The cardiac state diagram as a novel approach for the evaluation of pre- and post-ejection phases of the cardiac cycle in asphyxiated fetal lambs.

The aim of this study was to investigate myocardial wall motion using echocardiography and color-coded tissue velocity imaging and to generate a cardiac state diagram for evaluation of the duration of the pre- and post-ejection phases in asphyxiated fetal lambs. Six near-term lambs were partly exteriorized and brought to cardiac arrest through asphyxia. Echocardiography measurements were recorded simultaneously with arterial blood sampling for lactate and blood gases. All fetal lambs exhibited prolongation of the pre- and post-ejection phases at the time when the most pronounced changes in lactate concentration and pH occurred. The mean change in duration of the pre- and post-ejection phases for all fetal lambs was 36 ± 7 ms (p < 0.002) and 77 ± 17 ms (p < 0.019), respectively, and the percentage change was 50% (p < 0.001) and 38% (p < 0.049), respectively. As asphyxia progressed in fetal lambs, the duration of the pre- and post-ejection phases increased. The cardiac state diagram has the potential to be a comprehensible tool for detecting fetal asphyxia.

Establishing a national program for fetoscopic guided laser occlusion for twin-to-twin transfusion syndrome in Sweden.

OBJECTIVE: To describe the establishment of the fetoscopic guided laser occlusion (FLOC) technique for treatment of twin-to-twin transfusion syndrome (TTTS) and the initial results in a Swedish national center. DESIGN: Retrospective, descriptive study. SETTING: Tertiary level university hospital. POPULATION: All referred and treated cases suffering significant TTTS. METHODS: The present study includes all cases of FLOC for TTTS at the Center of Fetal Medicine at Karolinska University Hospital, Stockholm, Sweden from October 2001 until December 2009. Patients were referred from all over Sweden and a few from other Nordic countries. The patients were evaluated with ultrasound examination between gestational ages of 18 and 26 weeks. Data from patients were extracted from our electronic medical record system and, in addition, families were contacted and medical records requested from referring hospitals. MAIN OUTCOME MEASURES: Pregnancies with one or more surviving infants after FLOC treatment categorized according to stage of TTTS. RESULTS: In 75% of pregnancies, one or more infant was born alive. At stage I, both infants survived in one pregnancy and one survived in the second. There was no significant difference between cases at stage II or III, i.e. 73 vs. 78% of pregnancies resulted in one or more surviving infant. At stage IV, 66% of pregnancies ended with one or more surviving infant. CONCLUSIONS: Treatment of TTTS is feasible in a rather small country like Sweden, with comparable results to other centers. There are strong arguments for centralization and further improvement of this kind of highly specialized treatment.

Erythropoietin and intravenous iron therapy in postpartum anaemia.

BACKGROUND: We assessed whether recombinant human erythropoietin (rhEPO) enhances a rise in haemoglobin concentration in postpartum anaemia compared to intravenous iron alone. DESIGN: Some 60 patients with haemoglobin values