Parvovirus B19 in Pregnancy: A Case Review.

Parvovirus B19 has been identified as the cause of erythema infectiosum, a common childhood illness. Also known as fifth disease, this virus is highly contagious among school-age children, especially during the winter months when outbreaks within classrooms are widespread. The majority of adults have had the infection in childhood and are immune to recurrence. Approximately 40% of childbearing-age individuals, however, remain nonimmune and susceptible to infection. If acquired during pregnancy, parvovirus B19 infection can have devastating fetal consequences, especially if contracted in the second trimester. Vertical transmission of parvovirus B19 occurs more readily during this gestational period, and fetal loss rates of 8% to 17% have been reported as a result of severe fetal anemia and hydrops fetalis. Unfortunately, adults with parvovirus B19 infection are often asymptomatic and do not exhibit the classic slapped-cheek rash seen in childhood. More commonly, adults will exhibit atypical symptoms such as joint arthralgias. Maternal history of direct exposure to a confirmed case within the family or the presence of atypical symptoms warrants serum antibody screening. Although the presence of immunoglobulin G confirms immunity, any immunoglobulin M positivity will require ongoing fetal surveillance for evidence of fetal anemia and hydrops fetalis. Serial ultrasound imaging for 8 to 12 weeks with Doppler measurements of the peak systolic velocity in the middle cerebral artery are the mainstays of fetal monitoring. Referral to a maternal-fetal medicine specialist with experience in fetal blood sampling and intrauterine transfusion is recommended for any cases of hydrops fetalis or if a concern for severe fetal anemia exists.

Debriefing and Feedback in the Current Healthcare Environment.

Over the past several decades, simulation-based learning and postsimulation debriefing have become a mainstay of clinical education in healthcare. With origins in both the military and aviation industries, debriefing in particular has been used across multiple nursing and medicine disciplines to promote team training and reflective learning. Self-reflection and improvement in practice are at the core of effective debriefing. Feedback and simulation experts have continued to develop more effective debriefing strategies. Several models are described in the literature, and healthcare educators now have a variety of resources at their disposal. Many of these debriefing techniques offer thoughtful guidance for providing constructive, real-time clinical feedback to students. Incorporating reflective feedback strategies in clinical learning promotes meaningful learning. This, in turn, will only strengthen the capabilities of students and better prepare them for the complexities they will face in clinical practice.

Vaginal breech birth: can we move beyond the Term Breech Trial?

Since the publication of the Term Breech Trial in 2000, planned cesarean has become the preferred mode of birth for women whose fetus is in a breech presentation. Over the past 20 years, however, subsequent evidence has not shown conclusively that cesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. Many obstetric organizations support the option of planned vaginal birth for women with a breech presentation under strict prelabor selection criteria and intrapartum management guidelines. The growing trend toward cesarean unfortunately has left midwives and other intrapartum care providers in training with dwindling opportunities to competently master skills for vaginal breech birth. Although simulation training offers opportunities to practice infrequently encountered skills such as vaginal breech birth, it is unknown if this alternative will provide sufficient experience for future generations of clinicians. As a result, women with a breech presentation at term who desire a trial of labor often have limited choices. This article reviews the controversies surrounding the ideal mode of birth created by the Term Breech Trial. Criteria for vaginal breech birth are summarized and the role of simulation explored. Implications for midwifery practice when a breech presentation is diagnosed are also included.

Magnesium sulfate: past, present, and future.

First used anecdotally for the control of eclamptic seizures in the early 1900s, magnesium sulfate remains 1 of the most commonly used medications in obstetric practice today. Over the past 95 years, there have been countless research studies investigating the efficacy of magnesium sulfate for the management of eclampsia, preeclampsia, preterm labor, and most recently for prevention of cerebral palsy. The majority of this evidence undeniably supports the use of magnesium sulfate as the drug of choice for the prevention and treatment of eclampsia when evidence of severe disease is present. On the other hand, studies have not shown magnesium sulfate to be comparably more effective than other tocolytics for treating preterm labor, nor is there agreement on whether the evidence supports its use as a neuroprotective agent for prevention of cerebral palsy. The exact mechanism of action of magnesium sulfate remains largely hypothetical, and parenteral use has the potential to cause significant morbidity in high doses. This article reviews magnesium sulfate's remarkable history in obstetric practice and includes a summary of the evidence related to each of the controversies. An initial review of the physiology of magnesium sulfate is essential to understanding pharmacodynamic actions, dosing guidelines, and safety requirements.

Exploring the role of uterine artery embolization in the management of postpartum hemorrhage.

Postpartum hemorrhage is a potentially life-threatening obstetric emergency that requires prompt nursing and medical interventions. In the majority of cases, initial strategies such as fundal massage and uterotonic medications will effectively stop excessive bleeding. Unfortunately, the incidence and severity of postpartum hemorrhage are on the rise and peripartum hysterectomy remains a life-saving intervention in cases of intractable bleeding. As an emerging alternative to hysterectomy, uterine artery embolization (UAE) has demonstrated success rates of more than 90% in controlling postpartum hemorrhage unresponsive to other therapies. Research to date has shown UAE to be a safe, minimally invasive procedure with few reported complications and minimal effects on future fertility. For patients who are hemodynamically stable with access to an interventional radiology suite, UAE is an important consideration in the treatment of severe postpartum bleeding. This article explores the role of UAE as a part of this management algorithm. The technical aspects of this procedure, reported complications, and effects on future fertility are described. The prophylactic use of intra-arterial balloon catheters in the management of abnormal placentation is also discussed.

Issues in pregnancy dating: revisiting the evidence.

As the end point date in pregnancy, the estimated date of delivery provides guidance for the timing of specific prenatal tests, gauges fetal growth, and informs critical decision making for specific obstetric complications. It is prudent to use the most evidenced-based methods available to accurately determine gestational age. This article explores the accuracy of both menstrual and ultrasound dating techniques and discusses some of the issues and limitations for each method. In addition, a simple formula called the rule of eights can be used to determine a final estimated date of delivery when a discrepancy between menstrual and ultrasound dating occurs.

Stories as integrated patterns of knowing in nursing education.

The primary aim of this qualitative study was to explore the scholarly benefits of storytelling as a means to promote students' understanding and integration of both the art and science of nursing. As one of the oldest methods of communication, storytelling has been used in a variety of ways in nursing education. Despite this myriad of literature, there were no studies found that analyzed the actual content of students' stories. Using Carper's (1978) Fundamental Patterns of Knowing as a guiding framework for narrative analysis, twenty-five personal stories written by junior level nursing students were examined for evidence of empirics, ethics, esthetics, and personal knowing. Results indicated students were able to not only integrate art and science within their experiences but were also able to see themselves one day as caring nurses. Moreover, Carper's patterns add credibility to storytelling as a worthwhile teaching strategy with benefits to both students and faculty.

Storytelling as an educational strategy for midwifery students.

This article describes the use of purposive storytelling as a creative teaching strategy in the nurse-midwifery education program at San Diego State University and the University of California, San Diego. Student evaluations over a 4-year period showed overwhelming support for the inclusion of storytelling into a weekly didactic midwifery course. Benefits, such as increased cognitive learning, enhanced role transition, and emotional clarification were identified in the students' comments. The students' comments further supported the efficacy of incorporating storytelling into midwifery education. A review of the literature confirms the growing popularity of storytelling in both health care and education, and a conceptual framework is also provided. Further research is needed to examine the benefits of this worthwhile technique in promoting learning, stimulating interest, and facilitating the development of critical thinking.