Fetal death in eclampsia: II. The effect of non-therapeutic factors

Fetal growth retardation in infants of multiparous and nulliparous women with preeclampsia

OBJECTIVE

Infants of women with preeclampsia are considered at high risk of fetal growth retardation. The purpose of our study was to determine whether the risk differed by parity.

STUDY DESIGN

We compared the outcomes of 133 case patients with preeclampsia (101 nulliparous women and 32 multiparous women) and 132 normotensive control patients (52 nulliparous women and 80 multiparous women) who delivered at Northern California Kaiser Permanente hospitals between 1984 and 1985.

RESULTS

Women with preeclampsia were more likely than control patients to deliver a small-for-gestational-age infant (adjusted odds ratio 7.0, 95% confidence interval 2.8 to 18.1). After we controlled for smoking status, age, Quetelet index, and race, multiparous women with preeclampsia were at greater risk of having a small-for-gestational-age infant (adjusted odds ratio 29.4, 95% confidence interval 5.2 to 167.5) than were nulliparous women (adjusted odds ratio 4.1, 95% confidence interval 1.2 to 14.1) when compared with normotensive control patients of similar parity. Although multiparous women with preeclampsia had higher mean arterial pressures and somewhat earlier onsets of elevated mean arterial pressure than nulliparous women with preeclampsia, neither of these variables predicted whether the infants would be small for gestational age.

CONCLUSION

Multiparous women with preeclampsia are at higher risk of having an infant with fetal growth retardation than are nulliparous women with preeclampsia.

Drugs and stillbirth

In a case-control study spanning five years' experience at Group Health Cooperative of Puget Sound, we could demonstrate no plausible association between the use of spermicides, oral contraceptives, Bendectin, or antibiotics prior to conception and the occurrence of 73 nontraumatic stillbirths.

Evaluation of infants with acidosis using a perinatal "negative factor" score

Using Prechtl's concept of optimal conditions as modified by Michaelis et al. [7] we analysed the case records of 50 acidotic newborn infants (umbilical artery pH of 7,250 or less) and of 34 controls. Acidotic infants had a significantly higher negative (or adverse) factor score. There was a correlation between the degree of acidosis and the negative factor score. There were, however, no relations between scores in isolated subgroups of negative factors and fetal acidosis though the same was not true for some combinations of subgroups (such as pre-eclampsia, operative delivery, fetal bradycardia in the second stage of labour).

Ultrasonic features of preeclampsia

Preeclampsia, the hypertension of pregnancy, is a high-risk obstetric situation that can be monitored ultrasonically. Ultrasonic features commonly associated with preeclampsia, including decreased total intrauterine volume (TIUV), oligohydramnios, and intrauterine growth retardation (IUGR), are presented and their possible prognostic implications discussed.

Fetal death in eclampsia: I. Its relation to low gestational age, retarded fetal growth and low birthweight

Of 173 eclamptics admitted to the only public maternity hospital in Cali, Colombia 44 had stillbirths making a rate of 25-4 per cent. Fetuses delivered before 32 weeks had nearly four times the stillbirth rate of those delivered at term. Those weighing less than 1600 g. had stillbirth rates about six times higher than those weighing above 2500 g. An attempt was made to divide the risk conveyed by low birthweight into two components; that which was due to low gestational age, and that which was due to an abnormally low rate of growth during the gestational time available. Deviation of birthweight below that expected for age (retarded fetal growth, RFG) was used as a measure of the latter component. RFG became more common as gestation progressed and was associated with fetal death only in the latter part of gestation and with marginal statistical significance. After 35 weeks, fetuses at or below two standard deviations from Gruenwald's mean weight for gestational age (Gruenwald, 1966) had a fetal death rate five times higher than those at the mean. The risk of fetal (intrauterine) death conveyed by low gestational age has not been definitively explained. Alternative pathophysiological mechanisms are discussed.