From 1984 to 1987, 300 pregnant women with fetal malpresentations underwent an attempt at external cephalic version (ECV) during the last trimester. A consecutive analysis of factors associated with successful version was performed during this period. The final version rate after one or more attempts was 58%, being lower in nulliparous (39%) than in parous women (80%). Multivariate analyses (logistic regression) identified only three significant variables out of 16 with independent power to explain successful version. The overall most important factor was parity (p less than 0.001), followed by fetal presentation (p less than 0.001) and amount of amniotic fluid (p = 0.019).
Insulin (0.1 IU/kg bw) was injected intravenously in 9 pregnant diabetics in the last trimester of pregnancy. Maternal levels of blood glucose, estriol, human placental lactogen, blood pressure and pulse rate were measured and fetal heart rate (FHR) recorded. During hypoglycemia maternal blood pressure remained unchanged but maternal pulse rate tended to increase. Plasma levels of estriol and HPL remained unchanged. In 6 of the 9 patients there was a decrease in FHR variability during the hypoglycemic period. FHR variability increased after normalization of maternal blood glucose levels. The decrease in FHR variability could be a direct effect of glucopenia on the fetal heart.
A case of malformations of the fetal central nervous system following hypervitaminosis A in early pregnancy is reported. The mother was treated with 150 000 IU vitamin A daily during gestation days 19 to 40. Determination of urinary oestriol carried out in the 42nd week of pregnancy revealed a very low excretion (4.2-6.6) mumol/24 h). Induced delivery resulted in a microcephalic child who died after 18 min. The child had multiple malformations of the central nervous system and very small adrenal glands (1.5 g; normal 11 +/- 4 g). The very low urinary oestriol excretion is well explained by the hypoplastic adrenals, which in turn can be related to insufficient ACTH stimulation, a condition similar to anencephaly. The malformations shown in the present case are considered to be related to the high doses of vitamin A given to the mother, and the authors wish to warn against uncritical use of high doses of vitamin A in whomen of childbearing age.
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