The differential neonatal morbidity of the intrauterine growth retardation syndrome

Article Abstract:

Intrauterine growth retardation (IUGR) is a complication of pregnancy in which the fetus fails to develop and mature normally. Infants born with IUGR are more likely to experience complications and congenital malformations. Investigators have found that there are two subgroups of growth-retarded fetuses. One group consists of infants who experience growth retardation for a short period of time. In these cases the weight is reduced but there is a lesser reduction in length (disproportionate IUGR). The other group consists of fetuses with a proportionate decrease in both weight and length (proportionate IUGR). The complication and death rates were studied among both groups of growth-retarded infants. The infants were divided according to their birth weight/length relationship (ponderal index). There were 432 infants (12.5 percent) with a low ponderal index (disproportionate IUGR), 936 infants (27.1 percent) with intermediate ponderal index, 2,030 infants (58.8 percent) with adequate ponderal index (proportionate IUGR) and 52 infants (1.5 percent) with a high ponderal index. The relationship between ponderal index and complications such as low Apgar score (a measurement of fetal well-being performed at one and five minutes after birth), aspiration syndrome (breathing in of fetal stool in the amniotic fluid), hypoglycemia (low blood sugar) and fetal asphyxia (decreased oxygen supply to the fetus) were studied among IUGR fetuses. Infants with a low ponderal index (those infants with a disproportionate weight/length ratio) were between 1.6 and 12.5 times more likely to develop a complication than infants with an adequate ponderal index. Infants with a low ponderal index were two times more likely to stay in the hospital for more than one week. In addition, infants who had normal birth weights but a low ponderal index were also more likely to develop complications in the newborn period. Therefore, the lower the ponderal index, the greater the chances of a complication arising in the newborn period. The risk increases the longer the growth-retarded infant remains inside the uterus. Therefore, IUGR fetuses should be delivered as soon as physical lung maturity has been established to avoid further damage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Fetus, Birth weight, Low, Low birth weight, Infants (Newborn), Newborn infants, Fetal growth retardation, Infant development

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The measuring of blood pressure during pregnancy

Article Abstract:

Blood pressure measurements are usually obtained at every prenatal visit to screen for increases in blood pressure. Accurate blood pressure determinations are necessary for the diagnosis of pregnancy-induced hypertension, a potentially serious complication of pregnancy. The current methods of blood pressure measurement are not standardized and may be performed by many different healthcare providers. To evaluate the method of blood pressure measurement in pregnant women, 149 patients were tested. Blood pressure is measured by two numerical values: diastolic blood pressure, the lower number, indicates the pressure exerted on the wall of the arteries at rest, in between heart contractions; systolic pressure is that exerted on the walls of the blood vessels during heart contractions, when blood is being pumped into the arteries. The values obtained by the clinic staff and project coordinators were compared. A very accurate type of blood pressure measuring device, a random-zero sphygmomanometer, was used by the project coordinator to prevent the last digit from being rounded off. The clinic staff used the traditional device used for blood pressure measurement. The project coordinator had higher measurements for diastolic pressure and lower measurements for systolic pressure. Both values increased as the pregnancy progressed towards delivery time. The clinic staff measurements had more rounding off (50 percent) than the project coordinator (14 percent), indicating that staff measurements were less accurate. Suggestions to improve blood pressure determinations include training staff, using more accurate and standardized measurement devices, using the average of three measurements, using the right arm above the level of the heart while sitting and recording the fourth heart sound heard (the Korotkoff sound). The use of automated devices is not recommended. Adherence to a strict method of blood pressure measurement is essential for adequate prenatal care.

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Blood pressure self-monitoring during pregnancy: practical considerations

Article Abstract:

Accurate determination of a pregnant woman's blood pressure is important for monitoring maternal and fetal health, but measurements made in the course of regular prenatal visits can be misleading. ''White coat hypertension'' (blood pressure elevation at the sight of a physician or nurse, due to anxiety about the visit) may be confined primarily to that setting, and information is needed about blood pressure levels in other settings, such as home or work. For this reason, self-monitoring approaches have been developed. These are described and evaluated. Portable electronic and mechanical devices (sphygmomanometers) are readily available that use a non-liquid medium (aneroid; not mercury) to determine pressure. The values obtained by patients in their own homes are lower than clinic values in half the cases; they are almost never higher. Electronic devices are easier for pregnant patients to use than mechanical ones; no stethoscopes are required, and the cuffs are easy to position. These need recalibration periodically in the physician's office. According to Consumers Reports, the mechanical monitors are more accurate than some complex electronic devices. They are also somewhat less expensive (between $18 and $30, versus $40 or more). Self-monitoring of blood pressure is recommended for all pregnant women whose pressure reaches 140/90 in the office. After careful training by office staff, patients record their blood pressures at predetermined times, or whenever they suspect an elevation. Values are recorded on a form. The major potential drawback to self-monitoring of blood pressure is the possibility of errors. The advantages include more accurate measurement of the true blood pressure, which may allow women to be taken off antihypertensive medication that was not needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Equipment and supplies, Self-care, Health, Self care (Health), Sphygmomanometer, Blood pressure monitors

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