Survival of infants (<1000 g) depends on gestational age, centralization and multiple births.

Objective. The improvement of the accuracy of fetal heart rate (FHR) pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group) and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group) showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11%) without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1) without increasing the cesarean birth rate due to nonreassuring FHR patterns.

A 30-year-old woman at 37 weeks of gestation died during labor induction with oxytocin shortly after an episode of abrupt drop of fetal heart rate. Autopsy showed extensive microvascular plugging of the pulmonary capillaries by massive platelet aggregations. Aside from platelet aggregations, the keratinized substances and granulocytes were also shown in the capillary of pulmonary arterioles. These findings were not observed in other systemic organs (heart, liver, spleen, kidney, adrenal, alimentary canal and pancreas). In general, the postmortem histological diagnosis of amniotic fluid embolism consisted of demonstrating mucus, leukocytes, squamous, amorphous, and fatty cells in the arteries of the lung. To our knowledge, there have not been any reports regarding massive platelet aggregations shown at pulmonary capillaries in case of acute amniotic fluid embolism except for an experimental model. This is a rare case of amniotic fluid embolism in which massive platelet aggregations were confirmed in pulmonary capillaries by autopsy.

We used two different noninvasive methods, i.e., transcranial Doppler velocimetry and magnetic resonance angiography to serially assess cerebrohemodynamics in a patient with postpartum eclampsia. Five hours after an eclamptic seizure, a decrease in mean velocity in both middle cerebral arteries and slight angiographical spasms indicated cerebral hypoperfusion. On hospital day 8, the patient showed an increase in the mean velocity of the middle cerebral artery, accompanied by significant vasospasms. Abnormal findings were not observed on hospital day 20. These combined methods are useful in assessing cerebrohemodynamics in eclampsia.

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