Eliahu Sadovsky

Fetal Movements Recorder, Use and Indications

A new device for recording fetal movements is presented. This device is composed of 2 sensors, incorporating a highly sensitive piezoelectric material. It is sensitive to rapid straining forces such as fetal movements and relatively insensitive to steady, slow movements such as uterine contractions and maternal respiratory movements. In this study of 20 women, the sensors were placed on 2 different zones of the abdomen, usually above the umbilicus. There was a good correlation between fetal movements recorded by the device and those felt by the patients. Seventy percent of all observed fetal movements recorded by the device were registered simultaneously by the women. The device recorded 90.4% and the women recorded 79.7% of all such movements.

Retrograde Seeding of Endometrium: A Sequela of Tubal Flushing

: The problem of retrograde seeding of endometrial tissue fragments to the peritoneum was investigated by injecting fluids through the cervical canal into the uterus before and after curettage. Fluid samples were collected from the peritoneal cavity through a laparoscope. Endometrial glands were detected in almost all of the fluids samples, and seeding was greater after curettage than before. It is concluded that any procedure in which fluids are pushed through the uterus may cause peritoneal seeding of endometrium.

Fetal response to vibratory acoustic stimulation in periods of low heart rate reactivity and low activity

The fetal response to vibratory acoustic stimulation during periods of low fetal activity and low fetal heart rate reactivity was studied in 10 healthy pregnant women at term. In each case, two periods of low reactivity were studied. Consecutive cases alternated: The vibratory acoustic stimulus was applied 10 minutes after the first nonreactive period in half of the cases; the remainder were stimulated during the second nonreactive period. The unstimulated period served as a control. After vibratory acoustic stimulation the baseline fetal heart rate, the mean number of fetal heart rate accelerations, and, the number of fetal movements were significantly increased with values in the control nonstimulated periods (p less than 0.0001). This consistent response to vibratory acoustic stimulation may prove to be clinically useful in altering periods of low reactivity observed during nonstress testing of normal fetuses.

PROTEIN COMPOSITION OF EARLY AMNIOTIC FLUID AND FETAL SERUM WITH A CASE OF BIS-ALBUMINEMIA.

Abstract The protein composition of early amniotic fluid and the corresponding fetal and maternal serum has been determined with moving boundary electrophoresis apparatus. Considerable similarity in the relative distribution of protein components were found between fetal serum and amniotic fluid in contrast to maternal serum. In the amniotic fluid and in the fetal serum the α1-globulins were particularly elevated possibly due to the presence of a special fetal protein. In one case of fetal bis-albuminemia, the double albumin peak was also present in the amniotic fluid but not in maternal serum. These results seem to affirm the concept that the fetal circulation is the main source of amniotic fluid proteins.

Successful pregnancies of two patients with relapsing thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura is a severe multisystemic disorder of unknown origin. The association of relapsing TTP with pregnancy is rare but well documented and high mortality rates of mothers and fetuses have been reported so far. Since the introduction of plasma therapy for treating the acute exacerbations of the disease, overall mortality rates have decreased significantly. It is now evident that the manifestations of the disease may reappear even after long disease‐free intervals and as many as a third of the recovering patients may develop a relapse. Presented are two TTP patients with relapsing TTP complicating their pregnancies. Prophylactic treatment with aspirin and dipyridamole during their last three successful pregnancies prevented or minimized the severity of TTP relapses. The course of these pregnancies and the management of such patients is discussed.

Serotonin and 5-hydroxyindoleacetic acid in fertile and subfertile men.

High levels of serotonin and 5-HIAA were found in the urine of a group of 102 oligospermic and azoospermic men. These levels were significantly higher than those of normal fertile men.

Severe fetal bradycardia caused by external vibratory acoustic stimulation

A case is presented in which external vibratory acoustic stimulation performed on a term fetus produced severe prolonged bradycardia, necessitating emergency cesarean section delivery. The possible pathogenesis is discussed.

Fetal heart rate monitoring in cases of decreased fetal movement.

Thirty pregnant women in the third trimester of pregnancy in whom fetal movements were reduced up to cessation, for at least 12 hours, were monitored for FHR. The FHR 12–48 hours after the cessation of fetal movements was pathological in 21 cases and normal in 9 cases. The most frequent pathological FHR changes were loss of beat to beat variation and variable decelerations. In the following 48 hours another four cases showed pathological FHR changes. One to four days before the reduced fetal movements only six out of 15 cases showed pathological FHR changes which were L.B.B.V. Meconium was found in only 50% of the cases. It is suggested that pregnant women, especially high risk cases, should record fetal movements as a screening method. FHR monitoring is also a valuable method for detecting antenatal fetal distress, and should be used as an adjunct to fetal movements recording. When acute fetal distress has been established by MAS alone or with FHR change, the fetus should be promptly delivered.

Ultrasonographical evaluation of the incidence of simultaneous and independent movements in twin fetuses

Fetal movements (FM) may be spontaneous, originating in the fetus itself, or evoked by external stimuli. The relative rate of spontaneous and evoked FM has not yet been documented. As it is impossible to differentiate in a singleton pregnancy between these types of movements - the natural model of twin pregnancy was used. The FM of 10 normal twin pregnancies between 33 and 39 weeks of gestation were studied by two realtime ultrasounds, and were operated by two ultrasonographers over a period of 10 min. The mean number of independent FM of each fetus which occurred while the other fetus was resting was 7.9 FM and 7.7 FM, respectively (average 7.8 FM). A mean of 2.5 FM occurred simultaneously. The rate of independent FM was 75.7% and that of simultaneous FM was 24.3%. Vibroacoustic stimulation applied to the maternal abdomen evoked simultaneous movements of both fetuses in all cases. It is suggested that the independent FM may represent spontaneous FM and that the simultaneous FM may indicate the presence of an external stimuli and are therefore evoked responses.

Twin gestations and prophylactic hospitalization

The study evaluates the benefit of elective hospitalization in preventing premature deliveries of twin gestations. Three groups of women with twin gestations, having no other complications of pregnancy which could cause premature delivery, were evaluated. The study group was comprised of 43 women who were electively hospitalized between 30—32 and 36 weeks of gestation. Control group 1 was comprised of 55 women who were not hospitalized but were instructed to rest at home. Control group 2 was comprised of 53 women who were not hospitalized and were not instructed to rest at home. Our results showed that elective hospitalization did not significantly affect the gestational duration or the prematurity rate. However the mean birthweight difference between the study group and the two control groups were 143 ± 83 g and 205 ± 84 g, respectively. This result was more significant in multiparous women. The slight increase in birthweight of the hospitalized women compared to the controls, does not seem to justify the cost of hospitalization.