A comparison of the morbidity of midforceps and cesarean delivery.

Neonatal and maternal outcome in 358 midforceps and 486 cesarean deliveries was compared by retrospective analysis. Neonatal outcome was evaluated on the basis of Apgar score, cord blood gas values, admission to the neonatal intensive care unit, and birth trauma. Maternal outcome was based on intraoperative and postoperative complications, blood loss, and hospital stay. There was no increase in significant short-term neonatal morbidity in the midforceps group, while maternal morbidity was higher in the cesarean delivery group. It is concluded that, in selected cases, midforceps delivery is safe for the neonate and mother.

Lecithin:sphingomyelin ratio in pregnancies complicated by insulin-dependent diabetes mellitus.

One hundred forty-one samples of amniotic fluid in 105 pregnancies from 95 insulin-dependent diabetics were analyzed for the lecithin:sphingomyelin (L:S) ratio. Fetal pulmonary maturity seemed to progress at a normal rate. The mean L:S ratio was not significantly different in diabetic and nondiabetic patients at various stages of gestation. Only 3 cases of respiratory distress syndrome (RDS) were observed in 77 infants with an L:S ratio of 2.0 or more delivered of diabetic mothers within 72 hours of amniocentesis. This 3.9% incidence of RDS in infants of diabetic mothers with L:S ratios of more than 2.0 was not significantly higher than the 1.5% incidence in the nondiabetic mothers. It is concluded that by using the method of Gluck, an L:S ratio of 2.0 or greater at 36 weeks' gestation or later is a reliable indicator of fetal lung maturity in insulin-dependent diabetic pregnancies, and abdominal delivery after 36 weeks' gestation does not increase the risk of RDS in a diabetic pregnancy with an L:S ratio at 2.0 or more.

Heroin addiction and pregnancy.

Pregnant heroin addicts tend to be younger than nonaddicted pregnant patients, unmarried or separated from spouses, and a disproportionately large number are members of minority ethnic groups. Heroin addiction during pregnancy is associated with several significant medical and obstetrical complications and may result in both acute and chronic abnormalities in neonates. Malnutrition, venereal disease, hepatitis, pulmonary complications, preeclampsia and third-trimester bleeding are the most common maternal complications, while fetal death, intrauterine growth retardation, prematurity and withdrawal symptoms affect the fetus and neonate. There is controversy about treating addicts with methadone during pregnancy. The findings of studies in animals suggest that there may be a long-lasting drug-induced syndrome, characterized by growth retardation, delayed motor development and behavior abnormalities in offspring of heroin-addicted or methadone-treated mothers.

Retrograde menstruation in women undergoing chronic peritoneal dialysis.

Blood in the peritoneal dialysis catheter just before menstruation was regularly observed in 9 of 11 premenopausal women maintained on peritoneal dialysis for end-stage renal failure. Peritoneal bleeding at other times during the menstrual cycle was not seen in any of these patients. Likewise, peritoneal bleeding in men or nonmenstruating women on chronic peritoneal dialysis was exceedingly rare, was not periodic, and usually was due to recognizable causes. These observations suggest that retrograde menstrual bleeding into the peritoneal cavity is the rule rather than the exception in women on peritoneal dialysis and possibly in all menstruating women. Implications of this observation for the pathogenesis of endometriosis and dysmenorrhea are discussed.

Blind oxytocin challenge test and perinatal outcome.

A total of 435 oxytocin challenge tests (OCT) were performed on 217 high-risk pregnant patients, and the test results were blinded. The results were correlated with late decelerations of the fetal heart rate during labor, Apgar scores at 5 minutes, a neonatal morbidity score, and perinatal mortality. The incidence of late decelerations during labor was 17% in the negative group, 24% in the suspicious group, and 33% in the positive group. The correlation of OCT results and the various measures of fetal outcome indicated that an individual fetus at risk cannot be identified with a high degree of accuracy since 67% of the tests were false positive and 17% were false negative. Even when the OCT was positive, 61% of infants did not have late decelerations in labor, low Apgar scores, or significant neonatal morbidity. When elective delivery has been decided upon after consideration of all clinical information, induction of labor rather than primary cesarean section is usually indicated. In this study 78% of patients were delivered vaginally with no significant increase of cesarean sections in the positive and suspicious groups as compared with the negative group.

Thyrotropin-releasing hormone and thyroid hormones in amniotic fluid.

Immunoassayable TRH (iTRH) was measured in 50 amniotic fluid specimens with a mean concentration of 207 +/- 26 (SE) pg/ml. This iTRH demonstrates parallelism with the standard curve for synthetic TRH. With increasing gestational age there is an increase in iTRH levels in amniotic fluid with a decrease in 3,3',5'-triiodothyronine levels (rT3), while thyroxine levels (T4) remain unaltered. Preliminary data suggest that iTRH levels in amniotic fluid that are less than 150 pg/ml after 32 weeks of gestation may correlate well with low Apgar scores at birth. There was no correlation of rT3 or T4 amniotic fluid levels with the Apgar scores.

Plasma unconjugated estriol values in high-risk pregnancy.

The usefulness of plasma estriol concentrations in the management of high-risk pregnancy is controversial. In this study, serial plasma unconjugated estriol (E3) concentrations determined by radioimmunoassay were evaluated in 321 patients with high-risk pregnancy for correlation with fetal and neonatal performance. A plasma E3 concentration of 4 ng. per milliliter or less in late pregnancy correlated significantly with low one-and five-minute Apgar scores and selected neonatal problems in pregnancies complicated by chronic hypertension and intrauterine growth retardation, with a similar trend for pregnancies complicated by moderate and severe pre-eclampsia. Most perinatal deaths in the study were associated with acute problems which began during labor and delivery, or fetal death occurred before early intervention was practical. Therefore, the perinatal mortality rate is not likely to be influenced by the use of E3 values, and the perinatal mortality rate is not a realistic measure of the usefulness of plasma E3 values in management of high-risk pregnancy. Low plasma E3 values were not always ominous, and for this reason it is suggested that clinical indications and the results of other tests for fetal-placental function be considered along with plasma E3 values in the selection of patients for early delivery to reduce the possibility of inappropriate intervention.

Evaluation of azoestriol antisera for estriol measurements in pregnancy plasma directly and after extraction.

2-(4'-carboxyphenylazo)-estriol antisera were employed to quantitate pregnancy plasma estriol in ether extracts by single phase radioimmune assay without chromatography. Utilizing antiserum which crossreacted minimally even with the monoglucosiduronate metabolites, unextracted plasma estriol measurements were identical statistically to ether extract determinations.