Impact of Gestational Age at Delivery on Fetal Heart Rate Monitoring During the Second Stage of Labor

Objective: To clarify whether gestational age at delivery affects the interpretation level of fetal heart rate (FHR) tracings in the second stage of labor in primiparous and singleton pregnancies.Methods: The database at one tertiary hospital in Japan was retrospectively reviewed for women with singleton fetuses in cephalic presentation and vaginal labor at ≥37+0 gestational weeks between June 1, 2011, and March 31, 2013. Continuous FHR tracings in the second stage of labor were subdivided into 10-minute intervals, each of which we called a window, from the beginning through delivery, and were assessed according to the five-tier classification proposed by the Japan Society of Obstetrics and Gynecology, in which level 1 is normal, level 2 is subnormal, and levels 3-5 are abnormal patterns. Subjects were divided into two groups, including early term (37 0/7 to 38 6/7 weeks) and full term (39 0/7 to 41 6/7 weeks), according to the delivery age.Results: In total, 914 parturient women were eligible for the study protocol, including 228 and 686 women in early and full term, respectively. Vacuum extraction was more often observed in full term than in early term (P=0.007). Although the maximal level, number of level-5 windows, number of level-4 windows, and number of level-3 and level-4 windows were similar between the groups, the summation of level-4 windows ≥3 was significantly higher in full term than in early term (P=0.004).Conclusion: Full term delivery has a higher risk than does early term delivery from the standpoint of FHR monitoring

Changes in Intra-Amniotic, Fetal Intrathoracic, and Intraperitoneal Pressures with Uterine Contraction: A Report of Three Cases

Intra-amniotic, fetal intrathoracic, and intraperitoneal pressures during pregnancy have been previously investigated. However, to our knowledge, changes in these pressures during uterine contractions have not been reported. Herein, we present three cases of polyhydramnios, fetal pleural effusion, and fetal ascites, in which intra-amniotic, fetal intrathoracic, intraperitoneal pressures increased with uterine contractions. These pressure increases may affect the fetal circulation. We suggest that managing potential premature delivery (e.g., with tocolysis) is important in cases with polyhydramnios and excess fluid in fetal body areas, such as the thorax, abdomen, and heart. The results of this preliminary study on intrafetal pressure measurements will be useful in performing fetal and neonatal surgeries in the future

Amnioinfusion for variable decelerations caused by umbilical cord compression without oligohydramnios but with the sandwich sign as an early marker of deterioration

We report prophylactic amnioinfusion (AI) for variable decelerations in umbilical cord compression without oligohydramnios as an early sign of deterioration. We performed a transabdominal AI in cases without oligohydramnios using the ultrasonography findings of umbilical cord compression (i.e. sandwich sign [SWS]) and variable decelerations (VD) in a foetal heart rate. Thirteen cases and 21 AIs were analysed. Nine (69%) cases were of a foetal growth restriction and 4 (31%) had umbilical hyper-coiled cords. VD frequency (p < .0001), umbilical artery pulsatility index (PI) (p < .01) and ductus venous PI (0.66 vs. 0.48; p < .05) significantly decreased, and an umbilical venous (UV) flow volume (121 vs. 197 ml/min/kg; p < .05) significantly increased after AI. The umbilical artery diastolic blood flow abnormalities and UV pulsation improved. In conclusion, AI improves the umbilical cord compression even without oligohydramnios. The SWS is an important marker of deterioration to severe oligohydramnios and latent foetal damage. IMPACT STATEMENT What is already known on this subject? Antepartum variable decelerations due to umbilical cord compression are significantly associated with the deceleration in labour. In particular, foetal hypoxia leads to other adverse events such as foetal distress, hypoxic-ischemic encephalopathy, and pulmonary arterial hypertension after birth. Amnioinfusion has been shown to be effective in patients who also have oligohydramnios. What do the results of this study add? Amnioinfusion may be effective in the cases with ultrasonography findings of umbilical cord compression (i.e. sandwich sign) and in cases with variable decelerations in foetal heart rate, but without oligohydramnios. What are the implications of these findings for clinical practice and/or further research? Amnioinfusion may be helpful to prevent adverse events including oligohydramnios and anhydroamnios