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Indomethacin treatment given to pregnant women before an umbilical blood sampling appears to affect fetal heart rate and a blood velocity measurement called the pulsatility index. Prostanoids appear to mediate this effect. Fetal heart rate, pulsatility indices, and prostanoid levels were measured at an umbilical blood sampling among 20 women previously treated with indomethacin and 22 untreated women. The pulsatility index decreased among untreated fetuses but remained constant among treated fetuses. Fetal heart rate remained constant among untreated fetuses but increased among treated fetuses.

Measurements of the amount of fetal fibronectin in cervical secretions of pregnant women may predict which women are likely to have preterm delivery. Researchers evaluated 108 patients who were admitted to the hospital because of preterm labor. Cervical secretions with high fetal fibronectin levels were associated with preterm delivery. Fetal fibronectin levels predicted preterm delivery better than ultrasound examination of the cervix. Cervical fetal fibronectin was more sensitive than vaginal fetal fibronectin at predicting preterm delivery.

Reference ranges of inferior vena cava flow velocities were constructed from a cross-sectional study of 118 appropriate-for-gestational-age fetuses of 18 to 40 weeks of gestation. Blood flow velocity waveforms were recorded with color and pulsed Doppler equipment. Peak velocities and time velocity integrals were measured from inferior vena cava during systole, early diastole, and atrial contraction. The systolic-to-diastolic ratios between the peak velocities and time velocity integrals were calculated, and the reverse flow with atrial contraction was quantified as the percentage of forward flow (percentage of reverse flow). Recordings were also obtained from 79 small-for-gestational-age fetuses free of structural and chromosomal abnormalities, divided into three groups according to umbilical artery velocity waveforms: normal pulsatility index values (group 1, n = 26), pulsatility index >95th percentile of our reference limits but presence of end-diastolic velocities (group 2, n = 33), and absence of end-diastolic velocities (group 3, n = 20). Fourteen fetuses of groups 2 and 3 were also studied at weekly intervals until the onset of antepartum late heart rate decelerations. In appropriate-for-gestational-age fetuses no changes were evident in peak velocities and time velocity integrals ratios, whereas the percentage of reverse flow significantly decreased with gestation. No significant differences were found between these values and those obtained in small-for-gestational-age fetuses of group 1. A significant increase of peak velocities and time velocity integrals ratios and of percentage of reverse flow was evidenced in fetuses of both group 2 and 3. The fetuses of groups 2 and 3 with a percentage of reverse flow above the 95% confidence interval showed a poorer perinatal outcome when compared with the fetuses of the same groups but with values inside the normal range. In the 14 fetuses longitudinally followed up until the onset of late heart rate decelerations a significant and progressive increase of peak velocities and time velocity integrals ratios and percentage of reverse flow was evidenced in spite of minimal changes in the pulsatility index from both umbilical artery and different peripheral fetal vessels. This study presents evidence that in small-for-gestational-age fetuses with abnormal Doppler-measured placental resistance the modified flow velocity patterns in the inferior vena cava seem to deteriorate progressively with advancing gestation. (Am J Obstet Gynecol 1992;166:1271-80.)

Infants born to diabetic women have a risk of hypertrophic cardiomyopathy, a heart disease in which there is excessive cellular growth. However, the development of this disorder during gestation has not been well described. To better understand the disorder, cardiac function was studied using echocardiography in the fetuses of 40 women with well-controlled diabetes. The thickness of the interventricular septa (walls between the ventricles, the lower heart chamber, which provides most pumping action) were significantly thicker than normal, but the increase was not related to maternal diabetic control. The outside walls of the ventricles were also thicker than normal. These increases were associated with decreases in ventricular filling during the diastolic (resting) phase of the heartbeat. No changes in systolic (contracting) phase activities, such as blood flow velocity, were found. The study indicates that in spite of good metabolic control, fetuses of diabetic mothers may develop hypertrophy of the heart tissue that can affect heart function. (Consumer Summary produced by Reliance Medical Information, Inc.)