Feto-maternal Monitoring Research Articles

Pregnancy Complications and Feto-Maternal Monitoring in Rabbits.

Rabbit production holds significant relevance in modern agriculture due to its potential as a sustainable source of high-quality protein and efficient feed conversion, contributing to food security and economic diversification. Nevertheless, studies incorporating feto-maternal monitoring in this species are uncommon. This review gathers research on the monitoring and evaluation of factors affecting rabbit gestation, providing a better understanding of the causes of prenatal development abnormalities. These include studies regarding how chronic maternal hypertension, gestational diabetes, maternal stress, ectopic gestation, maternal uterine ischemia and fetal hypoxia, intrauterine growth restriction, superfetation, maternal age, maternal nutritional status, maternal physical condition, maternal and embryonic genotype, and the intrauterine location of rabbit fetuses can potentially impact rabbits' reproduction and maternal and fetal health. Among other monitoring techniques, ultrasonography, considered one of the best tools for diagnosing pregnancy and conducting follow-up, is also reviewed. Details on measurable fetal-development parameters in rabbits and precautions to be considered before and during the examination are also provided. Additional studies are required to understand why some events occur and their consequences throughout gestation, allowing the determination of new biomarkers or cut-offs that can be helpful for early diagnosis and improve reproductive efficiency.

Fetal and maternal outcome of higher-order multiple pregnancies in a tertiary hospital: A 5-year single-center observational study from Nigeria.

Objective:The aim of this study was to determine the pattern and outcomes of higher-order multiple pregnancies in a tertiary hospital in NigeriaMethods:This is a retrospective review of all cases of higher-order multiple pregnancies that were managed between 1 January 2012 and 31 December 2016 in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. Data obtained were represented with frequency tables, percentages, bar charts, and odds ratio.Results:There were 22 higher-order multiple pregnancies over the study period and 12,002 deliveries, giving a higher-order multiple prevalence rate of 0.2%. Five of the mothers (four triplets and one quadruplet) had in vitro fertilization (0.4 per 1000 deliveries), while other mothers conceived naturally. Many of the women (12, 54.6%) were in the 30–34 years age group, and more than half (16, 72.7%) were multiparas. More than half of the neonates were delivered preterm (13, 59.1%). Being booked is associated with better neonatal outcomes although not significant (odds ratio = 3.06. 95% confidence interval: 0.55–16.83, p = 0.197). Anemia was common in the antepartum and postpartum periods. Half of the women (11, 50%) were delivered by elective cesarean section and 7 (31.8%) by emergency cesarean section (C/S), while 4 (18.2%) had a spontaneous vaginal delivery. The neonates had a mean birth weight of 2.14 ± 0.35 kg. Overall, 61 neonates (91.0%) were born alive and 6 (9.0%) suffered perinatal deaths, giving a perinatal mortality rate of 89.8 neonates per 1000 live births.Conclusion:Our study shows that higher-order multiple pregnancies are high-risk pregnancies that are associated with fetal and maternal complications. Anemia is the commonest complication seen in our study. The majority had preterm delivery. Proper antenatal care and close feto-maternal monitoring are important in reducing adverse outcomes associated with these pregnancies.

Fetal mummification complicating a dichorionic twin gestation

Fetus papyraceous is a complication of multiple gestation characterized by single intrauterine fetal death of a twin, co-existing with a normal twin. It can present without problems to the mother and surviving twin but it increases the risk of death to the surviving twin, preterm delivery, dystocia, and other fetomaternal complications. This case aims to draw attention to the rare finding of a mummified twin coexisting with a normal twin, as well as the clinical management of such presentation. We present a case of a 32-year-old multigravida with no living children, who spontaneously conceived a twin pregnancy that was complicated by fetus papyraceous and eventual (inevitable) preterm delivery. The pregnancy was managed conservatively by frequent fetomaternal monitoring to allow for adequate fetal lung maturity. The surviving twin and mother remained stable postpartum. Frequent ultrasonographic monitoring along with conservative management to prolong pregnancy until fetal lung maturity is ascertained, are useful strategies in managing such a case, and the management of each case should be individualized. The following core competencies are addressed in this article: Medical knowledge, Patient care.

Differences in Endocrine and Cardiac Changes in Mares and Her Fetus before, during, and after Parturition in Horses of Different Size.

Simple SummaryMonitoring of the pregnant mare and her fetus is based on hormone analysis and heart rate recordings which may differ among small, medium-size, and full-size horses. Therefore, Shetland (n = 6), Haflinger (n = 8), and Warmblood pregnancies (n = 9) were studied before and at foaling. Foal weight always approximated 10% of mare weight but relative placenta weight was highest in full-size mares. The concentrations of progestins (hormones that maintain pregnancy) and cortisol (a hormone involved in the onset of foaling but also in an animal’s response to stress) was highest in full-size mares. Progestin concentration decreased towards foaling while cortisol concentration increased. Heart rate of mares increased before foaling with the most pronounced increase in small mares. Overall, Shetland mares foaled earlier than larger-size mares. At foaling, atrio-ventricular blocks (physiological omission of heart beats) regularly occurred in full-size mares but only occasionally in medium-size and small mares, reflecting differences in heart efficiency. In conclusion, some differences exist before and at foaling in horses of different size.Equine fetomaternal monitoring is based on endocrine and cardiac parameters which may differ among small, medium-size, and full-size horses. Therefore, Shetland (n = 6), Haflinger (n = 8), and Warmblood pregnancies (n = 9) were studied during late gestation and at foaling. Weight of mares, foals and placenta, plasma progestin and cortisol concentration, heart rate and heart rate variability (HRV) were determined. Foal weight always approximated 10% of mare weight but relative placenta weight was highest in full-size mares (p < 0.05). Progestin (p < 0.001) and cortisol (p < 0.05) concentration was highest in full-size mares. Progestin concentration decreased towards parturition (p < 0.001) while cortisol concentration increased (p < 0.01). Maternal heart rate increased before foaling with the most pronounced increase in small mares (p < 0.001). The HRV increased during foaling and decreased when delivery was completed (p < 0.001). Changes were most pronounced in full-size mares (p < 0.001). Atrio-ventricular blocks regularly occurred in parturient full-size mares but only occasionally in medium-size and small mares (time p < 0.05, time × group p < 0.05). This may reflect breed differences in cardiovascular efficiency. Fetal heart rate decreased towards birth (p < 0.001) with the most pronounced decrease in full-size horses (p < 0.01). Fetal HRV showed no consistent changes before birth but increased when the foal was born (p < 0.001), this increase being most pronounced in full-size foals (p < 0.05). In conclusion, this study demonstrates both similarities and differences in peripartum endocrine and cardiac changes in horses of different size.

Pregnancy and Fetal Development: Cephalic Presentation and Other Descriptive Ultrasonographic Findings from Clinically Healthy Bottlenose Dolphins (Tursiops truncatus) under Human Care

Simple SummaryUltrasound data are vital for monitoring and detecting problems in pregnancies, and although there is a significant amount of data for domestic species, data for marine mammals are scarce. In domestic species, the use of ultrasonography to monitor a pregnancy usually has the following aims: fetal movements, fetal heart rates, measurements of the skull and the thorax for the prediction of the birth date interval, the morphological aspects of the fetal organs, the appearance of the umbilical cord, and the placentation. The purpose of this study is to provide to the clinician additional relevant data on fetal development and well-being during a dolphin pregnancy that may also be useful for wild population monitoring. This study is the result of a retrospective analysis of 192 ultrasound scans over 10 years that, for the first time, describes the sonographic findings of the bottlenose dolphin organogenesis and their correlation with the stage of pregnancy, as well as the calf presentation at birth, according to its position within the uterus, and moreover a complete literature review.Ultrasonography is widely used in veterinary medicine for the diagnosis of pregnancy, and can also be used to monitor abnormal pregnancies, embryonic resorption, or fetal abortion. Ultrasonography plays an important role in modern-day cetacean preventative medicine because it is a non-invasive technique, it is safe for both patient and operator, and it can be performed routinely using trained responses that enable medical procedures. Reproductive success is an important aspect of dolphin population health, as it is an indicator of the future trajectory of the population. The aim of this study is to provide additional relevant data on feto-maternal ultrasonographic monitoring in bottlenose dolphin (Tursiops truncatus) species, for both the clinicians and for in situ population studies. From 2009 to 2019, serial ultrasonographic exams of 11 healthy bottlenose dolphin females kept under human care were evaluated over the course of 16 pregnancies. A total of 192 ultrasound exams were included in the study. For the first time, the sonographic findings of the bottlenose dolphin organogenesis and their correlation with the stage of pregnancy are described. Furthermore, this is the first report that forecasts the cephalic presentation of the calf at birth, according to its position within the uterus.

Elective Induction versus Expectant Management of Mild Pre-Eclampsia at Term.

To determine maternal and neonatal outcome in planned induction of labor versus expectant management in mild pre-eclampsia at term. Quasi-experimental study. Department of Gynecology and Obstetrics, Sir Ganga Ram Hospital, Lahore, from July to December 2016. After taking informed consent, 200 females fulfilling the inclusion criteria were included in the study. Sample was equally divided into two groups. In Group A (induction) depending upon the Bishop score, labor was induced with prostaglandins or amniotomy. In Group B (Expectant), expectant management was followed with feto-maternal monitoring. Maternal monitoring was done with blood pressure recording and laboratory tests while fetal monitoring was done by keeping maternal fetal kick count record, recording CTG and biophysical profile. Student t-test was used to analyze numerical data and Chi-square for qualitative data. A p-value of <0.05 was taken as statistically significant. There were more maternal complications in expectant management group as compared to induction group, while neonatal outcomes were comparable in both groups. In mild pre-eclampsia, induction of labor at term is beneficial for mother, but there is no difference in neonatal outcome in the two modes of management.

Quantification of Feto-Maternal Heart Rate from Abdominal ECG Signal Using Empirical Mode Decomposition for Heart Rate Variability Analysis

In this paper, a robust method of feto-maternal heart rate extraction from the non-invasive composite abdominal Electrocardiogram (aECG) signal is presented. The proposed method is based on the Complete Ensemble Empirical Mode Decomposition with Adaptive Noise (CEEMDAN) method, in which a composite aECG signal is decomposed into its constituent frequency components called Intrinsic Mode Functions (IMFs) or simply “modes”, with better spectral separation. Decomposed IMFs are then selected manually according to probable maternal and fetal heart rate information and are processed further for quantification of maternal and fetal heart rate and variability analysis. The proposed method was applied to aECG recordings collected from three different sources: (i) the PhysioNet (adfecgdb) database; (ii) the PhysioNet (nifecgdb) database; and (iii) synthetic aECG signal generated from mathematical modeling in the LabVIEW software environment. An overall sensitivity of 98.83%, positive diagnostic value of 97.97%, accuracy of 96.93% and performance index of 96.75% were obtained in the case of Maternal Heart Rate (MHR) quantification, and an overall sensitivity of 98.13%, positive diagnostic value of 97.62%, accuracy of 95.91% and performance index of 95.69% were obtained in case of Fetal Heart Rate (FHR) quantification. The obtained results confirm that CEEMDAN is a very robust and accurate method for extraction of feto-maternal heart rate components from aECG signals. We also conclude that non-invasive aECG is an effective and reliable method for long-term FHR and MHR monitoring during pregnancy and labor. The requirement of manual intervention while selecting the probable maternal and fetal components from “n” number of decomposed modes limits the real-time application of the proposed methodology. This is due to the fact that the number of modes “n” produced by the CEEMDAN decomposition is unpredictable. However, the proposed methodology is well suited for applications where a small time-delay or offset in feto-maternal monitoring can be acceptable. In future, application-specific modification of the CEEMDAN algorithm can be implemented to eliminate manual intervention completely and will be suitable for long-term feto-maternal monitoring.

A Comparative Study of e-Partogram with Conventional Partogram

ABSTRACT Introduction Obstructed labor remains an important cause of not only maternal death but also short- and long-term disability. Even though the partogram serves to assist in effective monitoring of the progress of labor and the condition of the mother and baby, its use in developing countries is limited. Aim To compare the reliability of mobile application-based e-partogram for feto-maternal monitoring in labor with the conventional World Health Organization (WHO) partogram. Setting A total of 40 patients in the delivery suite at Rangadore Memorial Hospital, Shankarapuram, Bengaluru. Design A randomized controlled trial. Materials and methods Study population was randomized into two groups of 20 patients each. Labor events, delivery, and baby details were randomly filled either in the modified WHO partogram or in the e-partogram app. Outcome measures The primary outcomes analyzed were regularity of monitoring of maternal and fetal parameters, consultant supervision of labor, and retrospective filling of data. Secondary outcomes studied were the mode of delivery, blood loss up to 24 hours of delivery, 1 and 5 minutes neonatal APGAR score. Statistical analysis used Averages and proportions were calculated for the study and appropriate statistical tests like chi-square test, Fisher's exact test, Z-test, and Levene's test for equality of variances were done using MiniTab version 16. Results The regularity of monitoring maternal parameters (p-value of 0.001) and consultant supervision (p-value of 0.000) was significantly higher using the e-partogram compared with those whose labor was monitored using the paper partogram. Retrospective filling of the partogram was higher in the modified WHO (on-paper) partogram (p-value of 0.000). The secondary outcomes — mode of delivery, blood loss up to 24 hours of delivery, 1 and 5 minutes neonatal APGAR score — were not significantly different between the two groups (p-value &gt; 0.05). Conclusion The e-partogram can provide safe births by increasing the quality and regularity of important observations on the progress of labor and early detection of problems by consultants, which can lead to better decision-making and earlier referrals. It also makes remote monitoring of labor possible, promotes logical human resource allocation, supports recordkeeping, and is thus a pragmatic way to reduce both maternal and newborn mortality and morbidity. How to cite this article Krishnaswamy PH, Venkatraman P, Shetty A. A Comparative Study of e-Partogram with Conventional Partogram. J South Asian Feder Obst Gynae 2016;8(4):319-323.

Decompressive craniectomy in term pregnancy with combined caesarean section for traumatic brain injury

Over the years the maternal mortality depending on the obstetric causes has reduced whereas there is a relative increase in maternal mortality and morbidity due to non-obstetric causes. Trauma during pregnancy, including head injury, is one of the leading causes of incidental maternal death and morbidity, and complicates 6%–7% of all pregnancies. Furthermore it predisposes two lives at risk and creates unique diagnostic and therapeutic challenges. Because of the physiological hormonal, hemodynamic and anatomical changes associated with pregnancy, certain standard neurosurgical practices may be challenged. We present a case of woman with term pregnancy who sustained moderate head injury requiring urgent caesarean section for pregnancy and decompressive craniectomy in the same sitting in Operation Theater. Issues like screening of mother and feto-maternal monitoring; physiological changes during pregnancy, choice of anaesthesia, intraoperative concerns and fetal monitoring, timing of delivery are discussed with review of pertinent literature.

Maternal and perinatal outcomes of delivery after a previous Cesarean section in Enugu, Southeast Nigeria: a prospective observational study

BackgroundObstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring.ObjectiveTo describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria.MethodsThis was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence.ResultsTwo thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03).ConclusionMost women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for non-recurrent indications were good. Obstetricians in this area should do more to allow VBAC in women with one previous Cesarean section for nonrecurrent indications.

Prevalence and outcome of higher order multiple pregnancies in Lagos, Nigeria

Objective: To determine the prevalence and outcome of higher order multiple (HOM) pregnancies in Lagos, Nigeria.Methods: The mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies were reviewed retrospectively from the labor ward and theater registers, neonatal unit admission records and medical notes in a tertiary referral centre from April 2009 to March 2012.Results: Twenty-two (15, 6 and 1 set of triplets, quadruplets and quintuplet, respectively) of 6521 pregnancies delivered during the period were HOM pregnancies giving a prevalence of 3.37/1000. All the 74 babies except 12 were delivered by cesarean section. There were 18 perinatal deaths giving a perinatal mortality rate of 243 per 1000. Overall mortality was significantly associated with no antenatal booking (21 versus 5, OR: 21.0, 95% CI: 2.1–72.3, p = 0.000), gestational age ≤30 weeks (21 versus 5, OR: 46.2, 95% CI: 11.2–189.9, p = 0.000) and birth weight <1000 g for live births (p = 0.000). Mode of delivery and number of fetuses >3 were however not significantly associated with mortality.Conclusion: Reduction of early preterm births by proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce the resultant immediate poor outcomes for these pregnancies and their newborns.

1362 Prevalence and Outcome of Higher Order Multiple Pregnancies in Lagos, Nigeria

Background and AimsHigher order multiple (HOM) pregnancies are associated with higher risk of complications for both mother and babies with resultant increase in financial and psychological strain on the families....

Electrical impedance tomography based image reconstruction and feto-maternal monitoring in pregnancy

Standard methods of monitoring the fetus and maternal health during labor are cardioto-cogram, tocography, ultrasound and magneto-cardiograpghy. These methods have some limi-tations in real time continuous monitoring and cause some degree of inconvenience to the pa-tient and demand special attendance of the ob-stetrician also these methods cannot be used for continuous monitoring of the fetal well being. To overcome the limitations of above techniques, a non-invasive bioimpedance measuring method is proposed. This technique helps in monitoring and recording of the electrical field distribution of a closed object. The output variation on the outer surface is likely to provide information because of fetal movements and related physio-logical parameters. It will also help in the de-velopment of Electrical Impedance Tomography based imaging technique for a closed body system with special reference to fetal monitor-ing in-utero during pregnancy and labor. Also we have developed the data acquisition system of 16 electrodes with software for image recon-struction.

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Antithrombin Deficiency in Pregnancy.

Background: During pregnancy untreated antithrombin deficiency is associated with up to a 50% risk of venous thromboembolism (VTE) and a relative risk of pregnancy loss of 2.1 with a 5-fold increase in stillbirths. Thus thromboprophylaxis is widely used, but little data is available to select type, dose & duration of anticoagulation.Method: We performed a retrospective, single centre observational study of our antithrombin deficient pregnancies since 1996.Results: There were 9 pregnancies in 8 women; median age at conception 33 (age-range 19–37). They separated into 3 groups (1) 4 asymptomatic patients diagnosed on family screening. They received unmonitored enoxaparin 40mg until 16 weeks then 40mg BD. (2) 2 with previous VTE, received intermediate dose enoxaparin (1mg/kg), increased to BD at 16 weeks. Monitoring was done to maintain an anti-Xa trough of <0.12 iu/ml and peak <0.8iu.ml. (3) 2 referred after presenting with VTE in pregnancy. They received enoxaparin 1mg/kg BD and the same monitoring These included a known antithrombin deficient woman, referred in her second pregnancy at 26weeks gestation with premature rupture of the membranes and an iliofemoral deep vein thrombosis which developed on enoxaparin 60mg OD. Enoxaparin was increased to 1mg/kg BD and an IVC filter inserted. Despite the filter however she had a pulmonary embolism. The filter was removed after Caesarean section at 31 weeks. Two had sagittal sinus thromboses in the first trimester associated with severe hyperemesis requiring IV fluids. One was our only thromboprophylaxis failure, receiving enoxaparin 40mg OD, she weighed 80Kg. The second presented at 11weeks gestation. She was intolerant of self injecting and so switched to warfarin at 15 weeks until 35 weeks as did one other mother. All mothers had close feto-maternal monitoring with uterine artery Doppler at 24 weeks if possible and then monthly growth scans thereafter.Delivery: Thromboprophylaxis was stopped at labour initiation or 12hrs prior to Caesarean section (3 women) and 50iu/kg of antithrombin concentrate was given. Anticoagulation was restarted 24hrs after delivery. Six weeks enoxaparin post-partum thromboprophylaxis was given or the women converted back to warfarin. Estimated blood loss at delivery was a median of 200ml (range 200–500ml), no transfusions were required. There were no post partum VTEs. Nine births occurred at a median gestation of 38weeks (range 31–41), median birth weight 3045g (range 1420–4120g). One child has West's syndrome.Conclusion: This is the largest case series on the management of antithrombin deficiency in pregnancy. The combined use of enoxaparin in pregnancy and post partum combined with antithrombin concentrate during labour appears to improve pregnancy outcome and reduce the rate of VTE. Larger studies are required to confirm this finding.

Increase in Caesarean Section Delivery at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria

Objective: Caesarean section rate has been on the increase of recent. This study therefore looked at he hospital Caesarean section rate, the indications and the reasons for the high rate. Materials: Caesarean sections performed at the UNTH, Enugu over a two-year period (January 1995 – December 1996) were reviewed. Results: Of the 1,641 deliveries, 450 were by caesarean section giving a rate of 27.4%. The commonest indication was two previous caesarean sections. Other major indications were, cephalopelvic disproportion (18.2%), fetal distress (17.1%), pregnancy induced hypertension (16.1%), obstructed labour (14.0%). 40.4% of the patients were primigravidae and 26.0% of the cases were unbooked while 56.7% were emergency procedures. Conclusion: The hospital caesarean section rate of 27.4% represents 1.5 fold or 66.8% rise over previous study. Some of the indications might not be justified if necessary facilities for fetomaternal monitoring and requisite manpower were available and properly utilized. The importance of education of our women on the need for early booking, regular attendance to antenatal clinics and hospital delivery is also emphasized. Sahel Medical Journal Vol.7(1) 2004: 6-9

Factors predicting peri- and neonatal outcome in diabetic pregnancy

A population-based birth cohort including 296 consecutive type 1 diabetic births in a geographically defined catchment area was used to evaluate factors predicting poor perinatal and neonatal outcome. Though perinatal mortality has decreased (17.1/1000 births at 28 or more weeks of gestation), the neonatal morbidity rate still remains high despite improved maternal metabolic control and developed antepartum surveillance. Poor glycemic control during the first weeks of pregnancy was the most important risk factor (relative risk (RR) 2.91; 95% confidence interval (CI) 1.29-6.55) predicting adverse neonatal events such as long (>10 days) stay in the neonatal unit, malformation or perinatal death. The risk was further increased in cases of severe diabetes (White class F-R; RR 2.75; 95% CI 1.59-4.76) and primiparity (RR 1.64; 95% CI 1.02-2.65). By evaluating these risk factors at the first antenatal visit, a subgroup with a particular need of counselling and intensive feto-maternal monitoring can be identified.

Fetal endoscopic (‘Fetendo’) surgery: The relationship between insufflating pressure and the fetoplacental circulation

Application of video-endoscopic surgery to the gravid uterus provides a new treatment option for the fetus with a correctable congenital anomaly. “Fetendo” surgery requires temporary enlargement of the uterine cavity to create a working space. Volume expansion of the amniotic space raises intrauterine pressure, which could increase placental vascular resistance and thereby reduce placental blood flow. To test this hypothesis, the authors developed a fetal sheep model to examine the relationship between insufflating pressure and flow in the placental circulation. Fetoplacental blood flow was measured via ultrasonic flow probes placed around the fetal common umbilical artery and the maternal uterine artery in five anesthetized 120-day-gestation ewes. Invasive feto-maternal monitoring permitted synchronous measurement of fetal mean arterial pressure, fetal central venous pressure, maternal mean arterial pressure, amniotic pressure, and fetal oxygen saturation, with calculated values for fetal and maternal placental vascular resistance. Amniotic pressure was raised from 10 mm Hg to 40 mm Hg in 5-mm Hg increments by a combination of saline amnioinfusion and external uterine compression. At amniotic pressures of 20 mm Hg or less, placental blood flow was preserved; however, elevation of amniotic pressure above 20 mm Hg resulted in a significant decrease in placental flow, with concomitant fetal hypoxia. The authors conclude that the relationship between intrauterine pressure, flow in the placental circulation, and fetal oxygen delivery must be considered when selecting intrauterine insufflation pressures for hysteroscopic intervention.

The advantages and risks of feto-maternal monitoring.

Intrapartum feto-maternal monitoring (f.-m. m.), which was first introduced by CALDEYRO-BARCIA [12] and SALING [42], can be regarded as the foundation of perinatal medicine. Its use not only reduced perinatal mortality repidly, but also increased our knowledge of the pathology and physiology of labor and their influence on maternal as well as fetal metabolism. In spite of this, critical comments regarding the dangers and even the need for f.-m. m. were published recently [25]. These unexpected requests to look at birth again as a natural, physiological process, making machines, and even delivery rooms unnecessary, raised doubts regarding the advantages of f.-m. m. The criticism even went so far as to state that f.-m. m. influences the physiological condition of a newborn child unfavorably. It would seem that the pendulum has swung back to what is described as natural childbirth, returning us to the days when PINARD's stethoscope was regarded as a modern, sufficient and effective Instrument in supervising the well-being of a fetus in labor. In 1979 DUNN [18] published a list of the dangers of f.-m. m. without giving exact figures of their frequency, which shocked those who have introduced this technique in their own delivery rooms. It was this paper which encouraged us to collect data regarding the benefits as well as the hazards of f.-m. m. on a large scale, to answer most of the questions raised by DUNN [18]. We also intend to give exact figures calculated from a large number of cases monitored in various centers with different degrees of experience.