Fetal monitoring during labor.

For three decades, cardiotocography has been the basic technique for fetal surveillance during labor, but its impact on fetal well-being remains controversial. The benefits and disadvantages of fetal monitoring with cardiotocography during labor are reviewed. Special reference is made to the possible effect on the rate of neonatal seizures in newborns and their long-term outcome.

Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases.

Background: Description of incidence, clinical signs, symptoms, and consequences of eclampsia in Scandinavia, and assessment of substandard care and potential preventability.

Methods: A descriptive cohort study including all women giving birth in a 2-year period (mid-1998-mid-2000) in Scandinavia. Notifications of eclampsia cases were obtained from all obstetric units at 3-monthly intervals.

How often is a low 5-min Apgar score in term newborns due to asphyxia?

Objective: To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia.

Study Design: A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10.

Pragmatic comparison of beta2-agonist side effects within the Worldwide Atosiban versus Beta Agonists study.

Objective: While beta2-agonists for the acute treatment of preterm labour unequivocally reduce the odds of delivery within 48 h and 7 days, they have been associated with substantial maternal and fetal side effects. We aimed to compare side effect profiles of beta2-agonist tocolytics.

Study Design: Pragmatic comparison of ritodrine, salbutamol and terbutaline from re-analysis of data obtained within three comparator arms of three simultaneous comparable randomised controlled trials of beta2-agonists against atosiban in 742 women in preterm labour.

Tocolytic therapy and clinical experience. Combination therapy.

Objective: Inhibiting preterm labour at extremely early gestations.

Design: Observational study. Case reports.

Fetal heart rate patterns and ECG ST segment changes preceding metabolic acidaemia at birth.

Objectives: To compare the rates of abnormal ST segment patterns of the ECG and cardiotocographic (CTG) abnormalities in fetuses with metabolic acidaemia at birth and controls. To evaluate the inter-observer agreement in interpretation of ST analysis and CTG.

Design: Case-control study.

Glomerular endotheliosis in normal pregnancy and pre-eclampsia.

Objective: To investigate the proportion of women with findings characteristic for pre-eclampsia, as opposed to renal disease, in a controlled study of hypertensive pregnant women undergoing antepartum renal biopsy.

Design: An observational prospective controlled study.

Setting: University Hospital of Lund, Sweden.

Serum cystatin C reflects glomerular endotheliosis in normal, hypertensive and pre-eclamptic pregnancies.

Objective: To study the correlation between serum cystatin C levels and renal structural changes in normal, hypertensive and pre-eclamptic pregnancy to evaluate it as a marker of the degree of renal involvement in pre-eclampsia.

Design: An observational prospective study.

Setting: University Hospital of Lund, Sweden.

Gender aspects of preterm birth.

It was previously believed that sex differentiation took place when the undifferentiated gonads formed either testes or ovaries. Studies in recent years indicate that sex differentiation begins at conception. The SRY gene on the Y-chromosome is already transcribed at the 2-cell stage and triggers growth acceleration in the XY embryos.

Indications for cesarean deliveries in Norway.

Objective: The purpose of this study was to investigate the indications for cesarean deliveries in Norway, related to type of operation, parity, and gestational age.

Study Design: This was a prospective survey that used information provided by clinicians at 24 maternity units. Two thousand seven hundred seventy-eight cesarean deliveries were included, which represents 69.

Significant delay of birth in advanced preterm labour at 23 gestational weeks with an oxytocin antagonist.

A 27-year-old primigravid woman with advanced preterm labour at 23 weeks and 5 days gestation received tocolytic therapy with a continuous infusion of the oxytocin antagonist, atosiban, during 154 h. The delivery was postponed for 12 days. The baby was discharged after 3 months of neonatal care and at 6 months of age is healthy.

An update on the controversies of tocolytic therapy for the prevention of preterm birth.

Preterm birth is the major cause of perinatal mortality and morbidity in the developed world. Where there are no contraindications to their use, tocolytics can improve neonatal survival rates by approximately 3% per day between 23 and 27 weeks gestation with a concomitant reduction in morbidity. The ultimate aim of tocolytic therapy is to prolong pregnancy until growth and maturation is complete, but even short-term delay may enable the administration of antepartum glucocorticoids to reduce hyaline membrane disease or to arrange transfer to a center with neonatal intensive care facilities.

Blood pressure during pregnancy in a Swedish population; impact of parity.

Subject: Hypertension represents the most commonly encountered complication of pregnancy. Normal levels of blood pressure (BP) need to be established in each pregnant population in order to recognize pathology. A lack of studies from our own country and certain methodological objections to early studies motivated this study.

Transient fetal cerebral dysfunction after road traffic accident. A case report.

We present a case at 30 weeks gestation with transient abnormal fetal cerebral function after a road traffic accident, with loss of fetal movements and abnormal FHR tracings for almost 1 week. The pregnancy had after this incident a normal course and a healthy baby boy was born at term. We suggest the mechanism to be related to fetal hypoxia after excessive maternal psychological stress.

Transient fetal cerebral dysfunction after road traffic accident. A case report.

We present a case at 30 weeks gestation with transient abnormal fetal cerebral function after a road traffic accident, with loss of fetal movements and abnormal FHR tracings for almost 1 week. The pregnancy had after this incident a normal course and a healthy baby boy was born at term. We suggest the mechanism to be related to fetal hypoxia after excessive maternal psychological stress.

Different types of acid-base changes at birth, fetal heart rate patterns, and infant outcome at 4 years of age.

Background: To study the relationship between different types of acidemia in umbilical artery blood at birth, fetal heart rate (FHR) patterns during labor, and infant long-term outcome.

Methods: Case-control study of 48 infants with pure high base deficit (base deficit (BD) > or = 12 mmol/L and pCO2 < 8.0 kPa), 51 with mixed acidemia (BD > or = 12 mmol/L and pCO2 > or = 8.

Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities.

Objective: To study the outcome after acidaemia at term birth, and the relation to gender and duration of pathological fetal heart rate changes.

Design: Population based study of 154 infants with umbilical artery pH < 7.05 at term birth.

Stillbirths and rate of neonatal deaths in 76,761 postterm pregnancies in Sweden, 1982-1991: a register study.

Objective: To study stillbirths and neonatal mortality in the postterm period.

Design: Register study of information obtained from the Swedish Medical Birth Registry (MBR), National Board of Health and Welfare, Stockholm.

Methods: Singleton pregnancies with deliveries occurring between 1982 and 1991 were selected involving 914,702 women (of whom 76,761 had a postterm pregnancy continuing beyond the 42nd week of amenorrhea).

Risk factors for acidemia at birth.

Objective: To identify risk factors for acidemia at birth.

Methods: From September 1988 to December 1996, cord arterial blood pH was measured in 23,016 of 27,064 live-born infants (85.0%).

Maternal fever in term labour in relation to fetal tachycardia, cord artery acidaemia and neonatal infection.

Objective: To determine 1. whether maternal fever during term labour is associated with acidaemia at birth and neonatal infection and 2. whether fetal tachycardia precedes maternal fever and is associated with neonatal infection.

Preeclampsia is associated with a reduced response to activated protein C.

Objective: Resistance to activated protein C is an inherited mutation of the coagulation factor V gene, a major factor predisposing to thromboembolic events. The purpose of this study was to investigate the occurrence of heterozygote and homozygote activated protein C resistance in women with preeclampsia.

Study Design: Activated protein C resistance and protein C and antithrombin III levels were determined in women (n = 50) with a history of preeclampsia and in controls (50 women with a previous normal pregnancy).