Elective hospitalization in the management of twin pregnancies

Article Abstract:

Premature birth is the most common cause of infant death in pregnancies involving twins. Other causes include retarded growth of the fetus, maternal high blood pressure and fluid retention caused by pregnancy (preeclampsia), compression of the umbilical cord and birth defects. Several different strategies have been tried in attempts to reduce the incidence of infant mortality in pregnancies involving twins. These preventive treatments include progesterone therapy, beta-agonist drugs (to lower blood pressure) and bed rest. The most frequently prescribed therapy is bed rest. However, whether bed rest actually reduces the incidence of premature birth is a controversial issue. Several studies have reported that hospitalization and bed rest reduce the incidence of premature birth in pregnancies involving twins, while others have found no benefit from bed rest. To further investigate this issue, the complications and outcomes of twin pregnancies were determined during a two-year period when an elective hospitalization policy (allowing women to choose hospitalization for weeks 24 to 34 of pregnancy) was in effect (134 women) and during another two-year period when there was no elective hospitalization policy (177 women). Fifty-eight (43 percent) of the 134 women with twin pregnancies occurring during the elective hospitalization policy period elected to be hospitalized. During this same period, 46 of the women who elected not to be hospitalized actually required hospitalization for different complications associated with their pregnancies. Of the 177 women who became pregnant during the period when there was no elective policy, 79 (45 percent) required hospitalization for specific problems. The remaining women from both groups were monitored as outpatients during their pregnancies. Thirty-two percent of the births occurring during the policy period were premature, compared with 36 percent when there was no elective policy. Morbidity (the rate of nonfatal complications) was the same during both periods (12 and 11 percent for the policy and nonpolicy periods, respectively), while the rate of infant death was higher during the policy period (8 percent compared with 2 percent when there was no elective policy). The incidence of premature birth was the same among the 58 women who elected to be hospitalized as for those who were not hospitalized. It is concluded that elective hospitalization does not influence the outcome of pregnancies involving twins, and that hospitalization has no effect on the incidence of premature birth. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Finance, Hospital patients, Prenatal care, Multiple birth

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Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection

Article Abstract:

Infection of the amnion (the inner layer of membranes surrounding the fetus) can lead to complications in the newborn baby, such as sepsis (systemic infection), meningitis (infection of the membranes surrounding the brain), and pneumonia. Another consequence of infection of the amnion is purported to be asphyxia of the infant during delivery; since the causes of many neurological abnormalities in newborns remain unexplained, asphyxia resulting from intra-amniotic infection is often used as an explanation, and a basis for litigation. Asphyxia of the newborn results in a state of insufficient oxygen (hypoxia), which, in turn, produces changes in the infant's acid-base balance. Metabolic acidemia (a blood pH that is too low, indicating an acidic condition) can be diagnosed by testing the blood in the umbilical cord. To determine whether, in fact, intrapartum (during birth) asphyxia and fetal acidemia are prevalent in babies born to women with intra-amniotic infection, 123 women with such an infection were studied. Another 6,769 women without signs of intra-amniotic infection were included as a control group. Data from routine sampling of umbilical cord blood were used, and asphyxia was said to exist when all three of the following occurred: metabolic acidemia; low Apgar scores (physical measures of the infant taken right after birth); and seizures during the first 48 hours of life. The overall incidence of chorioamnionitis (inflammation of the membranes surrounding the fetus) was 1 percent. Results showed that the average pH of the umbilical artery was the same for both groups, with no difference in the frequency of acidemia between the infected women and controls. However, more infants in the infected group than the control group had Apgar scores of 6 or less at one and five minutes after birth, levels that conventionally define asphyxia. More mothers in this group received general anesthesia. No infant in either group satisfied all three criteria for birth asphyxia. Thus, it appears that, although intra-amniotic infection may lead to neonatal complications and death, it is not generally associated with asphyxia as defined here. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Causes of, Complications and side effects, Asphyxia, Fetal anoxia, Chorioamnionitis, Amnionitis

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Pathologic fetal acidemia

Article Abstract:

Fetal acidemia, abnormally low pH of fetal blood, is associated with an increased risk for neonatal neurologic dysfunction and death. Traditionally, an umbilical artery blood pH of less than 7.20 at birth is defined as acidemia, although pathologic problems related to acidemia are rarely seen unless the pH is much lower than 7.20. To clearly define pathologic fetal acidemia, this study examined the pH levels at which major pathologic problems occurred. All hospital births occurring between March 1, 1988 and May 31, 1990 were evaluated for acidemia. Of more than 30,000 births, 3,506 newborns had an umbilical artery pH of less than 7.2. These cases were divided into five pH groups; neonatal outcomes were examined and compared among the groups. The pH was less than 7.0 in 87 infants, between 7.00 and 7.04 in 95 infants, between 7.05 and 7.09 in 290 infants, between 7.10 and 7.14 in 798 infants, and between 7.15 and 7.19 in 2,236 infants. Frequency of placental abruptions, fetal heart rate decelerations, and meconium increased as pH decreased. Cesarean delivery was required significantly more often in cases where pH was less than 7.05. The frequency of neonatal deaths and unexplained seizures was significantly greater when the pH was less than 7.00. The frequency of all seizures was significantly greater when pH was less than 7.05. These results indicate that a pH of less than 7.00 would be accurate for defining pathologic fetal acidemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Abnormalities, Fetus

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