the sexes towards the problem were outlined. The impact on perinatal mortality of the development of neonatal and pennatal intensive care units, shown through work done at the Montreal Jewish General Hospital, was described by Dr. A. Papageorgiou and associates. The reduction in mortality was drastic, a fact confirmed by papers given on the same subject by Dr. P. Fitzhardinge of the University of Toronto and by Dr. R.H. Usher of McGill University. Dr. D. Cudmore of Dalhousie University gave a paper on the effect of intensive care during labour and emphasized the need for good antenatal assessment to reduce preventable fetal

wastage. The various diagnostic procedures were discussed by the speakers; such procedures included estimation of urinary estriol, fetal scalp blood sampling, and analysis of amniotic fluid. Genetic disorders In presenting a paper on the diagnosis of genetic disorders in the fetus and newborn, Dr. T.A. Doran of the University of Toronto reviewed the indications for "genetic amniocentesis". These are: chromosome disorders, inborn errors of metabolism, X-linked recessive disorders and a history of open neuraltube defects. In the latter abnormalities a-fetoprotein levels are raised in amniotic fluid and maternal serum.

The increasing use of fetoscopy and techniques such as intra-amniotic muscle biopsy was discussed. Professor John Dobbing of the University of Manchester discussed the mechanisms of deficit and distortion in the developing brain. A "brain growth spurt" occurs after the 1st trimester and after neuroblast multiplication. This is at the time of glial multiplication and myelination. Cerebellum growth is rapid and is therefore most susceptible to deficit changes. This deficit and consequent distortion can be seen clinically as increased clumsiness. Brain growth follows a sigmoid curve and, in the human, lasts up to 24 months post partum.

Ultrasound providing valuable information in pregnancy Dr. Stuart Campbell, senior lecturer in obstetrics and gynecology at the Institute of Obstetrics and Gynaecology, Queen Charlotte's Maternity Hospital, London, England, spoke on the detection of neural tube defects in utero by means of ultrasound. The "pictures" thus obtained show the saucer-shaped depression in the neural tube that is indicative of spina bifida. Ultrasound scanning of the fetal skull also indicates the presence of hydrocephalus before the 20th week of pregnancy. Alphafetoprotein concentrations by themselves may be misleading but in conjunction with the scan can constitute supportive or presumptive evidence. Fetal age can be estimated from crown-rump length at up to 12 weeks' gestation and from biparietal diameter at 13 to 24 weeks' gestation. Growth retardation in utero can also be assessed using ultrasound, and Dr. Campbell demonstrated correlation of intrauterine growth retardation and below-normal neonatal and child height and growth patterns and noted that it is important to make a presumptive diagnosis of growth retardation if the biparietal diameter, skull circumference and abdominal circumference are all less than

normal. Ultrasound has also been used in making the diagnosis of rhesus incompatibility, and Dr. Campbell showed that repeated intra-abdominal intrauterine blood transfusions affect the fetal heart rate and growth pattern. The place of ultrasound in the diagnosis of early pregnancy was discussed by Dr. Martin Gillieson, instructor in obstetrics and gynecology at the University of Ottawa. A fetal sac is distinguishable at 5 weeks and both the presence of fetal parts and a recordable heart rate can be inferred from scans at 6 to 7 weeks. Ultrasound has also been used in diagnosing blighted pregnancy, missed abortion and hydatidiform mole and in locating intrauterine devices. Gynecologic use of ultrasound was considered by Dr. Murray Miskin, assistant professor of radiology at the University of Toronto. He commented on its use in cases of ascites and intestinal matting due to cancer of the ovary and stressed that a patient undergoing ultrasound scanning for gynecologic conditions should have a full bladder. The diagnostic use of ultrasound does have pitfalls and these were the

topic of a talk by Dr. J.C.G. Whetham, assistant professor of obstetrics and gynecology at the University of Toronto. He urged his audience to realize that the techniques and interpretation are not error-free. The ultrasound diagnosis of ectopic pregnancy is difficult, and a more effective diagnostic technique is laparoscopy. The use of ultrasound in detecting the placental site was discussed, as was the question of the so-called placental "migration" from the lower uterine segment in the later stages of pregnancy. Commenting on growth retardation in utero, Professor John Dobbing of the University of Manchester outlined instances in which there had been an apparent "catch-up" to normal measurements, sometimes coinciding with admission to hospital or with bed rest. The question of increased protein intake to effect this catch-up was raised but there was no clear answer on this point. Other questions concerned the use of ultrasound in assessing the state of scars in the uterine wall - that is, in pregnancies in those who have previously undergone cesarean section, myomectomy or hysterectomy.

Finding and helping the deprived child Although much has been written about the battered child, society has been slow to recognize a form of child abuse that is at least as prevalent, Dr. Richard Goldbloom observed at a symposium on pediatrics. This is what he described as the passive form, which shows up as a deprived child. Dr. Goldbloom, head of pediatrics at Dalhousie University, was chairing the session, which included Professor Murray Fraser, dean of law at the Uni-

versity of Victoria, Dr. John Anderson, assistant professor of pediatrics at Dalhousie and Dr. Henry Kempe, professor of pediatrics at the University of Colorado Medical Center, Denver. The deprived but not obviously battered child is less easy to identify, although the syndrome has been known for many years - it was first described in 1947. A failure to thrive may be ascribed to organic disease, and even when the physician is convinced the

problem stems from parental failure, it remains difficult to convince the courts. Dr. Anderson illustrated the problem in a series of case histories. The children arrived in hospital grotesquely underweight and undersized for their ages. Rigid clinical investigation produced no evidence of organic disease. In two of the cases the children eventually reached normal weight and height for their ages, while in a third, response was slow and the child died.

CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114 253

Ultrasound providing valuable information in pregnancy.

the sexes towards the problem were outlined. The impact on perinatal mortality of the development of neonatal and pennatal intensive care units, shown...
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