Maternal Exercise as a Screening Test for Uteroplacental Insufficiency (Upi)

Abstract

S t a t e Unlv., Hutzel osp. ~? l~p . % t~l i c h . , Dept. of Peds., D e t r o i t , Mich.H(Intr? by P.V.Woolley, J r . )A number of h o s p i t a l s s t i l l e x i s t w i t h t h e i r neonatal I C U n o t w i t h i n t h e v i c l n i t y of the d e l i v e r y rooms.Thismeans t r a n s p o r t i n compromised & u n s t a b l e i n f a n t s some d i s t a n c e t o reach t h e I~U . At Hutzel Hosp. t h i s problem was solved by t h e u s e of a NRRU i n t h e d e l i v e r y s u i t e . This r e p o r t e v a l u a t e s our experience. The NRRU was deslgned a s a miniature I C U & can accomodate 2 i n f a n t s . Hieh-risk i n f a n t s w i t h ~r o b l e m s d u r i n e d e l i v e r v and those born c i t h low APGAR scores were admitted Fo t h e NRRb f o r observation s t a b i l i z a t i o n of v i t a l s i g n s and/or f u r t h e r treatmenf. A nurAe from t h e neonatal ICUwas c a l l e d t o t h e NRRU i f a p a t i e n t was a n t i c i p a t e d . The i n f a n t s w e r e transf e r r e d o u t of t h e NRRU on1 a f t e r v i t a l s i g n s had s t a b i l i z e d & s k i n temp. was a t l e a s t 87 F.RESULTS: During a 10-monthperiod t o e.(1) t r a n s f u s i o n f o r seve;e va L n d z % meconium a s p i r a t i o n (67) 5 t677) & 4 normal APGAR but high-&k l m i n ;~~& d = 3 . 6 f 2.7 w i t h 89% r e q u i r i n g birthweight=2183*954g.Mean d u r a t i o n of s t a y = 4 8 . 3 m i n . 43% o f those admitted subsequently died b u t t h i s roup h a d a s i gn i f i c a n t l y lower gestational age weight &AP&R s c o r e corn ared t o those who survlved (P<0.005). f t cannot be concluded wtethe r theNRRUhas 1m roved s u r v i v a l but t h e 58% s u r v i v a l o f Inf a n t s w i t h m e a n~f G A~o f 3 6 i s encouraging One f a c t o r f o r t h i s might be t h e b e t t e r ;emp. of t h e babies upon a r r i v a l a t t h e ICU (97 I t 0 9) I n c o n t r a s t s k i n temp. on admission t o t h e NRRU = 95.8 ' l . f~. . I t was a l s o Aoted t h a t working i n t h e NRRU was more convenient because a e d i a t r i c nurse a s s i s t e d & n e ce s s a r y e uipment was on hand $he NRRU a l s o prevented th? holdi n up 03 a d e l i v e r y room (mean = 48.3 min.) because of an I n f a n t . ~h f s allowed more tlme f o r t h e i n f a n t t o s t a b i l i z e c o m p l e t e l y b e f o r e being transported.It i s f e l t t h a t a NRRU can be used f o r optimal c a r e t o I n f a n t s . THE ROLE OF A PEDIATRIC NURSE PRACTITIONER (PNP) I N A NEONATAL UNIT. ( I n t r . n g 3 . , v . Hutzel Hosp., D e t r o i t , Mich.The Hutzel Hos i n D e t r o i t has an annual d e l i v e r y r a t e of 56862 96 l i v e b i r t k LB & a neonatal m o r t a l i t y &morbldity r a t e o f 18 6* 1 0 & 286*$0 !!per 1000 LB r e s p e c t i v e l y Theprematur r t ;ate i s 11 2 * i 6%. I t was f e l i t h a t w i t h a 'significant n u d e r of high-kjsk ' & s i c k newborns r e q u i r i n g c a r e l e s s e r a t t e n t i o n was belng given t o t h e w e l l newborns a s t a r a s more frequent ...

Fetal Breathing Movements and Maternal Exercise

“…The present results agree well with the reports by Hon and Wohlgemuth (14) and Stembera (27) which demonstrated no, or only slight, FHR changes after step-test in uncomplicated pregnancies. However, Pomerance et al (24) showed that in 9 per cent of normal pregnant women, a reduction in FHR of more than 16 beats per minute followed a bicycle ergometer test at a load level similar to ours. The present fiidings confirm the greater reactivity to various stimuli of FBM compared with FHR.…”

“…Our knowledge of whether maternal physical activity affects the human fetus in normal gestation is at present incomplete. Only few clinically normal pregnant women subjected to exercise tests have shown any changes in the fetal heart rate (14,16,24,26,27). It has been suggested that measurements of fetal breathing movements (FBM) in man provide a more sensitive indication of fetal physiological state than does fetal heart rate (FHR) (5).…”

The Effect of Work Activity in Pregnancy on the Risk of Severe Preeclampsia

“…Another possible explanation involves the effect of intense physical activity on uteroplacental blood flow. Maternal exercise is known to reduce uteroplacental blood flow (23). The restriction of physical activity lowers blood pressure and promotes diuresis (19,24).…”

Fetal heart rate response to strenuous maternal exercise: Not a predictor of fetal distress

“…Previous studies have not analyzed factors in this population size to assess those mother who are at risk of the development of an abnormal trace in labor. 15 This noninvasive assessment of fetal heart rate patterns also gives an indication of fetal heart rate response to moderate exercise. Previous investigators have looked at the effect of moderate exercise on the resistance to blood flow (systolic/diastolic) in the umbilical and uterine artery.…”