The temporal association of the implementation of a fetal diagnostic and surveillance program and decreased fetal mortality in a private hospital

Article Abstract:

Diagnostic and surveillance (monitoring) programs have been shown to lead to substantially reduced fetal mortality among high-risk obstetrical patients. High-risk patients, however, tend to be concentrated in university hospitals, while private hospitals see a larger proportion of obstetrical patients at normal risk. It is possible that introduction of fetal diagnostic and surveillance programs could improve mortality among private hospital patients, as well. To determine this, mortality was assessed at a private hospital (the Latter Day Saints' Hospital, in Salt Lake City, Utah) before and after the introduction of a Fetal Diagnostic and Treatment Center. The Center was headed by a newly recruited fetal medicine specialist, and its program is described. It included antepartum testing through a newly established Antepartum Testing Center, and evaluated results from nonstress tests (NSTs), amniotic fluid measurement (the fluid in which the fetus floats), and assessment of blood flow in the umbilical artery (the artery that returns blood from the fetus to the placenta). Ultrasound examinations were also performed. Data regarding fetal and neonatal death and cesarean sections rates were recorded for two consecutive 15-month periods before the program started in October 1987, and for one 15-month period between October 1987 and December 1988. Results showed a dramatic decrease in fetal death rates from 6.09 per 1,000 (periods I and II) to 2.3 per 1,000 (period III, after the establishment of the Center). Prior to period III, 560 ultrasound examinations per 1,000 live births were performed; afterwards, the rate increased to 1,142. For fetuses older than 34 weeks' gestation, the decrease in death rate was 73.8 percent; decreases for younger fetuses, while considerable, did not reach statistical significance. No changes were noted in neonatal mortality (first six weeks after birth), but perinatal mortality (from week 28 of pregnancy through 28 days after birth) decreased from 8.76 per 1,000 to 4.42, a drop of about half. Clearly, improvement in fetal diagnosis and surveillance can lead to major improvements in mortality, even when implemented at a private hospital. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Diagnosis, Infants (Newborn), Newborn infants, Infant mortality, Obstetrics, Fetal death, Obstetrical diagnosis

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Antibiotic inhibition of bacterially induced fetal membrane weakening

Article Abstract:

Infections of the cervix and vagina during pregnancy are thought to cause premature rupture of the membranes surrounding the fetus (PROM). PROM is the leading cause of preterm delivery, that is, occurring before the 37th week of pregnancy. Although the exact mechanism involved in weakening the membrane is unclear, destructive enzymes produced by the bacteria may either alone or in combination with other factors impair and weaken the fetal membrane. Studies examining physical factors involved in membrane integrity have focused on the strength, bursting tension and elasticity of membranes in models set up in the laboratory. To see if bacterial-induced membrane damage can be prevented by antibiotics, clindamycin and erythromycin were added to the culture medium bathing fetal membranes that had been obtained immediately after delivery. Incubation with the bacteria Staphylococcus aureus weakened the fetal membranes by increasing bursting tension (maximum load to breaking point) and the work required to rupture, without affecting the elasticity of the membrane. Antibiotics prevented membrane impairment, bacterial growth and enzyme production. It is concluded that production of destructive enzymes by bacteria mediates the damage to fetal membranes and that antibiotics act to stop bacteria growth and eliminate membrane impairment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Erythromycin, Bacterial infections, Fetal membranes, Premature rupture of membranes, Premature rupture of the membrane, Clindamycin

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Fetal heart rate monitoring at home and transmission by telephone

Article Abstract:

A nonstress test (NST) is a method of assessing fetal well-being during normal uterine contractions and increased fetal activity. The fetal heart rate pattern is recorded and assessed. Although most NSTs are repeated every few days, some high-risk patients may require more frequent evaluations, performed on a daily basis. Since daily visits to a hospital or health facility can be difficult, particularly if the patient lives far from the facility, a home monitoring system has been developed. To see if home monitoring is effective and practical, 38 high-risk patients had transmitted results of 146 NSTs from their hospital rooms via the telephone to the hospital-based unit. The second phase of the study then compared 161 NST results from 34 women. Results of home monitoring unit were compared with those obtained by conventional in-hospital monitoring units. From a total of 72 patients, 307 transmission attempts were made, 93 percent of which were successful transmissions. A total of 282 (98 percent) were adequate for interpretation. Therefore, home fetal heart monitoring is a safe, reliable and feasible method of assessing fetal well-being in selected high-risk patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Fetal heart rate monitoring, Electronic fetal monitoring, Digital communications

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