[Doppler echographic study of placental circulation of the fetus of normal and hypertensive mothers]

Foetal blood velocity wave forms, as recorded in chorionic vessels by pulsed Doppler ultrasonography, reflect vascular resistance in foetal placental circulation. The minimal-to-maximal velocity ratio provides an index of vascular conductance; the higher the minimal velocity (positive forward diastolic blood flow), the lower the vascular resistance. In the present study, this index was the same in pregnant women with normal blood pressure (n = 19) and in those with pregnancy-induced hypertension (n = 12); however, it was significantly lowered (p less than 0.001) in pregnant women with essential hypertension (n = 9). In the population of women with normal blood pressure and pregnancy-induced hypertension, a positive correlation (r = 0.71), was found between index value and gestational age, indicating a progressive fall in placental vascular resistance. All placentas from these 31 women were histologically normal except two which showed one single marginal infarct less than 1 cm in diameter. In the group of women with essential hypertension, the 6 placentas examined were pathological, with multiple chronic infarcts, placental growth retardation and maceration. Thus, pulsed Doppler ultrasonography should be used for early detection of placental vascular damage and for improved surveillance of pregnancies complicated by maternal vascular diseases.

Fetal tachycardia and meconium staining: a sign of fetal infection

A retrospective study was carried out on 72 liveborn babies in whom perinatal infection was suspected. Twenty-nine of the 72 neonates were effectively infected. Analysis of intrapartum FHR recordings showed that tachycardia (base line FHR above 160 beats/min) during labor, occurred more often among infected babies (P less than 0.001). When fetal tachycardia is associated with meconium stained amniotic fluid (MSAF), the relative risk of fetal infection is 51 times as great as in babies without MSAF. Fetal tachycardia is not related to maternal fever nor to prematurity. It is not a sign of limited placental or amniotic fluid infection, but implies infection of the fetus itself. Since most infected babies displayed infectious diarrhea immediately at birth, it is suggested that MSAF may eventually be due to antenatal intestinal infection and intrauterine emission of infected stools. Although great caution is advocated for the management of labor in the presence of fetal tachycardia, MSAF should not be always regarded as a sign of acute fetal distress when antenatal infection of the fetus is suspected.

High-performance liquid chromatography with electrochemical detection for the simultaneous determination of the methoxylated amines, normetanephrine, metanephrine and 3-methoxytyramine, in urine

A simple method for the simultaneous analysis of normetanephrine, metanephrine and 3-methoxytyramine (both free and conjugated) in human urine by reversed-phase ion-pair high-performance liquid chromatography with electrochemical detection has been developed. Existing methods have been optimized for extraction by study of analytical parameters. The hydrolysed urines are purified and concentrated by successive passages on two ion-exchange resins and ammoniacal elution to eliminate interference from pigments or related chemical compounds. The methoxyamines are separated by high-performance liquid chromatography on a reversed-phase column. Detection and quantitation are achieved with an electrochemical detector using a vitreous carbon electrode. Samples can be injected at 25-min intervals. Reference values of adults and children are given.

[Early discharge of women after delivery. Results of an opinion survey among patients and unit personnel]

Women's and maternity staff's opinion about early discharge and home care after hospital delivery was studied in 1981 in an university clinic; 100 pregnant women and 100 newly delivered mothers filled in a questionnaire, the former during an antenatal visit, the latter during their stay in hospital after delivery; and so did all the staff of the maternity unit. We found that 28% of pregnant women, 22% of newly delivered mothers and 25% of maternity staff were in favour of a short stay in hospital after delivery followed by home care. The main reasons for disapproving a short postnatal stay were medical safety, need for rest and fear of being alone with the baby. For the women approving of early discharge the best duration of hospital stay was 2 or 3 days. Rather more doctors, head nurses and midwives than nurses, auxillary nurses and ancillary staff approved a short stay in hospital after delivery. It seems that the opinion of the maternity staff was not linked to changes in working conditions that this new organization would introduce. We consider that the women's preference should be given priority in deciding early discharge after delivery, when there is no medical contra-indication. Home care could be a useful transition between hospitalization and being alone at home; for instance health visitors could give advice about breastfeeding, infant care and birth control. But before generalizing this type of care it would be important to evaluate the medical, economic and psycho-social consequences.

[Necrotizing enterocolitis. A study of forty-six cases seen in a maternity hospital]

Forty-six cases of necrotizing enterocolitis were seen at the Baudelocque maternity hospital from august 1978 to october 1980. In eighteen cases, clinical signs associated with roentgenograms showing pneumatosis led to unequivocal diagnosis. A surgical procedure was done in nine of these patients, during the acute stage in four and later on in five. Diagnosis was strongly suspected in twenty-eight cases. Clinical features were less serious and included abdominal distension, bloody stools, and emesis. There were no roentgenological signs. None of these infants underwent surgery. Overall mortality rate was 7% (3/46). In comparison to previously published studies, our series shows lower perinatal risk factors, higher mean birthweight, and lower prematurity rate (14%). No evidence was found to support the responsibility of a specific bacterial agent. Corona virus was found in the stools of five out of eleven cases studied during the second epidemic wave in october 1979, suggesting a possible viral etiology. Several preventive steps have been taken. Breast-feeding has been encouraged. Each mother-infant pair has been isolated instead of grouping infants in night nurseries. Staff members have been given specific information on the means of preventing contamination.

[Incidence and fetal impact of hypertension in pregnancy: study of 2996 pregnancies]

To evaluate the incidence and the foetal effects of gestational hypertension, we studied 2 996 pregnancies with a single live birth in mothers selected on the basis of 1) a documented diastolic blood pressure (DBP) less than 90 mmHg before the 16th week of amenorrhea and 2) no history of hypertension or kidney disease. In 38,4% of the gravidas, the highest DBP during pregnancy was greater than or equal to 90 mmHg, and in 15,4% this level was reached twice or more. Gestational hypertension (two DBP readings greater than or equal to 90 mmHg) was more frequent in nullipara than in mothers with previous pregnancies (17,9 versus 12,4%, p less than 0,01) and its incidence tended to decrease with increasing maternal age. Irrespective of parity or maternal age, a significant increase in the percentage of small for gestational age infants was associated with increasing DBP levels: 3,2, 6,4 and 8,5% when the highest recorded DBP was less than 90 mmHg, equal to 90 mmHg (even at one single reading), or greater than or equal to 100 mmHg respectively (p less than 0,001). Very similar percentages were obtained in non-proteinuric pregnancies: 3,3, 6,5 and 7,8 respectively (p less than 0.001). Non-proteinuric gestational hypertension, even mild or transitory, is indicative of a high risk pregnancy and requires close medical supervision.

Sinusoidal fetal heart rate pattern in severe fetal anemia from feto-maternal transfusion

A case is reported where a sinusoidal fetal heart rate pattern was found in a fetus at 34 weeks. This pattern, at first isolated and later persistent for several hours, during a normal pregnancy became progressively transformed into a silent pattern. Cesarean delivery then performed resulted in the birth of an infant affected by a severe anemia due to a major feto-maternal transfusion and it died aged 36 h. The authors enquire into the significance of this pattern when found in apparently normal pregnancies, not involving rhesus iso-immunization, and they suggest a possible management when confronted with a sinusoidal fetal heart pattern.

Electrical activity of the pregnant uterus in the cynomolgus monkey

Electromyographic activity in six pregnant cynomolgus monkeys was recorded in vivo by means of bipolar electrodes individually attached to the surface of the uterine corpus. These data were compared with recordings of intra-amniotic pressure obtained simultaneously by means of an open-ended, fluid-filled catheter placed in the amniotic cavity. During the last third of pregnancy, the electromyograms showed recurrent electrical complexes (trains of potentials, TOP) which lasted for about 2 minutes and whose rate of occurrence varied during the nyctohemeral period. The initiation of electrical activity in various uterine areas was always synchronous with and was related to mechanical contraction. The complex, polyphasic contractions that were observed can be explained, largely, by the variations of potentials within a train of potentials. However, a simple quantitative relationship between the mean frequency of the potentials within the TOP and the mean amplitude of the change in pressure could not be demonstrated. In contrast to data available on the woman, the increase in contractile strength at the onset of labor in the macaque appears to be due to a higher frequency of excitation of individual cells rather than the result of an improved functional coordination between the active muscular elements.

A comparison of two policies of ante-natal supervision for the prevention of prematurity

The performance of 2 maternity units is compared. In comparable groups of average risk the prematurity rate was significantly lower in the unit practising intensive supervision during pregnancy.

[Therapeutic abortion during the second trimester of pregnancy, using intracervical injection of PgF2 alpha (author's transl)]

Prostaglandins constitute the best means of inducing therapeutic abortion during the second trimester of pregnancy. The authors review the methods in current use and describe their own technique, which consists of dilatation of the cervix with laminaria and intracervical automatic pump infusion of Pg F2 alpha at the rate of 0.6 mg/h. The results obtained in 34 women with a mean total dose of 16.4 mg PgF2 alpha over 20 hours are given. The technique is considered to be as effective as those previously published.

Antepartum fetal heart rate monitoring. A semi-quantitative evaluation of the 'non-stressed' fetal heart rate

1964 recordings (from 246 patients were analysed on the basis of a semi-quantitative evaluation of base-line heart rate variability. All the tracings were obtained in the antepartum period, between the 20th wk of pregnancy and prior to the onset of labour. None of the recordings were made during labour or after induction of uterine activity so that a 'non-stressed' fetal heart rate test was obtained in every case. The percentage of flat tracing in each recording and the presence of sinusoidal patterns were compared with the neonatal outcome. When the tracings included a more than 50% flat pattern, 81.8% of the babies were distressed at birth. When a less than 50% flat recording was present only 11.4% of the neonates were distressed. Sinusoidal patterns were more frequently associated with abnormal tracings including those with more than 50% flat recordings. The presence of sinusoidal features did not significantly influence the neonatal outcome for tracings with a less than 50% anomaly: conversely sinusoidal patterns superimposed on a more than 50% flat tracing were predictive of fetal compromise and neonatal distress in 100% of the cases. These results allow to advocate the use of 'non-stressed' antepartum fetal heart rate monitoring, as a reliable test in the management of high risk pregnancies.

Antepartum fetal heart rate monitoring. III. Fetal movements and accelerations in fetal heart rate

This third part of the paper deals with the study of the relationships between fetal movements, fetal heart rate accelerations associated with such movements, fetal heart rate instability and neonatal outcome. No correlations has been found between absence of fetal movements and neonatal distress. A correlation has been found between the lack of fetal heart rate accelerations, the flatness of the record and poor neonatal outcome. In extreme situations (i.e. flatness in less than 10% of the record or in more than 80%) the presence or absence of accelerations does not add further useful information. Such information, however, is gained in the intermediary situations (the 'combined' recordings) and particularly when the record is between 51 and 80% flat where there appears to be an 85.6% risk to the fetus. Consequently, when trying to analyse an antenatal record it seems advisable to take primarily into account the percentage of flat recordings (providing the records are numerous enough and of sufficient length). Then, in records between 10 and 50% flat, the presence or the lack of spontaneous decelerations requires consideration whereas, when the record is between 51 and 80% flat, it is the presence or absence of fetal heart rate accelerations which is important.

Antepartum fetal heart rate monitoring. II. Deceleration patterns

Fetal heart rate was studied during the antepartum period in 246 patients, yielding a total of 1964 recordings. The following parameters were evaluated and correlated: --the semi-quantitative assessment of fetal heart rate instability (as expressed by the percentage of duration of flat traces); --the presence of decelerations and their relationship to the presence or absence of uterine contractions; --the neonatal condition. Overall, 50% of the patients exhibited uterine contractions while 30% contained decelerations patterns either occurring spontaneously or in association with uterine contractions. A definite relationship was observed between the presence of severe decelerations (irrespective of the time relationship with any uterine contraction) and poor neonatal outcome. A relationship does exist between the presence of severe decelerations and flattening in the recording, which, as demonstrated in the previous part of the paper also exhibited a strong positive relationship with the neonatal outcome. When one considers the different degrees of flattening, it appears that a further correlation between decelerations and neonatal state is demonstrable only in the case of a 10--50% flat recording. Here the probability of a distressed baby is 20% in the absence of decelerations, but 43.4% in the presence of decelerations. In other cases (i.e., less than a 10% or more than a 50% flat recording) the pronostic significance of the instability of the record is not significantly modified by he presence or absence of decelerations. These results indicate that consideration of decelerations is only advisable in these cases where instability is moderately affected (flattening in 10-50% of the record) and that the use of the oxytocin challenge test OCT may be reserved for such cases, when these are neither spontaneous contractions nor decelerations and not contraindications present.

Experimental study of cervical blockage induced by continuous low-dose oral progestogens

An investigation correlating scanning electron microscopic observations with sperm penetration tests carried out on cervical mucus under the influence of low-dose continuous progestogen (Norgestrienone) is presented. The results demonstrate that such type of contraceptive is involved in drastic alterations of mid-cycle cervical mucus at the macromolecular level. The meshwork which constitutes the infrastructure of the cervical secretion appears to be greatly tightened as a result of the treatment, thus giving the woof a general appearance typical of cervical mucus in the late luteal phase. The immobilizing effect of such modified mucus on spermatozoa is demonstrated and the duration of effectiveness after the administration of a last pill on the morning of day 13 is determined.

A case report of maternal death associated with betamimetics and betamethasone administration in premature labor

A fatal case of pulmonary edema is reported after prolonged treatment with beta-mimetics during pregnancy for threatened premature labor. The mother had received betamethasone in order to enhance fetal lung maturity. Myocardial failure occurred 5 days after discontinuation of betamimetics. The potential toxic effects of beta-adrenergic agents and their association with corticosteroids are discussed. Caution is recommended when high doses of betamimetics are to be delivered to prevent premature labor. No patient should be treated unless her cardiac condition is normal. Cardiovascular evaluation should be regularly performed during the course of treatment. No patient should be discharged after treatment without a normal cardiovascular check-up.

Pharmacokinetics of buflomedil after intravenous and oral administration

Pharmacokinetics studies were conducted in 4 patients who received buflomedil 100 mg intravenously and in 3 volunteers who received buflomedil 450 mg per os. Buflomedil concentrations were determined by a gas liquid chromatography method. Buflomedil levels declined multiphasically with a mean clearance after intravenous administration of -0,034 (1 h-1 kg-1). The decline appeared to be monophasic after oral administration. In both cases the overall half-life is short, mean 2.07 hrs (range, 1,47-2,6 hrs).

Variations in the distribution of glycosaminoglycans in the uterine cervix of the pregnant woman

A study was made of the modifications of glycosaminoglycans in the uterine cervix and the relationship to gestation. These substances are essential constituents of connective tissue, and a modification of their concentration could affect the physical and chemical characteristics of the cervix. Glycosaminoglycans were extracted from cervical biopsies obtained from pregnant and non-pregnant women. This study showed dermatan sulfte to be quantitatively the most important glycosaminoglycan in the cervix of both the groups studied, and that a significant decrease in the concentration of both dermatan sulfate and chondroitin sulfates occurred in the biopsies obtained just after delivery. This was related to a decrease of collagen in the cervix at the end of gestation, as the proteoglycans containing dermatan sulfate are principally associated with collagen.

Exogenous DHA-S half-life: a good index of intrauterine growth retardation

E3 and HPL hormone levels in maternal plasma are predictable of adequate birth weight for gestation age (AGA) when their values are higher than the mean for the term of pregnancy, but low values correspond to 'small-for-gestation-age' (SGA) infants in about 50% of the cases only. DHA-S (50 mg i.v.) half-life (DHS-S t 1/2) was calculated by least-squares analysis on the plot of log DHA-S concentration versus time at several intervals. 102 tests were performed in pregnant women between 30 and 41 weeks of amenorrhea (43 control, 59 suspicion of IUGR among them 29 AGA and 20 SGA). The difference between DHA-S t 1/2 is statistically highly significant (p < 0.001) between SGA and the other groups. Evaluation of birth weight was correct in 95 cases (76 normal babies < 4.29 h, and 19 SGA greater than or equal to 4.29 h, showed false-positive results in 6 cases, and false-negative in 1 case. This test has now been included in our routine practice for further evaluation of intrauterine growth retardation.

Placental transfer of atropine at the end of pregnancy

In a first study, 28 pregnant women received a fast intravenous injection of atropine sulphate 12.5 microgram/kg, as in a classical atropine test. Fetal tachycardia resulted. The maternal venous blood concentration of atropine, determined by bioassay on guinea pig ileum, decreased rapidly in the first 3--5 min and very slowly therafter. In a second study, 45 women in labour received the same dose i.v., and at birth atropine was measured both in maternal and cord blood. Placental transfer of atropine had occurred in every case and was highly variable, depending on the maternal blood concentration of the drug. This suggests that the atropine test is not mainly dependent on placental function.

[Arterio-venous fistulae of interest in the uterine vessels (author's transl)]

The authors report an interesting case of arterio-venous fistula in the uterine vessels in a young two-para of 23 years of age. A pulsatile and throbbing mass was found in the right parametrium at her post-natal visit after the second delivery, although no abnormal sign had been noted during the pregnancy. The diagnosis was confirmed by arteriography. Two surgical procedures have not been able to cure this patient entirely of these multiple fistulae which were congenital in origin. The production of an arterial embolus finally got over the difficulty of removing the residual troubles at the same time allowing the patient to keep her uterus. Following this case, the authors discuss the aetiology of acquired or congenital fistulae and the means by which this rare vascular pathological condition can be diagnosed and treated in the pelvis.

Catecholamine levels in newborn human plasma in normal and abnormal conditions and in maternal plasma at delivery

High levels of catecholamines have been found in plasma from the umbilical cord of newborn infants, suggesting a release of catecholamine from the fetus during parturition. Plasma catecholamine levels are also elevated in mothers at delivery.

[A study of the comparative efficiency of ifenprodil and ritodrine in the treatment of threatened premature labour (author's transl)]

The study compares a sequential test of a beta mimetic drug (ritodrine) and an alpha inhibitor (ifenoprodil) to show that the beta mimetic drug is superior in treating threatened premature labour, because it has a success rate of 90 per cent whereas the second has a success rate of 45 per cent. Ritodrine produces secondary effects in 69 per cent of cases.

A comparative study of the efficiency of hydroxyprogesterone caproate and of chlormadinone acetate in the prevention of premature labor

The efficacy of caproate of hydroxyprogesterone and acetate of chlormadinone in preventing premature labore was compared in a controlled trial. The survey was based on 211 pregnant women with a high risk of premature delivery discovered during clinical examination. There are no significant differences between the two groups in either length of gestation, delay between the beginning of treatment and delivery or other parameters related to prematurity. The absence of evidence suggesting any significant difference between the two treatments can have three possible causes (which are discussed): the methodology, the inefficacy of the two products or the equivalent efficacy of the two products.

[François Lepage (1905--1978)]

Background

Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low.

Objective

The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs).

Methods

A search for apps was conducted in Google Play Store using the following search string: [“best weight loss app for obese teens 2020”] OR [“obesity applications for teens”] OR [“popular weight loss applications”]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app.

Results

The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app “Morphe,” intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings.

Conclusions

The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness.

Clinical evaluation of tissue pH monitoring during labor. Second series of 61 cases

A newly developed tissue pH electrode designed for continuous pH monitoring was evaluated in 61 fetuses during labor. The results obtained in this series confirm the reliability of this method. The correlation coefficient between tissular pH and capillary blood pH is 0.94. The correlation coefficient between the last intrapartum tissue pH and the umbilical arterial blood pH is 0.84.

Improvements in the results with the continuous pH electrode due to technical progress: a comparison between two series of cases

Our experience is based on 139 attempts of tissular pH electrode applications in the fetal scalp during labor and includes 119 records comprising 86 tracings of good quality and 33 tracings of bad quality. Technical progress in the electrode and application material allowed an increase in the good quality tracings rate (from 54.5--66%) and a decrease of the complications, particularly the numbers of broken electrodes (from 18 to 2.4%).

Application technique of tissue pH electrode on human fetuses

The application technique of a newly developed tissue pH electrode designed for continuous pH monitoring is described. Some parameters are described as criteria of technically accurate records.

Plasma hypoxanthine in neonatal hypoxia: a comparison of two methods

Hypoxanthine levels were determined in both venous and arterial cord blood of 42 neonates. Two methods were compared, a PO2 electrode determination and an HPLC (high-pressure liquid chromatography) method. A good correlation was found between the two methods. However, the HPLC method was more sensitive, more reproducible and easier to perform. Hypoxanthine levels in the umbilical artery were found to be higher than in the vein. A significant negative correlation between pH and hypoxanthine level was established. The studies showed that plasma hypoxanthine levels by themselves did not provide an absolute diagnosis of intrauterine hypoxia.

[Fetal hypothyroidism: a complication of amniofetography. Apropos of 3 cases]

The authors present three cases of fetal hypothyroidism following amniofetography, after they have reviewed the technique and complications of this procedure. (For outlining the fetus by injecting radio-opaque iodides into the amniotic sac). These are cases of hypothyroidism in the fetus caused by overdosage with iodides. The fetal thyroid is blocked by the large quantity of iodine which is necessary for amniofetography. The indications then for amniofetography should be reviewed. The only valid indication that remains is for the diagnosis of neurological malformations and especially spina bifida. Whenever amniofetography has been carried out the newborn should be assessed for thyroid function routinely.

Continuous subcutaneous pH measurement in human fetuses: correlations with scalp and umbilical blood pH

The subcutaneous pH values of 42 fetuses has been measured continuously during labor with the use of the electrode designed by Stamm and associates. We have obtained 60 per cent good tracings. The results have confirmed the reliability of the subcutaneous pH measurement, if the electrode is correctly inserted, when compared with both capillary and umbilical artery blood pH measurements (r = 0.91, p less than 0.001 and 0.83, p less than 0.001, respectively). Technical improvements appear to be necessary prior to widespread clinical use of continuous pH measurement.

Fetal death: coagulation defects and management. Report of 20 cases with study of the half-life of [125I]fibrinogen

This report concerns 20 patients with intrauterine fetal death. Blood samples for coagulation studies were obtained before, during and after delivery. No clinical defibrination or bleeding was noted. Coagulation defects were observed as follows: 2 biological defibrinations: The first case was a pregnancy of 32 wk with retention for more than 12 wk; hypofibrinogenemia was noted in all 6 samples, between 180 and 280 mg/100 ml. The second was a pregnancy of 32 wk with retention for more than 8 wk; fibrinogenemia was between 170 mg/100 ml and 140 mg/100 ml. 2 intravascular coagulations with normal fibrinogenemia, increase of fibrin degradation products and positive ethanol tests. 3 cases with slight coagulation defects that were difficult to explain. The coagulation defects appeared to be transient, and sometimes resolved themselves spontaneously. Induction of labour was made in 19 cases; quinine sulfate, used in 17 cases, was remarkably successful (1 intolerance, 1 failure). Study of the half-life of [125I]fibrinogen was made in 18 of the 20 cases. On average, it was reduced by half in comparison with the half-life of healthy men. The decrease was noted even in cases of fetal deaths without the coagulation defects detected by classical tests. The half-life of [125I]fibrinogen in 6 pregnant women before therapeutic abortion was also studied. The decrease of half-life was noted. Changes of metabolism of fibrinogen during pregnancy are discussed.

Nonstressed fetal heart rate monitoring in the antepartum period

The role of nonstressed monitoring of the fetal heart rate (HR) in determining fetal well-being during the antepartum period was assessed in 125 high-risk patients. Observations on HR, variability, and HR response to fetal movement (FM) and uterine contractions (UC) over a 30 minute period were made with an external microphone and tocotransducer. A total of 625 tests were performed; the earliest gestation tested was 28 weeks, and the latest was 46 weeks. A reactive pattern (variability greater than 6 b.p.m. and accelerations with FM) appears to be a reliable indicator of fetal well-being. All the 51 fetuses exhibiting this pattern survived. This group also had the lowest incidence of neonatal complications. On the other hand, of the babies who failed to show variability greater than 6 b.p.m. or accelerations with FM (nonreactive pattern), 40% died in the perinatal period. Thirty-five patients showed features of both a reactive and nonreactive pattern (combined pattern). Poor outcome in this group was confined to those in whom the majority of the pattern was nonreactive. An undulating HR pattern with virtually absent variability (sinusoidal pattern) was found in 20 Rh-sensitized fetuses, 50% of whom died in the perinatal period. Bradycardia and tachycardia were not found to be reliable signs of fetal distress antepartum. Of the 12 fetuses who died during observation, six showed late decelerations with spontaneous UC but all showed diminished variability. The close correlation between nonstressed patterns and neonatal outcome demonstrated by this preliminary study warrants further use of this technique for fetal evaluation.

[Electronic surveillance during delivery. A method of reading the tracings]

A method for reading the foetal heart rate tracings and a guide of management advise in each case have been established from a review of the literature and the study of 500 records. The tracings are schematically divided into three categories according to the presumed risk of foetal distress: normal or "tolerable" tracings, alarm symptoms and danger symptoms. For each categorie, and according to the duration of the variations, a type of management is proposed. Other diagnostic means, such as capillary blood pH measurement are desirable to improve the foetal state diagnostic and make the treatment more precise.