European multicentre studies in the field of obstetrics.

Within Europe a number of multinational, multicentre studies are performed in the field of Obstetrics and Gynaecology. Many of these are funded by the European Community. Unfortunately, concise information on currently ongoing European multicentre studies is not easily obtainable. There is no particular central information point. The current overview aims to provide insight in obstetrical EC/European multicentre studies which recently have been finished, are ongoing or have been planned for the near future. The various projects are described, and information on the number of participants, the research period, the responsible project leader and framework of each project is summarized in tables. A list with the addresses of the project leaders and/or contact persons in the EC member states is added. The paper hopes to facilitate researchers and institutes involved in Obstetrics within Europe to make easier contacts and to promote collaboration on the international level.

Organization of perinatal care within the European community.

A survey on the infrastructure and organization of maternity and neonatal services in the European Community has been conducted within the framework of the European Community Concerted Action Project 'New Methods for Perinatal Surveillance'. Objectives were to provide a basis for comparative evaluation of perinatal studies, to achieve a better understanding of differences in national perinatal services and to identify problem areas in provision of perinatal care. Data concern general maternal statistics, structure of maternity services and organization of maternity and neonatal services. Similarities between the perinatal services of the countries surveyed outweigh local deficiencies in some aspects of care and organization. Information tabulated in this survey can serve as a stimulant to reach a better understanding of current health care for pregnant mothers and their newborns within the European Community.

Diagnosis and management of intrapartum fetal distress.

Fetal distress is a frequent reason for obstetric intervention during labour. The final diagnosis generally is based upon the information in the cardiotocographic tracings, whether or not combined with the information from fetal scalp blood sampling. Reading, classification and interpretation of fetal heart rate (FHR) recordings is subject to considerable interobserver variation, even among experienced obstetricians. Far too often, individual decelerations in the heart rate are classified as early or late, merely on the basis of the relationship between the decelerations and the accompanying contraction. Hon's original flow sheet for classification of decelerations dictates assessment of the full tracing with, as a primary step: are decelerations uniform or not? Non-uniform decelerations should automatically be classified as variable. Comparison between the onset of the deceleration and the uterine contraction curve is the second step. Variable decelerations are the predominant type in the majority of intrapartum recordings. Features in the FHR rhythm to be assessed in case of variable decelerations include assessment of the baseline level, presence or absence of accelerations, variability in the baseline pattern and during the decelerative part of the tracing, initial and secondary acceleration, overshoot following the deceleration whether or not with smoothing, recovery from the deceleration, continuation of the baseline level and the time intervals between contractions or recurrent efforts of pushing activity. The paper further addresses pathophysiologic mechanisms of fetal distress, maternal and fetal risk factors and various alternatives in the management of intrapartum distress.

Automated analysis of near-term antepartum fetal heart rate in relation to fetal behavioral states: the Sonicaid System 8000.

Fetal heart rate and fetal movements were recorded in 16 uncomplicated near-term pregnancies. The recordings were used to evaluate a system for automated fetal heart rate analysis (Sonicaid System 8000). Fetal rest-activity patterns were considered in the analysis. The mean duration of C2F periods "active sleep," 33 minutes) was significantly greater than that of C1F periods ("quiet sleep," 19 minutes) (p less than 0.001). The incidence of accelerations and decelerations and the overall fetal heart rate variations were greater during C2F than during C1F (p less than 0.001). In 11 of 16 C1F periods, the system classified the fetal heart rate variation as "questionable" or "abnormal." Episodes of high variation were identified in only 3 of 16 C1F periods, but they were found in all 18 C2F periods. Episodes of low variation were identified in 14 of the 16 C1F periods but were not found in any C2F periods. During C2F periods, the system's criteria of normality were met in all cases but one; they were not met during any of the C1F periods. Thus the diagnosis of fetal distress should not be based merely on the absence of accelerations, low fetal heart rate variation, or absence of episodes of high variation in recordings with a duration of less than 45 minutes.

Prenatal diagnosis of fetal tumors by ultrasonography.

Fetal tumors lead to serious illness or even death in the fetal or neonatal period. Problems vary from severe hydrops to underdevelopment of fetal organs. In some instances a tumor may cause mechanical obstruction during the birth process. Polyhydramnios frequently develops. Adequate prenatal diagnosis is of utmost importance. Timely detection of the fetal tumor prevents traumatic birth and postnatal care and treatment can be scheduled. This report is a review of the relevant recent literature and the tumors detected in our ultrasound unit between 1982 and 1988. The ultrasonographic appearance, clinical course, and differential diagnosis of the tumors are discussed.