Computerized FHR traces in post-term pregnancies

[No abstract available

Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus

Aim: To evaluate whether computerized CTG (cCTG) is a reliable method of predicting neonatal outcome in pregnancies complicated by pregestational diabetes at term. Patients and methods: We considered 27 pregnant women affected by pregestational diabetes and 46 normal pregnancies as controls that fulfilled the following criteria: singleton, Caucasian, euglycemic pregnancies at term (>37 weeks gestational age). All women delivered by cesarean section (CS), with an antepartum cCTG performed within one hour before the CS and an UBGA available at birth. No patient was in labor during FHR monitoring. Results: Among cCTG parameters, accelerations 15 bpm, HV min, HV ms and STV were significantly lower in comparison to controls. We observed that in the diabetic pregnant women the parameter STV was not able to predict or to linearly regress with the most important UBGA parameters: pH and pCO(2). Contrarily, in normal pregnancies, the STV linearly regressed with both the pH (p<0.03) and pCO(2) (p<0.04). Conclusions: Computerized FHR criteria may not be applicable to fetuses in pregestational diabetic pregnancies at term. Therefore some criteria should perhaps be modified for a correct interpretation of cCTG in these pregnancies

Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry

Background: The effect of antenatal betamethasone on fetal parameters includes a transient reduction of FHR variation and of fetal body movements. An effect on maternal-fetal blood flow has also been shown, with non-univocal results. Aims: To evaluate the effect of antenatal betamethasone in third trimester singleton high-risk pregnancies by Doppler technology. Subjects and methods: Thirty-six pregnant women who received a full course of betamethasone (12 mg i.m, two times, 24 h apart) were studied. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI), the middle cerebral artery (MCA PI) and of resistance index of uterine arteries (Ut RI) before treatment, and 48 and 96 h after second dose of betamethasone. Results: No significant variation was noted in UA PI through betamethasone therapy. MCA PI decreased significantly 48 h from the last injection of betamethasone (P = 0.002), and returned to basal values at 96 h. No difference was found for the other Doppler parameters examined. When serial Doppler studies were analyzed according to the gestational age, in the group < 32 weeks' gestation, MCA PI decreased significantly after 48 h (P < 0.006) and returned to pre-treatment values after 96 h from the last betamethasone dose. Conversely, no difference was found in Doppler serial measurements in any of the analyzed districts in the subgroup greater than or equal to 32 weeks. Conclusion: Betamethasone treatment is associated with a significant, although transient, reduction of MCA PI, especially at gestational ages < 32 weeks'. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved

Amniotic fluid lamellar body counts for the determination of fetal lung maturity: An update

Aim: To reassess the cut-off value for lamellar body counts (LBs) for fetal lung maturity (FLM) over a 10-year study period. Patients and methods: 178 pregnancies were selected under strict inclusion criteria and delivered within 48 h from amniocentesis. FLM was determined by amniotic fluid LBs in centrifuged samples (300 × g for 10 min) in a commercially available Coulter Counter. Cases beyond 37 weeks were excluded. Results: Mean gestational age was 33.5±3.0 weeks at amniocentesis and 33.7±3.0 weeks at birth. After reassessing the best compromise between sensitivity and specificity for all cases using the receiver operating characteristic (ROC) procedure, an FLM cut-off value of ≤22,000/μL was obtained. Diagnostic accuracy (and confidence interval, CI) was: sensitivity, 73% (60.0-83.6%); specificity, 81.7% (CI 73.6-88.1%); positive predictive value, 66.2%; and negative predictive value, 86.0%. Conclusion: No significant change in FLM cut-off for LBs was found when comparing the value from this study and the results of our earlier report presented in 1996 (≤22,000 vs. <20,000/μL), although the new value may be more accurate, since it is based on neonatal outcome, with the exclusion of cases in which the diagnosis of FLM is seldom warranted, i.e., ≥37 weeks' gestational age

Intraamniotic surfactant for prevention of neonatal respiratory distress syndrome (IRDS): rationale and personal experience.

To evaluate the efficacy of intramniotic instillation of supplementary surfactant for the prophylaxis of neonatal IRDS in an emergency obstetric setting. Supplementary natural surfactant (SS) was administered intra-amniotically (80 mg in 1 ml) under ultrasound guidance in the proximity of the fetal nostrils and mouth in six pregnant women at 24-32 weeks gestation, with immature amniotic fluid indices of fetal lung maturity, and whose delivery was imminent because of severe fetal distress, deteriorating maternal conditions, or refractory vaginal bleeding. The administration of SS was preceded by IV aminophylline to the mother (a bolus of 240 mg over 10 min, and a maintenance dose of 0.02-0.1 mg kg-1 min-1) in order to elicit sustained fetal breathing movements. The clinical conditions of the six newborn infants were good with no respiratory problems in four cases, and with mild IRDS in the remaining two, which, however, resolved uneventfully. It is suggested that this prophylactic approach has a great potential for becoming a reliable option for the antenatal prevention of IRDS