Antepartum surveillance for a history of stillbirth: when to begin?

Article Abstract:

Surveillance tests of fetal well-being should probably not begin before 32 weeks gestation in healthy women who have had a prior stillbirth. Tests before this point are likely to produce false positives because of fetal immaturity and are unlikely to identify a threatened infant. Between 1979 and 1991, 300 women who had had a stillbirth in a prior pregnancy underwent fetal surveillance testing. Overall, 6.4% had a positive surveillance test, and 13.6% of deliveries were effected after positive or equivocal tests. All three women with a positive test prior to 32 weeks gestation gave birth to healthy babies at term. Three women were delivered before 36 weeks gestation for a positive test, of whom one fetus was clearly compromised. That mother had a cesarean for fetal distress. The other two babies had no problems. One woman had another stillbirth. She had had two prior unexplained term stillbirths. The third death occurred only hours after a normal test. Again, the cause was unknown.

Evaluation, Testing, Risk factors, Fetal heart rate, Prenatal diagnosis, Still-birth, Stillbirth

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Meconium has no lecithin or sphingomyelin but affects the lecithin/sphingomyelin ratio

Article Abstract:

There appears to be a substance in fetal meconium that could interfere with tests to determine fetal lung maturity. Meconium is a substance in the fetal intestines that is the fetal equivalent of feces. Researchers tested samples of meconium from 20 newborn infants for naturally occurring chemicals called lecithin and sphingomyelin. The levels of these chemicals in amniotic fluid are used to determine fetal lung maturity. Although the chemicals were not detected in meconium, an unknown chemical with a similar structure was detected. This indicates that meconium in amniotic fluid could interfere with the test.

Analysis, Measurement, Lecithin, Meconium

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