The Shirodkar operation: a reappraisal

Article Abstract:

An incompetent cervix (neck of the uterus) is one that does not remain closed throughout pregnancy; the condition is associated with an increased risk of miscarriage. The surgical procedure performed to treat the condition is called 'cerclage', and involves passing ligatures around the cervix to hold it together, much as a drawstring might cinch tight a leather pouch. One approach, the Shirodkar method, is suited for cases with old scars or anatomic defects, as well as for normal cervixes; however, the method is not often used. A report is provided of the outcome of 66 Shirodkar procedures performed on 46 patients (some women had more than one pregnancy) during a 15-year period. The surgical approach is described. Patients underwent cerclage on an elective basis between 13 and 18 weeks' gestation, and on an emergency basis up until 24 weeks. In prior pregnancies of these patients, the fetal survival rate past the first trimester was 35 percent. Results showed that 55 of the 66 pregnancies continued until at least 37 weeks. Only two of the 11 preterm (prior to 37 weeks' gestation) deliveries could even remotely have been due to cervical incompetence. A success rate of 88 percent term deliveries was achieved, with a corrected neonatal survival of 100 percent. Several patients had had many Shirodkar procedures performed; one, as many as five. In no case did complications related to the procedure necessitate a cesarean section. Training in this approach for obstetrical residents is recommended, as is the design of prospective, randomized studies comparing the Shirodkar method with the McDonald technique, the other commonly used procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Cervix uteri, Miscarriage, Incompetent cervix

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Aneurysm of the vein of Galen: a new cause for Ballantyne syndrome

Article Abstract:

Ballantyne triplet edema is a complication of pregnancy marked by maternal swelling, enlarged placenta and fetal swelling. It is thought to be related to preeclampsia, a disorder of pregnancy characterized by swelling, protein in the urine and high blood pressure. It is associated with pregnancies that are complicated by maternal-fetal blood incompatibilities, virus infection, syphilis or congenital heart disease. A 28-year-old pregnant woman underwent pelvic ultrasound examination of the fetus at 27 weeks. Fetal hydrops, a complication of pregnancy involving fetal swelling, and a deformity in the vein of Galen located in the brain, were diagnosed in the fetus of a patient who subsequently developed Ballantyne syndrome in the 30th week of pregnancy. The fetus was found to have a heart deformity, an aneurysm of the vein of Galen and increased amount of amniotic fluid. A cesarean section was performed when the mother's blood pressure increased to a critical level. The infant died of cardiac failure shortly after delivery. This is the first reported case of Ballantyne syndrome in the mother whose fetus had aneurysm of the vein of Galen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Fetus, Intracranial aneurysms, Cerebral aneurysm

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Esterase activity in the second- and third-trimester amniotic fluid: and indicator of chorioamnionitis

Article Abstract:

Chorioamnionitis is the swelling of the fetal membranes during pregnancy due to an infection in the amniotic fluid surrounding the fetus. Symptoms include fever, rapid heart rates in both the mother and fetus, tenderness near the uterus, and foul smelling amniotic fluid. Definitive diagnosis by current laboratory methods is difficult and complicated by the long wait for bacteria culture results. Leukocytes, a type of white blood cell, increase in the presence of infection and produce esterases, a type of enzyme. Two laboratory tests developed to measure esterase activity were used to analyze amniotic fluid obtained by amniocentesis of 57 patients. The results of amniotic fluid cultures were compared with those obtained by the two esterase activity tests. The most reliable method for diagnosing chorioamnionitis was the spectrophotometric test for esterase activity. When chorioamnionitis is suspected the quick dipstick test for esterase activity should be used initially. If negative results are obtained, the more accurate spectrophotometric esterase activity test should then be performed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Infection, Diagnosis, Esterases, Amniotic fluid, Prenatal diagnosis, Chorioamnionitis, Uterus, Pregnant, Pregnant uterus

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