[Concept of risk in perinatology: the obstetrician point of view (author's transl)]

Perinatal risks involve the life and health of the mother and baby. It is possible to define both medical and socio-cultural risk factors. They are frequently associated. The surveillance of pregnancy is modulated by the clinician according to his preception of these factors. One essential medical problem is to define the field of application of some examination or therapeutic procedures: to all patients or to selected groups according to clinical criteria. There is no general rule. Some types of surveillance such as serodiagnosis of rubella or toxoplasmosis, or the electronic monitoring of labour involve all women. At the opposite, progestative treatment must be given only to patients at high risk of premature labour. From the public health point of view, it doesn't seem realistic to implement different policies according to risk. Surveillance and perinatal care must apply to all pregnant women. This policy, however, must take into account a fondamental finding of recent surveys, i.e. the deficiency of prenatal surveillance among the most exposed socio-cultural categories and regions, in order to improve information about the rights and duties of the pregnant woman, the concept of risk and how it can be reduced. The role of epidemiological surveys in defining risk factors appears fundamental. Coordination among studies would be desirable. In the future they will probably aid the clinician in real time diagnosis and decision.

[Macroscopic examination of the fresh placenta. Statistical analysis of 1,200 cases. Comparison with maternal and neonatal pathology]

We have examined 1,200 placentas in a fresh state and have compared the results of these examinations with maternal pathology on the one hand and the neo-natal pathology on the other hand. It turns out that most abnormalities of pregnancy are associated in a significant way with the pathological findings in the placenta, and that the good or pathological health of the newborn is significantly associated with the normal of pathological character of the placenta. The principal weakness in this method of examination is the absence of information about infection. This is why it seems important to us to carry out smears from the placenta before examining it macroscopically.

[The induction of labor by prostaglandin F2alpha Clinical, tocographic and electrohysterographic study]

Induction of labor was performed in 65 patients by intravenous infusion of PgF2alpha. 55 patients were near term and induction made electively. 5 cases failed. No correlation was found between the stade of the cervix and the probability of success nor the length of the induction time. PgF2alpha induced labor needs to be closely monitored (electronical pumps and monitoring) because of the risk of hypertonus. With such a technique the side effects are minimal and no undesirable consequences were observed concerning either the mother or the child. During the course of this investigation a study was performed for the first time of the electrical activity of the human myometrium subjected to PgF2alpha stimulation. (26 recordings through the extra-amniotic intrauterine technique). The pattern of this activity is quite similar to spontaneously occuring alectrical activity.

[Automatic analyses of rapid fluctuations of basal fetal heart rate during delivery. Verification of parameters]

The authors using an electronic calculator have measured 3 parameters, which allowed them to carry out quantitative evaluations of rapid variations in basal fetal cardiac rhythms (fluctuation) of 29 samples of fetal heart rate obtained during labour. The three parameters are: 1. Mean variation by intervals. 2. Values for differences in intervals approaching zero. 3. Zero changes in the derived curve. Each of these parameters was compared with the values of fluctuations which were obtained by visual analysis quantified on the same samples of tracings. The results of these coefficients of correlation show that the chosen parameters enable quantitative values for these fluctuations to be obtained.

Evaluation of the fetal state by automatic analysis of the heart rate. 2. Deceleration areas and umbilical artery blood pH

Fetal heart rate (FHR) deceleration areas were studied to obtain by objective measurement of the FHR, their prognostic value of the new-born state. 1. There is a reasonably good correlation between FHR deceleration areas and UApH (Tab. II). Such a correlation was found by SHELLEY and TIPTON [6] for the whole deceleration area, and by TOURNAIRE et al. [10] for areas divided in a slightly different way. The correlation coefficients between FHR deceleration areas and Apgar score at 1 minute are within a close range of those of the FHR deceleration area and UApH (Tab. I and II). 2. According to the time relationship between deceleration areas and uterine contractions the best correlation coefficient was obtained surprisingly for total, followed by residual and then simultaneous areas. These results agree with those of SHELLEY and TIPTON [6] suggesting that in practice a simple measurement of the whole deceleration area, regardless of the uterine contractions is a sufficient method in evaluating FHR patterns. 3. The special purpose computer built by the BAUDELOCQUE research group can be used on-line, thus in clinical practice. It was not the case for the manual method [4] or the method using a large programmed computer [10]. 4 The evaluation of deceleration areas appears to have several advantages: 1. It provides objective measurements. 2. The unit used is independant of factors such as display speed or scale of the strip-chart. 3. The data is reduced: A few numbers replace the long descriptions of the usual clinical classifications.

[Use of the Doppler signal in the determination of fetal cardiac rhythm]

The authors, after going over in brief the technical details of the physical characteristics of ultra-sounds and in particular the Doppler effect, describe a new cardiotachymeter using ultra-sounds which they have developed at the Baudelocque Maternity Hospital in Paris. In the first month in which they used this apparatus they kept 37 records on women who had not yet started labour and 36 records on women who were in labour. In 9 of the latter group they recored the fetal cardiac rhythm by the external route using ultra-sound pick-up and a recording by internal route using the fetal electrocardiogram. Tracings were comparable. It is interesting to note that even when uterine contractions are very strong indeed or the mother moves a lot the ultra-sound pick-up very rarely loses the fetal signal.