Maternal perception of decreased fetal movement as an indication for antepartum testing in a low-risk population

Article Abstract:

More than half of all infants who die in the perinatal period (between the 28th week of pregnancy and the 4th week after delivery) die before birth. While the use of ultrasonography and external fetal monitoring devices would be effective in identifying problems, a more inexpensive and less complex approach is maternal assessment of fetal activity. A study was performed that compared the results of fetal testing with the mothers' impressions of decreased fetal movement. Two hundred ninety two patients at different stages of pregnancy were included. They had been instructed, as part of the standard treatment protocol, to report any period during which the fetus moved fewer than four times per hour for two consecutive hours, to the physician. The patients were first evaluated by an obstetric nurse; 62 had an abnormality that required further study. Fetal death had occurred in five cases (1.7 percent). Three of these patients were less than 37 weeks pregnant, and none had any known medical or obstetric problems. The infants did not have birth defects. None of the remaining patients with abnormalities experienced a fetal death. Thirteen women (4.4 percent) needed immediate delivery because of abnormal heart rate, abnormal biophysical profile scores (a composite measure of fetal function), insufficient amniotic fluid (oligohydramnios), or preeclampsia (a condition of high blood pressure and edema that can become very serious). These pregnancies ranged in gestational age from 35 weeks to 41 weeks and 5 days. In another 17 cases (5.8 percent), abnormal results on the fetal heart rate test required further examination. Fourteen of these women had vaginal deliveries at term; two of the remaining three had fetuses with intrauterine growth retardation. The fetuses that can best be helped by maternal evaluation of fetal movement are those affected by previously unsuspected uteroplacental insufficiency (insufficient blood flow between the uterus and placenta). Pregnant women with decreased fetal movements but normal results from a nonstress test (which monitors fetal movements) and ultrasonography do not need follow-up testing. However, even low-risk women who complain of decreased fetal movement should be evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Fetal death, Fetal movement, Fetal movements

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Automated blood pressure measurements in laboring women: are they reliable?

Article Abstract:

Blood pressure measurements obtained by automated monitoring devices appear to differ significantly from those obtained by the standard auscultatory method in women during labor. Blood pressure was measured three times by both the automated device and the standard method in 30 women in active labor, in 20 full-term pregnant women and in 20 non-pregnant healthy women. There were no significant differences in blood pressure readings obtained using the two methods in the non-pregnant women. Diastolic pressure readings obtained by the automated device were slightly lower than those obtained by the standard method in the pregnant women. Among women in labor however, the automated device gave significantly higher systolic readings and significantly lower diastolic readings than the standard method. The average blood pressure was the same using both methods, indicating that treatment decisions for high or low blood pressure during labor should be based on the average pressure if automated devices are used.

Evaluation, Medical equipment, Blood pressure, Blood pressure measurement

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Condition-specific antepartum fetal testing

Article Abstract:

A study is conducted to determine the best available antepartum fetal testing methods according to the underlying pathophysiologic condition. It is recommended that the nature of the risk to the fetus be determined on the basis of clinical information, which is followed by condition-specific antenatal fetal testing, an approach that takes into account essential pathophysiologic processes.

United States, Diagnosis, Fetal diseases

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