Cost-effective approach to office screening for gestational diabetes.

Gestational diabetes is a common problem during pregnancy. There are numerous screening programs, all of which are costly and time consuming. During a 6-month period, 50 patients were screened for gestational diabetes with a standard 50-g oral glucose load, and 1 hour later a capillary blood specimen was evaluated by means of a reflectance meter and a venous sample was evaluated in the hospital laboratory. We found that the capillary blood glucose determination was accurate, but we recommend that specific cutoff values for each meter be established for each facility. By using the glucose reflectance meter, 90% of patients will not require laboratory studies, which results in significant cost savings. Besides cost savings, the immediate results obtained by a reflectance meter allow for prompt identification of an abnormal screen and prompt scheduling for further evaluation of glucose intolerance during the pregnancy.

Patient attitude toward home uterine activity monitoring.

Forty private patients using a home uterine activity monitoring system and daily contact with nursing staff (Term Guard monitor and Tokos Perinatal Nursing Service; Tokos Medical Corp., Santa Ana, CA) were surveyed after delivery. Twenty-seven responses (67.5%) were obtained. The majority of the responding patients (81%) felt that the monitor helped their pregnancy and 92% would recommend it to family and friends. Eighty-five percent thought that the monitor and related nursing services would be something that they would use in future pregnancies. No subject concluded that the monitor depersonalized their obstetric care. Forty-one percent of the patients felt that the device was an intrusion into their life-style. Seventy-eight percent thought that the device was beneficial in their understanding of preterm labor and in learning to perceive their own baseline uterine activity. Almost 60% of the subjects noted that the monitor was useful in determining uterine activity because they did not perceive any contractions. Approximately 65% felt that unnecessary trips to the hospital for prolonged monitoring were prevented by the availability of 24-hour-a-day, 7-day-a-week emergency transmission and nurse contact. Nearly three-fourths of the patients felt that unnecessary calls to the physician were prevented by their ability to monitor. In summary, the services were well accepted by the patients and, despite the intrusion into their life-style, most felt that home uterine activity monitoring improved the outcome of their pregnancy.

Safety of predeposit autologous blood donation in the third trimester of pregnancy.

The option of predeposit autologous blood donation (PABD) before elective surgery has been gaining popularity as a means of eliminating the transmission of the acquired immune deficiency syndrome and hepatitis. It also prevents potential antigen sensitization and transfusion reactions. The use of PABD in pregnant women has been described, but its safety for both mother and fetus, especially in the first and third trimester, has not been established. After studying 16 third-trimester pregnant women with antenatal surveillance techniques and continuous fetal monitoring, we concluded that PABD is a safe procedure for both mother and fetus.