Conditions affecting nonstress test results.

A prospective investigation was conducted to examine associations between selected conditions encountered during nonstress testing with the intent of explaining false nonreactive results. During a 16-month period, nonstress tests (NSTs) were performed in 315 pregnancies; 64 (12%) of the initial 534 satisfactory tests had nonreactive patterns. Approximately one third (22 of 64, 34%) of these nonreactive tests either remained nonreactive or were followed by a positive or suspicious contraction stress test that same day. When compared with pregnancies that gave reactive test results, a nonreactive pattern was not found to be more commonly associated with maternal obesity, fasting, certain prescribed medications (methyldopa, phenobarbital, insulin), time of day, or recent amniocentesis. Recent cigarette smoking was infrequent (108 tests, 20%) but might explain a falsely nonreactive result. The data suggests that NST results might instead have been influenced by fetal activity and fetal health during the test period.

Angiotensin II stimulates phosphoinositide turnover in the rat myometrium.

Angiotensin II (AII) activates rat myometrium phospholipase C resulting in the hydrolysis of phosphoinositides. The response to AII is concentration- and time-dependent, and it is blocked by saralasin. During pregnancy there is a loss of responsiveness to AII at the site of placental implantation that appears to return during parturition.

Gestational alterations in phospholipase C coupled muscarinic response.

In the pregnant rat, carbachol-induced phosphoinositol hydrolysis by myometrium at the placental attachment region progressively decreased toward term, whereas hydrolysis was relatively stable in the myometrium of the non-attachment region. Tritium-quinuclidinyl benzilate binding increased in the myometrium of non-attachment regions as pregnancy progressed. At placental attachment sites binding remained relatively stable until parturition when it increased. Apparently the myometrium associated with the placental attachment site is less sensitive to cholinergic influence during pregnancy compared with the non-attachment site when evaluated by muscarinic activation of phospholipase C or ligand binding.

Appropriateness of antenatal referrals to a regional perinatal center.

In an ideal system, all women should receive perinatal care adequate to their needs. For specific high-risk groups, this can only be accomplished by antenatal referral to another source of care. The appropriateness of antenatal referrals for patients at risk for premature delivery (less than or equal to 34 weeks) was studied. Records of 122 women in preterm labor and/or with premature rupture of membranes (PROM) presenting to two level I rural hospitals located 60 miles from the regional perinatal center (RPC) were reviewed. Fifty-three patients were not referred and were delivered of 59 infants within 24 hours of admission. Cervical dilatation greater than or equal to 4 cm (34 patients), vaginal bleeding (6 patients), extreme prematurity (6 patients), and advanced labor (7 patients) precluded referrals. Realistically, two of these patients should have been referred. Twenty-two of the 59 infants weighed less than or equal to 1,500 g at birth, 17 weighed 1,501-2,000 g, and 20 weighed greater than or equal to 2,000 g. Five infants died in the hospital, two during the first month and three later. Twenty-two percent had Apgar scores of less than or equal to 3 at 5 minutes. Thirty-four infants were transported to a level III neonatal intensive care unit (NICU). Fourteen of the 69 antenatal referrals required hospitalization (average 11 days), were returned to their local hospital, and delivered at term. Forty-four patients were delivered within 24 hours and 11 between 1 day and 9 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

New concepts in the understanding of hypertensive diseases during pregnancy. An overview.

Preeclampsia is a syndrome of unknown etiology characterized by the sequential development of facial and hand edema, hypertension, and proteinuria after the 20th week of gestation. Patients with preeclampsia may progress to a seizure-like state: The patient is then said to have eclampsia. The major goal of prenatal care is detecting the early onset of preeclampsia and to activate aggressive therapy to prevent severe complications either for the mother or the fetus. There currently are no specific forms of therapy to prevent the disease.

Maternal intrauterine amine alterations in the pregnant drug addict.

The pregnant drug addict has been a good study patient. Her neural hormonal value, as measured by urinary norepinephrine and epinephrine, is altered during pregnancy. The major difference between the antepartum state in the pregnant drug addict and that in the nonpregnant drug addict is hyperactivity of the adrenal gland. The intrauterine fetal homeostasis is altered by drug addiction in that the fetus is addicted, ted, as indicated by depressed amniotic fluid norepinephrine and epinephrine levels. If detoxification takes place, the fetus can respond in a dramatic fashion with increased levels of both norepinephrine and epinephrine. Detoxification is not recommended in the second and third trimesters of pregnancy because of the potential seriousness of these neural hormonal alterations.

Prostaglandins: overview in obstetrics and gynecology.

PIP: The intention of this discussion is to review recent data on prostaglandins and to speculate on their use in clinical obstetrics and gynecology. The uses of prostaglandins are the induction of term labor, therapeutic abortion, and termination of normal and abnormal pregnancies. Prostaglandins E2 and F2alpha have been used successfully to induce labor at or near term. The oral administration of prostaglandins for the induction of labor has been reported by several investigators. Elias concluded that prostaglandins are efficient and safe for the induction of labor in both intravenous and oral forms. Continuous intravenous infusion of either prostaglandins E2 or F2alpha, when administered by the intravenous route, is capable of inducing abortion. Intravenous doses of prostaglandins that will induce abortion are frequently associated with undesirable side effects such as vomiting, diarrhea, and nausea. Due to the severity of the side effects, intravenous therapy is less clinically acceptable and attention has been directed to the vaginal route of administration. The vaginal route of administration can be used to induce abortion in the 2nd trimester with either prostaglandin E2 or F2alpha. The extra-amniotic intrauterine approach has been found to be highly effective, and the rate of abortion has been about 90% within a 36-hour period. The intra-amniotic administration of prostaglandins in 2nd trimester pregnancy compares most favorably with the extra-amniotic intrauterine method and is the only method found to be acceptable in the United States.^ieng

Pregnancies going to term in patients with porcine xenografts.

Three term pregnancies occurred in two women who had had porcine xenografts implanted at various times prior to pregnancy. These grafts were associated with uncomplicated pregnancies since chronic anticoagulation therapy was not necessary.

Amniotic fluid and fetal maturity.

The lecithin/sphingomyelin ratio in amniotic fluid is a method of predicting fetal lung maturity. The L/H ratios in certain high risk pregnancies are poorly correlated with the shake test. The L/S ratios in drug addiction methadone pregnancies and diabetic pregnancies do not have a high degree of correlation with normal L/S ratios after 36 weeks of gestation and are often low.

Pulmonary edema associated with the use of hydrocortisone and a tocolytic agent for the management of premature labor.

Three cases of peripartum pulmonary edema associated with steroid administration are reported. Two patients developed antepartum pulmonary edema after receiving hydrocortisone to promote fetal lung maturity. The third patient developed pulmonary edema shortly after delivery and after having received glucocorticoids antepartum.

Association of prolonged, preterm premature rupture of the membranes and abruptio placentae.

Nine patients with prolonged, preterm premature rupture of the membranes (PROM) had associated abruptio placentae confirmed at delivery. Antepartum vaginal bleeding during the course of expectant management was the most common feature in the clinical course of the patients who developed abruptio placentae. Other clinical and laboratory findings suggesting the diagnosis were not present consistently. Retrospective analysis of all patients with prolonged, preterm PROM led to an estimated risk of 4% for the development of abruptio placentae during the course of expectant management of such patients. This risk estimate is three to eight times greater than that for the development of abruptio placentae in pregnancy generally. A high index of suspicion for abruptio placentae is appropriate when patients with prolonged, preterm PROM develop vaginal bleeding or any other suggestive clinical signs or symptoms of abruptio placentae during the course of expectant management.

The effect of estrogen on monoamine systems in the fetal rat brain.

The effect of a pharmacologic dose of estrogen on brain monoamine systems in the rat fetus was determined using a semiquantitative measure of histofluorescence. Pregnant rats received a subcutaneous injection of cottonseed oil alone or estradiol (E2) in cottonseed oil just before the monoamine systems began to develop. The fetuses were delivered abdominally and killed on day 22 of gestation. A study of four major monoamine areas of the brain with a glyoxilic acid preparation showed that intrauterine exposure to E2 has a significant effect on the monoamine organization of the fetal hypothalamus. No treatment effects were noted in the areas of locus coeruleus, substantia nigra and corpus striatum. The litter sizes of the E2-treated rats and the body weights of the fetuses were much lower than those of the control group. The effect of E2 on monoamine distribution in the fetal hypothalamus may explain the reported disturbances of reproductive function and sexual behavior seen after perinatal exposure to high doses of estrogen in humans.