tured membranes.

In fact half the patients for bleeding and pain was lower in Fin- The Breast Stimulation
who developed amnionitis did so within land. Stress Test
48 to 72 hours. The risk for developing Based upon the assumption that an in- Hill W, M o e n n i n g R, Katz M, Kitz-
postpartum endometritis also did not in- correctly placed IUD causes intolerable miller J: Characteristics of uterine ac-
crease with longer duration of ruptured side effects more frequently than a cor- tivity d u r i n g t h e b r e a s t s t i m u l a t i o n
membranes. rectly placed IUD, the authors suggest stress test. O b s t e t G y n e c o l 64:489,
The authors note that the infant's ul- that the active removal rates in Denmark 1984.
timate survival was not influenced by its and Sweden account for the removal of
gestational age at time of rupture of m o r e incorrectly p l a c e d IUDs, and
This prospective study evaluated 185
membranes, but rather by its gestational thereby bring about the lower pregnancy
breast stimulation stress tests (BSTs) that
age at time of delivery. Therefore they rates in those countries.
were performed for I01 high-risk patients
point out that the decision of whether or It is proposed that the most effective
(70% postdates).
not to manage conservatively should not IUD contraception may be offered to
Patients were asked to roll one bare
be based upon the gestational age at time women when there is an active removal-
nipple until a contraction occurred, and
of rupture of membranes, and that one- reinsertion policy, and when an effective
bilateral stimulation was only used when
third (34%) of all pregnancies with early IUD is selected.
three contractions could not be obtained
rupture reached viability (26 weeks).
within a ten-minute period. Sufficient
These data indicate that with conser-
uterine activity to interpret a contraction
vative management maternal morbidity is
Umbilical Cord Prolapse stress test occurred in 174 (95.6%) of the
high (58.5%), but no complications re- L e v y H, Meier P, Makowski E: Um- patients. Forty-five percent of the patients
suited in permanent sequelae. The like-
bilical cord prolapse. O b s t e t G y n e c o l undergoing breast stimulation developed
lihood of a surviving infant was 25%, and 64:499, 1984. exaggerated uterine activity (contractions
from the limited number that were fol-
occurring closer than every two minutes
lowed-up, 56% were developmentally This study is a retrospective review of all or lasting longer than 90 seconds), and
normal, recorded cases of umbilical cord prolapse in 21.7% of these patients there were de-
The authors conclude that "conserva- occurring at the University of Colorado celerations of the fetal heart rate. How-
tive management may be a reasonable Health Sciences Center from July 1, ever, all these patients had eventual un-
alternative for some mothers who under- 1969 to June 30, 1982. During this pe- complicated deliveries of normal infants
stand and are willing to take the risks." riod there were 79 cases, for an incidence with good Apgar scores.
of 0.26%, or one in 385 births. The uterine hyperstimulation occurred
Pregnancy Rates with Selected Whereas malpresentation of the fetus within seven minutes of nipple stimula-
Intrauterine Devices is frequently associated with prolapse of tion and could not be predicted on the
A l l o n e n H, L u u k k a i n e n T, N i e l s e n the cord, nearly 50% of all cases oc- basis of unilateral versus bilateral nipple
NC, et al: Factors affecting the clin- curred in vertex presentations. In this use.
ical p e r f o r m a n c e of N o v a T a n d series, nearly one in five cases (15 of 79) Although no bad outcomes were ob-
Copper T 200. Obstet Gynecol was associated with some form of ob- served in this study, the high frequency
64:524, 1984. stetric manipulation. The majority fol- of exaggerated uterine response and its
lowed amniotomy (10 of 15), and two unpredictability caution that close obser-
In this randomized comparative use-ef- cases occurred when the vertex was dis- vation should be exercised when women
fectiveness study of two copper-releasing lodged from the pelvis during attempts to are undergoing breast stimulation stress
intrauterine devices (IUDs), an analysis apply a scalp electrode and to obtain a tests.
was made of the differences in women scalp blood sample. Two other cases oc-
between the participating countries and curred during attempts at mid- or high-
of the influence of various factors on forceps deliveries, a n d o n e o c c u r r e d
Long-Term Follow-up of
pregnancy rates and rates of termination. during an attempted vaginal delivery of
Ritodrine-Treated Children
Among 1865 women, the gross cumu- a breech second twin.
Polowczyk D, Tejani N, L a u e r s e n N,
lative pregnancy rates were 3.4 per 100 In this review, 15 of 79 (19%) of the
S i d d i q F: E v a l u a t i o n of s e v e n - to
women for the Nova T and 8.7 per 100 cases of cord prolapse were associated
n i n e - y e a r - o l d children e x p o s e d to ri-
women for the Copper T 200. with obstetric interventions, and of these,
t o d r i n e in u t e r o . O b s t e t G y n e c o l
The type of IUD, the age of the women three infants died, and 11 cesarean sec-
64:485, 1984.
(older women have fewer pregnancies), lions were performed which might have
and the country in which they lived were been avoided. The authors conclude that
found to have important effects on the "Taken together, these fetal and neo- Twenty children who had been exposed
rate of unwanted pregnancy. Because it natal deaths and operative deliveries are to ritodrine in the management of pre-
is well known that as women age their the direct cost for obstetric interventions term labor between 24 and 34 weeks'
fertility declines, it was curious to the au- that at times approach routine and cus- gestational age were examined at seven
thors that the rate of p r e g n a n c y was tomary practice in most labor and de- to nine years of life and compared with
higher in Finland where the women were livery services . . . it is far better to pre- matched control subjects.
older than in Sweden or Denmark. They vent the prolapse by diligently assessing Psychometric assessment included
also noted that the rate of IUD removal each patient . . . . " tests of: intelligence, visual-motor inte-

Journal of Nurse-Midwifery • Voi. 30, No. 2, March/April 1985 127