Alan A. Compton

Significance of the sinusoidal fetal heart rate pattern.

The sinusoidal fetal heart rate pattern has been reported to be an indication of fetal compromise. In this review of 31 cases, drawn from a total of 559 monitored cases of normal and at-risk women, only one resulted in poor outcome, and this was attributable to a difficult breech delivery. An association with administration of analgesics is confirmed. The sinusoidal fetal heart rate pattern does not appear to be uniformly associated with fetal distress. Its presence should be an indication for meticulous assessment of other electrocardiographic, biochemical, or clinical evidence of fetal status.

Abruptio placentae following a negative oxytocin challenge test

THE OXYTOCIN challenge test (OCT) has evolved as one method of assessing the respiratory function of the placental unit in the high-risk obstetric patient. It has been well established that oxytocin-induced uterine activity stresses the uteroplacental circulation. This may result in late decelerations of the fetal heart rate in patients with decreased fetoplacental reserve.” * Some investigators have reported uterine hypertonus caused by too-rapid increase in oxytocin dosage as a complication of the oxytocin challenge test. However. the safety of the OCT has not been questioned, and the only stated relative contraindications to its usage are those situations where the risk of oxytocin administration outweighs the advantages of the OCT. These include cases of previous classical cesarean section, placenta previa, cervical imcompetence. and premature rupture of the membranes.* The case presented is one in which abruptio placentae followed a negative OCT.

Clinical Significance of Home Blood Pressure Monitoring During Pregnancy

Blood pressure monitoring by the pregnant woman with chronic hypertension has recently been shown to be reliable. The purpose of this pilot study was to determine whether additional information from these recordings is truly helpful in improving antepartum care. During a recent two year study, 33 consecutively chosen women with chronic hypertension were instructed on monitoring their blood pressure twice daily. Drug therapy recommendations and antepartum hospitalization for hypertension related concerns were undertaken only if elevated blood pressures in the clinic were also elevated at home. Compared with our prior experience without home blood pressure monitoring, knowledge of daily blood pressure changes outside the clinic led to fewer antepartum hospitalizations and more precise prescribing of fewer antihypertensive medications. These trends were seen without compromising maternal and fetal well-being and offer the advantage of reducing the expense of antepartum care. A controlled clinical trial with ...