The Doppler cerebroplacental ratios and perinatal outcome in post-term pregnancy

Our purpose was to determine whether the Doppler cerebroplacental ratios predicts perinatal outcome in postterm pregnancy. The middle cerebral to umbilical artery resistant and pulsatility indices (MCA PI/UA PI and MCA RI/UA RI) were measured in 59 postterm pregnancies. We found significant correlation between MCA PI/UA PI, MCA RI/UA RI, nonstress testing and intrapartum fetal heart rate assessment. There was also an association between MCA PI/UA PI and 1- and 5-minute Apgar score. We conclude that the Doppler cerebroplacental ratios provide useful information about perinatal outcome.     

The computerized fetal heart rate analysis in post-term pregnancy identifies patients at risk for fetal distress in labour

OBJECTIVE: To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labour. STUDY DESIGN: Three hundred and two healthy post-term pregnancies were enrolled in a retrospective, cross-sectional study and subdivided into two groups, with (n=42) or without (n=260) fetal distress in labour. The last computerized FHR recording before onset of labour was analyzed. RESULTS: The two groups showed a significant difference only in FHR baseline and in percentage of small accelerations on total. The multivariate analysis showed that only the percentage of small accelerations was significantly related to the labour outcome. A higher diagnostic accuracy was obtained with use of neural network analysis, which allowed a sensitivity of 56%, specificity 91%, positive predictive value 53% and negative predictive value 92% with an overall accuracy of 86%. CONCLUSIONS: The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses. Use of neural networks seems to further improve the ability of computerized FHR analysis in the prediction of intrapartum distress.     

Management of post-term pregnancy

Simple titration of urinary estriol and of serum human placental lactogen (HPL) has recently proved valuable in the assessment of feto-placental function, and the non-stress test (NST), the contraction-stress test (CST), and other fetal reserve tests are now routinely used in the management of post-term pregnancy. Major progress has also been made in labor induction using prostaglandin and DHAS. Despite these advances, however, the prognosis of post-term fetus has not improved during the past five years at our department. Our statistical data indicate room for improvement in the management of post-term pregnancy, but independently of new methods of fetal assessment or of labor induction. The management of post-term pregnancy appears to have entered a new stage of development. Ultrasonic echography has made it possible accurately to estimate gestational age, and hence the date of conception, early in pregnancy and thus to exclude false post-term pregnancies. The post-term pregnancy rate was once as high as 7%. More than half of these cases were false and were often subject to unnecessary induction of labor. Echographic screening and correction of date of conception have now reduced the true incidence of post-term pregnancy to between 1.5% and 3.1%. Echographic screening should therefore be performed for this purpose whenever possible. The diagnosis of oligohydramnios has also been facilitated by ultrasonic echography for the semiquantitative measurement of amniotic fluid. It has been reported, for example, that the volume of amniotic fluid tends to decrease after the 38th week of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sweeping of the membranes to prevent post-term pregnancy and to induce labour: a systematic review

Objective To evaluate the effectiveness of sweeping of the membranes to prevent post-term pregnancy and to induce labour.
Design A systematic review of randomised controlled trials.
Methods Potentially eligible trials were identified in Medline and in the Cochrane Controlled Trials Register. Inclusion of studies and data extraction were performed by two reviewers working independently. Summary estimates of the effect of the intervention were computed as relative risks, risk differences and weighted mean differences.
Main outcome measures Use of formal methods of labour induction, delay before spontaneous onset of labour, prevention of post-term pregnancy, side effects, maternal and perinaial morbidity.
Results Sixteen reports were identified. Thirteen were included in the review, with a total of 1992 women. Sweeping of the membranes, when performed at term, reduced the duration of pregnancy and the proportion of women continuing pregnancy beyond 41 and 42 weeks. When sweeping of the membranes was performed, a reduction in the use of formal methods for labour induction was observed (  RR = 0.48  ; 95% CI 0.28485). There was no difference between groups in the mode of delivery or in the risk of infection. Discomfort during vaginal examination and other side effects (e.g. bleeding, irregular contractions) were more frequently reported by women allocated to sweeping.
Conclusions While sweeping of the membranes reduces the interval to spontaneous onset of labour, there is no evidence of a reduction in maternal or neonatal morbidity. When used as a means of induction of labour, the reduction in the use of formal methods must be balanced against women's discomfort and other side effects attributable to the procedure.     

过期妊娠的诊断与治疗

<正>过期妊娠(postterm pregnancy)指孕周达到或超过42周仍未分娩~[1]。虽然各地区对其发病率报道不一,但随着产前保健不断规范和合理的产科干预,过期妊娠的发病率呈逐年降低的趋势~[2-3]。2000年我国过期妊娠发病率为7.2%左右~[4],到2010年降至0.7%左右~[5]。据统计,我国2014年产前检查率为88.9%~100%,平均产前检查率自2000年的89.4%上升至2014年的96.2%~[6]。     

Intrahepatic cholestasis in pregnancy and perinatal risk

The main purpose of this study was to analyze the accuracy of severity criteria applied in cholestatic jaundice in pregnancy related to health problems in the newborn. The sample, 209 cases, is formed by the total of hospital patients discharges from the Pathologic Pregnancy Unit. Severe cholestatic jaundice (59.3% of cases) presented early itching and impeding premature delivery as the most frequent severity criteria. We found that the greater number of severity criteria, the worse prognosis for the newborn, as shown by birth weight under 2,500 g and Apgar at the minute of 7 or less. Both differences were statistically significant (p = 0.0001; p = 0.0348). No maternal or perinatal deaths were found. Our conclusions are: 1. Severity criteria used in cholestatic jaundice of pregnancy are valied and 2. Clinical management of cases is appropriate, since the major risk reported (perinatal mortality) was absent and maternal and perinatal morbidity were less than those reported in previous studies.     

Twin pregnancy with intrauterine death of one twin

The antepartum death of one twin is a rare obstetric complication. Two cases are presented, accompanied by a review of the current literature. The premature and neonatal death rates are high in the surviving twins. Toxemia, fetal distress, abnormal presentation, and dystocia are also increased. Maternal disseminated intravascular coagulation has been demonstrated without a concomitant fetal coagulation defect. A more unique finding is fetal disseminated intravascular coagulation with a monochorionic placenta. The common circulation between the live and dead twins may result in fetal cerebral, renal, and cutaneous lesions, usually without demonstrable maternal disease. High-risk obstetric management is reviewed and a careful pediatric follow-up is recommended with monozygotic twins.     

Psychotropic drug use in pregnancy and perinatal death.

The psychotropic drug use in mothers to all 73 perinatally dead infants in the city of Gothenburg, Sweden, in 1985-86, was compared to a control group of mothers to 73 surviving infants. Information regarding medication in pregnancy and pre- and perinatal data was collected retrospectively. In addition, serum samples obtained in early pregnancy were screened for benzodiazepines. Eighteen case-mothers used psychotropic drugs during pregnancy compared with 7 control-mothers. The association between psychotropic drug use and perinatal death was significant (p = 0.01). Psychotropic drug use and maternal disorder were closely correlated, but within the case group there were no significant differences between mothers using or not using psychotropic drugs in terms of age, parity or smoking habits. Although the etiology of death could be discussed in the individual infant, we find it noteworthy that the use of psychotropic drugs was so frequent in the mothers of perinatally dead infants.     

Induction of labour, birthweight and perinatal mortality by day of the week

There were 66,974 births at the three largest Dublin maternity hospitals in the years 1980-1982. Data on numbers of spontaneous and elective births, birthweight and perinatal mortality were analysed by day of the week. Perinatal mortality rates were highest on Wednesdays and Saturdays. The rate on Sunday was close to average. The largest number of perinatal deaths per day occurred on Wednesdays and the smallest on Sundays. Significant variations in mortality rates and percentage low birthweight were found among the 19% of infants who were born electively, but not among those born after a spontaneous onset of labour. High-risk pregnancies, including many with intra-uterine fetal death, were induced in large numbers from Tuesdays through Saturdays with a peak on Wednesdays. Low risk cases were induced mainly from Monday through Fridays with a peak on Fridays. The pattern of perinatal mortality through the week followed closely that of the risk status of pregnancies delivered electively. The results indicate that the pattern of perinatal mortality by day of the week of birth was determined by a highly organized weekly routine of selective elective delivery.     

Sweeping of the membranes to prevent post-term pregnancy and to induce labour: a systematic review.

OBJECTIVE: To evaluate the effectiveness of sweeping of the membranes to prevent post-term pregnancy and to induce labour. DESIGN: A systematic review of randomised controlled trials. METHODS: Potentially eligible trials were identified in Medline and in the Cochrane Controlled Trials Register. Inclusion of studies and data extraction were performed by two reviewers working independently. Summary estimates of the effect of the intervention were computed as relative risks, risk differences and weighted mean differences. MAIN OUTCOME MEASURES: Use of formal methods of labour induction, delay before spontaneous onset of labour, prevention of post-term pregnancy, side effects, maternal and perinatal morbidity. RESULTS: Sixteen reports were identified. Thirteen were included in the review, with a total of 1992 women. Sweeping of the membranes, when performed at term, reduced the duration of pregnancy and the proportion of women continuing pregnancy beyond 41 and 42 weeks. When sweeping of the membranes was performed, a reduction in the use of formal methods for labour induction was observed (RR = 0.48; 95% CI 0.28-0.85). There was no difference between groups in the mode of delivery or in the risk of infection. Discomfort during vaginal examination and other side effects (e.g. bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. CONCLUSIONS: While sweeping of the membranes reduces the interval to spontaneous onset of labour, there is no evidence of a reduction in maternal or neonatal morbidity. When used as a means of induction of labour, the reduction in the use of formal methods must be balanced against women's discomfort and other side effects attributable to the procedure.     

Clinical study of post-term pregnancy]

One hundred fourteen cases of post term pregnancy were clinically analyzed and classified. 1. In case of primipara, the duration of labor was longer and the frequency of prolonged labor (greater than 24 hours) was higher than that of the same number of cases of term delivery at 39 weeks. 2. The main cause of prolonged labor was weak pains. 3. The mean newborn umbilical artery pH in prolonged labor cases was not lower than that in other cases. 4. The cases of post-term pregnancy were classified into 4 groups and compared each other in several respects. Group I: prolonged labor(-), fetal distress(-), vaginal delivery. Group II: prolonged labor(-), fetal distress(+), vaginal delivery. Group III: prolonged labor(-), fetal distress(+), cesarean section. Group IV: prolonged labor(+). 1) The length of the fundus uteri: Group III: minimum after 31 weeks: Group IV: maximum after 35 weeks. 2) The body weight of the newborn and the weight of the placenta: Group III: minimum: Group IV: maximum. 3) The titer of E3 in urine: Group III: obviously low. 4) The frequency of Clifford's sign: Group III: high frequency of meconium staining. Cases of post-term pregnancy were composed of several groups with different clinical features.     

Twin pregnancy complicated by intrauterine death of one twin

In twin pregnancies single intrauterine death of one fetus is associated with significant morbidity and mortality of the surviving infant. The aims of our retrospective study were to review conditions of twin pregnancies complicated with SIUD in Polish Mother's Memorial Hospital in ?ód? between 1989-1999 and to assess the fetal outcome when conservative management had undergone. In this study we reviewed 30 twin gestations involving the intrauterine death of one fetus. The incidence of preterm delivery among pregnancies with fetal death was 83.3%; Caesarean section was the method of delivery in 53.3% cases. Monochorionic placentation was found in 60%. Conservative management until there is no risk for the fetus is apt.