Patterns of gross fetal body movements over 24-hour observation intervals during the last 10 weeks of pregnancy

Continuous measurements of gross fetal body movements were made with an ultrasonic real-time scanner for periods of 24 hours in 31 women. Fetuses made 0 to 130 gross fetal body movements per hour which accounted for 0% to 50% of the time. At 38 to 39 weeks' gestational age, fetuses demonstrated a peak in activity between 2100 and 0100 hours. The longest period of complete absence of gross fetal body movements was 75 minutes. Maternal meals and glucose concentrations did not influence gross fetal body movements.

Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes

PURPOSE

Gemcitabine-platinum combination activity has been clearly established in a number of phase II studies. It has also been compared against other combinations in many phase III trials. It is generally believed that all such regimens have an equivalent impact on survival. This meta-analysis aims to quantify the treatment effect of gemcitabine plus a platinum agent in the treatment of advanced NSCLC and compare the combination to other regimens used globally.

DESIGN

Data from a total of 4556 patients from 13 randomized trials investigating gemcitabine in combination with a platinum agent versus any other platinum-containing regimen were included in a meta-analysis of time-to-event outcomes.

RESULTS

A significant reduction in overall mortality in favor of gemcitabine-platinum regimens was observed, hazard ratio (HR) 0.90 (95% CI: 0.84-0.96) with an absolute benefit at 1 year of 3.9%. Median survival was 9.0 months for the gemcitabine-platinum regimens and 8.2 months for the comparator regimens. Sub-group analysis of the first- and second-generation platinum-based comparator regimens also indicated a significant benefit for gemcitabine-platinum regimens, HR 0.84 (CI: 0.71-0.9985). Analysis of third-generation agent plus platinum regimens showed a non-significant trend favoring gemcitabine-platinum regimens, HR 0.93 (CI: 0.86-1.01). There was a significant decrease in the risk of disease progression in favor of gemcitabine-platinum regimens, HR 0.88 (CI: 0.82-0.93). An absolute benefit of 4.2% at 1 year was estimated. Median progression-free survival was 5.1 months for gemcitabine-platinum regimens compared with 4.4 months for the comparator regimens. Sub-group analysis indicated a statistically significant progression-free survival benefit for patients assigned to gemcitabine-platinum treatment compared to first- and second-generation platinum regimens, HR 0.85 (CI: 0.77-0.94), and third-generation agent plus platinum regimens, HR 0.89 (CI: 0.82-0.96).

Patterns of human fetal breathing activity at 34 to 35 weeks' gestational age

Continuous measurements of human fetal breathing movements at 34 to 35 weeks' gestational age were made with an ultrasonic real-time scanner for periods of 24 hours in 11 women. A significant increase occurred in fetal breathing activity during the second and third hour following meals and this pattern apparently followed an increase in maternal plasma glucose concentration. There was a prolonged significant increase in fetal breathing activity between 0100 and 0700 hours. Increases in human fetal breathing activity accompanied by increased gross fetal body movements occurred for periods of 20 to 60 minutes out of every 1.0 to 1.5 hours of observation time. It was concluded that the percentage of time spent breathing by normal fetuses was related to time of day and maternal meals. The alternating changes of fetal activity and inactivity observed may represent biologic changes of sleep state in the human fetus in utero at 34 to 35 weeks' gestational age. It will be important to account for these three patterns of fetal breathing activity in clinical studies which examine the usefulness of fetal breathing movements in assessing fetal health.

An endodermal sinus tumor diagnosed in pregnancy: case report and review of the literature

OBJECTIVE

The use of chemotherapeutic drugs in pregnancy is a rare occurrence. Experience and results need to be shared.

METHOD

At 23 weeks gestational age, a patient was diagnosed with an endodermal sinus tumor of the ovary. She received one course of postoperative bleomycin, cisplatin, and etoposide. One week later, the patient was investigated for increasing abdominal pain and the fetus was noted to have ventriculomegaly.

RESULTS

The baby was delivered, and the patient was surgically staged and completed chemotherapy. Although the patient is alive and well 16 months after delivery, the infant has developed significant ventriculomegaly with cerebral atrophy.

CONCLUSION

The etiology of this infant's significant cerebral atrophy is not clear. Tumor-specific, perioperative, or drug-related events must be considered.

Measurement of fetal forelimb movements in the lamb in utero

Forelimb movements in the unanesthetized fetal lamb in utero were measured by means of transit-time ultrasound in conjunction with triceps and biceps electromyographic activity. The relationships between forelimb movements and electrocortical activity, hypoxia, and spontaneous labor were studied. There was no evidence of diurnal variation. The amount of time spent moving in low-voltage electrocortical activity with rapid eye movements was significantly less than in other electrocortical states. During acute hypoxia, forelimb movements were much reduced. In active labor near term, the fetal electrocorticogram continued to cycle between high- and low-voltage activity, and the number of movements was reduced; movements were present only during uterine contractions, provided that the fetus was not in low-voltage electrocortical activity with rapid eye movements.

Longitudinal measurements of fetal breathing, body movements, heart rate, and heart rate accelerations and decelerations at 24 to 32 weeks of gestation

Fetal breathing, fetal body movements, fetal heart rate, and fetal heart rate accelerations and decelerations were studied longitudinally in healthy fetuses between 24 and 32 weeks' gestation in the second and third hour following an 800 kcal maternal meal. The expected increase in fetal breathing following a maternal meal was not seen until fetuses were at 30 to 32 weeks' gestation. The number of body movements decreased and the interaction between body movements and fetal heart rate accelerations became more evident as fetuses became older. Fetal heart rate decelerations increased with gestational age, and the relative proportion of total decelerations that were either associated with body movements or were part of a deceleration/acceleration/deceleration complex increased from 24 to 32 weeks' gestation. The data support the hypothesis that gestational age is an important variable to consider when interpreting biophysical measurements in the human fetus at 24 to 32 weeks' gestation. Fetal body movements may be the single most important measurement of fetal health at these gestational ages.

Effects of human maternal venous plasma glucose concentrations on fetal breathing movements

Human fetal breathing movements were studied following the maternal ingestion of either a 50 Gm. oral glucose load or an equal volume of water in 22 healthy women with uncomplicated pregnancies at 32 to 34 weeks' gestation. The percentage of time spent breathing in fetuses of glucose-treated mothers increased from 23.2 +/- 2.2 per cent during the control period to a maximum of 58.9 +/- 5.2 per cent at 105 minutes following the oral glucose load (p less than 0.01) which was one hour following the peak maternal plasma glucose concentration. No similar increase in maternal glucose concentrations or percentage time spent breathing occurred in patients receiving water. Fetal breathing movements were observed in 97 per cent of the 15 minute periods during the second and third hour after maternal ingestion of a 50 Gm. oral glucose load. It was concluded that maternal carbohydrate intake two hours prior to fetal breathing observations should be documented to permit adequate interpretation of fetal breathing activity.

A definition of human fetal apnea and the distribution of fetal apneic intervals during the last ten weeks of pregnancy

Fetal breathing movements were studied over 24-hour observation periods for a total of 744 hours in 31 healthy pregnant women at 30 to 39 weeks' gestational age. An analysis of 165,786 breath-to-breath intervals in eight fetuses demonstrated that 97% of breath-to-breath intervals were less than 6 seconds in duration. It was concluded that a breath-to-breath interval of 6 seconds or more is a rational definition of fetal apnea during the last 10 weeks of pregnancy. An analysis of intervals during which time no fetal breathing activity occurred in the 31 fetuses demonstrated that prolonged episodes of apnea were distributed in a similar fashion at different gestational ages. The longest periods of apnea were 65 minutes at 30 to 31 weeks, 105 minutes at 34 to 35 weeks, and 120 minutes at 38 to 39 weeks. No periods of apnea of more than 45 minutes were measured during the second and third hours following maternal meals. A useful strategy for recognition of significant fetal apnea would be to make observations during the second and third hours following maternal meals when apneic lengths greater than 45 minutes were not observed in this highly selected group of normal fetuses.

Effects of intravenous glucose injections on human fetal breathing movements and gross fetal body movements at 38 to 40 weeks' gestational age

Fetal breathing movements and gross fetal body movements were studied subsequent to the intravenous injection of either 25 gm of glucose or an equal volume of normal saline solution in 10 healthy women with uncomplicated pregnancies at 38 to 40 weeks' gestation. The incidence of fetal breathing increased from 17.5% during the control period to 54.9% after glucose injection. Neither glucose nor saline solution had any effect on the incidence of gross fetal body movements. All fetuses made some breathing movements during any 15-minute interval between 30 and 75 minutes after glucose injection. These data suggest a useful strategy for clinical measurement of fetal breathing activity near term.

Circadian rhythms in maternal plasma cortisol, estrone, estradiol, and estriol at 34 to 35 weeks' gestation

In order to examine the relationship between circadian rhythms in different steroids, cortisol (F), estrone E1), estradiol (E2), and estriol (E3) were measured by radioimmunoassay in maternal venous plasma taken at 30 to 60-minute intervals over 24 hours from 11 healthy women at 34 to 35 weeks' gestation. Maternal F was maximal at 0730 hours and fell significantly to its lowest concentration at 0230 hours. Maretnal E3 was lowest between 1000 and 1130 hours and rose significantly to maximal values between 2230 and 0030 hours. Maternal E1 was maximal between 1000 and 1130 hours and showed a significant decrease to reach its lowest concentration at 0430 to 0630 hours. No significant circadian change was measured in uncorrected concentrations of E2. We conclude that there is an inverse relationship between maternal F and E3, which would be consistent with a maternal effect on fetal adrenal function, and the existence of circadian rhythms in F, E1, E2, and E3 must be taken into account in clinical investigations of these hormones during pregnancy.

Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension

OBJECTIVE

The purpose of this study was to determine the obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension.

STUDY DESIGN

Induction and operative delivery rates and indices of maternal and neonatal morbidity were determined in women (37-41 completed weeks) with gestational hypertension (n = 979), preeclampsia (n = 165), chronic hypertension (n = 187), and control subjects (n = 11,434) in a retrospective review of St. Joseph's Health Care Perinatal Database from November 1, 1995, to October 31, 1999. Data were analyzed by chi-square test, analysis of variance, Dunnett's t -test, and pairwise chi-square tests with Bonferroni correction.

RESULTS

The induction and cesarean delivery rates in gestational hypertension were similar to preeclampsia and chronic hypertension groups and almost double of control subjects. The length of labor and postpartum stays and the incidence of operative vaginal delivery, postpartum hemorrhage, and neonatal intensive care involvement were greater in the gestational hypertension group than in the control subjects.

CONCLUSION

Women with gestational hypertension had obstetrical intervention rates much higher than control subjects and similar to those with preeclampsia and chronic hypertension.

The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies

Objective

To investigate whether initiating external cephalic version (ECV) earlier in pregnancy might increase the rate of successful ECV procedures, and be more effective in decreasing the rate of non-cephalic presentation at birth and of caesarean section.

Design

An unblinded multicentred randomised controlled trial.

Setting

A total of 1543 women were randomised from 68 centres in 21 countries.

Population

Women with a singleton breech fetus at a gestational age of 33^0/7 weeks (231 days) to 35^6/7 weeks (251 days) of gestation were included.

Methods

Participants were randomly assigned to having a first ECV procedure between the gestational ages of 34^0/7 (238 days) and 35^6/7 weeks of gestation (early ECV group) or at or after 37^0/7 (259 days) weeks of gestation (delayed ECV group).

Main outcome measures

The primary outcome was the rate of caesarean section; the secondary outcome was the rate of preterm birth.

Results

Fewer fetuses were in a non-cephalic presentation at birth in the early ECV group (314/765 [41.1%] versus 377/768 [49.1%] in the delayed ECV group; relative risk [RR] 0.84, 95% CI 0.75, 0.94, P = 0.002). There were no differences in rates of caesarean section (398/765 [52.0%] versus 430/768 [56.0%]; RR 0.93, 95% CI 0.85, 1.02, P = 0.12) or in risk of preterm birth (50/765 [6.5%] versus 34/768 [4.4%]; RR 1.48, 95% CI 0.97, 2.26, P = 0.07) between groups.

Conclusion

External cephalic version at 34–35 weeks versus 37 or more weeks of gestation increases the likelihood of cephalic presentation at birth but does not reduce the rate of caesarean section and may increase the rate of preterm birth.

Human fetal breathing activity during electively induced labor at term

Human fetal breathing movements were measured during the first stage of electively induced labor in 20 healthy term pregnancies. Fetuses made breathing movements 25.6% of the time during a 1 hour control period and breathing decreased significantly to 8.3% during latent-phase labor and further decreased to 0.8% during active labor (P less than 0.001). Patterns of increased fetal breathing activity accompanied by increased gross fetal body movements and increased fetal heart rate variability for periods of 20 to 60 minutes out of every 1.0 to 1.5 hours were observed, and the intermittent patterns of increased body movement and heart rate variability continued throughout the first stage of labor despite the decrease in fetal breathing activity during latent- and active-phase labor. It will be important to account for rest activity patterns when interpreting variability of heart rate during labor. The absence of fetal breathing activity during electively induced labor at term is not a clinical indicator of fetal ill health.

Multicenter phase II study of brequinar sodium in patients with advanced lung cancer

A total of 53 patients with advanced lung cancer [non-small-cell (NSC), 21; small-cell (SC), 32] were treated with brequinar sodium. All of the NSC patients were chemotherapy-naive, but 31/32 (97%) SC patients had failed a multiagent chemotherapy program prior to study entry. Brequinar was given intravenously at a median weekly dose of 1200 mg/m2. The toxicity was moderate, with 19 patients (36%) experiencing grade 3 or 4 toxicity. Objective responses were observed in one NSC and two SC patients. We conclude that at this dose and on this schedule, brequinar does not have sufficient activity in patients with NSC or in patients with previously treated SC to warrant further evaluation. However, since responses were observed in previously treated SC lung-cancer patients, further evaluation in chemotherapy-naive patients may be warranted.

Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting

BACKGROUND

Many unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five. Presently, approximately 70 percent of children in the United States are currently enrolled in early childcare facilities, making this an ideal setting to implement and evaluate childhood obesity prevention efforts. We describe here the methods for conducting an obesity prevention randomized trial in the child care setting.

METHODS/DESIGN

A randomized, controlled obesity prevention trial is currently being conducted over a three year period (2010-present). The sample consists of 28 low-income, ethnically diverse child care centers with 1105 children (sample is 60% Hispanic, 15% Haitian, 12% Black, 2% non-Hispanic White and 71% of caregivers were born outside of the US). The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children's nutrition and physical activity behaviors. . The Healthy Caregivers-Healthy Children (HC2) intervention arm schools received a combination of (1) implementing a daily curricula for teachers/parents (the nutritional gatekeepers); (2) implementing a daily curricula for children; (3) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce; and (4) creation of a center policy for dietary requirements for meals and snacks, physical activity and screen time. Control arm schools received an attention control safety curriculum. Major outcome measures include pre-post changes in child body mass index percentile and z score, fruit and vegetable and other nutritious food intake, amount of physical activity, and parental nutrition and physical activity knowledge, attitudes, and beliefs, defined by intentions and behaviors. All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment.

DISCUSSION

Although few attempts have been made to prevent obesity during the first years of life, this period may represent the best opportunity for obesity prevention. Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting.

TRIAL REGISTRATION

TRIAL REGISTRATION NUMBER

NCT01722032.

Circadian rhythms in maternal plasma cortisol and estriol concentrations at 30 to 31, 34 to 35, and 38 to 39 weeks' gestational age

In order to examine the relationship between circadian rhythms in different steroids, cortisol and estriol were measured by radioimmunoassay in maternal venous plasma taken at 30- to 60-minute intervals over 24 hours from nine healthy women at 30 to 31, 11 at 34 to 35, and 10 at 38 to 39 weeks' gestation. Maternal cortisol was maximal at 0730 to 0830 hours and fell significantly to its lowest concentration between 1830 and 0130 hours. At 30 to 31 and 34 to 35 weeks there was a significant circadian rhythm in estriol concentrations which was inversely related to the circadian rhythm in cortisol. At 38 to 39 weeks mean estriol concentrations were significantly higher than those at 30 to 31 and 34 to 35 weeks but there was no significant circadian pattern. We concluded that there is an inverse relationship between maternal cortisol and estriol at 30 to 31 and 34 to 35 weeks, which would be consistent with a maternal effect on fetal adrenal function. The increase in mean concentration and absence of circadian rhythm in maternal plasma estriol at term might suggest an additional positive stimulus to fetal adrenal function. The existence of patterns in maternal estriol concentrations must be taken into account in the u;se of sequential measurements of this hormone during the last 10 weeks of pregnancy.

Risk and resilience of well-being in caregivers of young children in response to the COVID-19 pandemic

The COVID-19 pandemic is impacting communities worldwide, with direct effects of illness and mortality, and indirect effects on economies, workplaces, schools/daycares, and social life. However, we understand very little about the effects of this pandemic on families of young children. We used a risk and resilience model to evaluate the effects of the pandemic on mental health in diverse caregivers (N = 286) with children ages birth to 5. We evaluated the hypotheses that (a) pandemic stress and caregiver-reported child psychosocial concerns correlate with caregivers' mental health symptoms and (b) caregivers' pandemic-related self-efficacy and coping mediate these relationships. Caregivers completed surveys in April-May 2020 assessing pandemic stress (e.g., health, finances, and housing), child psychosocial problems, coping strategies, and self-efficacy to manage family needs. Our primary outcome was caregivers' self-reported changes in mental health symptoms since the outbreak. Path analysis revealed that higher pandemic stress was associated with caregivers' reduced confidence in meeting their family's needs related to COVID-19, which correlated with worse caregiver mental health symptoms. Greater child psychosocial problems also predicted worse caregiver mental health symptoms. Findings suggest that pandemic stress, child psychosocial problems, and caregiver self-efficacy are interrelated in their influence on caregivers' mental health. While further research is needed to examine strategies to foster resilience and buffer the pandemic's effects on caregiver mental health, this is a first step in evaluating the psychosocial effects of this pandemic in families of young children. Clinical implications are discussed for a tiered response to mitigate the pandemic's impacts on family functioning.

Biological determinants of spontaneous late preterm and early term birth: a retrospective cohort study

OBJECTIVE

Our aim was to examine the association between biological determinants of preterm birth (infection and inflammation, placental ischaemia and other hypoxia, diabetes mellitus, other) and spontaneous late preterm (34-36 weeks) and early term (37-38 weeks) birth.

DESIGN

Retrospective cohort study.

SETTING

City of London and Middlesex County, Canada.

SAMPLE

Singleton live births, delivered at 34-41 weeks to London-Middlesex mothers following spontaneous labour.

METHODS

Data were obtained from a city-wide perinatal database on births between 2002 and 2011 (n = 17,678). Multivariable analyses used multinomial logistic regression.

MAIN OUTCOME MEASURE

The outcome of interest was the occurrence of late preterm (34-36 weeks) and early term (37-38 weeks) birth, compared with full term birth (39-41 weeks).

RESULTS

After controlling for covariates, there were associations between infection and inflammation and late preterm birth (aOR = 2.07, 95% CI 1.65, 2.60); between placental ischaemia and other hypoxia and late preterm (aOR = 2.21, 95% CI 1.88, 2.61) and early term (aOR = 1.25, 95% CI 1.13, 1.39) birth; between diabetes mellitus and late preterm (aOR = 3.89, 95% CI 2.90, 5.21) and early term (aOR = 2.66, 95% CI 2.19, 3.23) birth; and between other biological determinants (polyhydramnios, oligohydramnios) and late preterm (aOR = 2.81, 95% CI 1.70, 4.64) and early term (aOR = 1.89, 95% CI 1.32, 2.70) birth.

CONCLUSIONS

Our findings show that delivery following spontaneous labour even close to full term may be a result of pathological processes. Because these biological determinants of preterm birth contribute to an adverse intrauterine environment, they have important implications for fetal and neonatal health.

Technical factors in early amniocentesis predict adverse outcome. Results of the Canadian Early (EA) versus Mid-trimester (MA) Amniocentesis Trial

The purpose of this study was to identify risk factors for fetal loss and other pregnancy complications associated with genetic amniocentesis. Data were acquired in the Canadian Early Amniocentesis Trial (CEMAT), a multicentered (12) prospective, randomized trial comparing continuous ultrasound-guided early amniocentesis (EA) and mid-trimester amniocentesis (MA) (CEMAT Group, 1998). Details of the procedure were recorded and analysed by allocation (EA versus MA), operator and centre, and correlated with pregnancy outcome. A total of 62 spontaneous pregnancy losses occurred between the procedure and 20 weeks' gestation among the 3691 patients who received their procedures within the allocated window (EA=53/1916, MA=9/1775). Technical factors correlating with these losses included procedures 'judged to be difficult' by the operator, and post-procedure amniotic fluid leakage or bleeding. Maternal risk factors included maternal hypertension (fetal loss 11. 1 per cent, compared with non-hypertensive women, 2.6 per cent) increased body mass index (BMI) and gravidity of three or greater. Allocation to EA was predictive of fetal loss, as well as failed procedure, multiple needle insertions, amniotic fluid leakage, failed culture and talipes equinovarus, in excess compared with MA. In conclusion, in this large prospective randomized trial evaluating amniocentesis, specific maternal, fetal and procedural variables were found to be predictive of fetal loss and adverse pregnancy outcome. Performing amniocentesis before 13 weeks' gestation (EA) was the major predictive factor for adverse outcome. These data suggest that first-trimester chorionic villus sampling (CVS) and MA will likely remain the invasive procedures of choice for evaluation of fetal karyotype.

Early screening for fetal cardiac anomalies by transvaginal echocardiography in an unselected population: the role of operator experience

OBJECTIVES

To examine the accuracy of early transvaginal fetal echocardiography performed in an unselected population by operators with different levels of experience and to compare the results with those obtained from a referral population.

DESIGN

Prospective study.

METHODS

A series of 4785 unselected fetuses and 221 referred fetuses were screened at 13-15 weeks' gestational age by transvaginal echocardiography. For each fetus, visualization of the four-chamber view plus the origin of the great arteries was attempted. Color Doppler imaging was only performed in cases of cardiac malformations already identified by two-dimensional echocardiography. The scans were performed by seven operators with different levels of experience. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first 3 months of life, and/or by autopsy in all cases of termination or fetal death.

RESULTS

The rate of complete visualization (four-chamber view plus great arteries) was 47.5% in the unselected population, and 76.9% in the referral population. There were four (0.08%) true positives among the unselected fetuses, and five (2.3%) among referrals, mostly with enlarged nuchal translucency or other malformations. Among the unselected fetuses, nine false negatives were detected by transabdominal echocardiography. Improvement in the operators' ability to recognize cardiac anomalies in unselected population was disappointing and was influenced more by individual approach than by the number of examinations performed.

CONCLUSIONS

Early screening for cardiac anomalies among unselected fetuses is ill-advisable. The usefulness of an early approach is confirmed in high risk fetuses or in the presence of enlarged nuchal translucency when performed by expert operators.

Comparisons of first and second trimester screening for fetal anomalies

Four thousand fifty unselected pregnant women bearing a total of 4,078 fetuses were examined by transvaginal sonography (TVS) at 14 weeks of gestational age and rescreened via transabdominal sonography (TAS) at 21 weeks. Fifty-four of 88 anomalies were correctly identified at first scan whereas 34 were not; of these, 24 were discovered at second trimester rescreening, and the remaining 10 were observed later in pregnancy or after birth. The sensitivity of TVS screening with respect to final outcome was 61.4% (54 of 88 malformations in total) and 69.2% in comparison to TAS screening results (54 malformations detected among 78 recognized within 21 weeks). The association between fetal malformation and chromosomal aberrations was also investigated: in our study population there were 21 aneuploidies, 14 of which were recognized because of abnormal findings at the 14 weeks' TVS, 5 at the TAS rescreening, and 2 after birth in neonates free of structural abnormalities.

Prediction of umbilical artery base excess by intrapartum fetal oxygen saturation monitoring

OBJECTIVE

Our purpose was to evaluate the predictive value of intrapartum fetal oxygen saturation as monitored by reflectance pulse oximetry (SpO2) for metabolic acidosis at birth.

STUDY DESIGN

An observational study was carried out on intrapartum patients at > or = 35 weeks' gestation having either a nonreassuring fetal heart rate pattern, intrauterine growth restriction, or thick meconium. Fetal oxygen saturation monitoring was performed with use of the Nellcor N-400 monitor and the FS-14 fetal oxygen sensor. Mean values of SpO2 from the last 30 minutes of monitoring were correlated with umbilical artery base excess and pH at birth, with use of regression analysis, whereas the prediction of acidosis by SpO2 at different thresholds was tested with use of receiver-operator characteristic curve calculations.

RESULTS

Fifty-four patients met the criteria for data analysis, with a mean SpO2 monitoring time of 150 +/- 124 minutes (SD) and a mean signal loss of 30% +/- 20%. Mean fetal SpO2 for the last 30 minutes of monitoring averaged 42.1% +/- 9.9% and, for individual patient studies, correlated significantly with calculated oxygen saturation in the umbilical vein (r = 0.52, p < 0.001) and in the umbilical artery (r = 0.34, p = 0.02) as measured at birth. However, the correlation with umbilical artery base excess values at birth was somewhat weaker (r = 0.30, p < 0.05), as was the correlation with umbilical artery pH values (r = 0.26, p = 0.05). Receiver-operator characteristic curve calculations were all nonsignificant when SpO2 from the last 30 minutes of monitoring was used as a diagnostic test for predicting acidosis at birth.

CONCLUSIONS

Intrapartum fetal SpO2 as monitored in the current study was of limited use as a diagnostic test for predicting acidosis at birth, regardless of the SpO2 cutoff value used.

Does cervical length at 13-15 weeks' gestation predict preterm delivery in an unselected population?

OBJECTIVE

To assess the role of early mid-trimester cervical length measurement as a predictor of spontaneous preterm birth in an unselected population.

METHODS

In this prospective study, unselected, asymptomatic, Caucasian women with singleton pregnancies underwent standardized transvaginal ultrasonographic (TVS) cervical length measurement at 13-15 weeks' gestation as a screening test for preterm delivery (PTD). Women with multiple gestations, iatrogenic PTD, and previous cervical conization were excluded. The primary outcome measures were spontaneous PTD at < 37 and < 34 weeks. The correlation between cervical length and previous obstetric history was evaluated.

RESULTS

A total of 2469 patients met the inclusion criteria. The mean gestational age at cervical assessment was 14 + 2 weeks. The mean gestational age at delivery was 40 + 0 weeks. The rate of spontaneous deliveries before 37 weeks' gestation was 1.7%. In 0.2% the delivery occurred before 34 weeks' gestation. The mean +/- standard deviation cervical length for the entire population was 44.2 +/- 5.4 mm. No difference was observed between cervical length in women that delivered at term and those that delivered either before 37 or before 34 weeks' gestation. Previous obstetric history (prior preterm birth, previous miscarriages and terminations, and parity) did not affect cervical length at 14 weeks of gestation.

CONCLUSIONS

Performed at 14 weeks' gestation, TVS measurement of the cervical canal length to predict spontaneous PTD is not a reliable screening procedure.

The relationship between movements and accelerations in fetal heart rate at twenty-four to thirty-two weeks' gestation

The purpose of this study was to establish the relationship between fetal heart rate accelerations and fetal body movements in fetuses at 24 to 32 weeks' gestation. The results suggest that body movements in younger fetuses do not occur with accelerations that are readily recognizable (i.e., less than 15 bpm), but as fetuses get older, the interaction between body movements and fetal heart rate becomes more evident and accelerations become more recognizable (i.e., greater than or equal to 15 bpm). The data presented suggest that there is a maturational aspect to the relationship between fetal heart rate and fetal body movements as fetuses increase in gestational age from 24 to 32 weeks. The conclusion, therefore, is that the nonstress test, as presently defined for older fetuses, is not valid for gestations below 32 weeks, and new criteria must be established.