Epidural analgesia with ropivacaine and sufentanil is associated with transient fetal heart rate changes.

AIM: Fetal heart rate (FHR) changes have been reported after regional labor analgesia. In this prospective single-blinded study, we aimed to assess whether epidural analgesia with ropivacaine and sufentanil is associated with significant changes in fetal heart rate. METHODS: Fetal heart rate traces from 120 women in active labor requesting epidural analgesia were recorded and analyzed by two reviewers 90 minutes before and after epidural analgesia for baseline fetal heart rate, accelerations, decelerations and long-term variability. RESULTS: A significantly decreased number of fetal heart rate accelerations (ANOVA P=0.0001) and a higher percentage of segments with decelerations (P<0.05) were observed in the three segments after analgesia as compared to the three preceding segments. The minimum number of accelerations occurred during the 30 minutes immediately after analgesia was initiated. The reviewers were concordant in finding a significant change from the 60 minutes before to the 60 minutes after analgesia, a period in which there CONCLUSION: Epidural analgesia with ropivacaine and sufentanil is associated with fetal heart rate changes. These modifications are transient and should be considered when evaluating fetal heart rate monitoring during labor to prevent inappropriate obstetric management decisions to proceed with operative labor.

The effects of serial intravascular transfusions in ascitic/hydropic RhD-alloimmunized fetuses.

OBJECTIVE: To evaluate the effects of serial intravascular transfusions on RhD-alloimmunized fetuses with ascites/hydrops at the time of the first transfusion by measuring multiple hematological/biochemical blood variables. METHODS: Thirty-one singleton pregnancies were referred for management of RhD alloimmunization. Seven fetuses had hydrops on presentation and were transfused immediately. The remainder underwent weekly ultrasound examinations, and fetal blood sampling and transfusion were performed on development of ascites. In the 104 samples collected overall from the 31 fetuses, glucose, uric acid, urea, creatinine, total protein, total and direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase (PCHE), creatine kinase, triglycerides and cholesterol were measured and compared with a reference range for non-anemic fetuses. RESULTS: The median gestational age at first transfusion was 26 (range, 18-34) weeks. There were three fetal losses after the first transfusion, two of which were due to procedure-related complications; one further loss occurred. At the first transfusion fetal hematocrit, pO2, total protein, PCHE, creatinine and urea concentrations were significantly decreased compared to reference data, while total and direct bilirubin, AST, ALT, amylase, triglyceride and uric acid concentrations were increased. In all surviving fetuses ascites/hydrops had disappeared by the second transfusion. Fetal pO2, total protein, AST, ALT and PCHE concentrations had normalized by the third transfusion. Correction of fetal anemia did not affect the other variables. CONCLUSIONS: RhD-alloimmunized fetuses with ascites/hydrops at the time of the first transfusion had a survival rate of 87%. Alterations of several biochemical fetal blood indices are present at the first sampling/transfusion, but most variables normalize with intravascular transfusions.

Fetal and maternal white cells and B- and T-lymphocyte subpopulations in pregnant women with recent infection.

OBJECTIVE: To study maternal and fetal white cell counts, B- and T-lymphocyte subpopulations in pregnant women with evidence of recent infection. METHODS: Thirty-seven pregnant women with recent infection and 38 controls were studied. All were referred for fetal blood sampling to exclude congenital infection, or to perform fetal chromosome analysis. There were 16 infected fetuses: 9 cytomegalovirus (CMV), 4 rubella, and 3 toxoplasmosis. Maternal and fetal blood was taken and white cell counts, the percentage of CD3+, CD4+, CD8+, CD56+, HLADR+CD3+ T-lymphocyte subpopulations and CD19+ B lymphocytes were measured. RESULTS: The percentage of CD3+, CD8+, and HLADR+CD3+ lymphocytes were significantly higher in infected mothers compared to controls, while CD19+ and the CD4+/CD8+ ratio were lower. Infected mothers carrying infected fetuses had significantly lower white blood cell counts compared to those infected mothers without fetal infection. The percentage of HLADR+CD3+ T lymphocytes was significantly higher and the CD4+/CD8+ ratio lower in infected fetuses compared to controls and noninfected fetuses of infected mothers. Abnormal CD4+/CD8+ ratios and/or increased HLADR+CT3+ T lymphocytes were found in 8 of 10 fetuses with structural abnormalities and/or hematological/biochemical signs of systemic damage, and in 7 of 27 without (RR = 3.1, 95% CI = 1.5-6.3). CONCLUSION: Both infected fetuses and their mothers have significant identifiable changes in white cell counts and T-lymphocyte subpopulations compared to controls. These tests may help in diagnosing maternal and fetal infection.

Complicated monochorionic twin pregnancies: experience with bipolar cord coagulation.

OBJECTIVE: The purpose of the study was to evaluate our experience with ultrasound-guided bipolar diathermy forceps for cord occlusion in complicated monochorionic twin pregnancies. STUDY DESIGN: Seventeen consecutive cases were included: 9 cases were twin-to-twin transfusion syndrome; 2 cases were twin reversed arterial perfusion syndrome, and 6 cases were discordant for fetal abnormality. Bipolar diathermy was performed under local anesthetic with the use of 3-mm forceps with ultrasound guidance. RESULTS: Cord occlusion was successfully accomplished in all cases between 18 and 27 weeks' gestation. There were 2 deaths of the co-twin within 12 hours; 1 death was due to cord hemorrhage, and 1 death was unexplained. One neonatal death occurred after delivery at 27 weeks, and 1 woman with twin-to-twin transfusion syndrome elected termination of pregnancy when hydrocephaly was diagnosed 7 days after the procedure (probably related to the underlying pathologic condition). All other co-twins are alive and well, although 2 pregnancies were complicated by preterm delivery and premature rupture of membranes before 30 weeks' gestation. CONCLUSION: Bipolar diathermy is an effective procedure for cord occlusion, although it still has significant morbidity and mortality rates.

Rural women's perceptions of community prenatal care systems: an empowerment strategy.

Rural U.S. women often experience many barriers to prenatal care involving health care provider shortages, distance to health care, and less health insurance coverage as compared to urban women. Fewer community planning and consumer resources as well as less transportation also often decrease opportunities for rural women to participate in community health planning and assessment. The purpose of this article is to describe social work strategies for empowering rural women in their assessment of community prenatal care systems. A case study of a rural demonstration project addressing prenatal care barriers is presented as well as implications for social work practice.

Social work practice in a rural community collaborative to improve perinatal care.

U.S. rural women encounter many logistical and psychosocial barriers to prenatal care, including high poverty rates, high rates of inadequate health insurance, health care provider shortages, transportation problems and health care systems that may be inadequate or unresponsive to the needs of poor women. The purpose of this article is to describe the role of the social worker in rural communities in the development, implementation and evaluation of a community effort that sought to improve prenatal care through a collaborative of health and human services organizations. The nature of social work participation and the implications for social work are discussed.

Communication about sexual behavior among adolescent women, their family, and peers.

PIP: Adolescent pregnancy and sexually transmitted disease rates in the US are among the highest of developed nations. Findings are reported from a study conducted to determine which reproductive health topics adolescents and their parents discuss, which immediate and extended family members discuss reproductive health topics with their female adolescent relatives, which family members and peers encourage female adolescents to use family planning services, and how adolescent age, pregnancy history, or parental encouragement of the use of family planning relates to the discussion of reproductive health topics. All females of maximum age 19 years registering for an appointment at 1 of 3 family planning clinics in Allegheny County, Pennsylvania, were consecutively recruited to participate in the study. A survey of 249 female adolescent family planning clients found that women aged 13-16 years were more likely than women aged 17-19 years to discuss sexual behavior with adult, nonparental relatives (p = .007). Teens with a prior pregnancy were more likely than never-pregnant teens to report parental discussion of contraception choices (p = .004) and of sites for contraceptive care (p = .0023). Adolescents discuss sexuality with a complex network of family and peers. Social work clinical and community skills facilitate family-centered reproductive health training and counseling for the improved reproductive health of US adolescents.^ieng

[Gastromiro vs gastrografin vs prontobario CAT for computerized tomography. Multicenter study]. / Gastromiro vs gastrografin vs Prontobario TAC per Tomografia Computerizzata. Studio multicentrico.

The opacification of intestinal loops is mandatory, during CT examination of the abdomen, to prevent the gut from being mistaken for a pathological process or vice versa. The authors compared Gastrografin and Prontobarium-CT with a new, orally administrable, non-ionic contrast medium (Gastromiro) to investigate whether the non-ionic molecule presents any advantages over the other contrast media usually employed with CT. Five hundred ml of water solution/suspension at 11.1% (Gastromiro or Gastrografin) and 1.7% (Prontobarium-CT) were administered 20 minutes before examination to 818 consecutive patients. Different parameters were considered--i.e., patient tolerance as far as "taste and vomiting" were concerned, gut opacification, and any reaction which might have occurred to the patients within 24 hours after examination. The results, statistically analyzed, are the following: no significant difference in the quality of opacification of stomach, duodenum, and large bowel; significant difference in the quality of opacification of small bowel, where Gastromiro proved to have the highest contrast resolution; Gatromiro stimulated diarrhea significantly less than Gastrografin and Prontobarium-CT.

The relationship between women's attitudes about condoms and their use: implications for condom promotion programs.

A survey of 759 women attending contraceptive care clinics revealed that a majority of women endorsed condom use as an important way to reduce the spread of AIDS (acquired immunodeficiency syndrome); 82 per cent reported past use of condoms, but only 14 per cent reported using condoms in addition to another form of contraception to prevent infection with sexually transmitted pathogens, including HIV (human immunodeficiency virus). Acceptance of condom advertisement, perceived male and peer acceptance of condoms, and the effect of condom use on the enjoyment of sexual intercourse predicted condom use.

Iopamidol: new preclinical and clinical data.

Iopamidol was rapidly eliminated from the central nervous system of dogs (greater than 90% in 24 hours). In rabbits, renal excretion involved tubular mechanisms at low blood levels, and predominant glomerular filtration at higher levels. Injection of iopamidol into the right atriums of rabbits produced hemodynamic effects similar to those of other contrast media, but less severe. The effect of iopamidol on peripheral vascular resistance was significantly lower than that of metrizamide. Iopamidol was found useful in clinical neuroradiology and angiography.