Faculty Bibliography

Fifty-one women in labor had continuous monitoring of fetal scalp tissue pH, fetal heart rate by ECG, and uterine contractions. A miniature pH electrode secured by a double spiral fetal ECG electrode was used for measurement of fetal pH every 15 seconds. The results were correlated with fetal scalp blood pH values obtained simultaneously. Fetal scalp sampling is intermittent, requires repeated scalp incisions, is subject to errors due to air mixing and coagulation of the blood sample, and is uncomfortable for the parturient. Placement of the tissue pH electrode allows continuous data recording with the minimum discomfort to the patient and the least number of fetal scalp incisions. Clinical use of the tissue pH electrode might be a practical alternative to fetal scalp samples, if the data obtained accurately reflect fetal status

Continuous tissue pH monitoring was performed in 61 high risk pregnancies in labor. Useful data was obtained in 48 cases, and compared with fetal scalp blood pH and umbilical artery and vein blood pH. The relationshiip of tissue pH and fetal heart rate changes was analyzed. The tissue pH changes occurred within 2--3 min of the fetal heart rate change, and conformed to the expected fetal physiology of their heart rate pattern

Simultaneous magnetic tape recordings of fetal scalp ECG, maternal ECG and uterine contractions were obtained from 23 patients in active labor. Computer-derived distributions of beat-to-beat changes were used to develop a simple numerical and graphical description of the long and short-term variability patterns. The visually observed variability may be described by the R-R interval change (beat-to-beat change), which is greater than 90% of the total number of beat-to-beat changes. Thus, the 90th percentile of R-R interval changes quantitatively describes the baseline variability. The variability may be classified as fixed, minimal, moderate or marked, based on this simple calculation. Graphs of cumulative percentage of R-R interval changes provide additional visual information. The effects of meperidine HCl on the observed variability were easily detected and visualized by these methods

PIP: As part of a study of anemia associated with oral contraceptive use, serum vitamin B12 levels, unsaturated B12-binding capacity, and B12 binder fractionation were examined in 67 consecutive mildly anemic (hemoglobin levels below 13 gm%) women using oral contraceptives and 59 such women using other means of birth control. Results were correlated with hematologic parameters such as complete blood counts and evaluation of iron status. Hemoglobin levels were significantly lower (p 0.01) in the non-oral-contraceptive group, while serum iron levels were significantly higher (p 0.05) in the oral contraceptive group and fewer oral contraceptive users demonstrated iron-deficiency anemia. While no B12-deficient subjects were found, serum B12 levels were significantly lower among oral contraceptive users (p 0.05), but differences were more striking between iron-deficient and non-iron deficient subjects, regardless of oral contraceptive status (p 0.02). The role of iron status needs further clarification as the finding of higher serum B12 levels in iron-deficient subjects contrasts with previous reports of lower B12 levels in cases of disease-related iron deficiency. Moreover, the relationship between iron status and serum B12 level was significant only in the oral contraceptive group. Among pill users, iron deficiency was most frequent in those taking sequential rather than combination preparations (67 vs. 39%). Among non-oral-contraceptive subjects, iron deficiency incidence was 96% in IUD users. Serum unsaturated B12 binding capacity was unaffected by pill use, but pill users showed significantly higher transcobalamin I levels, correlating best with white blood cell counts. The assumption that this elevation reflects pill effect on protein synthesis is premature, even though a general increase in alpha 1-globulin has been reported in pill users. Transcobalamin II and 3rd binder levels were not affected and did not correlate with white blood counts. The correlation between UBBC levels and white blood cell counts was significant in both oral contraceptive and non-oral-contraceptive groups. In contrast to previous findings, UBBC could not correlated with any iron parameter. O

The Obstetric Intensive Care Unit (OBICU) at Bellevue Hospital in New York City has adapted intensive care and coronary care models to the care of patients in labor. During the past 3 years, 519 of the most serious of 2 250 high-risk obstetric patients treated at the hospital were monitored in the OBICU. There were two maternal and six perinatal deaths. The perinatal mortality rate of the very high risk population of the OBICU was 11.6/1 000, compared to 14.7/1 000 for all deliveries performed at the hospital. Our findings indicate that the OBICU system provides the ideal mechanism for the rapid and continuous control of symptoms in very high risk gravidas which is essential for stabilizing the patient, both for prompt delivery and for optimal maternal and fetal survival

Two cases of Takayasu's syndrome in pregnancy are presented. The obstetric courses of these women are compared with those of 7 others described in the literature. Symptoms of this rare condition may respond variably during pregnancy. Of the 9 women, 5 had worsening of their symptoms during gestation while 4 had milder symptoms than they had had prior to pregnancy. The best therapy is rest. Vaginal delivery is recommended and cesarean section should be reserved for obstetric indications

A case of fetal trigeminal cardiac arrhythmia in labor is presented. The literature on fetal cardiac arrhythmias is reviewed. The significance and management of abnormal fetal rhythms in labor is discussed. The majority of fetal arrhythmias in labor do not require therapy

One hundred forty-four toxemic patients were studied by continuous electronic maternal and fetal monitoring. Ninety-seven were treated by intravenous bolus of 2 g MgSO4 every 1-2 hours, and 47 by intravenous drip MgSO4 at a rate of 1 g/hour. Clinical doses of MgSO4 do not affect maternal ECG, temperature, uterine contractions, or fetal heart rate. Intravenous bolus administration is frequently associated with slowing of maternal respirations and hypotension and occasionally with transient apnea