Administration of heparin by subcutaneous infusion with a programmable pump.

Heparin has a short half-life (8 to 12 hours) and therefore must be administered by continuous infusion or by intermittent subcutaneous injection. Intermittent subcutaneous injection may lead to fluctuation in the levels of anticoagulation attained. In correcting this deficiency, the programmable automated subcutaneous infusion pump in conjunction with weekly home nursing visits has been used. Eight pregnant women with documented deep venous thrombosis or embolic events before pregnancy who received such therapy were studied. Eight similar subjects who received intermittent subcutaneous injection, matched for age, parity, site of deep venous thrombosis, and days on a regimen of heparin therapy, served as the control group. The mean daily dose of heparin by subcutaneous infusion pump was higher (29,445 vs 13,822 U), resulting in smoother, more therapeutic heparinization (mean partial thromboplastin time, 20.6 vs 10.4 seconds above control) when compared with the intermittent subcutaneous injection group (p less than 0.05, p less than 0.007). There were two complications (hematoma, site infection) in the intermittent subcutaneous injection group while none occurred in the subcutaneous infusion pump group. When used in concert with weekly home visits, the subcutaneous infusion pump method of administration allowed more even control of anticoagulation, appeared to result in fewer complications (although not statistically significant), and subjectively was better received by patients than the intermittent subcutaneous injection technique.

Preventing preterm birth in twin gestation: home uterine activity monitoring and perinatal nursing support.

In this investigation, 45 women with twin gestations in four centers were randomly assigned to either daily home uterine activity monitoring and perinatal nursing support (19) or an education group (26). Patients in the home uterine activity monitoring and perinatal nursing support group monitored uterine activity twice daily, transmitted the data each day, and had 24 hour-a-day access to nursing support. Education patients were counseled regarding the common signs and symptoms of preterm labor. Both groups had scheduled prenatal visits at least every 2 weeks. Sixteen (62%) of the education group and 14 (74%) of the home uterine activity monitoring and perinatal nursing support group developed preterm labor, values that were not significantly different. Of the monitored group who experienced preterm labor, all 14 were dilated 3 cm or less at diagnosis of the first preterm labor, compared with ten of 16 in the education group (P = .01; one-tailed Fisher test). The mean cervical dilatation at the first preterm labor episode in the group receiving daily monitoring and contact (1.6 cm) was significantly less (P = .01) than that in the education group (2.9 cm). Thus, fewer preterm births were recorded in the home uterine activity monitoring and perinatal nursing support group and significantly fewer patients delivered because of failed tocolysis (P = .03).

A randomized study comparing two methods of performing the breast stimulation stress test.

Breast stimulation has been used as a method for inducing uterine activity during testing for fetal well-being. Practitioners using the breast stimulation stress test have employed a variety of methods to stimulate the breast, yet no one has determined the effectiveness of one method over another. A study was undertaken to test the efficacy and safety of two methods of breast stimulation: manual rolling of the nipple and application of moist, hot pads to the breast before stimulation. Fifty-four high-risk patients were randomly assigned to one of two study groups. Group 1 included patients who stimulated one bare nipple intermittently. Group 2 included patients who had moist, warm washcloths applied to the breasts for five minutes before breast stimulation. No differences, in terms of efficacy and safety, were found between the two methods of breast stimulation.

Characteristics of uterine activity during the breast stimulation stress test.

Characteristics of uterine activity produced by nipple stimulation were studied in 185 consecutive breast stimulation stress tests. Adequate contractions were produced in 95.6% of tests. Exaggerated uterine response (contractions occurring more than once every two minutes or lasting more than 90 seconds) was present in 45.5% of the patients. Twenty-one percent of the patients with such uterine activity also had a fetal heart rate (FHR) deceleration (hyperstimulation breast stimulation stress test), without adverse fetal outcome. The time in minutes from start of nipple stimulation to the first contraction (stimulation contraction interval) was recorded for each patient. Significant difference was not observed in the stimulation contraction interval distribution between the groups with and without exaggerated uterine activity. The authors conclude that there is a relatively high incidence of exaggerated uterine activity response to the breast stimulation stress test and that close surveillance of mother and fetus is warranted during antepartum nipple stimulation.