PP136. Blood pressure patterns in pregnant women who developed pre-eclampsia or hypertension.

INTRODUCTION: Early recognition of pregnant women at risk of pre-eclampsia (PE) in developing countries is essential to ensure timely transfer to the appropriate level of care. OBJECTIVES: Our aim was to determine the predictive value of blood pressure (BP) measurements taken in 4 week windows to identify women who will develop PE or new onset hypertension (NOHPT). METHODS: A prospective observational study.Women with one or more risk factors for PE presenting at a tertiary hospital for antenatal care before 14 weeks' gestation were approached to participate. After obtaining informed consent, a single researcher completed a comprehensive structured questionnaire regarding previous medical, pregnancy and contraceptive history, also including information of the patient's mother, siblings and the father. Clinical findings and the results of routine antenatal tests were documented. Subsequent care was according to existing management policies. The primary outcome was the development of PE (ISSHP definition). RESULTS: We enrolled 318 women, 9 of whom had uncomplicated deliveries elsewhere. There were 35 cases (12.6%) of PE and 39 cases of NOHPT amongst women who delivered after 20 weeks' gestation. Systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP) did not differ between groups at presentation. SBP was significantly higher in women in the PE group from 12-15 weeks' gestation (129.1±13.6 vs. 115.9±16.1mmHg) onwards, while the DBP became significantly higher from 24-27 weeks' gestation (84.0±13.3 vs. 69.3mmHg) onwards. MAP was also higher from 12-15 weeks' gestation (94.8±8.5mmHg) onwards. PP was not of value. In women with NOHPT, SBP became significantly higher at 16-19 weeks' gestation (124.1±12.1 vs. 118.4±14.6), MAP became significantly higher at 24-27 weeks' gestation (89.8±14.6 vs. 85.7±11.3mmHg) and DBP at 32-35 weeks' gestation (78.8±72 vs. 72.1±10.9mmHg). ROC curve analysis revealed poor ability of all four parameters to distinguish between women who will develop PE or NOHPT. CONCLUSION: SBP, DBP and MAP increases earlier in women who will develop PE compared with those who develop NOHPT. In both groups SBP and MAP changed earlier than DBP. PP did not differ between the various groups. There is no specific cut-off value of any parameter which will predict disease without an accompanying high false positive rate. SBP and DBP are only of clinical importance if specific threshold values as identified in existing classification systems are exceeded.

Segmental nerve damage during a McBurney's incision: a cadaveric study.

Injury to the ilioinguinal and iliohypogastric nerves after a McBurney's incision have been reported to cause paralysis of the conjoint tendon that may lead to the development of an indirect inguinal hernia. This study reports on the incidence of ilioinguinal and iliohypogastric nerve sectioning after the performance of a classic McBurney's incision as well as the distance and relationship of the ilioinguinal and iliohypogastric nerves to the anterior superior iliac spine and a classic McBurney's incision. The right iliac fossa and lumbar region of 33 cadavers were dissected for the uncovering of the ilioinguinal and iliohypogastric nerves after a correct McBurney's incision was made. Injury to the ilioinguinal and iliohypogastric nerves was recorded. The mean distance between the ilioinguinal nerve and the incision line was 41.89 mm and 34.63 mm between the iliohypogastric nerve and the incision line. The ilioinguinal and iliohypogastric nerves were found to be 6.69 mm and 12.08 mm from the anterior superior iliac spine, respectively. No ilioinguinal or iliohypogastric nerve was injured during all 33 McBurney's incisions.

Anthocyanins in vegetative tissues: a proposed unified function in photoprotection.

The function of anthocyanins in green, vegetative tissues has always been a contentious issue. Here we evaluate their proposed photoprotective function since recent findings have shown that anthocyanins reduce photoinhibition and photobleaching of chlorophyll under light stress conditions. Anthocyanins generally accumulate in peripheral tissues exposed to high irradiance, although there are some exceptions (e.g. accumulation in abaxial leaf tissues and in obligatory shade plants) and accumulation is usually transient. Anthocyanin accumulation requires light and generally coincides with periods of high excitation pressure and increased potential for photo-oxidative damage due to an imbalance between light capture, CO2 assimilation and carbohydrate utilization (e.g. greening of developing tissues, senescence and adverse environmental conditions). Light attenuation by anthocyanin may help to re-establish this balance and so reduce the risk of photo-oxidative damage. Although it has been suggested that anthocyanins may act as antioxidants, the association between anthocyanins and oxidative stress appears to relate to the ability of anthocyanins to reduce excitation pressure and, hence, the potential for oxidative damage. The various aspects of anthocyanin induction and pigmentation presented here are compatible with, and support, the proposed general role of anthocyanins as photoprotective light screens in vegetative tissues.

Umbilical cord blood gas analysis; a comparison of two simple methods of sample storage.

Umbilical cord vessel acid-base analysis is increasingly employed as an end-point in the study of ante-partum and intra-partum care. Delay in processing the sample can results in erroneous values as a result of gaseous diffusion and continuing metabolism. The effect of delay was investigated for samples stored in heparinized syringes at room temperature and simultaneously stored samples in double clamped cord segments. Small, but statistically significant changes were seen for pH, base deficit and PCO2 over 30 min. Storage in the syringe results in the most reliable values for pH and base deficit, whereas the cord segments showed no changes in PO2 and PCO2.

Favorable neonatal outcome after fetal entrapment and partially successful Zavanelli maneuver in a case of breech presentation.

A 16-year-old primigravida woman presented in advanced labor with a singleton breech presentation. Vaginal delivery was considered to be possible, but entrapment at the level of the fetal thorax occurred. The Zavanelli maneuver was attempted unsuccessfully. A cesarean section was performed immediately but was complicated by lateroflexion of the fetus. The attending pediatrician proceeded to endotracheal intubation and ventilation of the partially born baby. Repositioning of the mother facilitated delivery. The fetus survived without any complications. This case illustrates the lack of scientific data to support decision-making in the case of patients presenting with breech presentation late in labor, as well as the unconventional steps sometimes needed in these situations.

Does a nonreactive fetal heart rate pattern really mean fetal distress?

The aim of the study was to compare three different fetal heart rate (FHR) patterns, namely, a nonreactive pattern with good long-term variability (fluctuation of 5 or more beats/min), a reactive pattern, and a nonreactive pattern with poor long-term variability (less than 5 beats/min). For this purpose, nonstress tests done less than 24 hours before delivery and FHR patterns recorded during labor were separately assessed. Endpoints for comparison were 5-minute Apgar scores, intrauterine growth retardation, and umbilical blood gas values at birth. Regarding the nonstress test, the prevalence of low 5-minute Apgar scores in reactive, good variability, and in poor variability patterns were 7.2%, 5.3%, and 24%, respectively. The prevalences of small for gestational age newborns were 8%, 17.6%, and 60.6%, respectively. Blood gas values did not differ significantly. Regarding the FHR patterns during labor, using the same sequence, the prevalences of low 5-minute Apgar scores were 3.5%, 6%, and 23%, respectively. Small for gestational age babies occurred in 8.8%, 15.6%, and 80% of the different FHR patterns, respectively. Regarding umbilical artery blood gas values, the only significant difference was a lower pH in the poor variability group. No difference was found between the blood gas values of babies with a reactive pattern and a nonreactive pattern with good variability.