Electronic fetal monitoring during labor.

Intrapartum electronic fetal monitoring tracings from 620 women monitored internally over 60 minutes were analyzed. Fetal heart rate patterns were statistically analyzed against four variables of labor: 1) the presence of meconium; 2) fetal acidosis; 3) 1-minute Apgar score; and 4) clinical correlates considered as etiologic factors in FHR decelerations. No significant etiologic correlation was found between these clinical correlates and FHR deceleration patterns. Statistically significant correlations were established between poor neonatal outcome and fetal acidosis (P less than 0.01) and the presence of meconium (P less than 0.05). No correlation was found between FHR patterns and fetal acidosis. Variable deceleration showed no significant relation to low Apgar score (less than or equal to 6). Late deceleration showed a significant correlation with depressed infants. FHR patterns are best used as an alarm system of fetal difficulty than as an absolute measure of fetal distress.

Routine amnioscopy at term.

A controlled study for the management of antepartum meconium-stained amniotic fluid (MSAF) detected by amnioscopy performed in a total of 508 patients is presented. The incidence of antepartum MSAF was 2.2%, while intrapartum MSAF was found in 15% of cases. A significant incidence of depressed neonates was found in the latter group. Patients with antepartum MSAF had no perinatal losses, whether managed expectantly or by oxytocin induction. Immediate operative intervention (ie, cesarean section) is not warranted. Observations on FHR patterns, fetal pH, and Apgar scores of these patients are presented.

Deceleration/contraction ratios as an index of fetal health during labor.

Internal FHR tracings of 259 patients with variable decelerations and 49 with late decelerations were analyzed for frequency and severity of the pattern in an attempt to correlate with fetal pH or Apgar score at 1 minute. A significant increase in the risk of fetal acidosis was associated with a frequency of greater than 30% variable decelerations and 20% late decelerations. It also increased with the increase of severity of the pattern. Variable decelerations are not good predictors of Apgar scores less than or equal to 6 at 1 minute, but late decelerations are predictive when they occur more than 20% of the time. The fetus with variable decelerations a normal pH can be observed through the first stage of labor with a high degree of confidence. However, when a 20% or more moderate-to-severe late deceleration/contraction ratio is present, intervention is necessary even if scalp blood pH is normal. The FHR deceleration/uterine contraction (UC) ratio is a simple bedside technique for assessing fetal outcome.

Fetal heart rate acceleration: fetal movement ratio in the management of high-risk pregnancy.

The nonstress test (NST) was used as the primary tool in the management of 318 high-risk pregnancies. A simple and reliable method for interpreting the NST is obtained by dividing the total number of fetal heart rate accelerations associated with fetal movements by the total number of fetal movements. This is expressed as a percentage called the acceleration:fetal movement ratio. Fetuses at risk who were delivered within 7 days of the last NST from the basis of this report. The incidence of fetal distress and small-for-gestational-age infants was significantly higher (P less than .05) in 47 fetuses with an acceleration:fetal movement ratio below 10% than in the group with a ratio over 10%. Also, perinatal mortality was more common in this group. The advantages and limitations of applying this quantitative method of interpreting the NST to the management of high-risk pregnancies are discussed.

Fetal growth sustained by parenteral nutrition in pregnancy.

Severe maternal nutritional deprivation has been associated with intrauterine growth retardation, premature labor, and increased perinatal mortality and morbidity. The authors present four cases in which total parenteral nutrition was used successfully to support fetal growth in such diverse complications as twin pregnancy with maternal jejunoileal bypass, regional enteritis, and acute pancreatitis. Maintenance of fetal growth as evidenced by serial sonographic examination allows achievement of fetal lung maturation before delivery. In all the cases presented there was no perinatal mortality or morbidity. The main clinical implication of the report is the possible application of total parenteral nutrition to maintain adequate growth in fetuses small for gestational age because of maternal nutritional deprivation.

Potassium and glucose concentrations in patients treated with oral tocolytic agents: a preliminary report.

Fifteen patients referred to the Division of Maternal-Fetal Medicine with the diagnosis of cervical incompetence were placed in a study protocol where prophylactic oral beta mimetic agents were used in an attempt to prevent cervical dilatation between 20 and 36 weeks of gestation. Our study suggest that after the first week of therapy prolonged maternal oral tocolytic therapy has no significant effect on glucose or serum potassium levels and no deleterious effects on the immediate neonatal course.

Herpes simplex virus hepatitis in pregnancy. A case report.

Hepatitis is a rare but serious complication of a herpes simplex viral infection. Pregnancy is a risk factor and has been associated with a high maternal and fetal mortality rate. Acyclovir appears to improve the outcome.

Listeria monocytogenes. An important pathogen in premature labor and intrauterine fetal sepsis.

Listeria monocytogenes is a rare complication of pregnancy. Maternal listeriosis often causes premature labor and congenital infections. High perinatal morbidity and mortality rates are associated with this disease. Two cases of fetal perinatal infections, complications and management are discussed.

45,X/46,X,r(Y) karyotype transmitted by father to son after intracytoplasmic sperm injection for oligospermia. A case report.

BACKGROUND: The advent of assisted reproductive techniques, such as intracytoplasmic sperm injection (ICSI), has permitted conception and successful pregnancy for an increasing population of infertile men. Approximately 13.7% of infertile men with aspermia and 4.6% with oligospermia have a coexistent chromosome abnormality. Although the ICSI procedure appears safe thus far, early studies are in progress to evaluate outcomes of such pregnancies. For men whose infertility is linked to genetic conditions, it is an unprecedented challenge to predict the potential effects on their offspring. CASE: At 18 weeks' gestation, a 45,X/46,X,r(Y) karyotype was found on genetic amniocentesis performed for advanced maternal age. The pregnancy was achieved by ICSI using sperm from the husband, who was infertile due to severe oligospermia. Subsequently the same karyotype was found in the father. To our knowledge, this is the first reported case of familial transmission of ring Y chromosome. CONCLUSION: It is strongly recommended that ICSI and other new assisted reproductive techniques be preceded by genetic screening for male infertility as well as other indications warranted by the family history since traditional risk assessment may require revision and outcomes may be uncertain in some cases.

Anagen ratios in high-risk pregnancies.

Forty pregnant women attending the high-risk and normal obstetric clinics were evaluated for parietal scalp hair stage ratios during the second and/or third trimesters. In seven of the ten high risk patients from whom hair samples were obtained on two occasions, there was an observed fall in anagen hair percentages. Two of these had unfavorable outcomes, including severe anomalies and fetal death. These results are preliminary, but indicate the need for further evaluation of the anagen percentage as an indicator of pregnancy outcome.

Uterine tubulin production during early pregnancy in the rabbit.

Rabbit uterine tubulin levels rise rapidly in the preimplantation period to peak values of about 10-fold in the endometrium and about 4-5 fold in the myometrium on days 3-5 of pregnancy. Endometrial tubulin falls to non-pregnancy levels by mid-pregnancy while myometrial tubulin declines much more slowly. The rise in tubulin exceeds the early rate of increase in total uterine protein and DNA. Following implantation, tubulin content of the decidual basal plate area increases rapidly to peak about day 12 then declines. Production of uterine tubulin appears capable of a major, short term response to gonadal hormone stimulation.

Management of pregnancy after cesarean section.

Management of 226 patients with previous low transverse cesarean section in a special obstetric clinic for high-risk pregnancies significantly and safely reduced the incidence of purely elective cesarean section to less than 10%. A substantial incidence (25%) of other high-risk factors dictating antepartum indicated cesarean section were found in this population. There was 38.5% incidence of vaginal delivery in 145 patients who underwent a trial of labor. Patients delivered vaginally followed a normal labor curve up to full dilatation. Oxytocin was required in three cases of prolonged second stage of labor and resulted in instrumental vaginal delivery in all instances. There were no uterine ruptures on vaginal exploration after delivery or at the time of repeat cesarean section during labor. There was no maternal death or perinatal loss. No justification for the present clinical practice of a 99% inicidence of elective repeat cesarean section could be found. Substantial savings in hospital cost, as well as a decreased number of diagnostic tests for the otherwise normal gravid woman, can be safely achieved.

Umbilical blood waveforms in fetal surveillance of twins.

Umbilical arterial velocity waveforms were recorded in 69 pairs of twins by means of continuous-wave Doppler analysis and an Angioscan spectrum analyzer. A systolic/diastolic ratio was measured for each twin. The sum of the systolic/diastolic ratio was calculated and the difference between each twin was expressed as the delta systolic/diastolic ratio. Significant differences in delta systolic/diastolic and neonatal weight were previously set at 0.4 and 350 gm, respectively. Sonography was used for fetal age confirmation and diagnosis of fetal growth retardation. All neonates were weighed; at birth gestational age was assigned by Dubowitz criteria and categorized as adequate-, small-, or large-for-gestational age. The sensitivity, specificity, and predictive value of the delta systolic/diastolic ratio were determined. The perinatal implications of this test in the management of twin pregnancy are discussed.

Ultrasound and genetic features of a term triploid pregnancy.

A 69,XXY triploid term infant is reported to demonstrate the prenatal sonographic findings of first trimester intrauterine growth retardation as an important early indicator of this diagnosis. Progressive lag in early sonographic dating for gestational age should raise suspicion of triploidy, which can lead to an early diagnosis, genetic counseling, and a realistic management plan.

Gastrointestinal sediment layering. A useful sign for the prenatal sonographic diagnosis of fetal intestinal obstruction.

An instance of fetal intestinal obstruction uncovered during serial sonography in a pregnancy complicated by previous jejunoileal bypass is discussed. The presence of abnormal cystic structures with a gravity-dependent sediment layering effect within the fetal abdomen provided a useful, and possibly specific, sign in the diagnosis of fetal gastrointestinal obstruction.