Fetal atrioventricular blood flow throughout gestation.

The relative contribution of rapid ventricular filling to total ventricular filling increases as gestational age advances. A possible explanation for this observation is that the fetal cardiac compliance improves throughout gestation.

Sonographic diagnosis of fetal vascular rings in early pregnancy.

The use of transvaginal ultrasound enabled the detection of a fetal vascular ring as early as 14 to 16 weeks' gestation. Six fetuses with this anomaly were found in a study group of 5,896 pregnancies.

Roberts syndrome or "X-linked amelia"?

We report on a syndrome of tetra-amelia, facial clefts, absence of ears, nose, and atresia ani, affecting 7 male infants or fetuses in one Arab Moslem kindred. The combination of anomalies described in each affected member is consistent with Roberts syndrome and the prevalence of intermarriage in this kindred could suggest an autosomal recessive mode of inheritance. Alternatively, the existence of a new syndrome, namely, "X-linked amelia" is proposed.

Fetal vibroacoustic stimulation.

OBJECTIVE: To review the literature on fetal vibroacoustic stimulation as a method of changing the fetal sleep state during nonstress testing. DATA SOURCES: The MEDLINE data base and reference lists were used to select articles pertaining to human and animal fetal vibroacoustic stimulation. METHODS OF STUDY SELECTION: We reviewed the English-language literature with respect to sound intensity, stimulus duration, and repetition rate as possible means of altering fetal sleep-wake cycles. DATA EXTRACTION AND SYNTHESIS: Several criteria have been used to measure fetal response: gestational age, fetal heart rate, fetal movements, fetal breathing movements, fetal habituation, and fetal behavioral states. The use of vibroacoustic stimulation for antepartum and intrapartum fetal assessment and safety issues are also reviewed. CONCLUSION: Although further research is needed, the ability of vibroacoustic stimulation to elicit FHR accelerations has been established, thus decreasing the false-positive rate associated with nonreactive nonstress testing.

Transvaginal sonographic follow-up on the formation of fetal cephalocele at 13-19 weeks' gestation.

An occipital meningocele was detected by transvaginal sonography in a fetus of 13 weeks' gestation. This changed at 14 weeks to a cephalocele, which disappeared at 15-16 weeks and was detected again at 19 weeks. It is possible that sliding backward and forward of the herniated brain tissue caused this sequence of events.

Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant.

OBJECTIVE: To evaluate outcomes of fetuses with antepartum sonographic diagnoses of persistent intrahepatic right umbilical veins. METHODS: A detailed fetal sonographic examination was done in 30,240 consecutive pregnancies at 14-26 weeks' gestation. High- and low-risk pregnancies were included and persistent right umbilical veins specifically were recorded. RESULTS: Sixty-nine fetuses had persistent intrahepatic right umbilical veins, of which 60 had no additional sonographic abnormalities, four had transient nuchal findings, and four had minor anomalies or anatomic variants. Only one of the 69 fetuses had a major anomaly (diaphragmatic hernia), and died after surgery. The remaining 68 fetuses were normal and healthy after birth. CONCLUSION: Persistent intrahepatic right umbilical vein is a fetal anatomic variant that is not rare and usually associated with a favorable outcome.

The effect of cervical cerclage on the course of labor.

Although it is generally believed that patients with previous cervical cerclage have abnormal labor patterns, there is little evidence to support this belief. We analyzed the pattern of cervical dilatation during labor in 114 women with cervical cerclage by the McDonald procedure who delivered vaginally at term and compared them with 150 normal laboring women. Similar patterns of cervical dilatation were found in both groups and there was no case of cervical dystocia, a commonly cited complication of cervical cerclage.

Fetal cardiac abnormalities detected by transvaginal sonography at 12-16 weeks' gestation.

The use of transvaginal ultrasound scanning has substantially improved early pregnancy imaging of fetal anatomy. We detected cardiac abnormalities in ten fetuses at 12-16 weeks' gestation using transvaginal ultrasound.

Early ultrasound diagnosis of fetal congenital heart defects in high-risk and low-risk pregnancies.

OBJECTIVE: To evaluate the yield of early second-trimester transvaginal ultrasonography in the detection of congenital heart defects among patients with low or high risk for fetal anomalies. METHODS: During 5 years, we performed 12,793 transvaginal ultrasound examinations at 12-16 weeks' gestation, targeted for detection of fetal congenital anomalies. Three thousand four hundred fifty-three (27%) of these patients were considered to be at high risk for fetal congenital heart defects (because of family or medical history or teratogen exposure). The other 9340 patients were considered to be at low risk for fetal anomalies. The four-chamber view and the outflow tracts were evaluated systematically in all patients. RESULTS: Congenital heart malformations were observed in 47 cases, most of which (29 of 47) were diagnosed in the low-risk group. Additional extracardiac malformations were observed in 29 (62%) of the affected fetuses. Ten of 28 affected pregnancies that were karyotyped (36%) had abnormal chromosomes. Use of the four-chamber view alone would have failed to detect 11 (23%) of the abnormal fetuses. CONCLUSIONS: Transvaginal ultrasonography in the early second trimester is a useful tool for the detection of fetal cardiac structural defects, provided that both the four-chamber view and the outflow tracts are evaluated. When such an anomaly is suspected, additional fetal malformations should be sought and fetal karyotype should be determined.

Vibroacoustic stimulation evokes human fetal micturition.

OBJECTIVE: To examine the effect of vibroacoustic stimulation on fetal voiding as a measure of stress. METHODS: Fetal bladder volumes were examined serially by ultrasound 5 and 1 minutes before and 1 and 5 minutes after vibroacoustic stimulation (21 cases) or sham stimulation (20 cases). RESULTS: In the stimulated group, the mean (+/- SD) bladder volume decreased from 21.7 +/- 11.3 mL 1 minute before stimulation to 12.8 +/- 9.4 mL 1 minute after vibroacoustic stimulation, a statistically significant difference (P < .001). There was no significant decrease in bladder volume in the sham-stimulated fetuses. The correlations between bladder volume 1 minute before and 1 and 5 minutes after vibroacoustic stimulation were statistically significant (P < .01 and P < .001, respectively). CONCLUSION: Vibroacoustic stimulation induces fetal voiding, which may reflect a response to stress.

Sonographic growth measurements in triplet pregnancies.

Sonographic growth curves of biparietal diameter (BPD), head circumference, abdominal circumference, head circumference/abdominal circumference ratio, and femur length were generated from 24 uncomplicated, concordant triplet pregnancies. These were compared with the standard curves derived for singletons used in our medical center. Slowing of BPD, head circumference, and abdominal circumference growth was noted in triplets from the 28th week of gestation, whereas the head circumference/abdominal circumference ratio was similar to that of singletons. Femur growth was parallel to that of singletons, although on the low margin of the two standard deviations. We conclude that the growth patterns of triplets are different from those of singletons. We suggest that femur length derived for singletons may be suitable for the follow-up of triplets. However, when growth retardation is suspected, the growth curves presented herein may be used to identify the growth-retarded fetus.

Pain perception in women with dysmenorrhea.

OBJECTIVE: To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS: Twenty-two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra-threshold magnitude estimation to heat stimuli, pain-evoked potentials by laser stimuli, and anxiety scores four times across their menstrual cycles. RESULTS: Significant differences were found between dysmenorrheic and nondysmenorrheic women. In all four examinations across the menstrual cycle, dysmenorrheic women had longer latencies of pain-evoked potentials (383.08 +/- 6.8 msec versus 345.05 +/- 7.0 msec, P <.001), higher magnitude estimations on visual analog scale of supra-threshold pain (83.29 +/- 2.87 versus 63.50 +/- 3.82, P <.001), and higher state anxiety scores (37.69 +/- 1.7 versus 29.20 +/- 1.9, P =.002). CONCLUSION: Women with dysmenorrhea show enhanced pain perception compared to nondysmenorrheic women. This augmentation of pain perception may be part of the development of dysmenorrhea.

Nonstress Test in standing and lying women.

The effect of the maternal postural position on the Nonstress Test (NST) was evaluated in 14 normal pregnancies at 38-40 weeks of gestation. Each women was studied for two periods of 30 min, each in the standing and left lateral recumbent positions. Comparing both positions no significant difference was found in the number of fetal movements and heart rate accelerations. The total surface area of accelerations (TSAA) was significantly larger in the standing position.

Response of the premature fetus to stimulation by speech sounds.

The response of the premature fetus to speech stimuli was studied in 41 healthy pregnant patients at 26-34 weeks gestation. Speech stimuli consisted of repeated syllables ('ee' and 'ah') presented externally over the maternal abdomen at either 100, 105, or 110 decibels (dB). Sound stimuli were delivered during periods of both high and low fetal heart rate variability. During periods of low FHR variability, a decrease in fetal heart rate and an increase in the standard deviation of heart rate were found. During periods of high FHR variability, no significant change in either of these measures was observed. This is the first clear demonstration of heart rate responses to speech stimuli in the premature fetus. As is the case in the term fetus, this response is dependent on baseline heart rate variability which is the primary determinant of fetal state. The clinical usefulness of this finding may be limited by the magnitude of the response.

Survival and long-term outcome of infants delivered at 24 to 28 weeks' gestation, by method of delivery and fetal presentation.

Significant advances in perinatal intensive care and the increased chances of neonatal survival that have evolved in the last decade have posed moral and medicolegal questions for obstetricians that are as yet unanswered. Aggressive delivery management and major interventions for infants who were not long ago considered to be nonviable have become increasingly common. On the other hand, reports of high incidence of handicaps in the survivors cause great concern and add to the dilemma facing obstetricians. In this study, survival and long-term morbidity in 169 infants delivered at 24 to 28 weeks' gestation have been analyzed according to method of delivery and fetal presentation. At 24 to 25 weeks, survival was extremely low (10.5%) while major handicap rate was very high (42.9%). Infants born at 26 to 28 weeks' gestation had a considerably higher survival potential (42% to 74%), with an incidence of major handicap of less than 10%. At 26 to 28 weeks, abdominal delivery did not alter survival prospects of vertex-presenting infants; however, it improved survival of breech-presenting infants (70.0% compared with 22.2%) and showed a trend toward a lower handicap rate in the survivors.

The relationship between uterine contractions, fetal movements and fetal heart rate patterns in the active phase of labor.

The relationship between fetal movements, fetal heart rate and uterine contractions was studied with a computerized system in 18 parturients during the active phase of labor. 80% of FHR accelerations and 39% of uterine contractions were associated with fetal trunk movements. The probability of association was greater in longer movements and larger accelerations. 98% of fetal movements which lasted 10-15 s, 98% of accelerations with an amplitude of 25-30 bpm and 96.4% of accelerations with a duration of 40-50 s were associated with fetal trunk movements.

Medical complications in pregnancy and delivery of gifted children.

A questionnaire on medical complications in pregnancy, labor and delivery was given to 195 families of gifted children. 156 (80%) answered the questionnaire. The incidence of medical disorders in this group did not differ from the accepted incidence in a normal obstetric population. There was a sex ratio of 71.5% boys and 28.5% girls, and a higher probability of another gifted child in these families.

Variables associated with meconium aspiration syndrome in labors with thick meconium.

OBJECTIVE: To examine the possible maternal and fetal variables associated with meconium aspiration syndrome in labors with thick meconium. STUDY DESIGN: The fetal heart rate tracings, cord pH, Apgar scores and maternal risk factors were evaluated in singleton pregnancies with vertex presentation and thick meconium in labor. The study included 33 consecutive fetuses which developed a moderate or severe meconium aspiration syndrome and 104 consecutive fetuses which had a favorable outcome. RESULTS: Significant differences between fetuses with meconium aspiration syndrome and healthy fetuses were found in the following parameters: baseline FHR (154+/-17 vs. 136+/-10, P<0.0001), small accelerations/30 min (1.47+/-1.52 vs. 3.04+/-1.2, P<0.0001), large accelerations/30 min (1.46+/-1.96 vs. 3.5+/-2.31, P<0.0003), decelerations/30 min (4.9+/-3.9 vs. 2.4+/-2.1, P<0.0034), number of fetuses with reduced beat-to-beat variability (9/33 vs. 0/104, P<0.0001), cord pH (7.21+/-0.09 vs. 7.33+/-0.08, P<0.0013) and Apgar scores at 1 min (5+/-2 vs. 8+/-1, P<0.0001) and Apgar scores at 5 min (8+/-2 vs. 9.7+/-0.6, P<0.0001). Maternal risk factors were found in two of 33 sick infants and in 13 of 104 healthy infants. CONCLUSION: Thick meconium by itself is not associated with adverse fetal outcome. However, the incidence of meconium aspiration syndrome increases in cases of a non-reassuring FHR.

Computerized analysis of fetal heart rate after maternal glucose ingestion in normal pregnancy.

OBJECTIVE: To examine the effect of maternal oral glucose ingestion on antepartum FHR indices in normal pregnancies at term. STUDY DESIGN: A prospective study was performed on 44 non-laboring healthy women with normal singleton pregnancy at 37-40 weeks gestation. All women had a normal oral glucose tolerance test at 24-28 weeks gestation. FHR was recorded with the Sonicaid Fetal Monitor System (Oxford 8000), for 30 min prior to and 60 min following oral ingestion of 50 g of glucose in the study group of 27 women, and following water ingestion in a control group of 17 women. RESULTS: All pregnancies had a normal outcome. The maternal blood glucose levels before and 30 and 60 min after glucose ingestion were 70+/-14, 107+/-121, and 106+/-22 mg/dl, respectively (P<0.001). A significant negative correlation was found between the changes in maternal blood glucose levels 30 min after glucose ingestion and the changes in the number of large FHR accelerations at 30 and 60 min after glucose ingestion (r=-0.44, P<0.01 and r=-0.42, P<0.01, respectively). A significant correlation was found between the changes in maternal blood glucose levels 30 min after glucose ingestion and changes in episodes of low FHR variation at this time period (r=0.45, P<0.01). No significant changes in any of the FHR variables were noted in the control group. CONCLUSION: In normal pregnancies FHR indices of variation tend to decrease after maternal oral ingestion of glucose.

The influence of maternal hypnosis on fetal movements in anxious pregnant women.

The influence of maternal hypnotherapy on fetal body movements in anxious parturients was studied in 25 patients at 35-37 weeks of gestation. There were two groups of patients. Group A consisted of 16 parturients who performed self-hypnosis. Group B consisted of 9 parturients in whom hypnosis was induced by a physician. When compared to a control period of 30 min there was a significant increase in the duration of fetal body movements recorded by ultrasound during 30 min of maternal hypnosis, p less than 0.005 for group A and p less than 0.01 for group B. It is suggested that in anxious parturients fetuses move into a more active state when maternal relaxation is achieved by hypnotherapy.