Color Doppler ultrasonography for distinguishing myomas from uterine contractions in pregnancy.

OBJECTIVE: To determine the applicability and reliability of color Doppler ultrasonography (US) for distinguishing a uterine myoma from a focal myometrial contraction. STUDY DESIGN: Images from 36 patients with uterine thickenings were classified as myomas when color Doppler US demonstrated no centralized flow with a circumscribed vessel pattern at the border. Thickenings were classified as focal myometrial contractions when there was demonstrable vascular flow throughout the thickening. RESULTS: Using these diagnostic criteria, images from 36 patients were reliably characterized as representing myomas or contractions. The diagnosis was made more reliable by using the lowest velocity settings and exclusion of power Doppler US in nonretroplacental lesions. CONCLUSION: Color Doppler US is a sensitive and reliable tool for distinguishing uterine myomas from focal myometrial contractions.

A pilot study of time allocation and reimbursement for routine obstetric ultrasonography.

OBJECTIVE: To evaluate time allocation during initial and repeated ultrasonography and to formulate recommendations to improve unit efficiency. METHODS: Over a 2-year period, 51 comprehensive ultrasonographic examinations between 14 and 38 weeks' gestational age were observed by a single reviewer. Each patient-sonographer interaction was divided into timed segments, including setup, examination time, review, and turnover. Statistical analysis using descriptive statistics, Student ttest, and analysis of variance was performed to determine the effect of the number of ultrasonographic examinations, sonographer experience, estimated gestational age, and patient body mass index on examination time. RESULTS: The average time spent with each patient was 15 minutes 22 seconds: 2 minutes 10 seconds for setup, 9 minutes 38 seconds for examination, 1 minute 50 seconds for review, and 1 minute 44 seconds for turnover. Examination length was not significantly affected by estimated gestational age, body mass index, ultrasonography experience, or the number of ultrasonographic examinations (P > .05). No statistical significance in the duration of scanning was found between initial (15 minutes 3 seconds) and repeated (16 minutes 1 second) examinations (P = .609). Nonexamination activities, such as data entry and room cleanup, consumed 37% of the sonographer's time. CONCLUSIONS: Resource use within the ultrasonography department may be improved by reassigning clerical and custodial duties from sonographers to other personnel. Although differential reimbursement exists, no statistically significant difference in resource use between initial and repeated examinations was found.

Adherence to health advice amongst young people with chronic illness.

A literature review was undertaken to identify factors that may influence adherence to health advice amongst chronically ill young people. It emerged from the literature that internal and external factors influenced adherence in this client group. Internal influences were associated with adolescent biopsychosocial development and intra-personal dynamics. External factors were linked to interpersonal dynamics between the young person, family, peers, health care professionals and society as a whole. It is proposed that the difficulties in adherence to health advice were often due to 'adultist' beliefs. The implications of these findings are relevant to all health professionals involved in promoting health and in the development of approaches to promote 'young person-centred adherence.'

Temporal expression of the transgenic human protamine gene cluster.

OBJECTIVE: To ascertain the fidelity of expression of the genes from the transgenic human sperm-specific nuclear packaging protamine-1-->protamine-2-->transition protein-2 (PRM1-->PRM2-->TNP2) locus. DESIGN: Controlled human transgene study. SETTING: Basic science laboratory. ANIMAL(S): Age-matched transgenic and nontransgenic mice. INTERVENTION(S): Transgenic mice containing the human protamine locus were mated. One testis from each offspring was frozen at -80 degrees C and the other was preserved in formalin. MAIN OUTCOME MEASURE(S): The temporal expression of the human and mouse protamines was evaluated by Northern blot analysis. Orientation of the transgenic locus was determined by Southern blot analysis. Tissue morphology was assessed histologically. RESULT(S): Conservation of transgenic morphology was confirmed. Head-to-tail integration of the PRM1--> PRM2-->TNP2 locus was shown. Temporal expression of the mouse and human protamine genes was maintained in the transgenic state. CONCLUSION(S): These results show that the head-to-tail concatomer of the PRMI-->PRM2-->TNP2 locus contains all the necessary elements for appropriate temporal expression while maintaining testicular structure and function.

Congenital abnormalities in twins: selective termination.

Selective termination for an anomalous twin in discordant twin pregnancy has been a management option for nearly two decades. Using current conventional prenatal diagnostic techniques, the diagnosis of a twin gestation discordant for a congenital anomaly is commonly confirmed in the second trimester. Selective termination is thus usually a second-trimester procedure. The risks of second-trimester terminations as well as protocol choices, including indications and timing, have evolved over the years. Ethical issues regarding selective termination have developed significantly and continue to be debated.

Coronary artery disease in insulin-dependent diabetes mellitus of pregnancy (class H): a review of the literature.

Coronary heart disease and myocardial infarction are uncommon complications during pregnancy. Women with insulin-dependent diabetes mellitus (IDDM) have a much greater risk of serious coronary heart disease, but few cases of myocardial infarctions occurring during pregnancy have been reported. Significant maternal morbidity has been reported in half of these cases. This is a case of a myocardial infarction occurring at 21 weeks of gestation in a patient with class R/F IDDM and the subsequent pregnancy management as well as a review of the literature concerning Class H IDDM in pregnancy.

Ultrasound placental localisation in early pregnancy.

A retrospective study of 400 consecutive case records was made to establish the clinical significance of the low lying placenta found on ultrasound. Diagnostic accuracy is discussed. 30% of the patients had a low lying placenta on early scan. Of these, 73% had a follow up scan. There was a progressive drop in the incidence of low lying placentae through pregnancy until at term, in this study, there was no placenta previa. It is considered that a repeat scan is necessary to exclude placenta previa, but not until 34 weeks gestation. Amongst the patients with early low lying placentae the incidence of antepartum haemorrhage of indeterminate type was significantly high (P less than 0.001). A careful surveillance of these patients is therefore required. Dynamic placental migration may be the cause of this bleeding. Further study is necessary to determine the effect of early placental position on subsequent fetal development.

Pelvic dimensions and the outcome of trial labour in Shona and Zulu primigravidas.

Pelvic contraction is very prevalent in Africa while radiological facilities to assess pelvic size and shape are seldom available. A trial of labour using simple guidelines on a cervicograph can enable the midwife to detect dysfunctional labour and can help medical staff to manage these problems. Radiological checks in 116 Black primigravid patients with dysfunctional labour demonstrated that an active trial of labour is accurate in determining which of these patients have marked disproportion requiring caesarean section, minimal disproportion requiring assisted delivery, or primary uterine inertia responding to oxytocic stimulation. The role of radiological pelvimetry in African obstetrics is discussed, and the radiological features of the Shona and Zulu pelves in this series are described.

Recurrent bleeding from the lower segment scar--a late complication of Caesarean section.

Hysterectomy became necessary six months after Caesarean section because of recurrent severe haemorrhage from the uterine scar.