Thore Solum

Influence of occiput posterior position on the fetal heart rate pattern.

Fetal heart rate (FHR) recordings of 138 deliveries with the fetus in the occiput posterior position (OPP) are compared with recordings of 138 control fetuses in the occiput anterior position (OAP). The 2 groups are comparable in maternal age, parity, duration of first stage of labor, frequency of nerve blocks for analgesia, and incidence of cord complications. Variable decelerations were significantly more frequent and more pronounced in the OPP group than in the controls. The number of newborns with low Apgar scores was similar in both groups, despite a large number of pronounced decelerations in the OPP group. Possible mechanisms for the origin of variable decelerations in the occiput posterior position are discussed.

Fetal and uteroplacental haemodynamics during short-term atenolol treatment of hypertension in pregnancy

Fetal circulation was studied by means of combined realtime and pulsed Doppler ultrasound in 14 women with pregnancy‐associated hypertension before and during the first and third days of treatment with the β1‐selective blocker, atenolol; in seven of the women the maternal uterine arcuate blood velocity waveform was also studied. Blood flow characteristics were normal both in the fetus and in the maternal arcuate artery, compared with those in uncomplicated pregnancies of corresponding gestational ages. Volume blood flow remained unchanged in the fetal descending aorta, and in the umbilical vein during atenolol treatment, whereas the pulsatility index increased in the fetal descending aorta and in the arcuate artery. This suggests that the peripheral vascular resistance, both on the maternal and fetal side of the placenta, increased during short‐term antihypertensive treament with atenolol.

A one-year study of routine fetal heart rate monitoring during the first stage of labor.

At the Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden 90 per cent of all deliveries are monitored with cardiotocography (CTG). The fetal heart rate recording (FHR) together with various pregnancy‐ and delivery data, are continuously analysed. The present paper is an account of FHR changes during the first stage of labor of all patients registered during 1977.

Fetal distress during labour in diabetic pregnancy

Summary. The frequency of fetal distress in labour was studied in 46 diabetic women and in 46 non‐diabetic matched controls. Fetal distress was assessed by electronic fetal heart rate (FHR) monitoring and fetal scalp blood pH determinations in late first stage of labour. Ominous FHR and/or low pH (<7·26) was more common in the diabetic group than in the control group (17·4% and 10·9%, respectively) but the difference was not statistically significant. The frequency of caesarean section and low Apgar score at 1 min was significantly higher in the diabetic group (P<0·05). There was no correlation between maternal blood glucose regulation and the occurrence of fetal distress in the diabetic group. The results suggest that fetal distress may be slightly more common in labour in diabetic women compared with controls managed in a similar way. Careful FHR monitoring and liberal use of fetal scalp blood pH determinations is recommended.

A comparison of the Three Methods for External Fetal Cardiography

Phonocardiography, abdominal electrocardiography and ultrasound cardiography are the three methods for external fetal cardiography. In the present study the methods have been compared regarding the quality of the graphs. The patients (163) were between the 34th and the 40th week of gestation. Graphs with less than 15 per cent failure or artifacts were found in 23.4 per cent for phonocardiography, 55.2 per cent for abdominal electrocardiography and 85.9 per cent for ultrasound cardiography. It could be shown that the number of successful abdominal electrocardiograms was higher with advancing gestational age. The quality of the phonocardiograms was influenced adversely by an anterior placenta. No obvious influence of a thick abdominal wall on external cardiography could be demonstrated.

CLASSIFICATION OF THE NONSTRESS TEST AND FETAL OUTCOME IN 1056 PREGNANCIES

Abstract. During a 2 1/2‐year period, 1056 pregnant women (1072 fetuses) were monitored with the nonstress test (NST) in the antenatal period. Testing time was 30 minutes. The NST was classified into one of four classes: normal, suspect pathological, slight pathological, and severe pathological. In 88.5% of the pregnancies, all NSTs were normal. Suspect, slight, or severe pathological NSTs occurred at least once in 8.1%, 2.1%, and 1.3% of the women respectively. All women with a severe pathological NST had high‐risk complications. Lethal malformations excluded, there were only two perinatal deaths among the tested women. In the four different classes, the frequencies of cesarean section were 11%, 17%, 41%, and 79%. One‐minute Apgar scores were <7 in 5%, 12%, 41%, and 64%. The need for referral to neonatal intensive care was 19%, 40%, 41%, and 93% respectively. A normal NST predicted normal fetal outcome in an excellent way, while the three pathological classes appeared to represent different degrees of impending fetal jeopardy.

Influence of the β1-Adrenoceptor Blocker Atenolol on Antenatal Cardiotocography

Abstract. Forty term patients with pregnancy‐induced hypertension were treated with the β1‐adrenoceptor blocker atenolol (TenorminR; ICI) for at least 7 days prior to parturition. The antenatal cardiotocography (CTG) was visually analysed before and during treatment. The mean basal fetal heart rate (FHR) decreased from 143±7 beats per minute (bpm) to 13328 bpm. In 13.1% of the recordings in treated patients there was a decrease in long‐term variability for a period of more than 20 minutes; this was observed in only 2.3% prior to treatment. The amplitude of the accelerations was reduced from 23±6 bpm to 18±4 bpm. It was demonstrated that atenolol affected antenatal CTG, and this has to be taken into consideration when interpreting antenatal CTG as one parameter for evaluation of fetal well‐being.

Fetal surveillance in diabetic pregnancy. I. Predictive value of the nonstress test.

Ninety‐nine consecutive diabetic pregnancies (101 infants) were monitored with altogether 2672 nonstress tests (NSTs) from about 30 weeks of gestation until parturition. In 96% of the women the last NST was performed within 2 days of delivery. Fifty‐nine percent had normal NSTs throughout pregnancy. Only 3.7% of the 2672 tests were classified as pathological.

Fetal Surveillance in Diabetic Pregnancy: II. the Nonstress Test Versus the Oxytocin Challenge Test

At the Department of Obstetrics and Gynecology, University of Lund, it has been the routine management in diabetic pregnancy to use both nonstress test (NST) and oxytocin challenge test (OCT) for fetal surveillance. the study material reported comprised 61 pregnant diabetics, 1882 NSTs and 90 OCTs. Evaluations were made separately for the time interval 0–2 days antepartum, within 1 week antepartum, and all tests included. Predictive value, specificity and sensitivity were calculated for both the NSTs and the OCTs according to the following variables of neonatal outcome: Apgar scores at 1, 5 and 10 min, babys first cry (or not) within 1 min of birth, pulmonary function, and metabolic balance. No perinatal deaths occured. There were no statistically significant differences between the NSTs and OCTs in the antepartum time intervals 0–2 days and 1 week regarding any variable. When all tests were included, the OCT proved superior in that there were fewer falsely pathological tests, though biased by the fact that most of the NSTs evaluated were older than the oldest OCT in this context. Nevertheless, it is concluded that the OCT does not favor the NST for routine fetal surveillance in diabetic pregnancy.