Effect of ritodrine and betamethasone on metabolism, respiration, and circulation.

In order to obtain information on pharmacologic side effects of the most commonly used betamimetic in obstetrics, ritodrine (R) was infused under standardized, controlled conditions in one male and four nonpregnant female volunteers in increasing doses from 0.9 to 7.2 micrograms/kg/min. In second series, the same was done after premedication with 12 mg betamethasone (B), intravenously, 30 minutes before the start of the R infusion. Ritodrine caused increases in cardiac and respiratory work that were associated with rises in energy requirements and impaired efficiency of breathing. Premedication with betamethasone potentiated all side effects with the exception of diffusion capacity.

Comparison of ultrasonic and direct biparietal diameter measurements and placental localization.

The accuracy of fetal biparietal diameter (BPD) measurements and placental localizations performed by physicians in a university hospital obstetrical service using real-time ultrasound equipment was determined. The sonographic estimations were compared to caliper measurements on the neonate and to the implantation site of the placenta found at surgery in 40 patients undergoing repeat cesarean section. The correlation coefficient 0.93 and p less than 0.00001 indicate high agreement between the BPD measurements. The regression of caliper on sonar measurements gave 95% prediction intervals of +/- 3.50 mm compared to +/- 2.4 mm calculated from data reported by ultrasonic laboratories. Placental localization was in error in 5.9% of the cases. Thus, physicians should be aware that their errors are likely to be larger than those which have been published by experts in ultrasound diagnosis.

A sinusoidal-like fetal heart-rate pattern in association with fetal sucking--report of 2 cases.

A sinusoidal heart-rate pattern (SHR) is usually considered to signify fetal distress. Two cases are reported in which a sinusoidal-like fetal heart-rate pattern was caused by fetal sucking movements as observed by real-time ultrasonography. The patterns observed in these two fetuses were similar to that found in the neonate during suckling.

Effects of marijuana on human pregnancy, labor, and delivery.

We conducted a prospective study of the effects of marijuana use in 35 pregnancies. Thirty-six age- and parity-matched nonuser pregnancies were selected for comparison. (Users of other illicit drugs were excluded from study.) Users and nonusers were similar with respect to most potentially confounding prenatal risk factors, although users tended to come from lower income and educational background. Most adverse outcomes of pregnancy were too infrequent to allow reliable comparisons between the groups, but the infants born to users exhibited significantly more meconium staining (57%, versus 25% in nonusers). Significant differences in duration of labor were also observed. Possible reasons for these findings are discussed.

The effects of marijuana use during pregnancy. I. A preliminary epidemiologic study.

We conducted a prospective study of the effects of marijuana use in 35 pregnancies. Thirty-six age-and parity-matched nonuser pregnancies were selected for comparison. (Users of other illicit drugs were excluded from study.) Users and nonusers were similar with respect to most potentially confounding prenatal risk factors, although users tended to come from lower income and educational backgrounds. Most adverse outcomes of pregnancy were too infrequent to allow reliable comparisons between the groups, but the infants born to users exhibited significantly more meconium staining (57% versus 25% in nonusers). Significant differences in duration of labor were also observed. The findings were not altered by statistical adjustments for various prenatal differences between the groups. Possible reasons for these findings are discussed. We also address the implications of these findings for further research.

Heroin addiction and pregnancy.

Pregnant heroin addicts tend to be younger than nonaddicted pregnant patients, unmarried or separated from spouses, and a disproportionately large number are members of minority ethnic groups. Heroin addiction during pregnancy is associated with several significant medical and obstetrical complications and may result in both acute and chronic abnormalities in neonates. Malnutrition, venereal disease, hepatitis, pulmonary complications, preeclampsia and third-trimester bleeding are the most common maternal complications, while fetal death, intrauterine growth retardation, prematurity and withdrawal symptoms affect the fetus and neonate. There is controversy about treating addicts with methadone during pregnancy. The findings of studies in animals suggest that there may be a long-lasting drug-induced syndrome, characterized by growth retardation, delayed motor development and behavior abnormalities in offspring of heroin-addicted or methadone-treated mothers.

Blind oxytocin challenge test and perinatal outcome.

A total of 435 oxytocin challenge tests (OCT) were performed on 217 high-risk pregnant patients, and the test results were blinded. The results were correlated with late decelerations of the fetal heart rate during labor, Apgar scores at 5 minutes, a neonatal morbidity score, and perinatal mortality. The incidence of late decelerations during labor was 17% in the negative group, 24% in the suspicious group, and 33% in the positive group. The correlation of OCT results and the various measures of fetal outcome indicated that an individual fetus at risk cannot be identified with a high degree of accuracy since 67% of the tests were false positive and 17% were false negative. Even when the OCT was positive, 61% of infants did not have late decelerations in labor, low Apgar scores, or significant neonatal morbidity. When elective delivery has been decided upon after consideration of all clinical information, induction of labor rather than primary cesarean section is usually indicated. In this study 78% of patients were delivered vaginally with no significant increase of cesarean sections in the positive and suspicious groups as compared with the negative group.