[Administration of pethidine in labor with meconium contaminated amniotic fluid: effect on fetal outcome and respiratory disorders]. / Pethidin-Anwendung bei Geburten mit mekoniumhaltigem Fruchtwasser: Einfluss auf fetal outcome und respiratorische Störungen.

OBJECTIVE: The aim of the study was to evaluate the effects of maternal pethidine administration on fetal outcome and incidence of neonatal respiratory distress in deliveries with meconium stained amniotic fluid (MAF). STUDY DESIGN: Between 1989 and 1992, 849 live infants had MAF. For pain relief during labor 214 women received pethidine 50-150 mg i.m. The control group included 401 infants with MAF, who were not exposed to sedatives, analgesics, and anesthetics during labor. Fetal cord pH, Apgar 1 min (A1), Apgar 5 min (A5), and incidence of respiratory distress were compared retrospectively between the groups. Statistics and calculations were done by means of uni- and multivariate analyses. RESULTS: The presence of thickened MAF increased significantly the risk of low A1, low A5, low arterial cord pH, and the incidence of respiratory distress (p = 0.003, = 0.0003, = 0.016, = 0.000). Infants with thickened MAF, low A1, and low fetal cord pH proved to have an exceedingly high risk of respiratory distress. The application of pethidine (0 mg, 50 mg, 100-150 mg) does not discriminate the variables as arterial cord pH, A1, A5, and the incidence of respiratory distress significantly. However the medium cord pH values of infants without pethidine (7.27, s = 0.075) and with 100-150 mg pethidine (7.25, s = 0.078) were significantly different (p = 0.0006). The incidence of arterial pH, 7.10 did not differ significantly in cases with different pethidine doses. CONCLUSIONS: Thickened MAF is an obstetric hazard with small but significantly increased risks for poor fetal outcome and neonatal respiratory distress. This study failed to identify additional neonatal risks engendered by use of pethidine in cases of MAF.

[Fetal heart rate monitoring in the upright pregnant woman]. / Die fetale Herzfrequenzüberwachung bei der stehenden Schwangeren.

In a prospective study were performed methods for electronic supervision in 163 lying and standing patients beyond the end of pregnancy. Results of the nonstress test (NST) and standing challenge test (SCT) were correlated with late and severe variable decelerations of fetal heart rate during labor, Apgar scores at 5 minutes and pH in arterial cord blood. The correlation of NST and SCT results and the various measures of fetal and neonatal condition indicated that an individual fetus at risk cannot be identified with a high degree of accuracy. There were no significant differences for sensitivity, specificity, positive predictive value and negative predictive value if NST were compared with SCT. The clinical implications of these findings are discussed.

[Prevention of meconium aspiration]. / Untersuchungen zur Prophylaxe der Mekoniumaspiration.

The aim of the study was to determine the risk of meconium aspiration by perinatal and obstetric characteristics and to give directions for prophylactic management. 67 infants with meconium-stained amniotic fluid received intrapartum pharyngeal suctioning and postpartum direct laryngoscopy and suctioning of the trachea. The risk for the presence of meconium in airways is increased if meconium is visible at the vocal cords (p less than 0.01), amniotic fluid showing thick meconium staining (p less than 0.001) Fischer-score being below 7 points (p less than 0.05) or Apgar-score being below 8 points(p less than 0.05). Immediately after delivery inspection of the vocal cords is necessary by direct laryngoscopy. Suctioning of the trachea under direct vision after delivery should be done if meconium is visualized at the vocal cords. Meticulous care of the fetus exposed to a meconium containing amniotic fluid environment and the avoidance of acute fetal stress may decrease the incidence of meconium aspiration.