A comparison among oscillometric waveforms in healthy nonpregnant women, pregnancy and hypertensive disorders of pregnancy.

OBJECTIVE: Understanding of how oscillometric waveforms (OMW) vary between pregnant and nonpregnant individuals remains low. An exploratory analysis was completed to assess for quantitative and qualitative changes in OMW and oscillometric envelope features in pregnancy. DESIGN AND METHODS: Eighteen pregnant individuals (over 20 weeks gestational age) and healthy, nonpregnant (HNP) women were recruited. Six HNP were matched to six healthy pregnant (HP) women, and six pregnant women with a hypertensive disorder of pregnancy (HDP) by age, arm circumference, and cuff size. Blood pressure measurements were completed per the International Organization for Standardization (ISO) protocol using a custom-built oscillometric device as the test device and two-observer mercury auscultation as the reference measurement. Auscultatory blood pressure and blood pressure derived from slope-based and fixed ratio algorithms were determined. OMW and envelope features were compared among groups. RESULTS: In HNP, HP, and HDP groups respectively: mean auscultatory blood pressure (systolic mean ± SD/diastolic mean ± SD) was 103.4 ±â€…12.2/67.1 ±â€…7.9; 109.5 ±â€…3.1/58.1 ±â€…6.4; 135.6 ±â€…18.9/85.1 ±â€…14.2 mmHg. HDP had significantly higher auscultatory systolic and diastolic blood pressure than the HP group ( P  = 0.001). The pregnant groups had a lower average pulse width (mean ± SD: HNP = 0.8 ±â€…0 s, HP = 0.6 ±â€…0.1 s, HDP = 0.6 ±â€…0.1 s; HP vs. HNP mean difference [adjusted P value]: 0.2 [ P  = 0.004], HDP vs. HNP 0.1 [ P  = 0.018]) compared with the HNP group. The HDP group had a larger area under the OMW envelope than the HNP group (mean ± SD: HNP = 22.6 ±â€…3.4; HDP = 28.5 ±â€…4.2; HDP vs. HNP mean difference [adjusted P value]: 5.9 P  = 0.05). CONCLUSION: In this exploratory work, differences in the OMW morphology and parameters were found in pregnancy and in hypertensive disorders of pregnancy compared with healthy controls. Even small differences may have important implications in algorithm development; further work comparing OMW envelopes in pregnancy is needed to optimize the algorithms used to determine blood pressure in pregnancy.

When the heart stops: a review of cardiac arrest in pregnancy.

Cardiac arrest is a rare occurrence in pregnancy and may be related to obstetric or medical causes. Pregnancy is associated with profound physiologic changes that prepare the gravida for the challenges of labor and delivery, and resuscitation of the pregnant patient needs to take these changes into consideration. Cardiac output and plasma volume increase in pregnancy and distribute differently with the uterine circulation receiving approximately 17% of the total cardiac output. On the other hand, cardiac output is sensitive to positional changes in the second half of pregnancy but may improve with a lateral tilt of the gravida. Both oxygen reserve and upper airway size decrease in pregnancy, leading to difficulties surrounding airway management. Changes in the volume of distribution, renal and hepatic clearance may impact drug effects and need to be recognized. This review will discuss an overview of pregnancy physiology that is relevant to cardiac resuscitation, detail the challenges in the various resuscitative steps including a synopsis on perimortem delivery, and describe obstetric and nonobstetric causes of mortality and cardiac arrest in pregnancy.

Is There Just One Type of Multisport Pathway? A Scoping Review of Multisport Engagement in Early Athlete Development.

Multisport engagement is positioned as the antithesis to specialization within youth development pathways. However, different terms are used to describe the multisport pathway, which may create confusion regarding what the pathway should look like. This review investigated all published research examining the multisport pathway, with a focus on terminology, and how different terms have led to varying interpretations of this research. Four databases were searched for all peer reviewed studies published up until December 2021. All included papers were full text, in English, and focusing on multisport athlete engagement. In total, 1974 abstracts were screened for inclusion eligibility, resulting in 82 articles included within this review. General results showed most studies are empirical (71%, n = 58) and looked at athlete development pathways using retrospective questionnaires aimed at investigating the specific pathway to sporting excellence. However, despite the consensus that multisport athletes play many sports in their lifetime, there is little investigation into when and the level of intensity (play versus practice) at which these sports are being played. Further, inconsistencies in the terminology used to describe this pathway have made it difficult to understand potential mechanisms that lead to any positive or negative effects. It is recommended that differences between the key terms of diversification and sampling are clarified and should not be regarded as synonymous as they may represent different paths within multisport development based on varying levels of intensity of play and practice.

The ankle-to-arm blood pressure index predicts risk of cardiac complications after noncardiac surgery.

BACKGROUND: Peripheral arterial disease, as detected by a reduced ankle-to-arm blood pressure index (AAI), has been shown to predict future cardiac events. However, the utility of measuring the AAI to predict postoperative cardiac complications in patients undergoing noncardiac surgery is unknown. METHODS: We prospectively studied 242 consecutive patients aged 50 yr or older presenting to a university hospital preadmission clinic before elective noncardiac surgery. We performed a standardized clinical evaluation that included calculation of the revised cardiac risk index (rCRI) and measurement of the AAI using both palpation and Doppler techniques. Independent observers, blinded to preoperative assessment and AAI results, ascertained cardiac complications in the first 7 days after surgery. We assessed the ability of an abnormal AAI (