Routine hepatitis B screening

tions, breast stimulation produced contractions with a frequency of 3.6 minutes and intensity of 48 mmHg. In patients with infrequent contractions, the frequency increased, but there was no increase in intensity. Fourteen patients needed bilateral stimulation to improve the frequency from 6.6 minutes/40 mmHg to 4.5 minutes/39 mmHg. Eighteen patients (50%) had at least one episode of tachystole (contractions less than two minutes apart); there was only one minor fetal heart deceleration among the group with tachystole. Five patients (14%) had prolonged contractions of greater than 90 seconds; there were no fetal heart decelerations in this group.

Epidural Delivery

and Instrumental

Kaminski H, Stafl A, Aiman J: The Effect of Epidural Analgesia on the Frequency of Instrumental Obstetric Delivery. OBSTET GYNECOL 69(5): 770-773, 1987. Previous studies on the effect of epidural analgesia on instrumental delivery have either not used a control group or have not defined the characteristics of the group that might also affect the rate of instrumental delivery. This retrospective study examined 155 women who delivered at Milwaukee County Medical Center and who had epidural analgesia for the sole indication of pain relief; no one with dysfunctional or arrested labor was included. They were matched by age, parity, and race with 155 women who used only pudendal or local anesthesia. There were 125 primiparous and 30 multiparous women in each group. Delivery management for 95% of the patients was by the same group of obstetric residents. There was no statistical difference in infant birth weight or Apgar scores between the groups. The infant was in the posterior position in 27% of the epidural group; only 8% of the control group had an infant in the posterior position. The overall frequency of instrumental delivery was 2.5 times greater in the epidural group.

Routine Hepatitis B Screening Summers P, Biswas M, Pastorek J, Pernoll M, Smith L, Bean B: The Pregnant Hepatitis B Carrier: Evi-

366

dence Favoring Comprehensive Antepartum Screening. OBSTET GYNECOL 69(5):701-703, 1987. Cruz A, Frentzen B, Behnke M: Hepatitis B: A Case for Prenatal Screening of All Patients. AM J OBSTET GYNECOL 156(5):1X30-1183, 1987. Both of these articles recommend that institutions serving low socioeconomic groups require routine screening for Hepatitis B carriers in pregnancy. The Summers article presents data from Charity Hospital in New Orleans in 1983. All pregnant women (N = 15,399) were screened; 136 carriers were found, for a prevalence of 0.88%. The race-specific prevalence was 0.56% white/0.62% blacW8.8% oriental. The cost in their institution was $2.30 per screening test or $261 per maternal carrier identified. Assuming 30% risk of perinatal transmission, the cost becomes $871 per neonatal carrier prevented. The Cruz article retrospectively reviewed data from University of Florida Hospital in Gainesville, which began screening all patients on admission in 1983. The prevalence rate among obstetrical patients was 0.54%; only one third of the carriers identified had recognized risk factors for Hepatitis B. The cost of screening in their community was $27.60, ten times that of the Charity Hospital study. Nevertheless, these authors recommend routine screening at 34-36 weeks gestation in low socioeconomic groups; They felt that screening on admission of the mother to the hospital did not provide the necessary information in a timely enough manner to protect the hospital staff and to treat the newborn within 12 hours after birth.

Routine Ultrasound Recommended Belfrage P, Fernstrom I, Hallenberg G: Routine or Selective Ultrasound Examinations in Early Pregnancy. OBSTET GYNECOL 69(5):747-750, 1987. This Swedish study prospectively studied 2054 women who were routinely screened with ultrasound at lo-14 weeks (95% of total registrants screened). They were compared with an

Journal

of Nurse-Midwifery

l

historic control group of 1358 women who had been selectively scanned for clinical criteria the previous year (50% of total registrants screened). The expected date of delivery (EDD) was calculated by last menstrual period (LMP) and biparietal diameter (BPD)/ crown rump; if the dates did not differ by more than one week, the LMP date was used. If the discrepancy was greater than one week, the ultrasound (U/S) date was used; They changed the due date 20% of the time. The authors compared the accuracy of the LMP and U/S dates to predict the onset of spontaneous labor. When the LMP needed no correction, the length of pregnancy was 279 days. In cases in which the EDD was changed according to the ultrasound examination, the length of pregnancy calculated from LMP changed accordingly. There were fewer statisticallysignificant inductions for postdates in the ultrasound group.

Routine Monitoring

Not Supported

Luthy D, Shy K, vanBelle G, et al: A Randomized Trial of Electronic Monitoring in Preterm Labor. OBSTETGYNECOL 69(5):687-695, 1987. Six randomized clinical trials have been conducted to determine if routine electronic fetal monitoring (EFM) improves neonatal outcomes. None of the studies have found a significant difference in perinatal mortality rates although two studies suggest decreased neonatal seizures in the EFM group. All studies were done on low-risk populations. In 1981 the authors began a randomized clinical trial for high-risk, particularly preterm, pregnancies. The study examined the effect of monitoring on perinatal mortality and neurodevelopment at 18 months corrected age. This article addresses the issue of perinatal mortality. Three tertiary institutions in the Pacific Northwest enrolled a total of 376 women into the study. Participants had a singleton, cephalic infant with an estimated fetal weight (EFW) of 700-1750 g at 26-32 weeks. All study participants were followed on a one-to-one basis by a trained study nurse. The EFM group had external monitoring until 7 cm, at which time ROM was performed and an internal monitor applied; internal monitoring was used from

Vol. 32, No. 6, November/December

1987