Increased risk in the elderly parturient.

Purpose Of Review: The steady increase in age in primiparous and multiparous women raises questions concerning increased obstetric risk and outcome in such pregnancies. This review highlights the effects of maternal age on obstetric and perinatal outcome.

Recent Findings: Complications have been associated with increasing maternal age, including abnormal weight gain, obesity, gestational diabetes, chronic and pregnancy-induced hypertension, antepartum haemorrhage, placenta praevia, multiple gestation, prelabour rupture of membranes, and preterm labour.

Drugs used in hypertensive diseases in pregnancy.

Purpose Of Review: This review will summarize results derived from the most recent publications on the use of drugs in women with hypertensive diseases in pregnancy.

Recent Findings: There is consensus that severe hypertension should be treated without delay to reduce maternal risks of acute cerebrovascular complications. There is no consensus that antihypertensive drugs improve maternal or fetal outcome in mild to moderate hypertension.

Fluorescence diagnostics and kinetic studies in the head and neck region utilizing low-dose delta-aminolevulinic acid sensitization.

Diagnostic measurements and pharmacokinetic studies were performed in 17 patients with various kinds of malignant, premalignant and benign lesions in the head and neck region by means of point monitoring laser-induced fluorescence. For marking different types of tissue, delta-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) was used. The ALA-induced PpIX synthesis was monitored at different time intervals after oral administration of ALA in low doses, 5 and 15 mg/kg b.

Clinical spectral characterisation of colonic mucosal lesions using autofluorescence and delta aminolevulinic acid sensitisation.

Background And Aims: Laser induced fluorescence (LIF) from colonic mucosa was measured in vivo with and without delta aminolevulinic acid (ALA) in an attempt to differentiate between neoplasia and non-neoplasia in real time during colonoscopy.

Methods: Spectra from 32 adenomas, 68 normal sites, and 14 hyperplastic polyps in 41 patients were obtained with a point monitoring system. Twenty one of the patients had been given a low dose of ALA as a photosensitiser before the examination.

Clinical multi-colour fluorescence imaging of malignant tumours--initial experience.

Purpose: The detection of malignant tumours relies on a variety of diagnostic procedures including X-ray images and, for hollow organs, endoscopy. The purpose of this study was to present a new technique for non-invasive tumour detection based on tissue fluorescence imaging.

Material And Methods: A clinically adapted multi-colour fluorescence system was employed in the real-time imaging of malignant tumours of the skin, breast, head and neck region, and urinary bladder.

External cephalic version at term with tocolysis and vibroacoustic stimulation.

Objective: This study compared the obstetric outcome in women who had external cephalic version (ECV) for breech presentation after 36 weeks gestation with those who did not, to see whether ECV reduces breech deliveries and cesarean section rates with reduced complications.

Method: External cephalic version was attempted in 200 women (study group) with the use of tocolysis and vibroacoustic stimulation. The control group (ECV not attempted) comprised of 278 women with breech presentation after 36 weeks.

Medical prevention of pre-eclampsia.

There is no clear evidence that any of the antihypertensive drugs available can defer or prevent the occurrence of proteinuric pre-eclampsia or associated problems such as fetal growth retardation or perinatal death. When antihypertensive treatment is indicated, there seems to be no reason to prefer any of the tested beta-blockers, or to prefer labetalol to a pure beta-blocker, or indeed, to prefer beta-blockers to methyldopa. The increased maternal, fetal and infant mortality and morbidity associated with hypertension in pregnancy justify careful evaluation of the risks of the more severe forms of hypertension at an early stage in all pregnancies.

Fetal and neonatal haemodilution associated with multiple placental chorioangioma: case report.

A pregnancy with polyhydramnios and abnormal antepartum fetal heart rate pattern was found to have multiple placental haemangiomas. Multiple placental haemangiomas can give rise to fetal cardiac failure due to a hyperdynamic circulation or fetal anaemia either due to haemodilution or possibly destruction of blood cells in the chorioangioma. Whether fluid restriction with or without diuretics or blood transfusion is the correct form of treatment of neonatal cardiac failure in such a case is discussed.

Randomised controlled trial of methyldopa and isradipine in preeclampsia--effects on uteroplacental and fetal hemodynamics.

This is a prospective randomised controlled study in 21 women admitted with preeclampsia in the third trimester. The mean arterial blood pressure decreased by 11.1 mmHg (95% confidence interval -14.

Automated 24-hour ambulatory blood pressure monitoring in preeclampsia.

A prospective controlled study was designed to compare automated 24-hour ambulatory blood pressure monitoring with intermittent blood pressure recordings obtained using a sphymomanometer. Blood pressure was measured in 20 hospitalized preeclamptic women in the third trimester. Data obtained using the Spacelabs automated blood pressure monitor was recorded over a period of 24 hours, and thereafter stored and processed in a computer.

Maternal mortality: evolving trends.

Despite improvement in socioeconomic standards, good and accessible health care facilities the maternal mortality rate in Singapore is not declining. The maternal mortality rate in National University Hospital, Singapore, over a 7 year period 1986-1992 was 22.9 per 100,000 when direct and indirect causes were considered (34.

Evaluation of a simple method to assess fetal well-being in antenatal clinic.

To study the feasibility of assessing fetal heart rate (FHR) acceleration by a fetal doptone and fetal movements (FM) as perceived by the mother and observed by the attendant in response to a vibroacoustic stimulus. Baseline FHR and it's response during the first minute after vibroacoustic stimulation was observed by a fetal doptone with a digital display on 317 occasions in 201 pregnancies (81.4% of whom were high risk) during antenatal visits in the third trimester.

Effect of methyldopa and isradipine on fetal heart rate pattern assessed by computerized cardiotocography in human pregnancy.

Objective: The effects of two antihypertensive drugs, methyldopa and isradipine, on fetal heart rate pattern were analyzed by computerized cardiotocography.

Study Design: The first part of the study was a prospective, randomized, controlled trial of 19 women with preeclampsia in the third trimester given 2.5 mg of oral slow-release isradipine twice a day or 250 mg of methyldopa three times a day.

Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension.

Objective: Our purpose was to study the effect of methyldopa on uteroplacental and fetal hemodynamics in women with pregnancy-induced hypertension.

Study Design: A prospective study of Doppler ultrasonographic blood flow data before and after 1 week of methyldopa treatment was conducted at the Department of Obstetrics and Gynecology, National University Hospital, Singapore, in 20 women (mean 35 weeks' gestation) with pregnancy-induced hypertension. The main outcome measures were maternal blood pressure, maternal and fetal heart rate, and blood velocity waveforms characterized by the pulsatility index in the fetal ascending aorta, middle cerebral artery, umbilical artery, and maternal uterine and arcuate arteries.

Need for fetal assessment prior to and during external cephalic version. Occurrence of transient cardiac asystole.

We encountered two cases of cardiac asystole for one and three minutes respectively following external cephalic version. We describe the two cases and discuss the necessity for one to be aware of such an event and the possible advantage of performing a fetal heart rate (FHR) recording prior to the procedure and observation of the FHR during the version.

Plasminogen activators, plasminogen activator inhibitors and markers of intravascular coagulation in pre-eclampsia.

In pre-eclampsia (PE), reduced levels of plasma urokinase-like plasminogen activator (u-PA) and plasminogen activator inhibitor-2 (PAI-2), and increased levels of plasma tissue-type plasminogen activator (t-PA) antigen were seen. The majority of moderate and severe pre-eclamptic women (7 out of 10) ended up with pre-term delivery as compared with 2 out of 11 who went on to term. Patients with moderate and severe PE had significantly lower levels (mean +/- SD, ng/ml) of PAI-2 (58.

Randomised controlled trial of atenolol and pindolol in human pregnancy: effects on fetal haemodynamics.

Objective: To compare the effects of uteroplacental circulation of two beta adrenoceptor blockers, atenolol (cardioselective) and pindolol (non-selective with intrinsic sympathomimetic activity).

Design: Controlled double blind double dummy study.

Setting: Departments of obstetrics and gynaecology in two Swedish university hospitals.

Vibro-acoustic stimulation does not alter the duration of high and low fetal heart rate variability episodes.

To study the effect of vibro-acoustic stimulation on high and low fetal heart rate (FHR) variability episodes. Prospective control study, in 21 high risk pregnancies between 32 to 39 weeks gestation. FHR pattern was recorded with cardiotocograph (CTG).

Computerised cardiotocography following vibro-acoustic stimulation.

To study the effect of vibro-acoustic stimulation (VAS) to the mean fetal heart rate (FHR), period of high and low FHR variation, overall variation (msec and bpm) and short term variation (msec). In a prospective study 17 pregnant women between 34-42 weeks gestation admitted to antenatal ward for obstetric complications two 60 min FHR recording was carried out with an interval of 30 min in between recordings. On a random basis the fetus was stimulated by a vibro-acoustic stimulator for 5 sec at the beginning of one of the two 60 min FHR recordings.