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Basophilic or mucoid degeneration of the intima in the coronary arteries is an extremely rare cause of premature atherosclerosis. An unusual case of fatal basophilic degeneration of the coronary arteries 142 days after delivery is reported. (C) 1996 Wiley-Liss, Inc.

To assess the influence of in vitro fertilization (IVF) on maternal serum human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP), the maternal serum hCG and AFP values were studied in 67 IVF pregnancies and compared with the results of a control group of 4732 spontaneously conceiving patients. Maternal serum hCG was significantly higher and AFP significantly lower in the IVF group. Possible explanations and implications for prenatal diagnosis in IVF pregnancies are discussed.

Objective To study the relation between quantified fetal movements and fetal activity assessed by the biophysical profile score and the pH in umbilical arterial blood at elective caesarean section. Design Fetal activity was assessed within 24 h prior to caesarean section for decelerative fetal heart rate patterns both by quantification (% of time spent moving) and by applying the biophysical profile score (BPS) criteria. Setting Department of Obstetrics, University Hospital. Subjects Nineteen growth retarded fetuses. Main outcome measures Fetal generalised movements (FGM%), fetal breathing movements (FBM%), total fetal activity (TFA% = FGM% + FBM%); FGM, FBM and tone as assessed according the biophysical profile score (BPS); umbilical arterial pH. Results In all 11 acidaemic fetuses (pH Conclusion TFA%

Fetal heart rate (FHR) variation, general movements (FGM), breathing movements (FBM) and haemodynamics were studied longitudinally in 19 intrauterine growth retarded fetuses, who eventually were delivered by caesarean section (CS) because of fetal distress, in order to determine changes occurring with time. The fetuses were studied for the last 10 days on average before delivery (range 2-14 days). During this period on average eight 1-h FHR records were made and three 1-h movement recordings. The FHR pattern was analyzed numerically; the incidence of FGM and FBM was quantified and expressed as percentage of time. Blood flow velocity waveforms were measured in the umbilical artery (n = 19) and in the internal carotid artery (n = 14). In 14 of 19 fetuses abnormal velocity wave forms were present from the beginning of the study onwards. FHR variation was initially just within or below the norm and fell further during the last 2 days before CS. FGM and FBM fell below the normal range later and in a lower rate of occurrence than FHR variation. FGM showed a more or less consistent fall in time, whereas FBM showed a wide range throughout the period of observation. The poorest outcome occurred in fetuses with reversed end-diastolic velocities and rapid fall in FHR variation. It is concluded that with progressive deterioration of the fetal condition abnormal velocity wave form patterns occur first; FHR variation is reduced subsequently and FGM and FBM are the last to become abnormal. Assessment of fetal activity may be of help in fetuses with a marginally reduced FHR variation, in which prolongation of pregnancy is considered desirable to allow further maturation in utero.

OBJECTIVE: We attempted to determine changes occurring with time in fetal heart rate and its variation in fetuses with intrauterine growth retardation in whom late antepartum fetal heart rate decelerations eventually develop. STUDY DESIGN: Thirteen fetuses with intrauterine growth retardation were studied over a median period of 25 days. One-hour fetal heart rate records were made two to five times per week and were analyzed numerically. Fetal movements were recorded by the women. RESULTS: On average long-term fetal heart rate variation decreased gradually with time and fell below the norm (30 milliseconds) at about the same time decelerations appeared. Mean heart rate showed a slight but statistically significant increase after the occurrence of declerations. There were large interfetal differences in all parameters studied. CONCLUSION: In fetuses with intrauterine growth retardation a decrease in long-term fetal heart rate variation is a rather late sign of impairment that coincides with the occurrence of late decelerations. In the surveillance of the fetus with intrauterine growth retardation it might be most appropriate to use each fetus as its own control.

Continuous maternal hyperoxygenation treatment (2.5 l/min by means of a nasopharyngeal cannula) was given in four patients presenting with intrauterine growth-retarded (IUGR) fetuses and decelerative fetal heart rate (FHR) patterns at 27-28 weeks of gestation. The effect of maternal hyperoxia was studied longitudinally. Neither the incidence of generalized fetal movements (FGM%) nor the pulsatility index of the internal carotid artery increased under hyperoxia. In fact, both variables decreased progressively. FHR variation was abnormal prior to the start of hyperoxygenation and showed a slight but transient increase. On average, maternal hyperoxygenation 'resulted' in a prolongation of the duration of pregnancy of 9 days. The neonatal mortality was similar in the study group as compared to a control group of IUGR infants. However, hypoglycemia, thrombocytopenia and disseminated intravascular coagulation at birth were found more frequently in the study group. Conversely, blood gas abnormalities were less frequent in the fetuses of mothers that were treated with oxygen. We conclude that positive effects of oxygen therapy in IUGR fetuses remain uncertain and that detrimental effects due to prolongation of intrauterine malnutrition have not as yet been sufficiently excluded.

Fetal heart rate (FHR) monitoring and computer-assisted analysis were performed immediately before cordocentesis in 25 severely small-for-gestational age fetuses. There were significant associations between FHR variation and both umbilical vein blood Po2 (r = 0.66) and pH (r = 0.69). However, the wide scatter of values around the regression lines prevented accurate prediction of fetal blood gases from FHR patterns. Nevertheless, FHR variation

A software package for computer-assisted analysis of antenatal fetal heart rate (FHR) patterns has been commercially available from 1989. Reference ranges for the third trimester of pregnancy have been established. In order to obtain reference values for the second trimester, one hour FHR recordings were made between 20 and 29 weeks gestation in 77 women with uncomplicated pregnancies. There was a significant increase of (medium term) FHR variation and of the number of accelerations from 20 to 29 weeks (r = 0.48, p 20 heats/min and greater-than-or-equal-to 30 seconds) were present in 54% of the recordings and are a more or less common phenomenon at this age. It is concluded that during the second trimester FHR variation differs considerably from that in the third trimester. This should be taken into account in the interpretation of second trimester FHR records.