RESUMO
A protocol for antepartum supervision which included "non stress fetal monitoring" (NSFM) and the "oxytocin Challenge Test" (OCT) was followed in a series of 640 high-risk pregnancies. The perinatal mortality in this group was compared with that obtained in a group of 3,049 non-selected deliveries which occurred during the same period of time and which were not monitored in the same way. The perinatal mortality which could be attributed to placental insufficiency in the first group (the supervised group) was at 4.68 per 1000, about half that of the non-supervised group (8.72 per 1000) in spite of the low number of high risk cases in the second group. When NSFM was normal in the week before delivery there was no single perinatal death due to placental insufficiency. When the NSFM was normal and the OCT was pathological the OCT Test was probably wrong. When the NSFM test was non-reactive placental insufficiency could be predicted in only 28 per cent of the cases although a combination of NSFM with a positive OCT Test predicted correctly 91.3 per cent of the cases of placental insufficiency. We consider that there is fetal distress due to placental insufficiency when having found signs indicative of fetal distress in delivery (a pH of less than 7.25, recent passage of meconium, the Apgar score less than 7 in the first minute, and pathological fetal heart rhythm (RFC) we can find no other cause to explain the signs such as a short cord, prematurity, obstetrical trauma, prolonged pregnancy and malformations, etc.
