The fetal acoustic stimulation test: a reliable and cost effective method of antepartum fetal monitoring.

RATIONALE: A healthy foetus, if exposed to external sound stimulation, often responds with vigorous movements which can be felt by the mother. A hypoxic foetus usually does not show this response. OBJECTIVES: To evaluate the fetal acoustic stimulation test (FAST) in antepartum fetal monitoring. DESIGN AND SETTING: Prospective interventional study carried out at the Teaching Hospital, Galle. METHOD: An initial non-stress test (NST) followed by a FAST using the Corometric model 146 was carried out in 423 high risk pregnant women. The response to FAST was assessed and compared with the NST. A repeat NST was recorded in women who had an initial non-reactive NST. The results of the NST and FAST were compared with the fetal outcome if the woman delivered within 24 hours. OUTCOME MEASURES: Maternal perception of fetal movements after FAST, results of NST before and after FAST, and the babies' 5 minute Apgar scores if delivered within 24 hours of the FAST. RESULTS: Of the women, 349 (82.5%) noticed fetal movements after FAST. Of the 167 women who complained of absent or reduced fetal movements, 67% felt fetal movements after FAST. Ninety one had a nonreactive NST and 43 (47%) became reactive after FAST. Compared to the NST, the FAST had less sensitivity (93% vs 100%, p = 0.01), better specificity (79% vs 45%, p = 0.001), better positive predictive value (67% vs 50%, p = 0.02), similar negative predictive values (96% vs 100%, p > 0.05) and better accuracy (83% vs 69%, p = 0.03) in predicting neonatal asphyxia (5 minute Apgar score < 7) if the baby was delivered within 24 hours after the test. CONCLUSION: The FAST is a reliable, cost effective screening test for antepartum fetal monitoring. It significantly reduces the false positive (non-reactive) NST and has a good negative predictive value.

Adverse effects of teenage pregnancy.

RATIONALE: Recent studies have suggested that teenage pregnancies are not as hazardous as thought to be earlier. OBJECTIVE: To compare the sociodemographic data, obstetric complications and attitudes towards family planning in teenagers and older women. DESIGN AND SETTING: A prospective cohort study at the University Obstetrics Unit, Teaching Hospital, Galle. SUBJECTS AND METHOD: Sociodemographic data, details of antenatal care and family support, antenatal complications, gestation at delivery, mode of delivery, the proportion of unplanned pregnancies, and the possible effects of contraceptive counselling, in two groups of pregnant teenagers (13-16 years, n = 95 and 17-19 years, n = 250) were compared with a control group of pregnant women (20-24 years, n = 275). RESULTS: The teenagers were from lower socioeconomic strata and the younger teenagers were significantly less educated than the controls. Teenagers had a significantly higher risk of anaemia (Odds Ratio (OR) = 2.3, 95%CI = 1.7-3.3, p < 0.001). The younger teenagers had a significantly higher risk of gestational hypertension (OR = 4.8, 95%CI = 1.8-13.0, p < 0.001) and pre-eclampsia (OR = 5.0, 95%CI = 1-27, p = 0.03).The older teenagers had a significantly higher risk of delivery before 34 weeks of gestation (OR = 13.6, 95%CI = 1.8-287, p = 0.001). There were no significant differences in the mode of delivery. The younger teenagers had a much higher proportion (54%) of unplanned pregnancies compared to the controls (16 %). A significantly higher proportion of younger teenagers (48%) and older teenagers (25 %), if counselled, would have delayed their pregnancies compared to the controls (10 %). CONCLUSION: Teenage pregnancies, especially those below 17 years of age have a significantly higher risk of adverse outcomes. A large proportion of these pregnancies is unplanned and could be prevented by counselling.

Sperm preparation and in utero insemination in the management of subfertility.

OBJECTIVE: To study the place of sperm preparation and in utero insemination in subfertile couples in whom ovulatory and tubal aetiological factors have been excluded or treated. DESIGN: A retrospective cohort study. SETTING: Diagnostic Seminology Laboratory, Galle. SUBJECTS AND METHODS: Patients (n = 325) who had in utero insemination (IUI) from September 1990 to June 1994 were studied retrospectively. All had stimulation of ovaries with clomiphene and the Insler score was used to confirm ovulation before IUI. Swim up, spin down and glass wool filtration techniques, and the Earl's balanced salt solution with human serum albumin were used for sperm preparation. MAIN OUTCOME MEASURES: Association between variables. RESULTS: Of the subjects 97(30%) had male factor, 79(24%) abnormal sperm-cervical mucous interaction and 41(13%) idiopathic subfertility. In 114(35%) the cause was not documented. The number of IUI attempts per subject ranged from 1 to 19 with a mean of 4.2 and SD 3.2. There were no significant difference in conception rates in relation to the different methods of sperm preparation or the underlying aetiological factor. CONCLUSION: Sperm preparation and in utero insemination are feasible in Galle and should be considered as an option in the treatment of subfertility.