Instantaneous fetal heart rate monitoring by electromagnetic methods

Fetal magnetocardiography (FMCG) is a new complementary external method for accurate antepartal FHR recording. Because of the low magnetic noise level required it is not yet suitable for routine hospital use. Fifty-six simultaneous FMCG and external FECG measurements were made in order to compare these methods for instantaneous FHR recording. The error of the FHR value obtained with the instrumentation described is less than 1 per cent. Our results show that FMCG can be used for FHR processing from week 30 of gestation until term. Thirty-five of the measurements were done during this period. From these, a readable FHR curve was obtained in 21 cases with FMCG and in 12 cases with external FECG. The maternal complexes were always present in the FECG, but in only 15 of the recorded FMCG's.     

Evaluation of a rapid method for the detection of vaginal group B streptococci in women in labor

Group B streptococci infection is an important cause of neonatal morbidity and mortality. Effective therapeutic intervention has been prevented to date by our inability to rapidly detect vaginal colonization. Material obtained from the lower vagina of 414 women in labor was cultured, incubated in modified Islam serum starch broth and observed on the ward for the production of orange carotenoid pigment specific for group B streptococci. Subcultures yielded 48 true group B streptococci-positive results. For the Islam broth, the pigment appeared in 2 to 22.5 hours (median, 12.5 hours). The test was shown to have a sensitivity of 96% and a specificity of 100% for group B streptococci. This study demonstrated a simple inexpensive method of detecting vaginal group B streptococci colonization which does not require sophisticated 24-hour laboratory facilities. The method holds promise as a screening test for future intervention studies.     

Immunosuppression during pregnancy: transmission of azathioprine and its metabolites from the mother to the fetus

After oral administration of ³⁵S-azathioprine (³⁵S-AT) to 3 women during the ninth, fourteenth, and fifteenth weeks of pregnancy, the radioactivity in fetal blood was 64 to 93 per cent of that in maternal blood at abortion 150 to 360 minutes later. In chromatography, most of the label (48 to 63 per cent) in fetal blood moved like the uric acid reference, representing thiouric acid, a metabolite of AT. In maternal blood, three major components were found: thiouric acid (27 to 41 per cent), 6-mercaptopurine (6-MP) (14 to 27 per cent), and AT (21 to 28 per cent). The placenta and amniotic fluid contained mostly thiouric acid (41 to 49 per cent), but 6-MP (5 to 13 per cent) and AT (9 to 25 per cent) were also present. Both transplacental and transamniotic transmission of AT and its metabolites from the mother to the fetus seem possible.     

Chlamydia trachomatis in acute salpingitis

Of the 228 hospitalized patients who had acute salpingitis, 69 (30%) harbored Chlamydia trachomatis in the lower genital tract (LGT). The mean antichlamydial lgG immunofluorescence antibody titer was 264 in sera from the C. trachomatis culture-positive patients but only 49 in. culture-negative patients. In paired sera obtained from 167 of the patients, 32% of the culture-positive patients and 13% of the culture-negative patients showed significant titer change. Patients with abscess formation had higher mean antichlamydial antibody titer than the group with no abscess (192 vs. 53), although there was no difference between the groups in positive chlamydial cultures from the LGT (33% vs. 29%). Overall, this study indicates that C. trachomatis is a common etiologic agent in acute salpingitis, emphasizing the need to treat chlamydial cervicitis before this complication develops.     

Toxemia of pregnancy: assessment of fetal distress by urinary estriol and circulating human placental lactogen and alpha-fetoprotein levels.

The efficacy of three biochemical methods for the detection of fetal distress was assessed in a prospective study of 224 singleton pregnancies complicated by toxemia. Fetal distress was diagnosed in 65 cases (29 per cent). Abnormally low urinary estriol (E3) excretion pointed out 63 per cent, low serum levels of human placental lactogen (HPL) 27 per cent, and elevated maternal serum alpha fetoprotein (AFP) 10 per cent of distressed fetuses. The efficacy of each test increased with the severity of maternal disease. The frequencies of false pathologic levels were: E3 19 per cent, HPL 0 per cent, and AFP 1 per cent of the cases with a normal fetal outcome. Although E3 was by far the most effective marker, abnormal levels of HPL and AFP provided supportive evidence for fetal distress by pointing out those cases in which E3 reading was not a false positive.     

Postoperative cesarean section morbidity: A prospective study

During a 3-year period, 1,319 women delivered of their infants by cesarean section were prospectively studied to determine the type and rate of postcesarean complications and to identify risk factors which predispose to postoperative morbidity. The overall complication rate was 14.5% and the most common complication was infection (13.3%), in particular, endometritis (6.6%), urinary tract infection (3.1%), and wound infection (1.6%). A lower complication rate was seen in elective operations (4.7%) compared with emergency operations (24.2%). Four significant factors that predispose to postoperative morbidity were identified: duration of ruptured membranes prior to operation (p < 0.001), duration of labor prior to operation (p < 0.001), anemia (p < 0.01), and obesity (p < 0.01). Patients with a combination of risk factors had an increased complication rate, in some cases as high as 91%. The clinical relevance of these findings in trying to decide possible ways to reduce the complication rate by changing the delivery routines is discussed.     

Perioperative cephalosporin prophylaxis in cesarean section: effect on endometritis in the high-risk patient.

A total of 120 patients who were to be delivered by cesarean section and who were at high risk of postoperative infection received three doses of either cefamandole, cephalothin or placebo perioperatively. Maternal serum levels for both antibiotics were in the therapeutic range. Although both drugs reduced the incidence of febrile morbidity and endometritis, only cefamandole significantly reduced the fever index. Risk factors for postoperative infections were the presence of ruptured membranes, labor, and internal fetal monitoring. Cefamandole beneficially influenced all risk factors while cephalothin was able to reduce only the risk of ruptured membranes. When a new method for obtaining endometrial tissue was utilized, 50% of cultures were negative. There was no difference in the organisms isolated from patients with and without endometritis.     

Correlation of quantitative amniotic fluid cultures with endometritis after cesarean section

At the time of cesarean section, amniotic fluid was collected transabdominally from 60 patients, and quantitative cultures were performed on the amniotic fluid. A culture was defined as positive if ≥10² colony-forming units per milliliter of a high-virulence organism were isolated. Any other result was defined as negative. In 24 patients with no labor or rupture of the membranes, no positive cultures were found, but there was a 25% incidence of endometritis. Among 36 patients with labor or rupture of the membranes, or both, 13 (36%) had a positive culture. Twelve of the 13 (92%) developed endometritis, whereas nine of the 23 (39%) patients with a negative culture had endometritis (p < 0.002). The usual clinical risk factors for endometritis were not different between the positive and negative culture groups. However, the patients with positive cultures had a significantly shorter time interval from cesarean section to endometritis than did the patients with negative cultures (p < 0.02). There was an excellent correlation between a positive amniotic fluid culture and endometritis after cesarean section.     

Perinatal and maternal mortality in a religious group avoiding obstetric care

We investigated perinatal and maternal deaths occurring among women who were members of a religious group in Indiana; these women received no prenatal care and gave birth at home without trained attendants. Members of the religious group had a perinatal mortality rate three times higher and a maternal mortality rate about 100 times higher than the statewide rates. These findings suggest that, even in the United States, women who avoid obstetric care have a greatly increased risk of perinatal and maternal death.     

Plasma steroid hormones, cytosol receptors, and thymidine incorporation rate in endometrial carcinoma

Histopathologically evaluated endometrial carcinomas were analyzed for the presence of estradiol and progesterone receptors and for tumor thymidine incorporation rate. Plasma estradiol and progesterone concentrations were also measured. With the use of an improved assay, all endometrial carcinomas were found to contain estradiol receptors; 81 of 92 (88%) contained measurable concentrations of progesterone receptors. The concentrations of both receptors were positively correlated to the degree of differentiation. The moderately and poorly differentiated tumours could be further divided into subgroups with low and high concentrations of receptors, which might be a reflection of an independent biologic characteristic of a tumor. These subgroups did not differ in any of the other variables studied, including the age of the patients. The plasma concentrations of estradiol showed a positive correlation to the degree of differentiation and to the concentration of both receptors. It is suggested that improved analyses of estradiol and progesterone receptors in endometrial carcinomas may add information to the conventional histopathologic and clinical classification which will be of significant value in the proper treatment of the disease.     

Effects of electronic fetal heart rate monitoring on perinatal outcome and obstetric practices

Perinatal outcome and obstetric practices during 1970 and 1977 were compared. None of the 6,740 fetuses delivered with birth weights of 1,000 gm or greater in 1970 had electronic fetal monitoring (EFM). In 1977, 5,987 of 8,174 fetuses delivered had EFM (72.7%). High-risk factors were significantly more frequent in the pregnant patient population in 1977. The incidence of intrapartum stillbirths and severe birth asphyxia was significantly lower in 1977. These reductions remained significant when corrected for changes in obstetric practices other than EFM as well as for changes in patient population. The neonatal death rate was not significantly changed. The primary cesarean section rate increased from 4.4% to 10.1%, mostly because of a greater number of cesarean sections done for failure to progress in labor and breech presentation. Only 15% of the overall increase in cesarean section rate was because of a greater frequency of the indication of fetal distress. The incidence of severe birth asphyxia was the same among the unmonitored patients in 1970 and 1977. In 1977, however, the monitored patients had a significantly lower incidence of severe birth asphyxia than the unmonitored patients.