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.

Home birth: negative implications derived from a hospital-based birthing suite.

Our study of 390 patients enrolled in a birthing suite program revealed that antepartum or intrapartum problems allowed only 160 (41%) to actually give birth in the birthing suite. Antepartum complications included premature labor in ten (2.5%), premature ruptured membranes in 31 (8%), postdatism in 50 (13%), preeclampsia in 27 (7%), and diabetes mellitus in five (1.3%). Intrapartum complications included meconium in 62 (16%), arrest of labor in 64 (16%), oxytocin use in 85 (22%), and fetal heart rate decelerations in 28 (7%). Two hundred ninety-seven births (76%) were spontaneous. Forty-two low-forceps deliveries (10%), 12 mid-forceps deliveries (3%), and 39 cesarean sections (10%) were done in the traditional labor and delivery suite. Puerperal complications included one uterine inversion, two cases of placenta accreta, one rectovaginal fistula, and two requirements of blood transfusion. Neonatal morbidity included 22 low Apgar scores (7%), two shoulder dystocia, three cytomegalovirus infestations, and one lethal anomaly. Six infants had meconium aspiration, two with severe hypoxia. Any of these complications would overwhelm the patient in home birth. Intense prenatal screening may decrease some risk factors, but the intrapartum period was found to pose unacceptable risks for home birth in this population.

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.

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.