The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate.

Objective. The improvement of the accuracy of fetal heart rate (FHR) pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group) and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group) showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11%) without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1) without increasing the cesarean birth rate due to nonreassuring FHR patterns.

Mortality rates for extremely low-birthweight infants: a regional, population-based study in Japan during 2005-2009.

AIM: We investigated neonatal and infant mortality rates for extremely low-birthweight infants and clarified clinical factors associated with death. MATERIAL AND METHODS: A population-based study was conducted for 195 infants born from 2005 to 2009. RESULTS: The infant mortality rate was 28.6%, 21.7%, 34.2%, 6.7%, 6.3%, 13%, and 4.8% at 22, 23, 24, 25, 26, 28, and ≥28 weeks, respectively. The infant mortality rate according to birthweight was 50%, 9%, 31%, 16.7%, 19.4%, 7.5%, and 2.9% for <400 g, 400-499 g, 500-599 g, 600-699 g, 700-799 g, 800-899 g, and 900-999 g, respectively. Log-rank tests revealed a significant difference in the cumulative survival rates according to gestational age (P < 0.001). In the 24-week group, this rate in a tertiary center was higher than in a non-tertiary center (P = 0.001). The mortality of infants born by cesarean section (73%) was lower than that of infants born vaginally (P < 0.05). Multiple regression analyses show that the significant factors associated with death were 22-24 weeks of gestational age, management at non-tertiary centers, and multiple births. CONCLUSION: Survival of infants (<1000 g) depends on gestational age, centralization and multiple births.

A rare case of amniotic fluid embolism with massive platelet aggregations in pulmonary capillaries.

A 30-year-old woman at 37 weeks of gestation died during labor induction with oxytocin shortly after an episode of abrupt drop of fetal heart rate. Autopsy showed extensive microvascular plugging of the pulmonary capillaries by massive platelet aggregations. Aside from platelet aggregations, the keratinized substances and granulocytes were also shown in the capillary of pulmonary arterioles. These findings were not observed in other systemic organs (heart, liver, spleen, kidney, adrenal, alimentary canal and pancreas). In general, the postmortem histological diagnosis of amniotic fluid embolism consisted of demonstrating mucus, leukocytes, squamous, amorphous, and fatty cells in the arteries of the lung. To our knowledge, there have not been any reports regarding massive platelet aggregations shown at pulmonary capillaries in case of acute amniotic fluid embolism except for an experimental model. This is a rare case of amniotic fluid embolism in which massive platelet aggregations were confirmed in pulmonary capillaries by autopsy.

Serial assessment in eclampsia of cerebrohemodynamics by combined transcranial Doppler and magnetic resonance angiography.

We used two different noninvasive methods, i.e., transcranial Doppler velocimetry and magnetic resonance angiography to serially assess cerebrohemodynamics in a patient with postpartum eclampsia. Five hours after an eclamptic seizure, a decrease in mean velocity in both middle cerebral arteries and slight angiographical spasms indicated cerebral hypoperfusion. On hospital day 8, the patient showed an increase in the mean velocity of the middle cerebral artery, accompanied by significant vasospasms. Abnormal findings were not observed on hospital day 20. These combined methods are useful in assessing cerebrohemodynamics in eclampsia.