- Email: [email protected]
Ritodrine used to stop hypertonic contractions
quired operative delivery after 24 hours of ruptured membranes, whereas only two prostaglandin patients required operative deliveries (vacuum extraction). In an additional group of women, 12 of 17 had favorable cervixes 5 hours after application of the gel and all were delivered vaginally within 24 hours. The remaining five women received a second applica-
tion of the gel after 24 hours and delivered within 12 more hours. These results show that vaginal application of prostaglandin E2 gel is superior to oxytocin for cervical priming and labor induction in term women with PROM and unfavorable cervixes. For best results the authors suggest routine application of a second dose of gel 8 to 10 hours after the first application. This seems justified by the absence of infections in this group of patients as well as by the significantly lower rate of fetal distress in the prostaglandin group when compared with the oxytocin group.
Ritodrine Used to Stop Hypertonic Contractions Lipshitz J, Klose C: Use
drugs to reverse uterine hypertonus OBSTET
GYNECOL
of tocolytic
oxytocin-induced and fetal distress. 66: 16S,
1985.
This brief report documents a case of severe oxytocin-induced hypertonic contractions leading to severe fetal distress requiring immediate intervention. Rather than attempt to deliver a compromised infant by emergency cesarean section the authors gave the mother a 6-mg intravenous bolus of ritodrine, which immediately stopped all contractions and allowed the fetal heart to regain normal pattern. The patient later was restarted on oxytocin and subsequently delivered a healthy normal infant. The mother’s heart rate increased 55 beats per minute after the bolus of ritodrine, and she felt nervous, nauseous, flushed, and had palpitations. The authors caution that if placental abruption or uterine rupture are suspected this treatment would be contraindicated, as it would be if the mother had heart disease. Fetal Breathing Movements the Diagnosis of Labor
Journal of Nurse-Midwifery
and
?? Vol.
Boyland P, O’Donovan P, Owens 0: Fetal breathing movements and the diagnosis of labor: A prospective analysis of 100 cases. OBSTET GYNECOL
66:517,
1985.
This study was designed to test the theory that cessation of fetal breathing movements distinguishes true from false labor. This was based upon the established fact that fetal apnea is normal in labor and has no ill effect on fetal wellbeing. One hundred women of at least 28 weeks’ gestation were studied. These women felt they were in labor, and complained of regular painful uterine contractions, yet did not meet institutional criteria for true labor. No fetal breathing movements were noted during the 45 minute ultrasound observation period in 31 women, and 30 delivered within 48 hours. Among the 69 cases with fetal breathing movements, 56 pregnancies continued for at least 48 hours, and only eight delivered spontaneously within 48 hours. These results were not influenced by gestational age, as all 22 preterm patients who demonstrated fetal breathing movements continued their pregnancies for more than 48 hours. The authors feel that this study shows that the presence or absence of fetal breathing movements can aid in accurate diagnosis of labor, thereby decreasing both the number of patients receiving tocolytic drugs unnecessarily and the number of inadvertent inductions of labor at term. The Reactive
Nonstress
Test
Devoe L, McKenzie J, Searle N, et al: Nonstress test: Dimensions of tl0IT’l-d
reactivity.
66:617,
1985.
OBSTET
GYNECOL
This study was designed to describe characteristics of normal fetal heart rate (FHR) reactivity in term infants with known normal outcomes. This information was obtained because of a lack of consensus on criteria for normal reactivity. The authors studied 495 nonstress tests from 230 normal term fetuses, documenting the number of movement-associated FHR accelerations in lo-, 20., 30., and 40.minute windows. No signifi-
31, No. 2, March/April 1986
cant differences in the frequency of movement-associated hccelerations were observed for any sequential lo-minute window. Movement-associated accelerations were noted to be absent in nearly 20% of the lo-minute windows, and in 5 to 8% of the longer windows. The authors concluded that the broad frequency distributions of movementassociated FHR accelerations among normal fetuses preclude discrete diagnostic cutoffs in short-time windows.
Magnetic Resonance Used in Pregnancy
Imaging
Lowe T, Weinreb J, Santos-Ramos R, et al: Magnetic resonance imaging in human pregnancy. OBSTET GYNECOL 66:629,
1985.
“Magnetic resonance imaging is a new noninvasive diagnostic technique that involves no ionizing radiation, has no known significant adverse biologic effects, and produces high resolution cross-sectional body images.” In this report the authors used magnetic resonance imaging to examine 11 pregnant women and their fetuses. Because of the experimental nature of this study, all pregnancies were known to be abnormal from prior sonographic examinations. Many images are presented and described, showing very clear maternal anatomy and detailed fetal images as well. In contrast to x-rays or sonograms, these images show fetal or maternal fat as a bright area and fluid or bone as dark areas. The authors view magnetic resonance imaging as complementary to sonography and x-ray, for instance, in situations where obesity, the gravid uterus itself, or overlying bony structures or gasfilled organs may preclude identification of some abnormalities. They feel it is likely to prove especially useful in visualizing fetal intracranial anatomy, and may be valuable in measuring fetal subcutaneous fat, such as in cases of diabetes or intrauterine growth retardation. Disadvantages of this technique include the expensive equipment required, the lengthy examinations currently necessary (1 to 2 hours per patient), and significantly poorer images obtained due to fetal movement.
111
tion of the gel after 24 hours and delivered within 12 more hours. These results show that vaginal application of prostaglandin E2 gel is superior to oxytocin for cervical priming and labor induction in term women with PROM and unfavorable cervixes. For best results the authors suggest routine application of a second dose of gel 8 to 10 hours after the first application. This seems justified by the absence of infections in this group of patients as well as by the significantly lower rate of fetal distress in the prostaglandin group when compared with the oxytocin group.
Ritodrine Used to Stop Hypertonic Contractions Lipshitz J, Klose C: Use
drugs to reverse uterine hypertonus OBSTET
GYNECOL
of tocolytic
oxytocin-induced and fetal distress. 66: 16S,
1985.
This brief report documents a case of severe oxytocin-induced hypertonic contractions leading to severe fetal distress requiring immediate intervention. Rather than attempt to deliver a compromised infant by emergency cesarean section the authors gave the mother a 6-mg intravenous bolus of ritodrine, which immediately stopped all contractions and allowed the fetal heart to regain normal pattern. The patient later was restarted on oxytocin and subsequently delivered a healthy normal infant. The mother’s heart rate increased 55 beats per minute after the bolus of ritodrine, and she felt nervous, nauseous, flushed, and had palpitations. The authors caution that if placental abruption or uterine rupture are suspected this treatment would be contraindicated, as it would be if the mother had heart disease. Fetal Breathing Movements the Diagnosis of Labor
Journal of Nurse-Midwifery
and
?? Vol.
Boyland P, O’Donovan P, Owens 0: Fetal breathing movements and the diagnosis of labor: A prospective analysis of 100 cases. OBSTET GYNECOL
66:517,
1985.
This study was designed to test the theory that cessation of fetal breathing movements distinguishes true from false labor. This was based upon the established fact that fetal apnea is normal in labor and has no ill effect on fetal wellbeing. One hundred women of at least 28 weeks’ gestation were studied. These women felt they were in labor, and complained of regular painful uterine contractions, yet did not meet institutional criteria for true labor. No fetal breathing movements were noted during the 45 minute ultrasound observation period in 31 women, and 30 delivered within 48 hours. Among the 69 cases with fetal breathing movements, 56 pregnancies continued for at least 48 hours, and only eight delivered spontaneously within 48 hours. These results were not influenced by gestational age, as all 22 preterm patients who demonstrated fetal breathing movements continued their pregnancies for more than 48 hours. The authors feel that this study shows that the presence or absence of fetal breathing movements can aid in accurate diagnosis of labor, thereby decreasing both the number of patients receiving tocolytic drugs unnecessarily and the number of inadvertent inductions of labor at term. The Reactive
Nonstress
Test
Devoe L, McKenzie J, Searle N, et al: Nonstress test: Dimensions of tl0IT’l-d
reactivity.
66:617,
1985.
OBSTET
GYNECOL
This study was designed to describe characteristics of normal fetal heart rate (FHR) reactivity in term infants with known normal outcomes. This information was obtained because of a lack of consensus on criteria for normal reactivity. The authors studied 495 nonstress tests from 230 normal term fetuses, documenting the number of movement-associated FHR accelerations in lo-, 20., 30., and 40.minute windows. No signifi-
31, No. 2, March/April 1986
cant differences in the frequency of movement-associated hccelerations were observed for any sequential lo-minute window. Movement-associated accelerations were noted to be absent in nearly 20% of the lo-minute windows, and in 5 to 8% of the longer windows. The authors concluded that the broad frequency distributions of movementassociated FHR accelerations among normal fetuses preclude discrete diagnostic cutoffs in short-time windows.
Magnetic Resonance Used in Pregnancy
Imaging
Lowe T, Weinreb J, Santos-Ramos R, et al: Magnetic resonance imaging in human pregnancy. OBSTET GYNECOL 66:629,
1985.
“Magnetic resonance imaging is a new noninvasive diagnostic technique that involves no ionizing radiation, has no known significant adverse biologic effects, and produces high resolution cross-sectional body images.” In this report the authors used magnetic resonance imaging to examine 11 pregnant women and their fetuses. Because of the experimental nature of this study, all pregnancies were known to be abnormal from prior sonographic examinations. Many images are presented and described, showing very clear maternal anatomy and detailed fetal images as well. In contrast to x-rays or sonograms, these images show fetal or maternal fat as a bright area and fluid or bone as dark areas. The authors view magnetic resonance imaging as complementary to sonography and x-ray, for instance, in situations where obesity, the gravid uterus itself, or overlying bony structures or gasfilled organs may preclude identification of some abnormalities. They feel it is likely to prove especially useful in visualizing fetal intracranial anatomy, and may be valuable in measuring fetal subcutaneous fat, such as in cases of diabetes or intrauterine growth retardation. Disadvantages of this technique include the expensive equipment required, the lengthy examinations currently necessary (1 to 2 hours per patient), and significantly poorer images obtained due to fetal movement.
111