ABSTRACT
The evaluation of amniotic fluid volume plays a major role in antepartum fetal surveillance. Although the definition of diminished amniotic fluid volume varies, this sign is considered by itself an indication for intervention in the near-term fetus. The interval of testing is predicated on the concept that amniotic fluid volume diminishes slowly (unquantified) as a result of developing hypoxia. We present six postterm pregnancies in which amniotic fluid volume diminished abruptly over 24 hours. Although one fetus died, the three babies delivered by cesarean section and the two babies delivered after a 2-day labor did well, despite obvious postmaturity syndrome, meconium staining, and variable decelerations. Apgar scores in the survivors were above 8, and pH results failed to confirm hypoxia. These data suggest the need to better understand the mechanisms regulating amniotic fluid volume.
Subject(s)
Amniotic Fluid/analysis , Pregnancy, Prolonged/physiology , Acute Disease , Biophysical Phenomena , Biophysics , Female , Fetal Monitoring , Humans , Infant, Newborn , Male , Pregnancy , Time FactorsABSTRACT
The case of a 28-year-old multiparous woman with an incarcerated gravid uterus is presented. This largely unknown entity invariably results in spontaneous abortion if untreated. Patients present with a characteristic and readily recognizable sign and symptom complex and ultrasonographic findings. Early diagnosis is emphasized and therapy is outlined.
Subject(s)
Pregnancy Complications/diagnosis , Uterus/pathology , Adult , Emergencies , Female , Humans , Pregnancy , UltrasonographyABSTRACT
Routine ultrasound may have a positive effect on obstetric outcome when determination of gestational age and placental localization are combined with evaluation for multiple gestation, congenital anomalies and growth retardation. The potential risk and benefit of obstetric ultrasound must be better understood before this procedure is used as a screening tool in large populations.
Subject(s)
Prenatal Diagnosis , Ultrasonography , Diagnosis, Differential , Female , Fetal Diseases/diagnosis , Fetal Growth Retardation/diagnosis , Gestational Age , Humans , Placenta/anatomy & histology , Placenta Previa/diagnosis , Pregnancy , TwinsABSTRACT
A review of 14 cases of fetal cardiac asystole greater than two seconds during labor revealed two distinct patterns. Type 1 episodes developed without warning in eight apparently healthy fetuses at the nadir of a variable deceleration. These episodes were both preceded and followed by normal to increased variability, stable baseline heart rate, and less dramatic variable decelerations. Analysis of the fetal electrocardiogram (ECG) complexes during the asystole revealed a normal QRS complex, either biphasic or absent P-waves, and occasional ventricular extrasystoles. One of eight fetuses in this group died; the remainder were delivered in good condition and required minimal resuscitation. The mechanism of type 1 episodes appears to be an exuberant vagal response to umbilical cord compression. Rapid intervention probably is not warranted. Type 2 episodes developed in seriously asphyxiated infants and frequently were preceded by absent variability and, usually, severe decelerations. The fetal ECG pattern during the episode revealed bradycardia with sinus rhythm. Five of the six infants with type 2 episodes died either in utero or in the neonatal period. Despite the ominous portent of type 2 patterns, rapid delivery appears to be indicated.
