Search

The clinician considering administration of steroids to prevent respiratory distress syndrome (RDS) should attempt to identify patients who do not have criteria previously shown to increase the likelihood of benefit in the prevention of RDS. It is possible to accurately predict the interval to delivery in most cases. Four hundred thirty-nine patients at risk to deliver prior to 37 weeks have been screened for factors known to decrease the likelihood of benefit. Only 47 (10.7%) screened candidates have no exclusion criteria. Twenty-seven (6.9%) of 392 excluded neonates developed RDS; 20 of the 27 were predicted to and did deliver in less than 24 hours after initial screening. Only one case was inappropriately excluded. Fetal surfactant assessment is crucial; pulmonary maturity excludes 19% at 28 to 33 weeks and 35% at 34 to 37 weeks. Careful screening for exclusion factors known to decrease the likelihood of steroid derived benefit is essential when use of a drug with potential long-term consequences (risk) is considered.

The results of a multihospital study involving a total of 588 twin pairs born in Chicago in 1970–1975 are reported, with special respect to differences in mortality between first and second twins by time as well as by cause of death. Mortality was higher in second than in first twins and most commonly occurred after delivery and was the result of immaturity and of respiratory distress syndrome.

The transfer of methicillin and dicloxacillin from maternal blood to fetal blood and amniotic fluid was studied in 105 patients. Significant levels of methicillin were detected in fetal serum within 30 minutes after discontinuing the maternal infusion, with equilibration between maternal and fetal serum levels within one hour. Dicloxacillin is associated with lower levels of antibiotic activity in the fetal serum and insignificant levels in the amniotic fluid. Equilibration between maternal and fetal levels did not occur. Protein binding of antibiotics results in a reduced rate of transfer from the maternal to the fetal compartment.

Intrauterine pressure recordings were made during the active phase of labor in 64 patients. On-line electronic integration of the area under the pressure curve was used as a measure of uterine activity. A total of 204 hours of labor including 4,224 individual contractions were analyzed by (1) average pressure (integrator method), (2) Montevideo units, (3) Alexandria units, and (4) frequency distribution. Comparisons were made between spontaneous labor, oxytocin-stimulated labor, and hypertonic saline-induced labor. Oxytocin-stimulated labor and hypertonic saline-induced labor show increases in amplitude and frequency of contractions when compared with spontaneous labor. Concomitant increases in total uterine activity were noted by all methods of measurement. In this series, both hypertonic saline-induced and oxytocin-stimulated labor are different from spontaneous labor whether measured in Montevideo units, Alexandria units, or average pressure. Electronic integration of the pressure signal is recommended as a method of measuring uterine activity in physical units (mm. Hg).

Sonar biparietal diameter, head circumference, and abdominal circumference percentile values obtained late in the third trimester were compared with birth weight percentile (relative to dates) in 147 diabetic mothers and 40 control fetuses of nondiabetics. Estimates of fetal weight by the method of Shepard et al were also calculated from these sonar data and compared with birth weight percentile. Abdominal circumference values greater than the 90th percentile correctly predicted macrosomia (defined as birth weight greater than 90th percentile) in 78% of cases. Biparietal diameter and head circumference percentiles were significantly less predictive of macrosomia. When analyzed in a similar manner, estimated fetal weights greater than the 90th percentile correctly predicted macrosomia at birth in 74% of cases. However, when both the abdominal circumference and the estimated fetal weight exceeded the 90th percentile, macrosomia was correctly diagnosed in 88.8% of pregnant women with diabetes mellitus.

Electroacupuncture (ACP) during childbirth was used in 12 parturients. On the average, it produced 66 percent analgesia in 7 patients for 139 minutes while patients were in active, progressive labor. When ACP no longer could relieve pain, spinal, epidural, or double-catheter technic produced complete analgesia in all patients. ACP did not adversely affect the fetus or uterine contractions and had no harmful aftereffect on mother or neonate. However, its use as a routine method had disadvantages because analgesia was inconsistent, unpredictable, and incomplete. The technic was time-consuming, limited the patient's movement, added more wires and machinery, and interfered with electronic monitoring of the mother and fetus.

Serial ultrasound estimates of fetal biparietal diameter and abdominal circumference were used as differential indices of intrauterine growth of insulin-insensitive and insulin-sensitive structures, respectively, in 23 White's classes A to C diabetic women. Biparietal diameter in all fetuses conformed to growth patterns for fetuses of nondiabetic mothers. However, two patterns were noted for abdominal circumference. Normal increases occurred in 13 fetuses; in the remaining ten, growth of abdominal circumference exceeded upper normal limits from weeks 28 to 32 of gestation onward. This latter group with putative "accelerated somatic growth" in utero had more immunoreactive insulin in amniotic fluid, weighed more at birth, and had more subcutaneous fat. Serial differential ultrasonography may be useful for detecting evolving macrosomia in diabetic pregnancies, and fetal insulin or insulin-like principles may contribute to the macrosomia. ( JAMA 243:2405-2408, 1980)