Fetal breathing movements are not a good indicator of lung development after premature rupture of membranes and oligohydramnios — A preliminary study

Citations from the Literature Pregmmcy in sickle cell disease in Bahrain

El-Shafei AM; Kaur Dhaliwal J; Kaur Sandhu A Department of Obstetrics and Gynaecology. Salmaniya Medical Centre, Arabian Gulf University, Manama, BHR

BR J OBSTET GYNAECOL 1992 99/2 (101-104) Objective: To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls. Design: A casecontrol study. Setting: Ministry of Health hospitals in Bahrain. Subjects: 147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity. Main outcome measures: The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statistics in the index and control women. Results: Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity. Conclusion: Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.

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Fetal breathing movements are not a good indicator of hmg development after premature rupture of membranes and oligohydramnios - A preliminary study

Sival DA; Visser GHA; Prechtl HFR Department of Developmental Neurology, University Hospital, Oostersingel 59, 9713 EZ Groningen. NLD

EARLY HUM DEV 1992 28/2 (133-143) The effect of severe oligohydramnios (due to prolonged premature rupture of the membranes (PROM)) on breathing movements and lung development was studied longitudinally in I I human fetuses. Prenatally, fetal breathing movements (FBM) were scored off-line from weekly, I h during ultrasound recordings (n = 47). In each recording, the incidence of FBM was scored according to 4 different methods. Postnatally, the cases were retrospectively assigned to a group with normal (n = 4), partially hypoplastic (n = 3) or hypoplastic (n = 4) lungs. Compared to control fetuses, the percentage of time spent breathing (%FBM) was low (2-5%) and did not increase with gestational age. Large inter-individual and intraindividual variations in the %FBM were found in all 3 diagnostic groups. Evaluation of the %FBM according to the 4 different methods revealed no significant differences between the 3 groups. We conclude that lung development is, at least partly, independent of the incidence of FBM. Furthermore, the analysis of FBM cannot reliably predict lung development in fetuses with oligohydramnios due to PROM.

Antenatal testing to predict outcome in pregnancies with unexplained entepartum hemorrhage

Ajayio RA; Soothill PW; Campbells; Nicolaides KH Fetal Surveillance Unit, Department of Obstetrics and Gynaecology, King S College Hospital, Denmark Hill. London SE5 9RS, GBR The treatment of intrahepatic cholestasis of pregnancy by dexa-

nN?thasone Hirvioja M-L; Tuimala R; Vuori J Department of Obstetrics Tampere, Tampere, FIN

and

Gynecology,

University of

BR J OBSTET GYNAECOL 1992 9912 (109-I I I) Objective: To investigate whether dexamethasone supression of fetoplacental estrogen production can reduce obstetric cholestasis. Design: Observational study. Setting: Department of Obstetrics and Gynaecology, University of Tampere, Finland. Subjects: IO women, at between 28 and 37 weeks gestation, with intrahepatic cholestasis of pregnancy. Interventions: Treatment with 12 mg oral dexamethasone daily for 7 days, after which the therapy was gradually discontinued over 3 days. Main outcome measures: Serum estriol, estradiol, total bile acids and ALAT were measured before and during therapy and on days 4 and 7 and ALAT also on day 12. Differences were tested by paired t test. Results: Itching disappeared or was relieved in all patients. Serum estriol level fell significantly by day I of treatment, serum estradiol and total bile acid levels by day 4 and ALAT by day 12 from the beginning of the therapy. Conclusion: Dexamethasone is a drug of choice in the treatment of intrahepatic colestasis of pregnancy.

BR J OBSTET GYNAECOL 1992 99/2 (122-125) Objective: To investigate whether Doppler studies of placental perfusion and antenatal tests for fetal hypoxia can identify reduced placental functional reserve in women with unexplained antepartum hemorrhage (APH). Design: A prospective, longitudinal study. Setting: Fetal Surveillance Unit, King’s College Hospital, London. Subjects: 48 women with bleeding from the genital tract after 26 weeks gestation without a clinical diagnosis of abruption or ultrasound evidence of placenta previa. Interventions: Fetal surveillance by Doppler measurements of the umbilical and uterine arteries, biophysical profile scoring and computerized measurement of the mean min range of FHR variation. Main outcome measures: A poor outcome was defined by one or more of the following: (i) birthweight > 2 SD. below the normal mean for gestational age and sex, (ii) abnormal FHR pattern in labour resulting in operative delivery, (iii) umbilical vein blood pH at delivery < 7.15, (iv) a 5-min Apgar score < 7. Results: Fifteen of the 48 pregnancies had a poor outcome; seven occurred in the IO women delivered preterm (< 37 weeks) and eight in the 36 women delivered between 37 and 42 weeks. Two women were delivered after 42 weeks and both infants had a good outcome. The results of Doppler studies of uterine and umbilical arteries, fetal Int J Gynecol Obstet 39