Selective delivery in high-risk pregnancy

Ultrasonography, antepartum testing of the fetal heart rate, and amniotic fluid assays were used in a management protocol to select the optimal time for delivery of a group of 165 pregnancies complicated by diabetes mellitus or hypertensive disorders. Only six cases of intrauterine growth retardation were detected ante partum. Nonreactive nonstress tests were found in 28 pregnancies, and 12 of these also had positive contraction stress tests. Evidence of immaturity from amniotic fluid assay led to a needed delay in the delivery of eight infants. Seven antepartum fetal deaths occurred. Twenty-six infants were delivered prematurely, but there was only one late neonatal death. The uncorrected perinatal mortality for this group of high-risk pregnancies was 47.3 per 1,000 births.