Journal of perinatal medicine
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Two real-time ultrasound instruments were used simultaneously for comprehensive recording of "total" fetal motor activity in 50 patients in the second half of pregnancy. Synchronously, cardiotocographic findings and maternal perception of fetal movements were stored on magnetic tape. In most cases fetal "gross" movements were perceived by the mothers (mean: 63%). ⋯ In 30% of all cases the mothers perceived movements without sonographic confirmation. The findings of this study suggest that maternal perception of major fetal body movements is accurate in the majority of cases. However, the relatively high rate of false positive maternal perception should be taken into consideration if the maternal record of daily fetal movements is to be used for fetal monitoring.
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Vasoconstriction of the uterine arteries, hypertonus of the uterus, and the direct toxic effects of a local anesthetic on the fetus or a combination of the above have been presented as etiological factors of fetal bradycardia following paracervical block. The reduce fetal side-effects a superficial and lowdosage technique of PCB have been advocated. We have studied the effects of 25 mg of bupivacaine PCB using the above technique on fetal heart rate pattern (FHR), fetal acid-base balance, uterine activity, placental blood flow and maternal and fetal plasma levels of bupivacaine in 38 patients. ⋯ However, an obvious uterine hypertonus was observed after PCB was observed in three cases of fetal bradycardia but not in two other cases of bradycardia or in the 8 cases of silent FHR pattern. Mean maternal bupivacaine concentration 20 minutes after PCB was 0.14 +/- 0.06 microgram/ml and 0.07 +/- 0.04 microgram/ml at birth. Simultaneous fetal and umbilical venous and arterial concentrations were correspondingly 0.04 +/- 0.02 microgram/ml, 0.03 +/- 0.01 microgram/ml and 0.03 +/- 0.01 microgram/ml, and they were significantly lower than respective maternal concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)