Alfred D. Fleming

Relationship between fetal biophysical activities and umbilical cord blood gas values

In a prospective study of 62 patients undergoing cesarean section before the onset of labor a fetal biophysical profile assessment was performed within 3 hours before the cesarean section. The presence or absence of the individual fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetuses with nonreactive nonstress test results or the absence of breathing had significantly lower cord artery pH, PO2 bicarbonate, and base excess measurements but not a significantly different PCO2 level as compared with fetuses that had these activities present. Fetuses with the absence of movements or tone had lower pH, PO2 bicarbonate, and base excess levels and higher PCO2 levels as compared with fetuses with the presence of movements or tone, respectively. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. Subsequent analysis of the blood gas and acid-base measurements of the fetuses with compromised biophysical activities revealed that there are different levels of acidemia, hypoxemia, and hypercapnia at which the individual biophysical activities are compromised. These data suggest that the first manifestations of fetal hypoxemia and acidemia are nonreactive nonstress test results and loss of fetal breathing; in advanced acidemia, hypoxemia, and hypercapnia fetal movements and fetal tone are compromised.

Asphyxia at Birth as Determined by Cord Blood pH Measurements in Preterm and Term Gestations: Correlation With Neonatal Outcome

Normal cord blood gas parameters were statistically defined, depending on the presence or absence of labor, in a group of 243 uncomplicated term and preterm infants. There were no differences in cord blood gas and acid-base measurements between preterm and term infants. However, patients delivered before the onset of labor had significantly higher cord blood pH values, in both artery and vein, as compared with those who underwent a spontaneous vaginal delivery and those delivered by cesarean section after the onset of labor. Subsequently, 442 patients were analyzed after taking into account the presence or absence of labor. It was found that acidemic infants had a significantly higher frequency of neonatal complications as compared to nonacidemic infants: neonatal death rate, 17% vs. 8%; intraventricular hemorrhage/seizures, 33% vs. 8%; severe respiratory distress syndrome, 46% vs. 11%; ventilatory support over a 1-week duration, 29% vs. 12%; mean days of ventilator, 7.6 vs. 3.9; 1-min Apgar scores < 6, 5...

The relationships among umbilical artery velocimetry, fetal biophysical profile, and placental inflammation in preterm premature rupture of the membranes

The relationships among umbilical artery velocimetry, fetal biophysical profile, and placental inflammation in 44 consecutive patients with preterm premature rupture of the membranes were determined. All patients were followed up with daily fetal biophysical profiles and systolic/diastolic ratios. After delivery, placental pathologic examination for histologic evidence of infection (umbilical vasculitis) was performed in all cases according to a standard protocol. The longitudinal trends of fetal biophysical profile scores and systolic/diastolic ratios were analyzed for patients with and without umbilical vasculitis. Analysis of the longitudinal trend during the period of 2 to 7 days before delivery showed that there were no differences of biophysical scores of systolic/diastolic ratios in either group. However, in the last examination, within 24 hours of delivery, patients with umbilical vasculitis had higher systolic/diastolic ratios and lower biophysical profile scores as compared with previous examinations. In addition, the biophysical profile score of the last examination 24 hours before delivery in patients with umbilical vasculitis was found to be significantly lower as compared with patients without umbilical vasculitis (mean ± SD, 6.6 ± 2.3 versus 8.2 ± 2.4, respectively). These data suggest that subclinical stages of infection are associated with biophysical alterations of the fetoplacental unit (i.e., simultaneous decrease in fetal biophysical activities and increase in systolic/diastolic ratios). Daily umbilical artery systolic/diastolic ratios, in conjunction with biophysical profiles, may be useful to follow up patients with preterm premature rupture of the membranes.

Relationships Among Cytokines (IL-1, TNF, and IL-8) and Histologic Markers of Acute Ascending Intrauterine Infection

Amniotic fluid levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8) were determined in 13 pregnancies presenting with preterm spontaneous membrane rupture in which there were no clinical indications of intraamniotic infection. These levels were compared to the placental histology. All 8 cases in which elevated cytokine levels were identified also had histologic evidence of both maternal and fetal acute inflammation in choriodecidua and chorionic plate, and umbilical and chorionic vessels, respectively. Cytokine concentrations correlated with the severity of maternal inflammation, but not the severity of fetal inflammation as assessed histologically. Elevated levels of both IL-1β and TNF-α were not uniformly observed in amniotic fluid; all cases with either elevated IL-1β of TNF-α had elevated levels of IL-8. Microbial studies of the 8 patients with histologic acute inflammation showed 5 with positive amniotic fluid cultures and/or gram stains. One had positive gram s...

Arteriovenous Cord Blood pH Discordancy in a High-Risk Population and Its Clinical Significance

Five hundred and twenty patients with gestational ages between 24 and 42 weeks who had both umbilical cord venous (V) and arterial (A) gases recorded were studied retrospectively to 1) establish th...

Correlation of Uterine Fundal Height with Ultrasonic Measurements in Twin Gestations

Owing to the lack of fundal height (FH) nomograms for normal twin gestations, it has been a standard recommendation to use frequent ultrasound examinations in order to diagnose discordant fetal growth. The validity of such a practice, however, has not been established. The purpose of this study was to establish a nomogram for FH measurements in normal twin gestations and to evaluate it as a means of detecting discordant growth in twins.This is a prospective cross-sectional study of 160 twin pregnancies between 16 and 36 weeks presenting for an ultrasound. FH measurements were obtained by both the Division of Maternal-Fetal Medicine attending physician and fellow. Maternal age, gravidity, parity, height and weight, gestational age (GA), fetal presentation, placentation, amniotic fluid volume, estimated fetal weight, and percent discordance were also recorded. A nomogram for FH in normal twin gestations (n = 143) was developed and it was used to see if FH can detect discordant growth in twins (n = 17).The 1...