Bioelectric evaluation in intrauterine growth retardation.
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Biomedical subjects
Publications and source records attributed to C L Cetrulo.
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A simple and rapid test that correlates with L/S ratios has been developed. By centrifuging fresh, unfrozen amniotic fluids at 200g for 10 minutes and measuring the optical density at at 650 nm, correlation with L/S ratios is obtained. Optical density readings of 0.15 or greater correlate 100% with L/S ratios of 2.0 or greater. Optical readings below 0.15 correlate 94% with L/S ratios below 2.0.
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The perinatal mortality rate for twin gestation is in the range of 15%, and this is due predominantly to prematurity, although twins may also be born growth retarded. Ritodrine HCl, a beta sympathomimetic drug, has been shown to be effective, both in stopping premature labor and in preventing intrauterine growth retardation. With this in mind, a double-blind study using ritodrine HCl or placebo was begun in order to study its effect on premature labor, intrauterine growth retardation, and the perinatal mortality rate in twins. Thus far, 30 patients have delivered and have been followed to 6 weeks postpartum. Although the results on individual patients have remained blinded to the investigators, an initial evaluation of the ritodrine and placebo groups have revealed no difference with respect to gestational age, birth weight, or perinatal mortality. These preliminary results are not significant. However, it appears that ritodrine HCl is a safe oral agent for the antepartum gravida and her fetus. The study will be continued until approximately 100 patients have been enrolled.
A test that circumvents the complex methodology needed for the determination of L/S ratios has been developed. It has been observed that the optical density, measured at 400 nm, of supernatants collected from fresh amniotic fluids centrifuged at 2000 g for 10 minutes correlates with L/S ratios.
Four cases of intrauterine fetal demise in term infants are presented. From these cases and other published reports, a sequence of fetal heart rate changes preceding intrapartum death is presented. Late or variable decelerations, if unrelieved or uncorrected, lead to baseline heart rate changes of tachycardia and loss of variability reflecting loss of fetal reserve and fetal distress. This is followed by an unstable heart rate, a sinusoidal pattern, or a rapidly changing fetal heart rate. The final event is a profound bradycardia just prior to fetal demise.
A case is presented illustrating the complicating effects of antepartum steroids on a pregnant diabetic woman. The possible rapid deterioration of the diabetic state and the temporary suppression of estriol production are discussed.
A pilot study examined 23 patients who underwent simultaneous ultrasound and amniocentesis to determine whether the ratio of densitometrically determined tissue densities of fetal lung and liver correlate with the L/S, the OD 650, or phosphatidylglycerol levels. The incidence of a lung/liver ratio greater than 1 of 65% was similar to that of maturity levels of the standard tests. However, there was no statistically significant correlation between an L/L greater than 1 and/or any maturity parameter tested, nor was there any correlation with the absence of pulmonary maturity. We conclude that this test cannot be reliably used to predict L/S, OD 650 reading, or PG levels.
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