Confined placental mosaicism: placental size and function evaluated on magnetic resonance imaging.

OBJECTIVES: Evidence regarding placental function in pregnancies complicated by confined placental mosaicism (CPM) is conflicting. We aimed to compare placental function between CPM and non-CPM pregnancies prenatally and at birth. A secondary objective was to evaluate the relationship between placental function and chromosomal subtype of CPM. METHODS: This was a retrospective study of pregnancies with CPM and control pregnancies delivered at a tertiary hospital in Denmark between 2014 and 2017. Placental volume and placental transverse relaxation time (T2*) were estimated on magnetic resonance imaging (MRI), fetal weight and uterine artery pulsatility index (UtA-PI) were estimated on ultrasound and fetoplacental ratio was assessed on MRI and at birth. These estimates of placental function were adjusted for gestational age and compared between groups using the Wilcoxon rank-sum test. Within the group of CPM pregnancies, measures of placental function were compared between those at high risk (chromosome numbers 2, 3, 7, 13 and 16) and those at low risk (chromosome numbers 5, 18 and 45X). RESULTS: A total of 90 pregnancies were included, of which 12 had CPM and 78 were controls. MRI and ultrasound examinations were performed at a median gestational age of 32.6 weeks (interquartile range, 24.7-35.3 weeks). On MRI assessment, CPM placentae were characterized by a lower placental T2* Z-score (P = 0.004), a lower fetoplacental ratio (P = 0.03) and a higher UtA-PI Z-score (P = 0.03), compared with non-CPM placentae. At birth, the fetoplacental ratio was significantly lower (P = 0.02) and placental weight Z-score was higher (P = 0.01) in CPM pregnancies compared with non-CPM pregnancies. High-risk CPM pregnancies showed a reduced placental T2* Z-score (P = 0.003), lower birth-weight Z-score (P = 0.041), earlier gestational age at delivery (P = 0.019) and higher UtA-PI Z-score (P = 0.028) compared with low-risk CPM pregnancies. Low-risk CPM pregnancies did not differ in any of these parameters from non-CPM pregnancies. CONCLUSIONS: CPM pregnancies are characterized by an enlarged and dysfunctional placenta. Placental function was highly related to the chromosomal type of CPM; placental dysfunction was seen predominantly in high-risk CPM pregnancies in which chromosomes 2, 3, 7, 13 or 16 were involved. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Placental volume, thickness and transverse relaxation time (T2*) estimated by magnetic resonance imaging in relation to small for gestational age at birth.

INTRODUCTION: Placental magnetic resonance imaging (MRI) may be a valuable tool in the prediction of small for gestational age (SGA) at birth. MRI provides reliable estimates of placental volume and thickness. In addition, placental transverse relaxation time (T2*) may be directly related to placental function. This study aimed to explore and compare the predictive performance of three placental MRI parameters - volume, thickness and T2* - in relation to SGA at birth. METHODS: A mixed cohort of 85 pregnancies was retrieved from the placental MRI database at the study hospital. MRI was performed in a 1.5 T system at gestational weeks 15-41. In normal birthweight (BW) pregnancies [BW > -22 % of expected for gestational age (GA)], the correlation between each of the MRI parameters and GA was investigated by linear regression. The prediction of SGA was investigated by logistic regression analysis adjusted for GA at MRI. RESULTS: In normal BW pregnancies, a significant linear correlation was found between GA and each of the MRI parameters. Univariate analysis demonstrated that placental volume [odds ratio (OR) 0.97, p = 0.001] and placental T2* (OR 0.79, p = 0.003), but not placental thickness (OR 0.92, p = 0.862) were significant predictors of SGA. A multi-variate model including all three MRI parameters found that placental T2* was the only independent predictor of SGA (OR 0.81, p = 0.04). CONCLUSION: Among the MRI parameters investigated in this study, placental T2* was the only independent predictor of SGA in a multi-variate model. This finding underlines the strong position of T2*-weighted placental MRI in the prediction of SGA.

Placental magnetic resonance imaging T2* measurements in normal pregnancies and in those complicated by fetal growth restriction.

OBJECTIVES: The magnetic resonance imaging (MRI) variable transverse relaxation time (T2*) depends on multiple factors, one important one being the presence of deoxyhemoglobin. We aimed to describe placental T2* measurements in normal pregnancies and in those with fetal growth restriction (FGR). METHODS: We included 24 normal pregnancies at 24-40 weeks' gestation and four FGR cases with an estimated fetal weight below the 1(st) centile. Prior to MRI, an ultrasound examination, including Doppler flow measurements, was performed. The T2* value was calculated using a gradient echo MRI sequence with readout at 16 different echo times. In normal pregnancies, repeat T2* measurements were performed and interobserver reproducibility was assessed in order to estimate the reproducibility of the method. Placental histological examination was performed in the FGR cases. RESULTS: The method was robust regarding the technical and interobserver reproducibility. However, some slice-to-slice variation existed owing to the heterogeneous nature of the normal placenta. We therefore based T2* estimations on the average of two slices from each placenta. In normal pregnancies, the placental T2* value decreased significantly with increasing gestational age, with mean ± SD values of 120 ± 17 ms at 24 weeks' gestation, 84 ± 16 ms at 32 weeks and 47 ± 17 ms at 40 weeks. Three FGR cases had abnormal Doppler flow, histological signs of maternal hypoperfusion and a reduced T2* value (Z-score < -3.5). In the fourth FGR case, Doppler flow, placental histology and T2* value (Z-score, -0.34) were normal. CONCLUSIONS: The established reference values for placental T2* may be clinically useful, as T2* values were significantly lower in FGR cases with histological signs of maternal hypoperfusion. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Artistic assault: an unusual penetrating head injury reported as a trivial facial trauma.

The authors report a case of penetrating head injury that presented with a deceptively mild complaint. To our knowledge, it is the first report of a paint brush penetrating the brain. The patient reported being punched in the left eye and presented with a minor headache, swelling around the left orbit, a small cut on the cheek and slightly reduced left eye abduction. After radiological evaluation, a penetrating head injury was diagnosed. Under general anesthesia, through a lateral eyelid incision a 10.5 cm long paint brush, which had penetrated from the left orbit to the right thalamus, was removed. No post-operative infection was seen at six months follow-up. This brief report serves to highlight that penetrating brain injury can occur without neurological deficit and that a minimally invasive surgical approach was successful in avoiding any complications.

Quantifying client need for care in the community: a strategy for managed care.

The Community Health Intensity Rate Scale (CHIRS) is a tool that provides an index of a client's need for care. Emphasis in healthcare has shifted from episodes of illness to covered lives and managed care. CHIRS contains all the elements for holistically determining the intensity of a client's need for care and the environmental, psychosocial, and health behaviors of the client. The CHIRS has been utilized with a variety of community health populations. Each application of CHIRS provided feedback to the researchers for use in revising CHIRS. This article reports the findings of a study which tested the validity and reliability of the refined version of CHIRS. The validity and reliability needed further refinement at the indicator level. The study produced a more practical tool for determining intensity of need for clients in the community.

Stability of ursodiol 25 mg/mL in an extemporaneously prepared oral liquid.

The stability of ursodiol in an extemporaneously formulated oral liquid was studied. A suspension was prepared by combining the contents of commercially available 300-mg capsules of ursodiol with glycerin, Ora-Plus (Paddock Laboratories), and orange syrup. A second formulation was prepared by combining ursodiol capsules with sterile water for irrigation. The final concentration of ursodiol in each formulation was 25 mg/mL. Six samples of each preparation were stored in 4-oz amber plastic prescription bottles protected from light. Three were stored at 22-23 degrees C and three were refrigerated at 2-6 degrees C. Immediately after preparation and at 7, 15, 30, 45, and 60 days, samples were obtained and frozen until assay by high-performance liquid chromatography. On day 60 the mean percentage of the initial ursodiol concentration remaining was 108.4% for the suspension stored at room temperature and 103.3% for the refrigerated suspension. The ursodiolin-water formulation was not analyzed because of rapid settling of ursodiol. Ursodiol 25 mg/mL in an oral liquid prepared extemporaneously from capsules and sweetened vehicle was stable for 60 days when stored in amber plastic bottles at 22-23 and 2-6 degrees C. Addition of ursodiol powder to water without a suspending agent resulted in a liquid formulation with a high variability in content uniformity.

Preliminary development of the School Health Intensity Rating Scale.

Nursing consultants from the states included in the Mountain Plains Regional Resource Center, U.S. Dept. of Education, identified the need for a scale to classify student health status. The classification would allow schools to determine the level of needed student health services. This identified need led to the development of the School Health Intensity Rating Scale (SHIRS) degree in partnership with Donna A. Peters. RN, PhD. FAAN, developer of the Community Health Intensity Rating Scale (CHIRS). The consultants and school nurses participating in the project piloted the scale and a scale research project is now in progress.

Measuring the essence of nursing: a guide for future practice.

Today's changing health care environment presents nursing with the opportunity to expand its role in the health care system. With this opportunity, issues of appropriate education, delegation of supplemental activities to nonprofessionals, and cost of nursing services become significant. Satisfactory resolution of these issues will require a clearly articulated language for what nursing does so that services can be well defined in some way other than a medical model. Once there are clear definitions, competencies for education can be established, decisions regarding delegation of activities can be made, and costs can be assigned. This article describes the use of the Community Health Intensity Rating Scale (CHIRS) as a beginning point for resolving these issues. The CHIRS is a reliable and valid patient classification tool developed to measure the needs of clients of community health nurses as a basis for projecting agency resources required to address those needs. Data elements in CHIRS offer a nursing perspective that incorporates environmental, psychosocial, and health management concerns; more specific definitions of the content and context of care; and an expanded basis for defining resource consumption.

Outcomes: the mainstay of a framework for quality care.

To move toward quality care, it is important to understand all relevant terminologies and concepts. A conceptual framework is useful for organizing all the relevant practice components, such as professional standards, protocols, critical paths, and care plans. The article presents a framework for quality care that focuses on outcomes and defines and incorporates all the other essential elements that are used to reflect quality.

Determining intensity of need of high-risk maternal and infant clients.

Sound funding decisions by policymakers require data that relate health care services to both client need and client outcome. However, client need for care is not easy to express quantitatively, particularly in the realm of preventive and health promotion services. Application of the Community Health Intensity Rating Scale (CHIRS) with high-risk infants and prenatal clients revealed that differences in intensity of need, particularly in contextual and behavioral domains, helped to explain variation in amount of care received. The CHIRS holds promise of providing the language and measurement with which to articulate client need as the basis for cost-effective multidisciplinary care.

A new look for quality in home care.

The management of quality is being transformed in healthcare. Continuous improvement is a cornerstone to this new look at quality. However, no continuous quality program will succeed without incorporating the values and wants of the consumer of care and the end point they want to reach. This article presents an overview of the values to consider and the way to define outcomes.

Measuring quality: inspection or opportunity?

This article has attempted to provide a different way of looking at the quality of health care and its measurement. How well quality is measured is based on beliefs about health, the provider-client relationship, and the health care system. In the end, quality really depends on the human spirit itself and how individuals treat themselves and others. Without a personal commitment to quality and respect for one's self and others, there is no means to achieve quality. There never will be sufficient financial resources, organizational artifice, or measurable standards to safeguard quality any other way. Each of us must care enough to make this happen--for ourselves, for our patients, and for our profession.