Maternal Pulse Rate Research Articles

Vaginal Drain to Prevent Ascending Infection in Preterm Premature Rupture of Membranes: A Novel Method.

Not to delay delivery for more than 24 hours after rupture of the membrane is the thumb rule in obstetrics. Ascending infection from the vagina results in dangerous chorioamnionitis, which threatens the lives of the baby and mother. We developed a novel method to prevent ascending infection by using a vaginal drain, which helps to continue pregnancies if the leak stops and buys some time for antenatal steroids to act if the leak doesn't stop. In this study, 20 uncomplicated singleton pregnant women with spontaneous preterm premature rupture of membranes at gestational ages <35 weeks were recruited. Under the speculum, vaginal epithelial debris and secretions were cleared by a saline wash. The tip of the Nelaton Catheter was kept in the posterior fornix and then strapped to the thigh. The outer end was connected to the collection bag system and allowed to hang down to the ground. The foot end of the cot was raised. Leaked amniotic fluid and amniotic fluid index (AFI) were measured daily. A daily AFOD estimation was done for leaked AF. Uterine activity was controlled with low-dose Isoxsuprine Hydrochloride rapid infusion tocolysis. Antenatal steroids (ANS) were given. The spread of infection was monitored by maternal pulse rate, fetal heart rate, TC, and CRP. Pregnancies were terminated when leaks didn't stop, AFI didn't raise, or mature AFOD was observed. The number of women in whom leaks stopped, the number of dayspregnancies continued, neonatal respiratory distress (NRD), birth weights, and perinatal deaths were recorded. Results: Leaks stopped in eight (40%) women. Pregnancy continuation ranged from 7 to 74 days. In 12 women, the leak did not stop, but we could buy 2-5 days' time for ANS to act. All parameters of the infection were within normal limits. Thirteen babies developed mild NRD, and we lost one baby. By using a vaginal drain for P(P)ROM, ascending infection can be prevented, leaks can be stopped in 40% of women, and can buy time for ANS to act.

EVALUATION OF INTRATHECAL DEXMEDETOMIDINE ADDED TO BUPIVACAINE FOR LABOR ANALGESIA

Background And Aims: The aim of this study was to evaluate the effectiveness of intrathecal dexmedetomidine with bupivacaine for labor analgesia by assessment of onset, duration and quality of analgesia and neonatal outcomes. Method: In this study 40 eligible parturient who received dexmedetomidine 5 g and heavy bupivacaine 0.5% 2.5 mg diluted upto 2.5 cc with sterile NS intrathecally for labor analgesia were selected. The time of onset, duration and quality of analgesia were noted. Maternal parameters pulse rate, systolic blood pressure, motor block and side effects of pruritus, nausea, vomiting, hypotension and headache were recorded. Neonatal outcomes in terms of mode of delivery and APGAR score were noted. If VAS &gt;3, analgesia was supplemented with epidural bupivacaine 0.125% 10 ml during labor. For rescue analgesia, Inj. Tramadol 1 – 2 mg/kg iv was given as per institutional protocol if the patient VAS score was still more than 3 even after second dose of epidural. Result: Mean time for onset of analgesia was 2 minutes (VAS&lt;3). All parturient had VAS &lt; 3 throughout the labor. Mean duration of Labor was 99.4 ± 48.35 min. Total duration of labor ranges from 45 minutes to 210 minutes in our study. Most 92.5% of parturient had maximum motor blockade of grade 1 and it was lasted maximum upto 30 min. Hypotension was observed in two parturient and one parturient had nausea, which responded to conservative management. The mean APGAR score at 1 min was 8.85 ± 0.97 and at 5 min it was 10 (excluding LSCS delivery). Out of 40 total, 30 parturient have graded labor analgesia as excellent and rest have graded as good. Conclusion: Dexmedetomidine (5μg) seems to be a safe and efcacious adjuvant to intrathecal bupivacaine 0.5% (2.5 mg) in women undergoing vaginal delivery. This may be helpful for parturient coming late to the delivery room, seeking rapid onset with good quality of analgesia

Oral nifedipine and parenteral isoxsuprine in arresting preterm labor: A comparative study.

ABSTRACTObjective:To compare the efficacy of oral nifedipine and parenteral isoxsuprine in arresting preterm labor. Considering the paucity of studies comparing these two agents, a comparative analysis is obligatory.Materials and methods:Eighty antenatal women in the gestational age range of 28–37 weeks, with regular uterine contractions, cervical dilatation ≤3 cm, and <50% cervical effacement, admitted with complaints of preterm labor pain were randomized to receive either 40 mg isoxsuprine or 20 mg nifedipine. Efficacy of the drugs was measured in terms of arrest of preterm labor, prolongation of pregnancy, and the days gained by infant before birth.Results:Isoxsuprine showed increased lowering of systolic blood pressure (SBP), diastolic blood pressure (DBP), and slightly higher maternal pulse rate, but higher fetal pulse rate post-administration in comparison to nifedipine (P < 0.05). Isoxsuprine was significantly associated with more side effects. Pregnancy was more prolonged in the nifedipine group (25 days) than in the isoxsuprine group (19 days) (P < 0.05). The birth weight of neonates in group B was more than that of neonates in group A (P < 0.05). At 5 min after birth, none of the neonates in group B had an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) abnormal score <7, compared to neonates in group A. Majority of neonates in group A showed tachycardia and respiratory distress syndrome (RDS) (17.5% and 12.5%, respectively), compared to group B (12.5% and 7.5%, respectively). The overall success rate was better in group B (86.8%) compared to group A (80%).Conclusion:Nifedipine was slightly more effective in arresting preterm labor with fewer side effects, compared to isoxsuprine.

Asymptomatic complete heart block in labor: A case report of none response to atropine therapy

Introduction: A complete heart block is a cardiac electrical conduction disorder with a very rare occurrence in pregnancy, which may be asymptomatic. There are no specific guidelines for the management of asymptomatic complete heart block in labor, vaginal delivery, and cesarean with only a few reports of cesarean management of patients with complete heart block. Case report: A 30-year-old woman, Gravida 4, abortion 3, gestational age of 41 weeks without any specific problems, was referred to our maternity hospital. The pulse rate and blood pressure were 68 and 60/110, respectively. Labor was induced with oxytocin and, after three hours, was discontinued due to late decelerations of fetal heart rate. Electrocardiography confirmed a maternal pulse rate of 42. Cardiac consultation led to the diagnosis of a complete heart block. Due to the frequent late decelerations of fetal heart rate and no response to atropine therapy, the patient was a candidate for a cesarean. Before cesarean, the pacemaker was installed. Cesarean was performed with general anesthesia, and the infant was delivered in good condition. In Postpartum, the pacemaker was removed (PR=55, BP=125/80), and the mother was discharged the next day. Due to the lack of specific guidelines, fetal indication for an emergency cesarean, mother poor obstetrics history, and none response to atropine therapy, we chose to incorporate pacemakers and remove it after cesarean safely. Conclusion: Vital signs assessment during pregnancy and childbirth is recommended to detect cases of complete heart block and provide optimal care.

Comparative evaluation of continuous epidural infusion of 0.0625% Bupivacaine + 0.0002% Fentanyl and 0.1% Ropivacaine + 0.0002% Fentanyl for labour analgesia

Aim&amp; Objectives: To compare the total dose of Fentanyl and Bupivacaine with total dose of Ropivacaine and fentanyl in terms of total volume delivered-loading, infusion and top ups. Also, to compare Analgesic efficacy (VAS score) and adverse events if any. Methods: 60 ASA physical status I or II parturients in labour who were either primigravidae or gravida 2 were included in a randomized, single blind, prospective study. After a bolus dose of 0.125 % Bupivacaine and 25 mcg Fentanyl, the group BF received a continuous epidural infusion of 0.0625% Bupivacaine and 0.0002% Fentanyl whereas the group RF received a bolus of 0.2% Ropivacaine and 25 mcg Fentanyl followed by an infusion of 0.1% Ropivacaine and 0.0002% Fentanyl. Results: The Group BF and Group RF were comparable with respect to their physical parameters. It was seen that the pain relief in the group BF was excellent for 8 out of 30 patients (26.67%) whereas for the group RF it was excellent for 9 of 30 patients (30%). After that till delivery, both the groups had a comparable mean maternal pulse rate (p value &gt;0.05). None of the parturient in study or control group ever had an episode of bradycardia. Throughout the remaining period of analgesia, the mean foetal heart rate was comparable between the two groups. In the present study groups only 2 parturients from group BF and only one parturient from group RF underwent caesarean section due to foetal distress. 6 parturients (20%) from group BF and 5 parturients (16.67%) from group RF developed hypotension. Conclusion: Continuous infusion of 0.1% Ropivacaine + 0.0002 % Fentanyl provides equipotent labour analgesia and maternal satisfaction as 0.0625% Bupivacaine + 0.0002% Fentanyl infusion can provide.

A Pilot Randomized Controlled Trial to Evaluate Isosorbide Mononitrate (IMN) Efficiency for Cervical Ripening Prior to Labor Induction in Iranian Pregnant Women.

Our aim was to examine the effect and cost-effectiveness of isosorbide mononitrate (IMN) for outpatient (at home) cervical ripening in Iranian women with term pregnancy. Term pregnant women were randomly selected to receive either 15 mg vaginally administered IMN or placebo. Patients were advised to take the second dose at home 24 h later and return to the hospital for admission after the next 24 h if the onset of spontaneous contraction does not occur. Cervical status, maternal blood pressure, maternal pulse rate, fetal heart rate and various side effects were examined. IMN induced a significant increase in cervical Bishop Score; headache, nausea, and dizziness were seen in 8 of 28 participants of IMN group; although, all had normal vital signs and normal FHR, they had to be hospitalized and receive medication to relieve the unpleasant symptoms. Vaginal administration of 15 mg of IMN induced cervical ripening in term pregnant women. However, the administration of IMN for cervical ripening is not recommended as it produced headache in significant number of Iranian pregnant women.

Use of the Partogram in the Bamenda Health District, North-West Region, Cameroon: A Cross-Sectional Study

Background: The partogram is an effective instrument in the follow-up of labor. It enables timely diagnoses of abnormalities and helps in decision-making. Objectives: This study was carried out to 1) establish and compare the proportion of labor cases followed up with the partogram in primary and secondary healthcare facilities in the Bamenda Health District and 2) appraise the attitudes of the health workers towards the partogram and how those attitudes impact outcomes. Methods: A cross-sectional study was carried out in which 383 files were reviewed and 42 questionnaires were administered to health workers. The information extracted from the files focused mainly on the number of partograms used and the standard criteria under study were: cervical dilatation, station, the state of the amniotic fluid and maternal temperature monitored every four hours. Maternal blood pressure, pulse rate and Fetal Heart Rate (FHR) were monitored every hour. Each of the parameters was judged as correctly filled if they met the above criteria; as not correctly filled if the criteria were not met; and as not filled if no information was recorded. Statistical analysis was with Epi-InfoTM. Results: The results showed that 223(58.2%) deliveries were followed up with the partogram, only 4(1.0%) of which had all the parameters filled to standard. Two hundred and six (86.2%) deliveries in the Bamenda Regional Hospital and 17(11.8%) in the primary healthcare facilities were followed up with the partogram. Forty (95.2%) health workers agreed that the partogram was useful in following up labor. Conclusions: The health workers had a positive attitude towards the partogram, but on the whole it was incorrectly used. The instrument was for the most part unavailable, and even where it was, poor supervision and absence of guidelines on its use led to poor diagnoses. We recommend that supportive supervision and regular in-service training be encouraged; and that partograms and guidelines be made available.

Effect of xylazine, isoxsuprine, and lidocaine on Doppler sonographic uterine and umbilical blood flow measurements in cows during the last month of pregnancy

The maternal portion of the bovine placenta receives blood mainly from the uterine arteries (AUT) and the fetal portion from the umbilical arteries (AUM). Placental perfusion is crucial for fetal development and undergoes adaptive changes during pregnancy according to the fetal requirements. One goal of this study was to investigate changes in Doppler sonographic measurements of blood vessels that supply blood to the placenta in cows during the last 4 weeks of pregnancy. Another goal was to examine how these measurements are affected by three drugs commonly used in cows at the time of parturition. Nine cows underwent Doppler sonographic examination of the AUT ipsilateral and contralateral to the pregnant horn and one AUM three times per week during the last 4 weeks of gestation. This was followed by the randomized administration of one of the three following experimental drugs per day: isoxsuprine (200 mg/cow, iv), xylazine (2 mg/100 kg, iv), and lidocaine for epidural anesthesia (100 mg/cow). Doppler sonographic examination was repeated 30 minutes after medication. Maternal pulse rate increased during the study period (P < 0.001), and the diameter of the contralateral AUT was smaller in the last week before birth than in the two preceding weeks. The resistance index (RI) of the ipsilateral AUT was smaller in the last week than in the first 2 weeks of the study period. Uterine blood flow volume increased after isoxsuprine by 5% and after epidural anesthesia by 6% (both P ≤ 0.05) and decreased after xylazine by 10% (P < 0.001). Isoxsuprine was the only drug that elevated the blood flow volume in the AUM (P ≤ 0.05). Xylazine increased the RI of both AUT (both P < 0.001) and significantly reduced maternal and fetal pulse frequencies, whereas isoxsuprine significantly reduced the RI of both AUT and the AUM and increased maternal and fetal pulse frequencies. The results reported that Doppler sonographic measurements of uterine and AUM change little in the last month of pregnancy in the cow. Isoxsuprine and epidural anesthesia with lidocaine have the potential to improve uterine perfusion.

Maternal position during caesarean section for preventing maternal and neonatal complications

During caesarean section mothers can be in different positions. Theatre tables could be tilted laterally, upwards, downwards or flexed and wedges or cushions could be used. There is no consensus on the best positioning at present. We assessed all available data on positioning of the mother to determine if there is an ideal position during caesarean section that would improve outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 August 2012), PubMed (1966 to 20 August 2012) and manually searched the references of retrieved articles. Randomised trials of woman undergoing caesarean section comparing different positions. Two review authors assessed eligibility, trial quality and extracted data. We identified 22 studies with a total of 857 women included. We included 11 studies and excluded 11. Included trials were of variably quality with small sample sizes. Most comparisons had data from single trials. This is a shortcoming and applicability of results is limited.The incidence of air embolism was not affected by head up versus horizontal position (average risk ratio (RR) 0.85; 95% confidence interval (CI) 0.28 to 2.57; Tau² = 0.50; I² = 74%).We found no change in hypotensive episodes when comparing left lateral tilt (RR 0.11; 95% CI 0.01 to 1.94), right lateral tilt (RR 1.25; 95% CI 0.39 to 3.99), a right lumbar pelvic wedge (RR 0.85; CI 0.53 to1.37) and head down tilt (RR 1.07; 95% CI 0.81 to 1.42) with horizontal positions. We found no change in hypotensive episodes when comparing full lateral tilt with 15-degree tilt (RR 1.20; 95% CI 0.80 to 1.79). Hypotensive episodes were decreased with manual displacers (RR 0.11; 95% CI 0.03 to 0.45), and increased with a right lumbar wedge compared with a right pelvic wedge (RR 1.64; 95% CI 1.07 to 2.53) and increased with a right lateral tilt compared with a left lateral tilt (RR 3.30; 95% CI 1.20 to 9.08).Position did not affect systolic blood pressure when comparing left lateral tilt (MD 2.70; 95% CI -1.47 to 6.87) or head down tilt (MD -3.00; 95% CI -8.38 to 2.38) with horizontal positions, or full lateral tilt with 15-degree tilt (MD -5.00; 95% CI -11.45 to 1.45). Manual displacers showed decreased fall in mean systolic blood pressure compared with left lateral tilt (MD -8.80; 95% CI -13.08 to -4.52).Position did not affect diastolic blood pressures when comparing left lateral tilt versus horizontal positions (MD-1.90; 95% CI -5.28 to 1.48). The mean diastolic pressure was lower in head down tilt (MD -7.00; 95% CI -12.05 to -1.95) when compared with horizontal positions.There were no statistically significant changes in maternal pulse rate, five-minute Apgars, maternal blood pH or cord blood pH when comparing different positions. There is limited evidence to support or clearly disprove the value of the use of tilting or flexing the table, the use of wedges and cushions or the use of mechanical displacers. A left lateral tilt may be better than a right lateral tilt and manual displacers may be better than a left lateral tilt but larger studies with more robust data are needed to confirm these findings.

Effect of hyoscine-N-butyl bromide rectal suppository on labor progress in primigravid women: a randomized double-blind placebo-controlled clinical trial

AimTo determine the effects of hyoscine-N-butyl bromide (HBB) rectal suppository on labor progress in primigravid women.MethodsA randomized double-blind placebo-controlled clinical trial was carried out on 130 primigravid women admitted for spontaneous labor. The women were recruited based on the inclusion and exclusion criteria and randomized into the experimental (n = 65) and control group (n = 65). In the beginning of the active phase of labor, 20 mg of HBB rectal suppository was administered to the experimental group, while a placebo suppository was administered to the control group. Cervical dilatation and duration of active phase and second stage of labor were recorded.ResultsThe rate of cervical dilatation was 2.6 cm/h in the experimental and 1.5 cm/h in the control group (P < 0.001). The active phase and the second stage of labor were significantly shorter in the experimental group (P = 0.001 and P < 0.001, respectively). There was no significant difference between the two groups in the fetal heart rate, maternal pulse rate, blood pressure, and the APGAR score 1 and 5 minutes after birth.ConclusionUse of HBB rectal suppository in the active management of labor can shorten both the active phase and second stage of labor without significant side-effects.Registration NoIRCT138804282204N1.

EPHEDRINE FOR PREVENTION HYPOTENSION

Background/Aim:. To ameliorate post spinal anesthesia hypotensionin patients undergoing cesarean section. To compare the incidence of maternal hypotension associated withspinal anesthesia for cesarean section when intravenous (IV), intramuscular (IM) or oral prophylactic boluses ofephedrine were used. Design: Prospective randomized double blind study. Setting: Department of anesthesiology,Zainibiae Hospital, Shiraz University, Iran. Period: From: June 2004 to November 2005. Materials and Methods:60 ASA grade I-II pregnant mothers were enrolled. Spinal anesthesia was performed using 60-70 mg of 5% solutionof lidocaine. The patients were divided into three equal groups (n=20). Oral and IM ephedrine (25 mg) wasadministered to the first two groups 30 to 60 minutes before induction of anesthesia (Group A and B, respectively). Inthe last 20 patients, IV Ephedrine (25 mg) was administered immediately after induction of spinal anesthesia (GroupC). Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10-mg ephedrine boluses. Results: Both IM and IV prophylactic doses of ephedrine significantly decreased the incidenceof hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups,respectively vs. 9/20 in the oral ephedrine group (p &lt; 0.05)]. Conclusion: Oral prophylactic dose of ephedrine is noteffective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore,we only recommend a single bolus of IV ephedrine with a dose of 25mg.

Pregnancy Complicated with Maternal Pulmonary Hypertension and Placenta Accreta

Pregnancy is contraindicated in cases of maternal pulmonary hypertension, a highly morbid disease affecting young women of childbearing age. The rate of heart failure increases gradually with the severity of pulmonary hypertension. In certain instances, the severity of maternal pulmonary hypertension in rheumatic heart diseases can be higher than in congenital heart diseases. Placenta accreta is an important cause of bleeding in the second half of pregnancy and in labor. In severe cases, hysterectomy is the only way to manage the bleeding during cesarean section. A 33-year-old gravida, G2P0AA1, suffering from rheumatic heart disease with mitral valve stenosis and pulmonary hypertension, was referred to our high-risk pregnancy center at 10(+3) weeks of gestation due to lower abdominal pain and brownish vaginal bleeding. She had received 2 mitral valve replacements in Shenzhen, China, at the ages of 22 and 26, respectively. Ultrasound scan of the abdomen at 12(+2) gestational weeks showed that the internal cervix was completely covered with the placenta, and a retroplacental hypoechoic space measuring 35 x 13 mm was observed at the upper posterior margin of the placenta. On color Doppler scan, an area of lacunar lake flow was observed in the hypoechoic space of the placenta and a spiral artery with low blood flow resistance was detected. The pulsation of the placental flow was synchronized with the maternal pulse rate. Team specialists, including neonatologists, pulmonary physicians, pediatric cardiologists, hematologists, anesthesiologists, psychiatrists and social workers, as well as high-risk obstetricians were consulted in an effort to minimize fetal and maternal morbidity and mortality. At 29(+2) weeks, the patient developed preeclampsia and delivered a healthy newborn by cesarean section, the uterus being preserved by square compression sutures. The gravida tolerated the procedures and was discharged in stable condition.

Vaginal administration of the nitric oxide donor isosorbide mononitrate for cervical ripening at term: a randomized controlled study

Objective Our aim was to examine the effect of the nitric oxide donor isosorbide mononitrate on the uterine cervix at term and to evaluate possible adverse effects of this treatment. Study design Term pregnant women were randomly selected to receive either 40 mg vaginally administered isosorbide mononitrate or placebo 4 hours before elective cesarean section. Cervical status, maternal blood pressure, maternal pulse rate, fetal heart rate, umbilical arterial Doppler indices, and various side effects were examined. Results Isosorbide mononitrate induced a significant increase in cervical distensibility. It also caused a significant change in maternal blood pressure and maternal pulse rate. In addition, the frequency of maternal headache and palpitations was significantly higher in the isosorbide mononitrate group versus the placebo group. However, the intensity of these symptoms was moderate. Conclusion Vaginal administration of 40 mg of isosorbide mononitrate induces cervical ripening at term. Although the majority of women experienced side effects, no serious clinical maternal or fetal adverse effects, resulting in specific medication or emergency cesarean section, were diagnosed.

Effects of San-Yin-Jiao (SP6) Acupressure on Anxiety, Pulse and Neonatal Status in Women during Labor

Purpose: In the study effects of San-Yin-Jiao (SP6) acupressure on anxiety and pulse during labor, and on neonatal status were examined. Method: The design was a randomized controlled clinical trial with a double-blind method. Data were collected before (pre) and after (post) treatment using structured questionnaire, anxiety scale, pulse rate, umbilical vein pH and Apgar scores. The experimental group received SP6 acupressure for the duration of each uterine contraction over a period of 30 minutes, but the control group received SP6 touch. Results: The anxiety scores between the two groups increased, but the increase was less in the SP6 acupressure group and the difference was statistically significant (p=0.019). Maternal pulse rate was not significantly different immediately after treatment (p=0.711), at 30 and at 60 minutes (p=0.140 ; p=0.108), but while the SP6 acupressure group had a stable pulse, the SP6 touch group showed an increased rate. There was no significant difference between the two groups for umbilical vein pH (p=0.124), and neonatal Apgar score at one and five minutes (p=0.387 ; p=0.979). Conclusion: These findings strengthen the belief that SP-6 acupressure can be used to relieve anxiety during labor with no side effects to either mother or baby.

Vaginal application of the nitric oxide donor isosorbide mononitrate for preinduction cervical ripening: A randomized controlled trial to determine effects on maternal and fetal hemodynamics

Objective: Our aim was to assess the effects of vaginally administered isosorbide mononitrate (a nitric oxide donor) on maternal and fetal hemodynamics in pregnant women at term. Study Design: We conducted a randomized controlled trial. Women were randomly selected to receive vaginally administered isosorbide mononitrate, 20 mg (n = 13) or 40 mg (n = 11), or to undergo a vaginal examination only (n = 12). Maternal pulse, blood pressure, and fetal heart rate were recorded at baseline and then every 30 minutes until 360 minutes. Umbilical artery resistance index and pulsatility index measurements were performed at 0, 180, and 330 minutes. Results: Maternal pulse rate was greater after the administration of isosorbide mononitrate, 20 or 40 mg, compared with the pulse rate in the vaginal examination–only group (greatest difference in means, 21 beats/min; P <.01). Maternal systolic and diastolic blood pressures were greater in the 20-mg and 40-mg isosorbide mononitrate groups than in the vaginal examination–only group (greatest difference in mean systolic and diastolic blood pressure, 15 and 16 mm Hg, respectively; P <.02 and P <.001, respectively). Fetal heart rate was greater in the 40-mg isosorbide mononitrate group than in either the 20-mg isosorbide mononitrate group or the vaginal examination–only group (difference in mean, 15 beats/min; P <.05). No woman required treatment for maternal or fetal tachycardia or maternal hypotension. Neither dose of isosorbide mononitrate had a significant effect on umbilical artery resistance or pulsatility index. Conclusions: Vaginal administration of 20 or 40 mg isosorbide mononitrate to pregnant women at term has an effect on both maternal and fetal hemodynamics, but this effect is not clinically significant. (Am J Obstet Gynecol 2001;184:958-64.)

Antenatal origins of individual differences in heart rate.

This study examines prenatal-to-postnatal stability in heart rate and variability from mid-gestation through the first year of life. Fetal heart rate data were collected from 52 healthy fetuses at 24, 30, and 36 weeks gestation, and again at 2 weeks and 12 months of age. Fetal heart rate measures were stable during gestation and positively associated with neonatal and infant measures. Maternal pulse rate and oxygen saturation were moderately associated with fetal heart rate. Together, fetal cardiac (heart rate and variability) and maternal physiologic measures (blood pressure and oxygen saturation) explained 40 and 48% of the variance in heart rate and variability, respectively, at 1 year of age. These common measures of individual differences in autonomic function are enduring characteristics that originate during fetal development.

Maternal and Fetal Cardiovascular Effects of Transdermal Glyceryl Trinitrate and Intravenous Ritodrine

In Brief Objective To determine the maternal and fetal cardiovascular effects of transdermal glyceryl trinitrate compared with ritodrine for acute tocolysis. Methods Sixty women in preterm labor were enrolled in this study that was part of a multicenter study of glyceryl trinitrate. Once randomized, the women received transdermal glyceryl trinitrate or intravenous ritodrine for acute tocolysis. Measurements of maternal pulse, blood pressure (BP), and fetal heart rate (FHR) were recorded for up to 24 hours and compared over the treatment course. Results Changes from baseline in mean maternal heart rate, FHR, and maternal BP (mean arterial pressure [MAP]) were compared between the glyceryl trinitrate and ritodrine groups over the entire treatment course. The mean change from baseline in maternal heart rate was 21.1 beats per minute less (95% confidence interval [CI] 15.7, 26.5, P < .001), and the mean maternal heart rate was 21.8 beats per minute lower (95% CI 16.9, 26.7, P < .001) in the glyceryl trinitrate group. The mean change in FHR was 9.2 beats per minute less (95% CI 3.8, 14.6, P = .001) and the mean FHR significantly lower (6.9 beats per minute, 95% CI 1.9, 11.9, P = .008) during glyceryl trinitrate treatment. Ritodrine had a significantly hypotensive effect on MAP (95% CI −4.3, 0.0, P = .03). Mean arterial pressure was not significantly different over the treatment course. Conclusion At doses required for acute tocolysis, transdermal glyceryl trinitrate had minimal effects on maternal pulse, BP, and FHR, and significantly fewer adverse cardiovascular effects than intravenous ritodrine. Thus, transdermal glyceryl trinitrate might be a safer treatment for women in preterm labor. Transdermal glyceryl trinitrate has significantly fewer maternal and fetal cardiovascular side effects than intravenous ritodrine at doses required for tocolysis.

Maternal and fetal cardiovascular effects of transdermal glyceryl trinitrate and intravenous ritodrine

Objective: To determine the maternal and fetal cardiovascular effects of transdermal glyceryl trinitrate compared with ritodrine for acute tocolysis. Methods: Sixty women in preterm labor were enrolled in this study that was part of a multicenter study of glyceryl trinitrate. Once randomized, the women received transdermal glyceryl trinitrate or intravenous ritodrine for acute tocolysis. Measurements of maternal pulse, blood pressure (BP), and fetal heart rate (FHR) were recorded for up to 24 hours and compared over the treatment course. Results: Changes from baseline in mean maternal heart rate, FHR, and maternal BP (mean arterial pressure [MAP]) were compared between the glyceryl trinitrate and ritodrine groups over the entire treatment course. The mean change from baseline in maternal heart rate was 21.1 beats per minute less (95% confidence interval [CI] 15.7, 26.5, P < .001), and the mean maternal heart rate was 21.8 beats per minute lower (95% CI 16.9, 26.7, P < .001) in the glyceryl trinitrate group. The mean change in FHR was 9.2 beats per minute less (95% CI 3.8, 14.6, P = .001) and the mean FHR significantly lower (6.9 beats per minute, 95% CI 1.9, 11.9, P = .008) during glyceryl trinitrate treatment. Ritodrine had a significantly hypotensive effect on MAP (95% CI −4.3, 0.0, P = .03). Mean arterial pressure was not significantly different over the treatment course. Conclusion: At doses required for acute tocolysis, transdermal glyceryl trinitrate had minimal effects on maternal pulse, BP, and FHR, and significantly fewer adverse cardiovascular effects than intravenous ritodrine. Thus, transdermal glyceryl trinitrate might be a safer treatment for women in preterm labor.

Blood pressure and fetal heart rate changes with patient-controlled combined spinal epidural analgesia while ambulating in labour.

To determine the effect of patient-controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour. A prospective study. Queen Charlotte's and Chelsea hospital, London. Fifty-five primigravid women in labour at > or = 37 weeks of gestation; 40 women had supervised standing top-ups given by an anaesthetist. A further 15 women had PCEA top-ups given in each of standing, sitting and lying positions. Maternal pulse rate, blood pressure and fetal heart rate changes following epidural top-ups. In the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top-ups had no fall in blood pressure in the standing and sitting positions, though the average blood pressure fell significantly when a top-up was given in the lying position. Maternal heart rate increased significantly at 12 min post top-up when the women were in the standing position (P = 0.0018). In the 15 women who had PCEA top-ups, the CTG showed improvement in decelerations when women were in the standing position but deterioration when in the lying position (P < 0.01). Patient-controlled epidural analgesia top-ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top-ups in the lying position.

Nicardipine versus salbutamol in the treatment of premature labor. A prospective randomized study

Objective: To compare the tocolytic action and the side effects of nicardipine to those of salbutamol in patients presenting premature labor in order to propose nicardipine as a promising alternative to salbutamol in the treatment of premature labor. Study design: Ninety patients admitted to the Saint-Antoine Hospital (Paris, France) for premature labor were included in this prospective randomized open study comparing nicardipine and salbutamol. Each study group included 45 patients. Results: The mean term of delivery in the nicardipine group was 38.4 ± 1.7 and 37.6 ± 2.1 weeks in the salbutamol group ( p < 0.05). The percentage of deliveries after 37 gestational weeks was higher with nicardipine ( P < 0.05). The birthweight of infants was 3131 ± 488 g with patients treated with nicardipine and 3019 + 494 g with the salbutamol group (NS). The Apgar scores were identical in the two groups at 1 and 5 min. There was no statistically significant difference in the number of neonates admitted into intensive care nor the premature infant center between the two groups. Nicardipine reduced the systolic and diastolic blood pressure whereas there was no change in the salbutamol group. Maternal pulse rate was significantly increased in the salbutamol group ( P < 0.01) and was unchanged in the nicardipine group. The most common side-effects with nicardipine were headaches, and with salbutamol, tremors and palpitations. Conclusions: Nicardipine is a tocolytic agent as effective as salbutamol in the treatment of premature labor. The use of nicardipine is an interesting alternative to salbutamol, especially in cases of hypertension, diabetes or maternal cardiopathy.