Assessment of the effects of increased intravenous hydration on the course of labor in nulliparous term pregnancies

Physiologists have shown that increased fluids improve skeletal muscle performance in prolonged exercise. Typical orders provide for 125 mL of intravenous fluids per hour in patients taking limited oral fluids during labor. Our purpose in this study was to determine whether increased intravenous fluids affect the progress of labor. In a prospective randomized institutional clinical trial, one-hundred ninety-four nulliparous women with uncomplicated singleton gestations at term in spontaneous active labor with dilatation 2-5 cm and a cephalic presentation were selected. 82 were designed to receive 250 mL per hour of intravenous normal saline in dextrose water [first group], and 112 to receive 125 mL per hour of the same solution [2[nd] or control group].Prerandomization variables such as mother's age, weight, previous pregnancy history, general health, sex and weight of the newborn, rupture of the membranes and presenting part were balanced between the two groups.The frequency of labor lasting >10 hours was statistically higher in the 125mL group [[16.7%] vs [7.4%] p<0.0002].This study showed that increasing fluid administration for nulliparous women in labor is associated with a shorter duration of the first stage and possibly less need for augmentation of uterine contraction [[4.8% vs 6.25%] p= 0.002]. Thus dehydration in labor may be a contributing factor for dysfunctional labor and need for cesarean-section, and oxytocin infusion

Screening of fetal chromosomal abnormalities by obstetric ultrasonography in Tehran, Iran

Early identification of fetuses with chromosomal abnormalities enables health care providers to form an appropriate management plan for each patient. The main objective of this study was to determine the role of ultrasonography in screening and identifying fetuses at risk for chromosomal abnormalities. A retrospective review of 6480 patients from the Obstetrics and Gynecology ward of Firouzgar hospital in Tehran was undertaken. Computer databases of patients were correlated to compare the results of the fetal ultrasonographic examination with the cytogenetic results from amniocentesis. Univariate and multivariate analyses were used to determine the best correlations between ultrasonography findings and chromosomal abnormalities. Thirty-seven chromosomal abnormalities were found in 6480 fetuses [0.57%]. Down syndrome was the most common finding with trisomy 18 and 13 being the next two most common abnormal findings. Multivariate analysis showed significant correlations between anomalies of the central nervous system, heart, face and neck, and extremities and increased nuchal fold, increased bowel echogenicity, abnormal biparietal diameter to femur ratio and the presence of chromosomal abnormalities [p value<0.001]. Analysis of data indicated that the presence of any kind of ultrasonographic abnormality increases significantly the risk of fetal chromosomal abnormalities. It is also suggested that a normal ultrasonographic examination in an otherwise at-risk patient will significantly reduce the risk of fetal chromosomal abnormalities

Comparative study of perinatal outcome of growth restricted fetuses in hypertensive mothers versus other causative factors

From July 1998 to November 1999 we have followed up 15712 deliveries [12044 vaginal and 3668 cesarean section] in our hospital. Among these, 182 cases were primarily diagnosed as intrauterine growth restriction [IUGR] and 248 pregnancies were complicated with hypertensive disorders. In these two groups we have investigated the outcome of the neonates. Neonatal weight under the 10th percentile in these two groups was 1.63% and 36.3% and perinatal mortality was 4.4% and 6.1% respectively [p<0.05], due to the much higher incidence of IUGR and greater perinatal mortality in hypertensive pregnant women as compared with the general obstetric population. We conclude that it is valuable to manage close observation in all cases of pregnancy induced or aggravated hypertension