NST versus OCT

circumferences, and some demonstrated skeletal growth disproportion. These characteristics occurred in varying combinations in both low-birth-weight and normal-birth-weight infants. The authors postulate that “short low-birth-weight IUGR may represent more severe growth retardation than the slim and very slim LBW groups because

skeletal growth achievement was normal in the slim and very slim LBW growth retarded newborns.” The authors also comment on the importance of accurate obstetric dating of length of gestation, as some newborns would change classifications of appropriateness of birth weight when obstetric dates are used instead of neonatal Dubowitz gestational age scores.

NST versus OCI Pratt D, Diamond F, Yen H, et al.:

Fetal stress and non-stress tests: An analysis and comparison of their ability to identify fetal outcome. Obstet Gynecol 54419, 1979. Over a two-year period at this Chicago center, 1000 nonstress tests (NSTs) and 919 oxytocin challenge tests (OCTs) were performed on 362 high-risk patients. This study was designed to compare the ability of each test to predict perinatal morbidity. Only the last test performed on each patient, within one week of delivery, was used for the comparisons. A positive OCT was associated with perinatal morbidity somewhat more frequently than the nonreactive NST (65% for the OCT and 55% for the NST). This study also showed higher morbidity in the face of an equivocal NST (44%) than an equivocal OCT (31%). This led the authors to conclude that the equivocal NST must be considered as ominous as the nonreactive NST, and when this was done the NST was equally capable of identifying cases of future perinatal morbidity. When the results of the NST and OCT in each patient were assessed together in the group of patients who had a nonreactive NST and a positive OCT, there was an 83% incidence of morbidity. In the group who had a reactive NST and a negative OCT the incidence of morbidity was only 29%. False-positive rates were found to be high, 45% for the NST and 35% for the

40

OCT; false-negative rates were similar for the two tests, approximately 27%. The authors conclude that the NST is as good at predicting perinatal morbidity as the OCT when the equivocal NST is considered ominous, and an indication for further evaluation. It is also suggested that since the OCT is tremendously more costly and time consuming, both for the staff and for the patient, the NST should be the primary screening test for high risk pregnancies, and the OCT should be used after an equivocal or nonreactive NST.

local cervical prostaglandin release and may explain the slight improvement in the cervical scores of the untreated group, though none of these patients progressed to labor. No complications that could be ascribed to the use of the gel were noted, patient response was enthusiastic, and the authors claim that the patients’ experiences were quite similar to spontaneous labor.

Routine nancy? Prostaglandin

Gel Ripens Cervix

O’Herlihy C, MacDonald H. Influence of pre-induction prostaglandin E, vaginal gel on cervical ripening and labor. Obstet Gynecol 54709, 1979. In order to decrease the risk of cesarean section in situations where labor must be induced despite an unfavorable cervix, these researchers have used prostaglandin E, in a vaginal gel to ripen the cervix prior to the induction. Sixty-five primigravidas were treated with the PGE, gel the evening prior to their scheduled induction of labor. Thirty other patients were used as controls. Modified Bishop scores (for favorability of the cervix) were assigned to each patient prior to the treatment and agairi in the morning prior to the induction. Thirty-one of the 65 treated patients (48%) were in labor and 14 (21.5%) had delivered within 16 hours of gel insertion. None of the control group went into labor, despite similarities in gestational age, though some slight cervical improvement had occurred. The typical side effects of oral and parenteral prostaglandins-shivering, pyrexia, and gastrointestinal upset-did not occur with the use of the vaginal gel. The effects of the prostaglandins continued into labor, and led to a significant reduction in the length of labor and in the incidence of cesarean section in the treated group (as compared to the control group). Although birth weights did not vary significantly, the difference in the incidence of cesarean section was statistically significant (1.5 in the treated group, 23.9 in the untreated group). The authors point out that vaginal examination alone probably stimulated

Chest

X-Rays

in Preg-

Hadlock F, Park S, Wallace R: Routine radiographic screening of the chest in pregnant women: Is it justified? Obstet Gynecol 54433, 1979. In this review of 5422 chest x-rays done routinely on women from the antepartum and abortion clinics of Jefferson Davis Hospital in Houston, Texas, only eleven cases of significant pathology were found. Of these eleven, only three cases would not have had a chest x-ray suggested by findings from a thorough history and physical examination. Two cases of active tuberculosis were discovered in recent immigrants from British Honduras and Thailand, countries with much higher incidences of pulmonay tuberculosis than the United States. Both women had strongly positive PPDs and were asymptomatic. The authors state that this exceedingly low incidence (0.2%) of unsuspected chest pathology in their population and the high cost of routine radiographic screening had led them to discard the practice of routine chest x-rays for pregnant women. They also suggest that given the declining incidence of pulmonary tuberculosis in this country, similar studies at other institutions would probably show similar results.

Intrapartum

Fetal Arrhythmias

Young B, Katz M, Klein S: Intraparturn fetal cardiac arrhythmias. Obstet Gynecol54427, 1979. In this review of 1043 direct fetal heart rate tracings from Bellevue Hospital in New York, 15 cases of fetal cardiac ar-

Journal of Nurse-Midwifery

??

Vol. 25, No, 3, May/June 1980