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Long-term intravenous ritodrine
to 48 hours, and cultures require 5 to 7 days. Success with both methods was related to the quality of the specimen, which increased with physician experience. In phase 2, after Institutional Review Board approval was obtained, 20 women with ongoing pregnancies elected chorionic villus sampling, mainly for advanced maternal age. Sampling attempts were fewer and the quality of specimens obtained was greater than in phase 1 of the study. Two cases of chromosomal abnormality were found, and the remaining 18 pregnancies are continuing. There were no spontaneous abortions within 1 week of the procedure, although four patients experienced vaginal spotting for up to 6 days after the procedure. The authors delineate the several potential problems affecting diagnostic accuracy and safety with this technique and conclude that substantially more data must be obtained before it can be assumed that chorionic villus biopsy has the same diagnostic accuracy as amniotic fluid culture. Complication rates also will be difficult to determine because the natural loss rate in the first-trimester still is unclear. Maternal Obesity and Pregnancy Complications Garbaciak J, Richter M, Miller S, et al: Maternal weight and pregnancy complications. AM J OBSTET GYNECOL 152:238, 1985. Previous studies of maternal obesity in pregnancy have not been adequately controlled for other complications, according to these authors. In this study obese pregnant women without antenatal complications were compared with undernourished and normal weight women without complications. The obese (120 to 150% of ideal body weight) and morbidly obese (150% of ideal body weight) women were shown to be at significantly high risk for hypertensive disease, preeclampsia, diabetes, and urinary tract infections. Undernourished women showed a greater incidence of anemia. In those patients without antepartum complications, there was no significant difference in perinatal mortality regardless of weight. Those women with antenatal complications, however, did show
350
a significant difference in perinatal mortality as a function of weight. The authors conclude that “it would appear that maternal weight, in and of itself, when no other antenatal complications are present, is not associated with a poorer pregnancy outcome.” Long-Term Intravenous Ritodrine Hill W, Katz M, Kitzmiller J, et al: Continuous long-term intravenous B-sympathomimetic tocolysis. AM J OBSTET GYNECOL 152:271, 1985. This report describes the use of continuous intravenous ritodrine in a group of 16 patients who developed recurrent episodes of premature labor in whom attempts at transfer to oral therapy were ineffective. Surveillance of these women in the high-risk pregnancy unit included frequent monitoring of maternal vital signs, weight changes, fetal heart rates, electrocardiograms (ECG), fluid intake and output, and glucose and potassium levels. Half of the patients were maintained on this therapy for at least 5 weeks. It was discontinued when fetal lung maturity was documented, the patient completed 36 weeks’ gestation, or other indications for delive y occurred (eg, preeclampsia). In none of the study patients was therapy discontinued because of drug-related problems, ECG changes, chorioamnionitis, or fever. Of the 21 infants in this study, four suffered mild respirato y distress syndrome and nine were treated for mild hyperbilirubinemia. In all patients, labor and delive y followed discontinuation of therapy within 24 hours, supporting the accuracy of the diagnosis of premature labor. Maternal cardiovascular and metabolic changes in response to tocolysis were most pronounced during the first 24 to 96 hours of therapy, after which there was a return to pretreatment values. The authors conclude that for a selected group of patients who cannot be placed on oral therapy without serious risk of immediate preterm delivey, continuous intravenous therapy should be considered an option. Further studies with larger numbers of patients and longterm follow-up would seem warranted. Intrapartum External Version Ferguson J, Dyson D: Intrapartum
Journal of Nurse-Midwifery
??
external
cephalic
STET GYNECOL
version.
152:297,
AM J OB-
1985.
This report details the authors’ experience with external version in a small group of women who presented in active labor with breech presentation and who were not considered candidates for vaginal breech delivery. Early in the study attempts were made to perform external version on patients whose membranes had ruptured spontaneously, however the procedure was noted to be uniformly unsuccessful. Attempts at version in 15 patients with intact membranes were successful in 11 (73%) and ten of the 11 delivered vaginally. Ritodrine was used generally for tocolysis; in addition three patients had versions performed while under epidural anesthesia. Bradycardia of no longer than 2 minutes duration occurred in four patients during the attempted version, but resolved quickly. There was no evidence of abruption or maternal complications, and all infants were vigorous at birth. The versions all were done in an operating room with capability for immediate cesarean section. The authors do not advocate intrapartum version as a replacement for antepartum treatment, but simply as an adjunct when antepartum version may not have been attempted. Significance of Meconium at Genetic Amniocentesis Allen R: The significance of meconium in midtrimester genetic amniOCf?nteSiS.
152:413,
AM J OBSTET
GYNECOL
1985.
Reports of discolored amniotic fluid, whether brown, red, or green, have associated such findings with increased risk of poor outcome for that pregnancy. This report presents data from 4709 consecutive amniocenteses performed from 1978 to 1983. When only cases specifically noted to have meconium or green fluid were included, 79 cases of meconium staining were found, which constitutes an incidence of 1.67%. This correlates with other reported incidences. Among these cases there were four incidences of fetal death (including one therapeutic abortion) for a neonatal mortality of 5.06%.
Vol. 30, No. 6, November/December
1985
350
a significant difference in perinatal mortality as a function of weight. The authors conclude that “it would appear that maternal weight, in and of itself, when no other antenatal complications are present, is not associated with a poorer pregnancy outcome.” Long-Term Intravenous Ritodrine Hill W, Katz M, Kitzmiller J, et al: Continuous long-term intravenous B-sympathomimetic tocolysis. AM J OBSTET GYNECOL 152:271, 1985. This report describes the use of continuous intravenous ritodrine in a group of 16 patients who developed recurrent episodes of premature labor in whom attempts at transfer to oral therapy were ineffective. Surveillance of these women in the high-risk pregnancy unit included frequent monitoring of maternal vital signs, weight changes, fetal heart rates, electrocardiograms (ECG), fluid intake and output, and glucose and potassium levels. Half of the patients were maintained on this therapy for at least 5 weeks. It was discontinued when fetal lung maturity was documented, the patient completed 36 weeks’ gestation, or other indications for delive y occurred (eg, preeclampsia). In none of the study patients was therapy discontinued because of drug-related problems, ECG changes, chorioamnionitis, or fever. Of the 21 infants in this study, four suffered mild respirato y distress syndrome and nine were treated for mild hyperbilirubinemia. In all patients, labor and delive y followed discontinuation of therapy within 24 hours, supporting the accuracy of the diagnosis of premature labor. Maternal cardiovascular and metabolic changes in response to tocolysis were most pronounced during the first 24 to 96 hours of therapy, after which there was a return to pretreatment values. The authors conclude that for a selected group of patients who cannot be placed on oral therapy without serious risk of immediate preterm delivey, continuous intravenous therapy should be considered an option. Further studies with larger numbers of patients and longterm follow-up would seem warranted. Intrapartum External Version Ferguson J, Dyson D: Intrapartum
Journal of Nurse-Midwifery
??
external
cephalic
STET GYNECOL
version.
152:297,
AM J OB-
1985.
This report details the authors’ experience with external version in a small group of women who presented in active labor with breech presentation and who were not considered candidates for vaginal breech delivery. Early in the study attempts were made to perform external version on patients whose membranes had ruptured spontaneously, however the procedure was noted to be uniformly unsuccessful. Attempts at version in 15 patients with intact membranes were successful in 11 (73%) and ten of the 11 delivered vaginally. Ritodrine was used generally for tocolysis; in addition three patients had versions performed while under epidural anesthesia. Bradycardia of no longer than 2 minutes duration occurred in four patients during the attempted version, but resolved quickly. There was no evidence of abruption or maternal complications, and all infants were vigorous at birth. The versions all were done in an operating room with capability for immediate cesarean section. The authors do not advocate intrapartum version as a replacement for antepartum treatment, but simply as an adjunct when antepartum version may not have been attempted. Significance of Meconium at Genetic Amniocentesis Allen R: The significance of meconium in midtrimester genetic amniOCf?nteSiS.
152:413,
AM J OBSTET
GYNECOL
1985.
Reports of discolored amniotic fluid, whether brown, red, or green, have associated such findings with increased risk of poor outcome for that pregnancy. This report presents data from 4709 consecutive amniocenteses performed from 1978 to 1983. When only cases specifically noted to have meconium or green fluid were included, 79 cases of meconium staining were found, which constitutes an incidence of 1.67%. This correlates with other reported incidences. Among these cases there were four incidences of fetal death (including one therapeutic abortion) for a neonatal mortality of 5.06%.
Vol. 30, No. 6, November/December
1985