Impact of the introduction of fetal central monitoring on hospital expenses with cardiotocographic paper.

Digital storage of cardiotocographic (CTG) tracings by fetal central monitoring systems (fCMS) obviates the need for printing, or alternatively, the tracings can be printed in regular paper instead of CTG thermal paper. We aimed at evaluating the impact of the introduction of the Omniview-SisPorto(®) system on CTG paper costs in a large university hospital. After introduction of the fCMS, there was an 87% reduction in median annual expenses with CTG paper in the labour ward (p = 0.011) and a 78% decrease in the prenatal clinic (p = 0.017), despite a more than 40% increase in the median number of observed women. Routine use of fCMS may provide an important reduction in hospital expenses associated with the use of thermal CTG paper, thus reducing the investment made in their acquisition and maintenance.

Knowledge of adverse neonatal outcome alters clinicians' interpretation of the intrapartum cardiotocograph.

OBJECTIVE: To evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG). DESIGN: Prospective evaluation of pre-recorded cases. SETTING: Five maternity hospitals. POPULATION: From a database of intrapartum CTGs acquired with a scalp electrode in singleton near-term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20. METHODS: Five experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn's arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same. MAIN OUTCOME MEASURES: The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available. RESULTS: In the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051). CONCLUSIONS: A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability.

[Effect of feeding competencies on the nutritional status of children with cerebral palsy]. / Efeito das competências alimentares no estado nutricional de crianças portadoras de paralisia cerebral.

The purpose of this study was to determine if the feeding competencies influence the nutritional status in a group of Portuguese children with cerebral palsy (CP). One hundred and five children, aged between 4 and 12 years, were studied. Nutritional status was determined through BMI for age (BMI_y), and subescapular (SSF) and tricipital skinfolds (TSF). Feeding competencies were evaluated using the seven levels of the Functional Feeding Assessment test (FFA). This study confirmed the high prevalence of malnutrition in children with CP, since 44,8% of the sample had a BMI_y bellow the 5th percentile (Pct5). Significant differences were observed between males and females, namely in malnutrition which was higher in females (52, 4% had a BMI_y

An interactive web site for research on fetal heart rate monitoring.

BACKGROUND: Traditional methods of exchange of research information may not be rapid enough, especially for international multicenter studies or when discussing controversial issues such as the value of fetal monitoring. The Internet is a useful tool that provides numerous opportunities for immediate communication within a large and diverse community of researchers. METHOD: A Web site at http://www.sisporto.med.up.pt was developed for a multicenter research project with interlinked pages on automated fetal heart rate (FHR) monitoring. It includes background knowledge about the subject, detailed information about the project, and a few interactive pages. These pages allow online discussions, simulations of data analysis, and download of data for local FHR analysis. EXPERIENCE: The Web site has been accessed from all over the world. In particular, participating research centers have had easy and fast access to background project information, and a few other clinicians and researchers participated in our online discussions and used the simulation tools or the data provided for analysis of typical FHR patterns. CONCLUSION: Web sites can be useful in multicenter research projects and for scientific information exchange.

Barium 'granuloma' of the rectum. A light and electron microscopic analysis.

A barium granuloma of the rectum, observed 6 and 9 months after a barium enema, was studied by light and electron microscopy. Mononucleated macrophages filled with electron dense material were located between the glands and the muscularis mucosae. No electron dense material was observed in the endothelial and epithelial cells. The difficulties in the identification of the material can in part be overcome with the use of electron microscopy.