Antepartum fetal surveillance in post-date pregnancy.

OBJECTIVES: Three different antepartum surveillance tests were evaluated in the management of postdate pregnancy. The aim was to evaluate the reliability and predictive value of BPS, NST and AFV in antepartum fetal surveillance of post-date pregnancy in terms of pregnancy outcome. METHODS: Forty-five pregnant women who were proven to be postdate were included from the antenatal clinic of Shatby Maternity Hospital, Alexandria, Egypt. Patients were put into 3 groups according to management protocol: group I (n = 15) managed by BPS, group II (n = 15) managed by NST and group III managed by sonographic assessment of AFV with NST. RESULTS: AFV had higher positive predictive value (66.67%) than BPS (50%) and NST (50%) and also more sensitivity (66.67%) than BPS (33.3%) and NST (50%). The 3 tests had more or less equivalent negative predictive values and specificities. CONCLUSIONS: The study highly recommends sonographic assessment of AFV with NST as an ideal antepartum surveillance test in prediction of fetal well-being in post-date pregnancy.

Local effect of thromboxane B2 on the contractility of the human non pregnant uterus.

The effect of intra-uterine instillation of 100 micrograms thromboxane B2 [TXB2] on the contractility of the non-pregnant uterus was studied in 30 subjects during the different phases of the menstrual cycle [menstrual, proliferative, periovulatory and secretory]. Twenty control cases received a similar volume of diluted ethanol. The TXB2 proved to be a powerful uterine stimulant at all phases and the response [maximum elevation in tonus and duration] appeared to be most pronounced in the secretory phase. The implication of these findings in the control of uterine activity is discussed.

Effect of heat on uterine contractions during normal labor.

The effect of local application of heat on the abdominal wall on uterine activity was evaluated in 15 full-term multiparous women early in the first stage of labor. Cardiotocographic monitoring showed that heat induces a significant increase in uterine activity without causing any abnormal fetal heart changes. The stimulated contractions return back to base line level following removal of heat. The application of heat on the abdominal wall of women in early labor appears to offer a new non-pharmacological modality for the stimulation of uterine activity.

Effect of prostaglandin A1 on renal hemodynamics in pregnancy toxemia.

PGA1 was infused at a constant rate for 2 hours in 35 pregnant women in the third trimester. Twenty-five patients had clinical manifestations of pregnancy toxemia and 10 served as control subjects. Two dose levels (0.5 to 1.0 mug/kg/min) were investigated and obstetric aspects as well as renal hemodynamics were evaluated. At the high-dose level, the drug induced labor in half the subjects (toxemia patients and control subjects) and elicited a hypotensive response only in hypertensive cases. A marked increase in GFR and RPF was achieved at both dose levels in all cases. Plasma electrolytes, osmolality, and urea levels were unaltered. Also, the infusions did not induce any appreciable diuresis or natriuresis. Tph mechanisms of the induced changes and possible etiologic involvement of PGA1 in toxemia are discussed.

Reduced uterine response to PGF2alpha under oral contraceptives.

The effect of prostaglandin F2alpha (PGF2alpha) on the nonpregnant human uterus was evaluated in 35 patients. The compound was administered both by intra-uterine and intravenous routes. Two groups of volunteers were studied;fifteen cases who were under oral contraceptives and twenty women with normal ovulatory cycles. The uterus under the influence of oral contraceptives showed a reduced response to local and systemic administration of PGF2alpha at all phases of the menstrual cycle. The implications of these findings in certain physiological and pathological conditions related to reproduction are discussed.

Management of missed abortion and fetal death in utero.

Termination of pregnancy in missed abortion and intra-uterine fetal death was accomplished using vaginal suppositories of 20 mg PGE2 in 31 cases and the results were compared with oxytocin induction (with or without estrogen pre-treatment) in 17 cases at the doses routinely used in our hospital. The PG suppositories proved much more superior (96.7%) than oxytocin (47.7%), but induced a higher rate of side effects. The latter were not serious and were generally tolerated by the patients. There was a positive correlation between duration of fetal retention in utero and the induction expulsion time. The over all patient acceptance of the method was quite favourable and the approach appears to be a definite advance towards management of these cases.

Renal prostaglandins for induction of labour-a dual clinical advantage in toxemia of pregnancy.

Prostaglandin A is known to be an antihypertensive vasodepressor agent produced by the kidney and has the basic potentialities of a hormone. No information is available at present concerning its effect on the human pregnant uterus and whether it can be used as an oxytocic compound to induce labour. The uterine stimulating and labour inducing ability of PGA1 was evaluated in 10 cases; seven patients were suffering from pregnancy toxemia while three were normal pregnancies near full term. Cardiotocographic tracings showed that uterine activity was markedly stimulated to a degree sufficient to induce labour. Continuous i.v. infusions at a rate of 0.25-1.0 mug/Kgm/min given over a fixed period of only 6 hours resulted in delivery in all cases except one following the discontinuation of administration. Beneficial effects on blood pressure were observed in toxemic subjects. Potentially serious FHR patterns and occasional hypertonus during therapy were seen and stress the need for more information to evaluate the safety, optimum dosage and duration of infusion as well as the place of this approach in clinical practice for the management of pregnancy toxemia. The absence of antidiuretic effect, the hypotensive response and uterine stimulating property of PGA1 indicate a possible advantage in toxemia of pregnancy as compared to oxytocin infusions.

Control of bleeding due to IUDs by a prostaglandin biosynthesis inhibitor.

PIP: To explore the possible clinical use of prostaglandin inhibitors in the control of IUD complications, 70 women with bleeding problems due to IUDs which had been inserted for at least 6 months were given indomethacin, a prostaglandin inhibitor. 25 others were given a placebo. Patients with active bleeding were immediately given the drug for 3 days; others were instructed to use it 2 days before and 2 days after menstruation. The dosage was 1 capsule (25 mg) orally 3 times a day. 90% of the menorrhagic test subjects had a satisfacory outcome (arrest of bleeding within 48 hours), as did 95% of the women with intermenstrual bleeding and 95% of those taking indomethacin prophylactically. .01). The main drawback of indomethacin use is gastric upset; rectal suppositories might reduce the incidence of this side effect. In addition, since the IUD is not 100% effective against pregnancy, there is a risk of exposing a fetus to the drug early in gestation.^ieng