Effect of maternal carbon dioxide inhalation on human fetal breathing movements in term and preterm labor

Article Abstract:

A healthy fetus exhibits irregular, yet frequent breathing movements in utero. As labor approaches, the frequency of these movements decreases measurably. This phenomenon has a possible use as an indicator of true labor. Because breathing movements may cease for 30 minutes or longer in up to 10 percent of healthy fetuses of non-laboring women, a prolonged observation period is necessary to diagnose true labor. This study examined whether administering carbon dioxide to mothers to induce hypercapnia, or increasing levels of carbon dioxide in the mother's blood, would stimulate breathing in fetuses when labor is not occurring, but not stimulate breathing during labor. A group of healthy pregnant women volunteered for the study. When they entered the hospital for labor or suspected labor, breathing movements of the fetuses were monitored. The women were given air containing three percent carbon dioxide if the movements were greatly decreased or absent. The subjects included 14 women in labor at term and 34 women with suspected labor prior to term. In the 14 women at term, fetal breathing movements were detected in two fetuses before and five fetuses after carbon dioxide inhalation, but the movements were decreased and did not increase with the inhalation. In the 34 preterm women, 5 were actually in labor. In these five fetuses, breathing movements decreased from 4.1 to 0 percent after carbon dioxide was given. Of the women who were not in labor, 21 fetuses showed decreased breathing movement which increased from 4.8 to 37.1 percent when carbon dioxide was given. When fetal breathing movements are decreased and carbon dioxide inhalation results in significantly increased movement, the mother is not in labor. On the other hand, following carbon dioxide inhalation by a woman with decreased fetal movements, no change or a decrease in breathing movements indicates that the mother is in labor. These results indicate that this method may be valuable in determining if a preterm women is in labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Fetus, Physiological aspects, Carbon dioxide, Labor (Obstetrics)

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Infant survival following delayed postmortem cesarean delivery

Article Abstract:

The successful delivery of a healthy infant whose mother had been shot dead is reported, to illustrate that, even when the interval between fatal maternal injury and delivery is quite long, a normal infant can be delivered. The woman was shot 25 minutes before the paramedics arrived, and they were unable to note signs of heart or respiratory activity. Nor were they able to detect fetal heart sounds or insert an intravenous line. Forty-seven minutes after injury, cesarean delivery was performed at the hospital after an intravenous line was inserted into an abdominal artery. The female infant was limp, with a heart rate of 30 beats per minute, and underwent active resuscitation. The estimated gestational age was 32 weeks. A seizure occurred and respiratory distress syndrome (extreme difficulty in breathing) developed; however, by 27 days of age, the infant could breathe room air. When discharged at the age of two and one half months, the infant had poor muscle tone and gag reflexes. However, examination at 18 months of age indicated normal development and no evidence of neurologic damage. Prompt cesarean delivery after grave injury can improve the chances of survival for both mother and infant. This case suggests that injury to delivery intervals longer than the previously recommended 15 minutes can lead to positive outcomes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, First aid in illness and injury, First aid, Cesarean section, Resuscitation

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Septic shock complicating drainage of a Bartholin gland abscess

Article Abstract:

The first case report is presented of a patient who developed septic shock (widespread, bloodborne infection) after surgical drainage of an infected Bartholin gland (mucous-secreting glands in the vaginal wall). After the procedure, the patient left the emergency room, refusing to allow the abscess cavity to be packed with gauze. Four hours later, she returned with fever and chills; her condition rapidly deteriorated. The patient was admitted to the intensive care unit, where she underwent treatment with antibiotics. The abscess cavity was packed. The patient recovered and was discharged home, with oral antibiotic therapy. An abscess of the Bartholin gland represents an acute bacterial infection; nonetheless, complications after treatment rarely occur. The three other reported cases in which sepsis occurred in association with a Bartholin gland abscess were detected before the abscess was drained. The results in this case report suggest that patients should be observed for a period of time following the drainage of an abscess of this type. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Complications and side effects, Septic shock, Drainage, Surgical, Abscess, Drainage (Surgical), Bartholin's gland, Bartholin's glands

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