ABSTRACT
Four hundred forty-two studies of the Valsalva maneuver were performed on 282 pregnant subjects and 37 nonpregnant female control subjects. A fetal monitor was used for graphic presentation of the subject's beat-to-beat heart rate changes. The Valsalva ratio was calculated, defined as maximum tachycardia divided by maximum bradycardia during a Valsalva maneuver. The data from the studies on pregnant subjects were grouped according to weeks of gestation: less than 13, 13 to 16, 17 to 20, 21 to 24, 25 to 28, 29 to 32, 33 to 36, and greater than 36. The mean Valsalva ratio for control subjects is higher than the mean for every gestation group, and there is a definite downward trend in the means for each successive gestation group through 29 to 32 weeks. The tendency for pregnant women to have an "abnormal" Valsalva ratio (that is, less than 1.5) also appears to be related to gestation. This exploratory study demonstrates that the Valsalva ratio is sensitive to physiologic changes associated with pregnancy. This test might have use as a noninvasive indicator of certain types of abnormalities associated with pregnancy.
Subject(s)
Autonomic Nervous System/physiology , Heart/innervation , Pregnancy , Valsalva Maneuver , Adolescent , Adult , Female , Heart Rate , HumansABSTRACT
Forty-four women were examined for evidence of traumatic intercourse. Toluidine blue dye was employed as an objective adjunct in the evaluation because of its sensitivity for exposed superficial nuclei. Seventy percent of nulliparas and 40% of the total number of patients examined within 48 hours after complaint of sexual assault demonstrated toluidine blue-positive lacerations. Only 1 of 22 patients presenting after consenting intercourse demonstrated toluidine blue-positive lacerations. This new use of toluidine blue may prove of value in examining of the victim of sexual assault because of the dye's ability, independent of the examiner's skill, to indicate injury in collection of evidence for court proceedings.
Subject(s)
Forensic Medicine , Genitalia, Female/injuries , Rape , Tolonium Chloride , Female , Georgia , Humans , Rape/legislation & jurisprudenceSubject(s)
Nurses/statistics & numerical data , Female , Humans , Interprofessional Relations , Obstetric Nursing , Physicians , PregnancyABSTRACT
Despite a lack of proof that overall perinatal outcome is improved, physicians and patients participate in a growing regional maternal transport program in a community hospital setting. Over the course of 3 1/2 years, 129 patients were transferred from 23 institutions. Maternal transport and the changes which result in the interactions of the physicians are compared to traditional referral systems. Obstacles and guidelines for minimizing them are discussed.
Subject(s)
Perinatology/methods , Pregnancy Complications , Referral and Consultation , Transportation of Patients/methods , Female , Hospitals, Community , Humans , Infant Care , Infant Mortality , Infant, Newborn , Intensive Care Units , PregnancyABSTRACT
Development of a Perinatal Center delivering Level 3 intensive care in a community hospital is described. The inborn neonatal mortality at the hospital in which the Center is located, as well as that of the 13 surrounding counties, has diminished more rapidly than the state neonatal mortality. This has coincided with an almost constant delivery rate, increased proportion of staff patients, relatively constant rate of low birth weight, and declining total perinatal mortality. Our experience suggests that appropriately trained and motivated people, not equipment or geographic location, represent the key factor in the development of such a center.
