of the amniotic fluid lecithin:sphingomyelin ratio (L:S ratio) between 28 and 42 weeks' gestation. A distal femoral epiphysis measuring greater than or equal to 5 mm and a proximal tibial epiphysis measuring 3 mm or greater was seen at 34 to 35 weeks' gestation. A mature lecithin: sphingomyelin ratio (lecithin: sphingomyelin greater than or equal to 2.0) was present with 66, 94, and 100% of proximal tibial epiphysis measuring 0 to 2, 3 to 4, and 5 to 7 mm, respectively. A mature lecithin: sphingomyelin ratio was present with 39, 76, and 95% of distal femoral epiphysis measuring 0 to 2, 3 to 4, and 5 to 7 mm, respectively. These results suggest that in nondiabetic patients, the ossification centers about the fetal knee as measured by ultrasound correlate well with amniotic fluid lecithin: sphingomyelin ratio.
Creatine kinase isoenzyme analysis was performed on the cord blood of 125 infants who had undergone at least 30 minutes of intrapartum electronic fetal monitoring. The tracings were scored blindly according to severity of abnormal patterns, and the infants were grouped into ominous, intermediate, and normal scores. No differences were seen in creatine kinase MM or creatine kinase MB levels among the three groups. However, infants with ominous fetal heart rate patterns had higher creatine kinase BB levels and poorer outcome than infants with normal patterns.
