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.

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.