Teiichiro Fukushima

Limitations of autocorrelation in fetal heart rate monitoring

Fetal heart rate monitors that use autocorrelation of the ultrasonic fetal signal usually produce a cleaner fetal heart rate record than that obtainable with conventional ultrasonic fetal monitors. However, since the autocorrelation function will emphasize any periodic signal originating from the fetus or the mother, in clinical situations the resultant fetal heart rate tracing may contain spurious data. To illustrate the limitations of the autocorrelation technique in fetal monitoring, we compared the autocorrelated ultrasound fetal heart rate records from 23 patients in active labor with the simultaneously recorded direct scalp fetal electrocardiogram tracings. The results indicate that every hour of recording contained, on the average, five instances in which data were missing (range, 0 to 13), four in which data were added (range, 0 to 23), and seven instances in which data were absent for greater than 1 minute (range, 0 to 26). The potential problem of misinterpretation of autocorrelated fetal heart rate data is discussed.

The racial disparity in infant mortality.

From the standpoint of both science and social policy, it is important to focus on the more than twofold disparity in mortality between black and white infants in the United States. This disparity ...

Noninvasive Measurement of Peripheral Pressure Pulse Compliance and Systolic Time Intervals

Systolic time intervals provide a basis for the indirect determination of total electromechanical systole and offer a physiologic approach to cardiovascular assessment. In addition, examination of the pulse wave contour changes with advancing age and hypertension suggests that these data may be useful in assessing the vascular compliance and peripheral resistance of a subject. In this report, we explore the use of noninvasively obtained peripheral systolic time intervals in normal and pathologic conditions and the automated measurement and continuous plotting of several parameters, including heart rate, pulse wave arrival time, rapid ejection time, peripheral pulse wave contour, and cutaneous pressure pulse. Although this is an empirical system whose clinical usefulness has yet to be determined, the development of peripheral systolic time intervals seems promising.

The age extremes for reproduction: current implications for policy change.

The changing demographic features of births in the United States include an increasing number of older women and a decreasing number of adolescents giving birth. Births in adolescents have lower risks than those in women more than 34 years of age and probably of those more than 30 years of age. There is an increase in complicated pregnancies in the United States, related, no doubt in part, to the above. Older women require more costly, high-technology prenatal care, such as genetic counseling, genetic antenatal diagnosis, amniocentesis, ultrasonography, and electronic fetal heart rate testing. The financing of health care needs to recognize these changes. Detailed studies of the economics of perinatal care, more specific to patient population mix and complication-treatment patterns are needed to establish priorities with the payment system to assure appropriate care.

Apparatus for Home Monitoring of Pregnant Hypertensive Patients

A simple, convenient to use apparatus suitable for patient self-monitoring is described and illustrated with graphs of mean arterial pressure determinants which provide clinically useful hemodynamic details unobtainable with cuff blood pressure measurements. A bathroom scale and a forearm cuff blood pressure system completes the home monitoring apparatus.

Cutaneous Pressure Pulse Contours Associated with Chronic Hypertension in Pregnancy

This report describes the association of cutaneous pressure pulse waveforms, mean arterial blood pressures, and neonatal birthweights of 27 chronic hypertensive patients. The infant weight percentiles were higher than the median when the pressure pulses showed good compliance, and lower when there was poor compliance

Cardiovascular Concomitants of Syncope in Pregnancy

This report describes detailed cardiovascular changes observed in 38 pregnant patients who experienced syncope during postural change from sitting to standing. Sixteen (42%) of the patients had diabetes mellitus. The patients were divided into two groups based on the severity of their symptoms. The 19 who had more severe symptoms had mean arterial pressure (MAP) and MAP-determinant changes that were beyond the 10th and 90th percentile range, while those who had less severe symptoms had lesser cardiovascular changes. Syncope in normal pregnancy is usually short-lived and of little consequence. However, it may provide early warning of a cardiovascular problem. Hence, a simple, convenient cardiovascular test may be a useful adjunct to prenatal care.

Cardiovascular Concomitants of Uterine Contractions: Physiologic Bases

This report describes the different cardiodynamic changes concomitant with the uterine contractions of prelabor and active labor. With active labor there are clear identifiable changes in arterial compliance and cardiac load as reflected in rapid ejection times (RETs) and pulse wave arrival times (PWATs), respectively. These findings are absent in prelabor.