We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Major Congenital Neurologic Malformations-Reply

Am J Dis Child. 1991;145(1):30. doi:10.1001/archpedi.1991.02160010032009.
Text Size: A A A
Published online


In Reply.—I appreciate Dr Ryals' comments regarding the incidence of major congenital neurologic malformations that we recently reported.

Having spent many years as a military physician, I recognize that pregnant women known to be carrying fetuses with malformations are not infrequently referred to civilian hospitals. However, this has likely played a minimal role in affecting the results of our study. Only in the past 2 years has routine α-fetoprotein screening been performed on all pregnant woman in the major army medical centers, a period subsequent to the dates of the study. In addition, most of the smaller military hospitals do not have this capability. Furthermore, ultrasound study is not routinely performed on pregnant women. Although they have been commonly performed since the mid-1980s, the minority of women undergo ultrasound studies.

α-Fetoprotein levels in amniotic fluid have been evaluated since the mid-1970s. However, these evaluations were performed only in women with prior


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.