Effects of hypertension on pregnancy monitoring and results

Article Abstract:

Hypertension in pregnancies is associated with complications such as poor fetal growth, fetal distress, and increased infant death at the time of delivery. The incidence of these complications is thought to increase with severity of hypertension. The effect of hypertension is thought to be mediated through constriction of peripheral blood vessels, which should be reflected in abnormal patterns of fetal heart rate (FHR). The association between severity of hypertension and altered FHR patterns was assessed from the records of 666 pregnant women with hypertension. Half of the women had blood pressure between 125/75 and 135/85 (group one), 38 percent had blood pressure up to 150/100 (group two), and the remainder had pressure readings over that level (group three). Up to 85 percent of premature deliveries (occurring before 36 weeks of gestation) were to the women in groups two and three. As hypertension worsened, the rate of cesarean sections increased because of increasing fetal distress. Rather than oscillating normally, FHR in group three significantly more often had a fixed baseline level. Tachycardia, rapid heart beat, tended to occur more often in this group as well, but not to a significant extent. Significantly more infants in group three also scored lower on indexes of cardiovascular function at birth, indicating neonatal depression. This was particularly related to FHR characterized by fixed baseline and late decelerations. Perinatal (last trimester and first month of birth) mortality increased with the severity of hypertension, but neonatal death was related only to lack of the fetus' reaction to nonstress testing of the mother prior to delivery. FHR was not predictably affected by drugs commonly used to treat maternal high blood pressure. The study suggests that close maternal and fetal monitoring should allow appropriate intervention and reduce illness and death related to maternal hypertension. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prognosis, Fetal heart rate monitoring, Electronic fetal monitoring, Hypertension in pregnancy, Gestational hypertension

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Maternal-fetal outcomes in prolonged pregnancy

Article Abstract:

The normal period of gestation, from conception to delivery, is 40 weeks. Pregnancies continuing beyond 42 weeks (294 days from the last menstrual period) can result in poor outcomes for the infant and mother. To reduce the number of deaths from a prolonged pregnancy, most practitioners will use drugs which induce labor. The effect of a prolonged pregnancy on the mother and fetus was evaluated in 379 pregnancies continuing beyond 42 weeks gestation. The fetal heart rate, the characteristics of the labor and delivery, and the infant outcome were monitored. Labor was drug-induced in 48 percent and augmented in 28 percent of the women. Cesarean delivery was performed in 13 percent of the patients and delivery was assisted by forceps in 15 percent of the deliveries. The birth canal was unable to accommodate the passage of the infant in 60 percent of the cesarean sections and 13 percent of the infants were too large to deliver vaginally. Particularly fast fetal heart rates were detected in 39 percent of the infants. Inducing labor did not increase the need for cesarean section. It was concluded that preventive measures such as labor induction are a justified intervention in the treatment of prolonged pregnancies.

Health aspects, Patient outcomes, Mortality, Causes of, Infants, Infant mortality, Pregnancy, Complications of, Pregnancy complications, Infant care, Gestational age

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Active management of prolonged pregnancy

Article Abstract:

Induction of labor may reduce the number of complications and deaths among newborns with a prolonged gestation, or those who are delivered 14 or more days past their predicted due date. Among 12,930 infants who were delivered at the same hospital between Jul 1980 and Dec 1984, 707 were delivered 14 or more days past their predicted due date. The number of deaths was significantly higher among infants with prolonged gestation than among infants with a normal gestation length. Of the women with prolonged gestation, labor started spontaneously in 62% and was induced in 38%. None of the infants for whom labor was induced died, compared with approximately 2% of those for whom labor started spontaneously. One of the complications that can occur in infants with prolonged gestation is passage and inhalation of meconium, a green mucilaginous material in the intestines of a full-term fetus.

Management, Labor (Obstetrics), Pregnancy, Protracted, Post-term pregnancy

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