Umbilical artery Doppler velocimetry as a predictor of fetal hypoxia and acidosis at birth

390

Citations from the Literature

waveforms. In this group, 12 of 13 patients had normal perinatal outcome, defined by the absence of intrapartum fetal distress or evidence of intrauterine growth retardation. Group 2 consisted of nine subjects with abnormal waveforms. Perinatal morbidity occurred in lad% in this group. We conclude that an abnormal umbilical artery waveform may provide confirmatory evidence of impending fetal compromise when the antenatal sonographic diagnosis of oligohydramnios is made. Ultrasonography versus amniotic fluid spectral analysis: Are they sensitive enough to predict neonatal complications PSSOtinted with isoimmunization?

Reece EA; Cole SW; Romero R; Gabrielli S; O’Connor TZ; Hobbins JC Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510; USA Obstetrics and Gynecology/74/3 I (357-360)/1989/ The modern management of pregnancy complicated by erythroblastosis fetalis is based on serial amniocenteses followed by either intrauterine transfusions or early delivery of affected infants, depending on the gestational age. A retrospective study was undertaken involving 92 isoimmunized pregnancies in which ultrasonography and amniotic fluid analyses were used to assess the relative predictive values for neonatal complications. Our data demonstrated that ultrasonography and optical density analyses were comparable in the evaluation of the isoimmunized pregnancy. The combined information from both these modalities did not increase the predictive value over that observed with either one alone. Both instruments were found to have high negative predictive values. However, neither method, used singly or in combination, was highly predictive of neonatal complications. In light of the low positive predictive values, caution should be exercized in using the results of amniotic fluid spectral analyses and/or ultrasound examinations for predicting perinatal complications. Umbilical artery Doppler velocimetry as a predictor of fetal hypoxia and acidosis at birth

Tyrrell S; Obaid AH; Lilford RJ University Department of Obstetrics and Gynecology, St. James’s Hospital, Leeds LS9 7TF; United Kingdom Obstetrics and Gynecology/74/3 I (332-337)/1989/ We studied the relationship between preoperative umbilical artery Doppler waveforms and umbilical vein p0, and pH at elective cesarean section. An absence of end-diastolic velocities had a strong statistical association with hypoxia and acidosis, and was an accurate clinical test for hypoxia (sensitivity 78%, specificity 98%, positive predictive value 88%, and negative predictive value 98%) and acidosis (sensitivity 90%, specificity 92%, positive predictive value 53%, and negative predictive value 100%). It was also a clinically sensitive indicator of perinatal morbidity and mortality. Most fetuses with no end-diastolic velocities were growth-retarded, but the reverse was not true. The absence of end-diastolic velocities also divided both mature and immature fetuses into high- and low-risk groups Int J Gynecol Obstet 31

for hypoxia and acidosis. In the presence of end-diastolic velocities, only very high S/D ratios (above 4.5) have any association with hypoxia. As a noninvasive test of fetal umbilical vein p0, and pH, umbilical artery Doppler performs well. Efficacy and safety of indomethacin

versus ritodrine in the

management of preterm labor; A randomized study

Morales WJ; Smith SC; Angel JL; O’Brien WF; Knuppel RA Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Orlando Regional Medical Center, University of South Florida, Orlando, FL; USA Obstetrics and Gynecology/74/4 (567-572)/1989/ One hundred six patients in preterm labor with intact amniotic membranes and gestational age less than or equal to 32 weeks were randomized to receive either ritodrine hydrochloride or a 48-hour course of indomethacin for tocolysis. The relative efficacy, maternal and neonatal safety, and costs were evaluated to determine which may be the more appropriate first-line pharmacologic agent used to manage preterm labor. Fifty-four patients and 52 patients were randomized to receive ritodrine hydrochloride or indomethacin, respectively. Ritodrine hydrochloride and indomethacin were equally effective in inhibiting uterine contractions and delaying delivery. Delivery was delayed for at least 48 hours in 83 and 94%, and for at least 7 days in 70 and 75% of patients receiving ritodrine or indomethacin, respectively. Tocolysis with indomethacin was associated with no maternal side effects, whereas tocolysis with ritodrine hydrochloride was associated with a 24% incidence of serious cardiovascular and metabolic adverse effects prompting discontinuation of the drug. There were no differences in outcome between the infants exposed to indomethacin versus ritodrine hydrochloride when delivered either remote from therapy or during therapy, except for a statistically high serum glucose in the infants exposed to ritodrine hydrochloride when delivered during tocolytic therapy. There were no cases of premature closure of the ductus arteriosus or pulmonary hypertension. Tocolysis with indomethacin was 17 times less costly than tocolysis with ritodrine hydrochloride. For gestations less than or equal to 32 weeks complicated by preterm labor, indomethatin may be an appropriate alternative as a first-line tocolytic agent. Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes

Jovanovic-Peterson L; Durak EP; Peterson CM Sansum Medical Research Foundation, Santa Barbara, CA 93105; USA American Journal of Obstetrics and Gynecology/l61/2 (415419)/1989/ We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus. Women with gestational diabetes mellitus (N = 19) were randomized into either group I, a B-week diet alone group (24 to 30 kcal/kg/24 hours; 20% protein, 40% carbohydrate, 40% fat), or group II, which followed the same diet plus exercise (20 minutes three times a week for 6 weeks). An arm ergometer was used to maintain heart rate in the training group. Glycemic response was moni-