ABSTRACT
The aim of this study was to investigate the effects of (1) maternal epidural analgesia and (2) uterine contractions on fetal oxygen saturation. After informed consent 18 women were included in our prospective, non-blinded, observational study. After 30 min of monitoring fetal oxygen saturation and uterine contractions, all the parturients, at cervical dilatation >/= 3 cm, received epidural analgesia for labour: a Pajunk epidural catheter was passed through a 17-gauge Tuohy needle and left in the lumbar epidural space (insertion level L3-4 or L2-3). Sufentanil 10 microg and 0.1% ropivacaine 15 mL were injected into the epidural catheter. A second and third 15-mL epidural dose of 0.1% ropivacaine were administered on patient demand. Fetal oxygen saturation was unaffected by epidural analgesia and there was no change in fetal SpO(2)following an uncomplicated epidural top-up. SpO(2)values (%) 30 s before, during and after contraction were 47.6 +/- 2.4, 52.5 +/- 5.3 and 42.9 +/- 7.2 respectively. These changes were significant. A contraction appeared to inject a bolus of oxygenated blood into the fetus, causing an initial increase in fetal oxygenation followed by a decline. The lowest SpO(2)values observed occurred 120 s after the start of contractions.
ABSTRACT
We compared the diagnostic value of foetal fibronectin (fFN), phosphorilated insulin-like growth factor protein binding-1 (Birth test) and insulin-like growth factor protein binding-1 (PROM test) as markers of premature rupture of membrane (PROM) and in prediction of preterm labor with intact membranes. The study population included 120 asymptomatic women (group 1), with gestation of 24-34 weeks; we also considered 21 patients with clinically confirmed PROM (group 2) and 26 patients with suspected PROM with gestation between 15 and 24 weeks (group 3) (as measured by sonography data). From our data, it seems that only the predictive value of each test is related to the characteristics of the population considered. The fFN test and the Birth test prove to be highly predictive in pregnant women without PROM, on the contrary the use of the PROM test is optimal in pregnant women with suspected PROM or with PROM, regardless of risk factor or with contractile activity.
