Evaluation of non-reassuring fetal heart rate patterns with fetal pulse oximetry combined with vibratory acoustic stimulation.

OBJECTIVE: To determine the value of fetal pulse oximetry and vibratory acoustic stimulation in the presence of non-reassuring fetal heart rate patterns during labor. DESIGN: Prospective study in women monitored by cardiotocography and fetal pulse oximetry during labor. MATERIALS AND METHODS: During a period of 18 months, 907 consecutive parturients in labor were monitored by cardiotocography. Out of these women, 63 were selected on the basis of a non-reassuring fetal heart rate tracing during the first stage of labor. In these cases, fetal pulse oximetry was applied. Vibratory acoustic stimulation was applied in fetuses without spontaneous reactivity in order to evaluate the fetal status. RESULTS: Our cases were classified into three groups, according to the lower fetal oxygen saturation levels, from the time of oximetry application until delivery. Group A consisted of 29 cases where fetal oxygen saturation levels were > or = 41%, group B (20 cases) with fetal oxygen saturation of 31-40% and group C (14 cases) with levels of < 30%. Spontaneous reactivity was observed in 15 fetuses of group A and seven of group B, while no case of reactivity was noted in group C. Vibratory acoustic-induced reactivity was associated with low fetal oxygen saturation levels. The mean umbilical artery pH levels were 7.29 +/- 0.051 in group A, 7.21 +/- 0.057 in group B and 7.04 +/- 0.05 in group C. CONCLUSION: Fetal pulse oximetry should be indicated not only in fetuses without any reactivity but also in those with induced reactivity, after the application of vibratory acoustic stimulation.

Sweeping of the membranes versus uterine stimulation by oxytocin in nulliparous women. A randomized controlled trial.

The aim of this study was to evaluate whether sweeping of the membranes at term could shorten the length of pregnancy and reduce the incidence of postterm pregnancies. We randomly selected 104 nulliparas with uncomplicated pregnancy and gestational age between 281 and 287 days. Our patients were divided into three groups. Group A consisted of 34 women who were subjected to sweeping of the membranes. Uterine stimulation with oxytocin was applied in 35 women (group B), and 35 women (group C) were used as a control group. We had no significant reduction of the time interval from sweeping of the membranes until delivery (1.9 +/- 1.2 days), compared to that of group B (2.1 +/- 0.8 days) as well as that of the control group (2.5 +/- 0.9 days). The incidence of spontaneous labor in patients after sweeping of the membranes was greater (67.6%) when compared with oxytocin-stimulated patients and the control group (p < 0.05). Furthermore, a better Bishop score was noted in patients of group A. No statistically significant difference was noted in the mode of delivery between the groups, but sweeping of the membranes significantly decreased the incidence of postterm pregnancies (p < 0. 05). We concluded that sweeping of the membranes is an effective method for initiating labor in women with a gestational age between 40 and 41 weeks, thus reducing the need for induction.

Intrapartum vibratory acoustic stimulation after maternal meperidine administration.

OBJECTIVE: To examine the effectiveness of the acoustic stimulation test in the interpretation of suspicious cardiotocograms obtained after meperidine administration to the mother during the first stage of labor. SUBJECTS AND METHODS: We studied 45 unselected parturients who received 50 mg meperidine i.m. when cervical dilatation was 5 cm. In all cases a decreased beat-to-beat variability of the fetal heart rate and fetal movements was noted after the injection of meperidine. A vibratory acoustic stimulation was performed in 25 patients (group A) while the remaining 20 (group B) had no stimulation. RESULTS: After the meperidine injection, the acoustic-induced reactivity returned immediately in group A, while the spontaneous reactivity returned 30 minutes later. The mean number of fetal movements in all parturients was 8.71 +/- 2.18 before meperidine administration. Sixty minutes after the meperidine injection the mean number was 8.52 +/- 2.48 in group A and 1.65 +/- 1.81 in group B (p < 0.0001). CONCLUSION: The acoustic stimulation test is an effective method of interpreting suspicions CTG's obtained after meperidine administration to the mother during the first stage of labour.

Maternal blood parameters and neonatal birth weight.

The objective of this study was to examine the possible correlation between maternal hematologic parameters and neonatal birth weight. For this purpose 305 pregnant women were studied during labour. Hemoglobin, Ht, MCV, MCH, MCHC, serum Fe and reticulocytes were measured in maternal blood sample and umbilical cord blood sample. Fetal MCH and MCHC had no statistical significance compared to maternal, while maternal MCH and MCHC were statistically significant (p < 0.05 and p < 0.01 respectively) compared to neonatal weight.

Comparison between metal cup and silicone rubber cup vacuum extractor.

A total of 400 primiparous patients who were delivered by vacuum extractor were studied. The patients were divided in two groups: Group A included 200 patients who were delivered by metal cup vacuum extractor and Group B consisted of 200 patients who were delivered by rubber cup vacuum extractor. There were no statistically significant differences in the mean maternal age, mean gestational age, mean neonatal birth weight, indications for operative delivery, occipital positions and head stations between the two groups. No differences were found in the rates of birth canal trauma (11% vs. 12.5%), major neonatal scalp trauma (6.5% vs. 5.5%), neonatal jaundice (15.5% vs. 13.5%) and Apgar score. From this study we can conclude that both metal and silicone cups are equally satisfactory for vacuum extraction.