The significance of antepartum variable decelerations

A total of 4886 nonstress tests were reviewed to establish the relationship between antepartum variable decelerations and perinatal outcome. The association between various fetal heart rate components and variable decelerations was also studied. The incidence of variable decelerations, defined as three or more decelerations greater than or equal to 15 bpm lasting at least 15 seconds in a 20-minute period, was 1.3%. The results suggest that in the presence of variable decelerations: there is a higher incidence of fetal distress in labor, low Apgar scores, neonatal intensive care unit admissions, and nuchal cord involvement; the presence of accelerations and normal variability is associated with good neonatal outcome, whereas their absence is associated with adverse outcome; the presence of accelerations or good variability is not independently correlated with neonatal outcome.

Diabetes in pregnancy: evaluating self-monitoring performance and glycemic control with memory-based reflectance meters

Reflectance meters modified by the addition of a memory microchip that stored glucose values were used to measure the difference between self-reported and actual blood glucose data in 34 pregnant diabetic women. Overall two thirds of the patients reported values that were significantly lower and less variable than those recorded in the memory meters.

Terminal pattern: characteristics and management

Terminal prepartum patterns from 31 patients were associated with 39% perinatal mortality rate and major degrees of perinatal asphyxia among survivors. Conditions most commonly associated with these patterns were intrauterine growth retardation, preeclampsia, and prolonged pregnancy. NST patterns in which there was absence of accelerations, absent or reduced variability, with or without variable or shallow late decelerations, portended very omnious outcomes when accompanied by absent fetal movements and/or oligohydramnios. Perinatal mortality was 39% under these circumstances. Immediate cesarean section is warranted when this situation is encountered.

The heightened significance of prolonged bradycardia associated with intrauterine growth retardation

The significance and management of prepartum bradycardia is not well established in prepartum fetal assessment. The incidence of prolonged bradycardia was 3.5% (45 per 1284), defined as a decrease of greater than or equal to 40 beats per minute of the fetal heart rate (FHR) below the baseline for at least 2 minutes. Thirty-two maternal, fetal, and FHR tracing characteristics were examined to study correlations between the variables, the presence of the bradycardia, and neonatal outcome. Neonatal outcome was evaluated by dividing the population into two groups. Group 1 consisted of infants with 1-minute Apgar scores less than 6 and NICU admissions greater than 24 hours. Group 2 comprised infants with 1-minute Apgar scores greater than 6 and no NICU admission or less than 24 hours NICU admission. IUGR was diagnosed in 40% of the patients. Statistically significant associations were found for correlations between Group 1 infants and IUGR (P less than .05), oligohydramnios (P less than .05), cesarean section rate (P less than .04), and the presence of meconium (P less than .01). There were no fetal heart rate characteristics found to be significantly associated with IUGR or neonatal outcome. The data do not support the need for immediate delivery in patients with prolonged prepartum bradycardia, but its presence does warrant a workup for intrauterine growth retardation.

Unusual skeletal metastases in carcinoma of the cervix

In a series of 1347 patients with carcinoma of the cervix, 62 or 4.6% had metastatic spread to the bones. Bone metastasis correlated with more advanced disease, occurring in 39.1% of patients with Stage II disease. The role of isotope bone scanning and of the radiographic skeletal survey in the investigation of carcinoma of the cervix is considered. Eight patients having unusual radiographic appearances of skeletal metastases are discussed.

Prolactin, cortisol and thyroxine levels and the premature infant

The relationship of prolactin, cortisol and thyroxine values in cord and maternal plasma to fetal age and weight and to the incidence of hyaline membrane disease (HMD) was investigated in 80 neonates of whom 40 were born at more than 37 weeks' gestation. Of the 40 born at less than 36 weeks 11 developed HMD. Serum cortisol has been shown to be a differentiating factor for HMD, but cord thyroxine and prolactin levels seem to be related more to age and weight than to the occurrence of HMD.

Characteristics and management of intrapartum prolonged fetal bradycardia

Twenty-five patients had intrapartum prolonged fetal bradycardia, defined as a drop of the fetal heart rate (FHR) by greater than or equal to 50 beats/min maintained for greater than or equal to 3 min; 10 were delivered by caesarean section and 15 vaginally. The only neonatal death occurred in the group delivered abdominally. Statistical analysis showed no difference in amplitude or duration of deceleration in the two groups but the 1 and 5 min Apgar scores were higher in the group delivered vaginally (P less than 0.01), whereas the onset of deceleration to delivery interval was shorter in the group delivered by caesarean section (p less than 0.005). Appropriate management of prolonged bradycardia is outlined and the characteristics of the FHR tracings are identified that are of prognostic value in determining whether or not immediate delivery is indicated.

Obstetrics in the very young black South African teenager

A group of 200 14-16-year-old Black obstetric patients was compared with controls aged 20-23 years. We found a significantly higher incidence of occipitoposterior presentations in the former group, resulting in higher caesarean section and assisted delivery rates. Decreases i the incidence of pre-eclamptic toxaemia and in perinatal mortality are evident in comparison with a similar study 10 years age.

Effect of addition of 10% Amberlite XAD-2 to the diet on serum cholesterol and atherogenesis in rabbits

The effects of addition of the polystyrene resin XAD-2 to the diet of rabbits on serum cholesterol, on hepatic enzyme of cholesterol synthesis (HMG-CoA reductase), and on atherogenesis was determined. Feeding of XAD-2 caused substantial decrease of total serum cholesterol and of the cholesterol of the apo B-containing lipoproteins (50%). Atherogenesis, which was induced by mechanical injury to the arterial wall, greatly decreased (p < 0.01) in animals fed with 10% XAD-2 supplement in their diet. Average lesions volume of 4.2 +/- 2.0 mm3 per aorta was observed in animals maintained on XAD-2 diet, in comparison to 15.42 +/- 3.3 mm3 in animals maintained on regular diet. The animals maintained on XAD-2 showed elevated activity of hepatic HMG-CoA reductase. The activity of this enzyme was 3.2 fold that obtained from livers of control animals.