Congenital obstruction of the upper airway (CHAOS) is CASE REPORTA 27-year-old woman, gravida 2, para 1, was referred to our institution at 31 weeks of gestation. Previous ultrasound findings at 17, 20 and 23 weeks were interpreted as suggestive of bilateral congenital cystic adenomatoid malformation (CAM) of the lung, Type III. Both lungs were hyperechoic, with the mediastinum shifted to the midline, diaphragm flattened, and the heart appearing compressed (Figures 1 and 2). In addition, an elongated hypoechoic structure in the posterior mediastinum was identified and thought to represent the fluid-filled esophagus (Figure 3). Polyhydramnios and a single umbilical artery were also detected. The patient underwent genetic counseling and amniocentesis, which revealed a normal male karyotype. Ultrafast fetal magnetic resonance imaging performed at 24 weeks showed a grossly normal fetal chest (sequences after balanced fast field-echo localizers consisted primarily of T2-weighted single-shot imaging with additional fast field-echo images).The initial ultrasound scan at our facility at 31 weeks revealed normal echogenicity of the lungs, and the previously described elongated hypoechoic structure in the posterior mediastinum was no longer detectable. Amniotic fluid volume was normal by 32 weeks of gestation, when pectus excavatum and right ventricular enlargement were also noted. Fetal echocardiography confirmed right ventricular enlargement and suspected pulmonary hypertension. A repeat ultrasound scan at 35 weeks yielded no additional relevant information. Biometry indicated appropriate fetal growth, with an estimated fetal weight at the 39th percentile for dates.The mother had no significant personal or family history. The current pregnancy was complicated by dietcontrolled gestational diabetes and late-onset gestational hypertension. She was admitted for labor induction at 38 weeks of gestation after spontaneous rupture of membranes. Ten hours after admission, a nonreassuring fetal heart rate pattern necessitated a primary low-transverse Cesarean delivery under lumbar epidural anesthesia. A liveborn male infant weighing 2655 g

Cobblestone lissencephaly is the characteristic brain malformation observed in Fukuyama congenital muscular dystrophy (FCMD), muscle-eye-brain disease (MEB), and Walker-Warburg syndrome (WWS). The diagnostic criteria for all three require the presence of congenital muscular dystrophy, and criteria for MEB and WWS require retinal abnormalities. We report three patients from two consanguineous families of Middle Eastern origin with cobblestone lissencephaly but no abnormalities of the eyes or muscle. Based on the current diagnostic criteria for the cobblestone lissencephaly syndromes, this disorder must be classified separately from the others, but it may well be allelic to MEB and WWS. Linkage studies have excluded the gene for this disorder from the region of the FCMD gene on chromosome 9q31-32.

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Obstet Gynecol 2000;96:504–6 The purpose of this study was to compare vaginal wet‐smear diagnosis and gram‐stain diagnosis of bacterial vaginosis among asymptomatic pregnant women. Sixty‐nine asymptomatic women had samples obtained for each technique. Eighteen of the study participants had a diagnosis of bacterial vaginosis by gram stain; however, only slightly more than on‐half of these cases were detected by clinical diagnosis. The sensitivity of the clinical diagnosis was 56%, but the specificity was 96%. In obstetrics there may be a role for the laboratory diagnosis of bacterial vaginosis in the absence of symptoms—if it is ever convincingly established that the presence of these changes lead to obstetrical problems. I think that issue is still open to debate; however, if it becomes clear that women should be screened for these changes, gram staining appears to be a far superior method when compared to clinical diagnosis. (KLN)

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