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Fetal and infant outcome was studied in 38 singleton pregnancies complicated by very early rupture of membranes (PROM), in gestational weeks 19-29, over a 4-year period, in a Swedish population. The pregnancies were managed according to a specified protocol, including postponement of delivery until 34 weeks of gestation if possible. Stillbirth occurred in 10 cases (26.3%), all with PROM before 26 completed weeks, while 6 other infants died in the neonatal period. Respiratory distress syndrome was evident in half (50.0%) of the 28 liveborn infants. The surviving 22 infants (57.9%) were followed up to 2 years of age. The rate of neurological sequelae at follow-up was 22.7 % (5/22). The fetal outcome of the 20 pregnancies with rupture of membranes before 26 completed weeks was poor; only 7 infants of the 10 born alive survived the neonatal period. The short-term fetal outcome in the group with rupture of membranes in 26-29 completed weeks was better: 15 of the 18 infants survived, but 4 had neurological sequelae. PROM before 29 completed weeks of gestation is associated with severe short-term and long-term fetal complications, in cases where the pregnancy is prolonged for several weeks.

Placental grading was studied prospectively with real-time ultrasound in 654 consecutive pregnancies. the placental maturation was clearly demonstrated in both unselected and hypertensive pregnancies. No differences in placental grading were found between normotensive and hypertensive pregnancies. Fetal outcome was not associated with different placental grades and a grade III placenta was not predictive of an adverse outcome. the value of antenatal placental grading in unselective and hypertensive pregnancies could not be demonstrated.

During a 2 1/2-year period, 1056 pregnant women (1072 fetuses) were monitored with the nonstress test (NST) in the antenatal period. Testing time was 30 minutes. The NST was classified into one of four classes: normal, suspect pathological, slight pathological, and severe pathological. In 88.5% of the pregnancies, all NSTs were normal. Suspect, slight, or severe pathological NSTs occurred at least once in 8.1%, 2.1%, and 1.3% of the women respectively. All women with a severe pathological NST had high-risk complications. Lethal malformations excluded, there were only two perinatal deaths among the tested women. In the four different classes, the frequencies of cesarean section were 11%, 17%, 41%, and 79%. One-minute Apgar scores were <7 in 5%, 12%, 41%, and 64%. The need for referral to neonatal intensive care was 19%, 40%, 41%, and 93% respectively. A normal NST predicted normal fetal outcome in an excellent way, while the three pathological classes appeared to represent different degrees of impending fetal jeopardy.

In order to describe the outcome of a one-year material of hypertensive pregnancies, a retrospective analysis was made of the patients with respect to time of onset of hypertension, absence/presence of significant proteinuria, and maxium recorded serum urate values less or greater than 350 μmol/l. The material comprised 113 hypertensive patients, 3.7% of 3036 deliveries in 1980. Of these only 87 could be classified as intended. Twenty-two patients lacked information on serum urate values, and the remaining 4 did not fulfil the inclusion criteria.As the type of antihypertensive treatment was almost exclusively restricted to β1-selective betablockers, alone or in combination with hydralazine, the type of treatment given was analysed with respect to the classification system applied.From this retrospective study it is evident that most hypertensive patients tend to be older than the average pregnant woman and that they also tend to represent problems arising during recurrent pregnancies. Patients with additive risk factors such as proteinuria and high serum urate values tend to need more vigorous antihypertensive treatment and in that sense seem to be more difficult to treat. In our material, patients with an early rise in high blood pressure and high serum urate values accounted for the entire perinatal mortality of the hypertensive pregnancies. The values of serum urate monitoring and the future detection and monitoring of hypertensive pregnant patients is discussed.

Forty term patients with pregnancy-induced hypertension were treated with the β1-adrenoceptor blocker atenolol (TenorminR; ICI) for at least 7 days prior to parturition. The antenatal cardiotocography (CTG) was visually analysed before and during treatment. The mean basal fetal heart rate (FHR) decreased from 143±7 beats per minute (bpm) to 13328 bpm. In 13.1% of the recordings in treated patients there was a decrease in long-term variability for a period of more than 20 minutes; this was observed in only 2.3% prior to treatment. The amplitude of the accelerations was reduced from 23±6 bpm to 18±4 bpm. It was demonstrated that atenolol affected antenatal CTG, and this has to be taken into consideration when interpreting antenatal CTG as one parameter for evaluation of fetal well-being.

We encountered two cases of cardiac asystole for one and three minutes respectively following external cephalic version. We describe the two cases and discuss the necessity for one to be aware of such an event and the possible advantage of performing a fetal heart rate (FHR) recording prior to the procedure and observation of the FHR during the version.

A rare complication in twin pregnancy is acute polyhydramniosis. If left untreated, the perinatal mortality is 100%. the clinical courses of two cases treated with ultrasound-guided amniocentesis are presented. in the first case altogether 4 87S ml amniotic fluid was drained. Both twins died within the first 24 hours of life after delivery in gestational week 26. in the second case 2 150 ml amniotic fluid was drained. Both twins survived and were delivered in good condition in gestational week 35. We recommend ultrasound-guided amniocentesis to be performed in twin pregnancy affected by acute polyhydramniosis.

The effects of two different β-adrenergic antagonists on maternal arterial pressure and fetal heart rate were studied in 8 pregnant women with pregnancy hypertension. The fetal heart rate was monitored by abdominal ECG recording under standardized conditions. Basal heart rate, long-term variability and short-term variability were calculated in a computer. Four patients received 50-100 mg atenolol once daily; the other 4 received pindolol 10 mg b.i.d. Reduction in mean arterial blood pressure was seen in both groups of patients. The basal fetal heart rate was decreased in atenolol-exposed fetuses but not in pindolol-exposed fetuses. In this preliminary study there was no apparent effect on the fetal heart rate variability.