Faculty Bibliography

A trial of intravenous dexamethasone for prevention of neonatal respiratory distress syndrome was carried out prospectively. There were 112 treated and 188 control patients, matched for gestational age, birth weight, rupture of membranes, and antepartum diagnosis. No short-term deleterious effects on mother or infant were demonstrable. There was an increased incidence of cesarean section and puerperal infection in the treated patients. This was not related to the steroid therapy. There was no increased incidence of infection in the treated neonates. At 28 to 33 weeks' gestation, the treated newborn infants had one half the perinatal mortality and one fourth the incidence of severe respiratory distress syndrome seen in the controlls. Under 28 weeks, and from 34 to 36 weeks, no difference between treated and control groups was observed. Intravenous dexamethasone is effective in reducing perinatal mortality from respiratory distress syndrome in premature infants delivered between 28 to 33 weeks' gestation

Continuous tissue pH, scalp blood pH, and umbilical artery pH were studied in 89 patients with variable decelerations and 5 control patients in labor. The characteristics of the variable decelerations were analyzed. The deceleration pattern was classified as variable without late component (V), variable with late onset (VLO), or variable with late recovery (VLR). The patterns with a late component showed a greater incidence of falling pH during the decelerations. The VLR pattern was very likely to show a tendency to fetal acidosis and a high incidence of low Apgar scores. Variable decelerations without a late component were found to be innocuous. The VLO was an intermediate pattern, often progressing to the potentially more hazardous pattern of VLR

The use of internal monitoring, in which an electrode is attached to the fetal scalp, may be associated with serious complications. The authors present a case of fetal neonatal sepsis due to herpesvirus arising at the electrode site

Two cases of SHR in labor monitored by continuous fetal tissue pH measurements are presented. Both showed onset of the pattern in the absence of fetal acidosis, a fall in TpH following the appearance of the abnormal FHR pattern, and fetal compensation with a good perinatal outcome. These patients demonstrate that the fetus may tolerate a SHR and recover from preacidosis and acidosis. Continuous pH measurement may be helpful in conservative management of patients with abnormal FHR patterns

Sixteen cases of SHR are analyzed with respect to perinatal outcome, fetal scalp and umbilical arterial pH, and characteristics of the FHR pattern. There were no perinatal deaths in this series. The SHR is defined and a plan for management of the patient with SHR is proposed. A theoretical explanation of the pathophysiology of SHR is presented in terms of a fetal compensatory mechanism for hypoxia, based on these observations as well as a review of the literature. Biochemical data may provide valuable information permitting optimal management of patients with SHR patterns