Search

The well-being of a fetus can be assessed by measuring the response of the fetus to noise (acoustic stimulation) and to contraction-induced stress tests. In both techniques, the fetus responds to the stimulus by altering its heart rate. Abnormal fetal heart rate patterns can predict abnormal fetal conditions. The benefit of continuous electronic fetal monitoring over listening to fetal heart rate intermittently (intermittent fetal auscultation) has not been clearly demonstrated. A method of predicting which fetuses are not likely to tolerate a stressful labor would be beneficial. The usefulness of fetal acoustic stimulation in predicting future fetal conditions was evaluated for 201 patients. All women had cervical dilation of at least four centimeters and were carrying a single fetus. One or more complications of pregnancy was present in 118 patients (60 percent). Acoustic stimulation was applied using a stimulator placed on the mother's abdomen. Fetal heart rate acceleration of at least 15 beats per minute over the baseline for 15 seconds was considered reactive. Lack of accelerated fetal heart rate after three stimulations was considered nonreactive. Of the 201 fetuses receiving acoustic stimulation, 14 (7 percent) were nonreactive. A nonreactive response was associated with future fetal complications. There was no difference in the fetal complication rate of fetuses with pure reactive responses and the 25 percent of the fetuses who experienced a transient fetal heart rate decrease after stimulation. Therefore, acoustic stimulation of a fetus early in labor is useful in isolating fetuses likely to develop a complication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetal distress can be identified by abnormal fetal heart rate patterns. During labor, periodic fetal heart rate assessments are as effective as continuous electronic fetal heart rate monitoring in assessing fetal distress. A test performed at hospital admission would be helpful in identifying the current condition of the fetus and the likelihood of distress. Patients could then be classified with either low or high risk status. Methods for determining the possibility of fetal distress include nonstress testing, initial fetal heart monitoring strips, and assessments of fluid surrounding the fetus (amniotic fluid) and blood flow inside the umbilical artery. The flow of blood through the umbilical artery was determined by Doppler ultrasonography, the use of high frequency sound to determine the behavior of moving structures. The value of these methods in predicting subsequent fetal distress was studied. In the 109 patients evaluated, fetal heart rate patterns and the amount of amniotic fluid were the best predictors of potential fetal distress. Doppler velocimetry during labor was not useful as a predictive tool when used alone. Initial fetal heart tracings and the measurement of amniotic fluid can be used as an admissions test to facilitate the management of patients in labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Women who have had a prior cesarean sections (delivery of an infant by abdominal incision) commonly have repeat cesarean in subsequent pregnancies because the possibility of separation of previous surgical incisions (dehiscence) is generally considered too great. Dehiscence actually only occurs in 2 percent of single fetus pregnancies. Vaginal delivery after cesarean section now is much more widely accepted and trial labors, induced in order to observe the likelihood of vaginal delivery being successful, are now considered safe in single fetus pregnancies. The safety in twin pregnancies is unknown. Cesarean sections involve many risks, including maternal infections and surgical complications, which may even cause the death of the mother. Pregnancy outcomes of 56 women with twin pregnancies who had had previous cesarean deliveries were evaluated. Of these, 25 patients were selected for vaginal delivery, and 18 delivered both twins successfully. The dehiscence rate was 4 percent, and there were no differences in morbidity and mortality rates between trial labor and non-trial labor groups. Following usual safeguards recommended for a twin delivery, vaginal delivery after cesarean can be attempted in carefully selected patients.

Objective: To determine whether a term neonate who has had sufficient intrapartum asphyxia to produce persistent brain injury will manifest the following four criteria: profound acidemia (arterial pH < 7.00), an APGAR score ≤ 3 for 5 min or longer, seizures within 24 h of birth, and multiorgan system dysfunction.Methods: Singleton, liveborn, neurologically impaired neonates ≥ 37 weeks gestation who lived at least 6 days and had sufficient documentation of current intrapartum asphyxia criteria were retrospectively analyzed. Of these infants, solely neonates with acute fetal asphyxia due to a sudden prolonged FHR deceleration that lasted until delivery from a catastrophic event, e.g., uterine rupture, cord prolapse, were included. Organ system dysfunction was defined by separate criteria for each organ system. Dysfunction in one or more was defined as multiorgan system dysfunction.Results: Of the 292 eligible infants in the registry, 47 satisfied the entry criteria. In these 47 neonates, 10 (21%) satisfied all 4 criteria for intrapartum asphyxia.Conclusions: Our retrospective study suggests that currently used indicators to define permanent fetal brain injury are not valid.