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Reconstruction of the mons pubis with a myocutaneous island flap of the rectus abdominis muscle

Discussion This study confirms an important role for computerised cardiotocography in women with a high risk for placental abruption, distinguishing three patterns of fetal heart rate changes before delivery. Pattern A probably represents a further stage of deterioration of fetal heart rate variation as observed in pattern B. At least two categories of placental abruption are suggested, an acute type without prior deterioration in mean minute range (pattern C) and a more chronic type. Fetal heart rate variability increases in hypoxaemia in sheep (Dalton et al. 1977). In the pattern B group, the passing increase in mean minute range and the percentage of high variation in the placental abruption subgroup may result from increased levels of catecholamines which gradually overcome the bradycardia induced by vagus stimulation (Jones & Knox-Ritchie 1983). This could be the earliest fetal response to decreased blood flow at the onset of placental abruption. In the subgroup without placental abruption, the high incidence of abnormal Doppler studies indicate chronic hypoxia (Chudleigh & Pearce 1992) with progressively decreasing mean minute range. While small numbers preclude definite conclusions, this may contribute to knowledge of the pathogenesis of placental abruption.