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- Title
The importance of amnioscopy in the supervision of the pregnant woman at risk: Retrospective analysis of 4277 cases.
- Authors
Roversi, G. D.; Canussio, V.; Gargiulo, M.; Pedretti, E.; Nicolini, U.; Spreafico, A.; Bagozzi, D. Clerici; Vergani, P.
- Abstract
Since 1967 amnioscopic control has been daily routine in our Clinic. The number of pregnancies at risk controlled by amnioscopy from 1967 to 1975 is about 19.000. This large number of cases has offered us the chance to reflect again on the values of this test in the selection of patients presenting risks for fetal hypoxia. A retrospective analysis of 4000 cases was carried out: 2000 controlled from 1. 1. 1968 to 30. 8. 1969 and 2000 from 4. 6. 1974 to 24. 3.1975. In addition to this 348 diabetic patients supervised by amnioscopy from 1967 to 1975, were examined; in these patients metabolic control was quite strict and was obtained adopting the criterium of insulin administration to each individual point of tolerance (P.H.I.T.) [6]. The amnioscopic tests was repeated on alternate days using Instruments and methods proposed by SALING [11]. As regards P.M. pregnancies, amnioscopic control began from the 280 th day of amenorrhea. There were 13 (0.3%) false positive cases (stained A.F. not confirmed by amniorexis), amnioscopy was not feasible in 18 cases (0.4%). Such small percentages can be explained by the fact that only 5 colleagues worked in the amnioscopy out-patients department from 1967 to 1975. The incidence of stained and/or sparse-absent A.F. was in all 13% both in group A and group B: it was different in the various pathologies which compose each group. The frequency of stained and/or sparse-absent A.F. in diabetic patients was 12.6%. Labour was induced when the amnioscopic tests was positive (stained and/or scarseabsent A. F.) as according to the higher risk for the fetus as diagnosed by means of other tests. In P.M. and diabetic pregnant women the decision to induce labour was taken only on the basis of amnioscopy. No case of ante-partum fetal death occurred in pregnant women with a clear A.F. (Part 2.6). A higher incidence of C.S. (Tab. IV) and agreater perinatal mortality rate was observed in cases with stained and/ or scarse-absent A.F. in comparison to those with clear A.F. It is probable that this increase of perinatal risk is associated with the belated finding of meconium in the A.F. in respect to the cause which determined its emission (Part 3.1.). The perinatal mortality not corrected (including cases of feto neonatal weight of ⩽ 1000 grs) of group A is 7.5 ‰ and that of group B is 3 ‰ This fall is due to the reduction of the neonatal mortality rate (6‰ in group A and 1 ‰ in group B) (Tab. VI). In P.M. pregnancies perinatal mortality was 3.2‰ (Tab. VII). No case of ante-partum fetal death occurred. Perinatal mortality not corrected in pregnant diabetics was 0.6% in class A and 1.8% in patients of classes B-F (Tab. VIII). These results confirm those of a recent trial [2] where the importance of amnioscopy in reducing ante-partum fetal death rate was assessed; this reduction is so remarkable that it cannot be further modified; in our series antepartum mortality rate of group A (1968-1969) is very limited (1‰) and similar to that of group B (1974-75). As regards P.M. pregnancies the amnioscopic test represents a method which can guarantee by itself a reliable control of fetal condition. In these pregnancies as we have already indicated [5] amnioscopic control should be initiated after the 280th day of amenorrhea: because the percentage of stained A.F. is high from the first 5 overterm days (Fig. 3). Furthermore, our results reconfirm the value of amnioscopy in the supervision of the fetus in pregnant diabetic women: we remember that labour had never been induced except on the basis of stained A.F. (excluding the two exceptional cases reported above). The reduction to 20% of C.S. in our series is surely to be attributed to the "non active" obstetric conduct. It is probable that a strict metabolic control of maternal diabetes represents a "sine qua non" condition for amnioscopy to maintain its prerogatives also in diabetic pregnant women.
- Publication
Journal of Perinatal Medicine, 1978, Vol 6, Issue 2, p109
- ISSN
0300-5577
- Publication type
Article