Maternal perception of preterm labor: is it reliable?

The objective of this study was to determine the reliability of maternal perception of uterine contractions and the influence of gestational age and maternal training on the perception level. Three hundred fifty patients at high risk for preterm delivery were followed from 20 to 35 weeks of gestation. The average maternal perception (79%) of contractions did not significantly vary as a function of gestational age. Four groups of women were identified according to the perception index (PI) defined as the ratio of contractions felt by the mother and the contractions documented by tocodynamometer. Within each group, the PI did not significantly vary during consecutive monitoring sessions, as the women become more familiar with self detection of uterine contractions (R < .65, P > .95). Twenty-one percent (+/-5%) of all preterm uterine contractions were not perceived by the pregnant women from 21 to 35 weeks. Thirty-two patients (9.1%) fail to perceive most or all uterine contractions while 189 (54%) detect most or all at any time during the study period.

Clinical assessment of gestational age: a comparison of two methods.

The ratio of fundal height (FH) to maternal abdominal length (MAL) was defined as percentage of maternal abdominal length (PMAL) and compared to FH alone in 100 consecutive uncomplicated pregnancies from the 18th week of gestation to delivery at term. Reference graphs for fetal growth evaluation were developed using these two clinical methods. The predictive value of each technique was assessed by comparing gestational age estimates in 29 additional patients at various gestational ages. The correlation coefficient between the known gestational ages and estimates by the PMAL method was .86, and between known gestational ages and estimates by the FH method, .94. Twenty more patients were evaluated by three obstetricians in a double-blind fashion to determine gestational ages by each technique. The average deviation from the real gestational age varied from 2.07 to 3.14 weeks using the FH method, and from 2.82 to 3.97 weeks using the PMAL graph. It was concluded that FH measurement correlates better with gestational age than its ratio to the MAL.

Percentage of maternal abdominal length for detecting accelerated uterine growth from a twin gestation.

Serial measurement of the uterine fundal height (FH) is the clinical parameter used most commonly in the assessment of fetal growth. A comparison of the FH value with its ratio to the symphysioxyphoid distance, or percentage of maternal abdominal length (PMAL), using two reference graphs, showed that the PMAL is a more sensitive parameter than FH alone in detecting accelerated uterine growth secondary to a twin gestation.

Fetal heart rate decelerations after oxytocin infusion in an abdominal pregnancy.

Fetal heart rate (FHR) decelerations during a contraction stress test are recognized as signs of possible uteroplacental insufficiency. Although these decelerations have been described commonly in intrauterine pregnancies, they have not been noted in extrauterine pregnancies. Reported herein are FHR decelerations associated with oxytocin infusion in an extrauterine pregnancy and a discussion of the possible pathophysiologic mechanisms.

Relationship of ultrasound findings after cesarean section to operative morbidity.

Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have noted fluid collections around the incision site. In this report of 100 postcesarean section patients, it is noted that echo-free areas anterior to the incision site, which correspond to the described fluid collections, were present in 29% of patients and were more frequently found in patients with excess blood loss at surgery. Patients whose echo-free areas were greater than or equal to 3.5 cm were significantly more likely to have postoperative morbidity. The significance of these findings and the role of ultrasound in the evaluation of the postcesarean section patient are discussed.