- Email: [email protected]
Intrapartum fetal heart rate variability and subsequent neonatal cerebral edema
Uterine Rupture: A Placentally Mediated Event? Irma Jauregui Childbirth Injury Prevention Foundation, Pasadena, CA
C. Kirkendall, M. O. Ahn, and J. Phelan Objective: After previously demonstrating that uterine activity patterns and oxytocin did not appear to be associated with uterine rupture, our objective was to determine whether the placenta plays a role in uterine rupture. Study design: From a national registry of brain-injured neonates, cases were obtained from patients with a uterine rupture sufficient to produce fetal brain injury or death. Through retrospective chart review, the placental implantation site was determined, and its relationship to the site of uterine rupture was recorded. Exclusion criteria were as follows: no record of placental location—13, the uterine rupture site—3, or the intactness of placenta—3. Results: Of 81 uterine rupture cases resulting in fetal brain injury, 62 (77%) cases met entry criteria. Of these 62, the site of the uterine rupture was at the prior incision— 42 (68%) or at a nonscar site—17 (27%), and 3 (5%) had no prior incision. Of these, the placenta was found at the rupture site in 37 (60%). In the 25 (40%) in whom the placenta was not found at the rupture site, 21 (84%) experienced a partial or complete placental abruption. Conclusions: Uterine rupture in the patient with prior cesarean delivery is not always associated with the prior uterine incision. Of those patients who experienced a uterine rupture, the placenta appears to have been at the uterine rupture site and/or partially or completely abrupted. These findings suggest that the placenta may play a role in uterine rupture.
Intrapartum Fetal Heart Rate Variability and Subsequent Neonatal Cerebral Edema Joo Oh Kim, MD Childbirth Injury Prevention Foundation, Pasadena, CA
G. Martin, C. Kirkendall, and J. Phelan Objective: To determine whether fetal heart rate variability (FHRV) in the neurologically impaired neonate is associated with cerebral edema. Study design: Through retrospective chart review, singleton term infants with neonatal encephalopathy and permanent neurologic impairment were identified in a national registry of brain-injured infants. Cerebral edema was defined as follows: (1) ultrasound-generalized increases in echodensity throughout the brain with loss of normal landmarks or slitlike ventricles, (2) computed tomography scan-low attenuation throughout the brain, or mass effect as evidenced by sulcal
VOL. 95, NO. 4 (SUPPLEMENT), APRIL 2000
effacement, displacement of the midline structures, ventricular distortion, or compression of subarachnoid spaces, and (3) low magnetic resonance imaging signal on T1-weighted images and high signal on T2-weighted images or morphologic change on T1-weighted image detected by gross enlargement of structures or by distortion of normal adjacent structures. Cases with a Hon intrapartum fetal heart rate (FHR) pattern (reactive pattern on admission followed by tachycardia and repetitive FHR decelerations) were selected. These cases were then categorized according to the FHR variability at the end of the monitor strip as follows: average ⱖ6 bpm or diminished (D) ⬍6 bpm. Exclusion criteria were as follows: (1) nonqualifying FHR pattern—183; (2) no neuroimaging studies within 7 days of birth— 48; (3) insufficient data—19; and (4) other—7. Results: Of 300 singleton term brain-injured neonates, 43 (14%) neonates met entry criteria. Prior to birth, the FHRV average was 10 (23%) or diminished (33 [77%]). Of these infants, cerebral edema was found in 18 (42%) patients. But, average FHRV was associated with significantly less cerebral edema (average 1/10 [10%] versus diminished 17/33 [52%] [P ⫽ 0.02]). Conclusions: In brain-injured neonates, cerebral edema appears to be associated with the Hon FHR pattern. Cerebral edema also appears to be associated with diminished FHRV. These findings suggest that the presence of average FHRV in the fetus with the Hon FHR pattern is associated with fetal brain injury, but not necessarily neonatal cerebral edema.
Home Uterine Activity Monitoring in the Care of Preterm Labor: A Review of the Evidence Melissa McPheeters, MPH Research Triangle Institute–University of North Carolina Evidence-Based Practice Center, Chapel Hill, NC
John M. Thorp, MD, Norma I. Gavin, PhD, Victor Hasselblad, PhD, Nancy D. Berkman, PhD, Kathleen N. Lohr, PhD, and Katherine E. Hartmann, MD, PhD Objective: Preterm labor (PTL) that results in cervical change and spontaneous preterm birth requires organized forceful uterine contractions. Home uterine activity monitoring (HUAM) detects increases in activity and facilitates intervention. We sought to summarize randomized trials comparing pregnancy outcomes of women who did and did not receive HUAM. Methods: We worked as part of the AHCPR Evidence Report on the Management of Preterm Labor and restricted our search to randomized trials of HUAM among women who had experienced PTL in the pregnancy for which they were receiving monitoring. With ACOG and an advisory group, we developed search criteria. We did an exhaustive literature search, including the gray literature, for articles in English from 1980 to 1998. The initial search identified 37 studies; after review (masked to author and journal), 4 studies met inclusion criteria.
Wednesday Posters 75S
C. Kirkendall, M. O. Ahn, and J. Phelan Objective: After previously demonstrating that uterine activity patterns and oxytocin did not appear to be associated with uterine rupture, our objective was to determine whether the placenta plays a role in uterine rupture. Study design: From a national registry of brain-injured neonates, cases were obtained from patients with a uterine rupture sufficient to produce fetal brain injury or death. Through retrospective chart review, the placental implantation site was determined, and its relationship to the site of uterine rupture was recorded. Exclusion criteria were as follows: no record of placental location—13, the uterine rupture site—3, or the intactness of placenta—3. Results: Of 81 uterine rupture cases resulting in fetal brain injury, 62 (77%) cases met entry criteria. Of these 62, the site of the uterine rupture was at the prior incision— 42 (68%) or at a nonscar site—17 (27%), and 3 (5%) had no prior incision. Of these, the placenta was found at the rupture site in 37 (60%). In the 25 (40%) in whom the placenta was not found at the rupture site, 21 (84%) experienced a partial or complete placental abruption. Conclusions: Uterine rupture in the patient with prior cesarean delivery is not always associated with the prior uterine incision. Of those patients who experienced a uterine rupture, the placenta appears to have been at the uterine rupture site and/or partially or completely abrupted. These findings suggest that the placenta may play a role in uterine rupture.
Intrapartum Fetal Heart Rate Variability and Subsequent Neonatal Cerebral Edema Joo Oh Kim, MD Childbirth Injury Prevention Foundation, Pasadena, CA
G. Martin, C. Kirkendall, and J. Phelan Objective: To determine whether fetal heart rate variability (FHRV) in the neurologically impaired neonate is associated with cerebral edema. Study design: Through retrospective chart review, singleton term infants with neonatal encephalopathy and permanent neurologic impairment were identified in a national registry of brain-injured infants. Cerebral edema was defined as follows: (1) ultrasound-generalized increases in echodensity throughout the brain with loss of normal landmarks or slitlike ventricles, (2) computed tomography scan-low attenuation throughout the brain, or mass effect as evidenced by sulcal
VOL. 95, NO. 4 (SUPPLEMENT), APRIL 2000
effacement, displacement of the midline structures, ventricular distortion, or compression of subarachnoid spaces, and (3) low magnetic resonance imaging signal on T1-weighted images and high signal on T2-weighted images or morphologic change on T1-weighted image detected by gross enlargement of structures or by distortion of normal adjacent structures. Cases with a Hon intrapartum fetal heart rate (FHR) pattern (reactive pattern on admission followed by tachycardia and repetitive FHR decelerations) were selected. These cases were then categorized according to the FHR variability at the end of the monitor strip as follows: average ⱖ6 bpm or diminished (D) ⬍6 bpm. Exclusion criteria were as follows: (1) nonqualifying FHR pattern—183; (2) no neuroimaging studies within 7 days of birth— 48; (3) insufficient data—19; and (4) other—7. Results: Of 300 singleton term brain-injured neonates, 43 (14%) neonates met entry criteria. Prior to birth, the FHRV average was 10 (23%) or diminished (33 [77%]). Of these infants, cerebral edema was found in 18 (42%) patients. But, average FHRV was associated with significantly less cerebral edema (average 1/10 [10%] versus diminished 17/33 [52%] [P ⫽ 0.02]). Conclusions: In brain-injured neonates, cerebral edema appears to be associated with the Hon FHR pattern. Cerebral edema also appears to be associated with diminished FHRV. These findings suggest that the presence of average FHRV in the fetus with the Hon FHR pattern is associated with fetal brain injury, but not necessarily neonatal cerebral edema.
Home Uterine Activity Monitoring in the Care of Preterm Labor: A Review of the Evidence Melissa McPheeters, MPH Research Triangle Institute–University of North Carolina Evidence-Based Practice Center, Chapel Hill, NC
John M. Thorp, MD, Norma I. Gavin, PhD, Victor Hasselblad, PhD, Nancy D. Berkman, PhD, Kathleen N. Lohr, PhD, and Katherine E. Hartmann, MD, PhD Objective: Preterm labor (PTL) that results in cervical change and spontaneous preterm birth requires organized forceful uterine contractions. Home uterine activity monitoring (HUAM) detects increases in activity and facilitates intervention. We sought to summarize randomized trials comparing pregnancy outcomes of women who did and did not receive HUAM. Methods: We worked as part of the AHCPR Evidence Report on the Management of Preterm Labor and restricted our search to randomized trials of HUAM among women who had experienced PTL in the pregnancy for which they were receiving monitoring. With ACOG and an advisory group, we developed search criteria. We did an exhaustive literature search, including the gray literature, for articles in English from 1980 to 1998. The initial search identified 37 studies; after review (masked to author and journal), 4 studies met inclusion criteria.
Wednesday Posters 75S