Arterial stiffness throughout pregnancy: Arteriograph device-specific reference ranges based on a low-risk population.

OBJECTIVE: The maternal cardiovascular system undergoes significant adaptation during pregnancy. We aimed to examine the changes in arterial stiffness parameters during normal pregnancy and establish reference ranges for the general population. METHODS: We performed a prospective cross-sectional observational study at the University Hospitals of Leicester. We included low-risk healthy pregnant women with singleton and viable pregnancies with no evidence of foetal abnormality or aneuploidy. Smokers, women with pre-existing or gestational hypertensive disorders and diabetes, booking BMI at least 30, on medication that could affect cardiac function and/or those who delivered before 37 completed weeks of gestation, and/or a neonate with birthweight less than 10th centile were excluded. Brachial (BrAIx) and aortic augmentation indices (AoAIx), and pulse wave velocity (PWV) were assessed using the Arteriograph. Data were analysed using a linear mixed model. RESULTS: We analysed a total of 571 readings from 259 women across different gestational ages and present the 10th, 25th, 50th, 75th and 90th centiles for BrAIx, AoAIx and PWV from 12+0 to 42+0 weeks' gestation. All haemodynamic variables were significantly associated with maternal heart rate. BrAIx, AoAIx and PWV demonstrated significant change with gestation, with all reaching their lowest value in the second trimester. CONCLUSION: The current study presents reference ranges for BrAIx, AoAIx and PWV in low-risk singleton pregnancies. Further work is required to establish if women in whom measures of arterial stiffness lie above the 90th centile could be at increased risk of adverse pregnancy outcomes and to identify the optimum time for screening.

A Demonstration of Long-Term Outcomes in a Case of Toe to Thumb Transfer Following Traumatic Amputation.

The thumb is pivotal to many functions of the hand. Loss or absence of the thumb can be catastrophic to a patient's functioning. Different methods can be employed to surgically fashion a new thumb. This case report aims to demonstrate one patient's 34-year experience, reporting objective measures for a toe to thumb transfer, and documenting aesthetic outcomes. A semi-structured interview was conducted to gain insight into the patient's personal experiences. Validated assessment tools were used to assess range of movement and power, including Kapandji test, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Cochin Hand Function Scale, Qingfeng Hand Dynamometer, Self-Administered Foot Evaluation Questionnaire (SAFE-Q). A physical examination on the neothumb was performed, along with photography to document aesthetic outcome. A 55-year-old white British male injured his right thumb whilst on a placement year in a sugar refinery in the Netherlands. The thumb was traumatically amputated proximal to the metacarpophalangeal joint. The patient lived for a year without a thumb on his dominant hand, which had a huge effect on his functioning, with extensive input from physiotherapists to help increase his handgrip strength. He then underwent a transfer operation, with the removal of the second toe which was transferred to create a right neothumb. The patient has high physical functioning of his neothumb, however, he is still mildly limited due to pain 34 years post-operation. The objective assessment tools demonstrate a high functioning of the neothumb, with only mild deficits in the dexterity and the physical functioning of the right hand. He experiences mild pain and reduced function of the donor foot. Light touch was found to be absent on the right thumb, but present on the left. Two-point discrimination was 7 mm on the right thumb, and 0.5 mm on the left. In this case, we present a toe to thumb transfer that had very good outcomes after 34 years with few complications. This case demonstrates that great adaptation can occur over long periods of time, restoring near-normal function. Measures of functional outcomes were generally high, with main deficiencies in fine motor skills such as picking up a penny from a flat surface and undoing small buttons. Additionally, there can be good long term outcomes from toe to thumb transfer despite moderate impairment of function. There is hope that this can be used to encourage and reassure patients and surgeons alike that the neothumb is likely to give good outcomes both functionally and aesthetically for many years.