Biophysical profile for fetal assessment in high risk pregnancies.

BACKGROUND: A biophysical profile (BPP) includes ultrasound monitoring of fetal movements, fetal tone and fetal breathing, ultrasound assessment of liquor volume with or without assessment of the fetal heart rate. The BPP is performed in an effort to identify babies that may be at risk of poor pregnancy outcome, so that additional assessments of wellbeing may be performed, or labour may be induced or a caesarean section performed to expedite birth. OBJECTIVES: To assess the effects of the BPP when compared with conventional monitoring (CTG only or MBPP) on pregnancy outcome in high-risk pregnancies. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2007), CENTRAL (The Cochrane Library 2006, Issue 4), MEDLINE (1966 to November 2006), EMBASE (1974 to November 2006) and CINAHL (1980 to November 2006). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials involving a comparison of fetal BPP with other forms of antepartum fetal assessment in women with high-risk pregnancies. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligibility, quality and extracted data. MAIN RESULTS: We included five trials, involving 2974 women. Most trials were not of high quality. Although the overall incidence of adverse outcomes was low, available evidence from randomised controlled trials does not support the use of BPP as a test of fetal wellbeing in high-risk pregnancies. We found no significant differences between the groups in perinatal deaths (relative risk (RR) 1.33, 95% confidence interval (CI) 0.60 to 2.98) or in Apgar score less than seven at five minutes (RR 1.27, 95% CI 0.85 to 1.92). Combined data from the two high-quality trials suggest an increased risk of caesarean section in the BPP group RR 1.60, 95% CI 1.05 to 2.44, n = 280, interaction test P = 0.03. However, the number of participating women was relatively small (n = 280). Therefore, additional evidence is required in order to be definitive regarding the efficacy of this test in high-risk pregnancies. Furthermore, the impact of the BPP on other interventions, length of hospitalisation, serious short-term and long-term neonatal morbidity and parental satisfaction requires further evaluation. AUTHORS' CONCLUSIONS: At present, there is insufficient evidence from randomised trials to support the use of BPP as a test of fetal wellbeing in high-risk pregnancies.

The use of intrapartum electronic fetal heart rate monitoring: a national survey.

This study describes the use of intrapartum electronic fetal monitoring in Ireland. Electronic fetal monitoring (EFM) has become routine in the assessment of fetal wellbeing during labour. Current evidence indicates that the routine use of EFM leads to an increased caesarean section and operative vaginal delivery rate and a reduction in the rate of neonatal seizures. Practices and service provision related to the use and interpretation of and educational provision for electronic fetal monitoring have not been investigated in Ireland. A national survey of all (n = 22) maternity units in Ireland was undertaken using a self-reported questionnaire amended, with permission, from that used in the 8th CESDI report. The questionnaire sought information on unit birth rate in 2002, number of cardiotocograph (CTG) monitors available in delivery units, use of the admission CTG, use of continuous EFM for women with various risk factors for pregnancy and/or labour, availability of fetal blood sampling facilities, use of umbilical cord blood sampling and availability of guidelines on the use of EFM. All units responded to the survey giving a national picture of the use of EFM during labour. All units had cardiotocograph (CTG) monitors available in the delivery area (median 6, range 3-14). An admission CTG was performed on all women by 96% (n=21) of units. Thirty six per cent of units (n=8) used continuous EFM routinely during labour in women who did not have risk factors for labour. Fetal blood sampling (FBS) was used in 36% (n=8) of units in cases of suspicious CTG tracings. Umbilical cord blood gases were sampled routinely following emergency caesarean section in 46% (n= 10) of units while 64% (n= 14) did so if the baby's condition was poor at birth. A departmental guideline on the use of EFM was available in 73% (n= 16) units. The findings of this survey indicate wide variations in the use of intrapartum EFM in Ireland. The use of continuous EFM for specific high-risk indications was variable and EFM was used by a third of units for women who did not have risk factors for labour. The admission CTG was used by 21 of the 22 units despite evidence of no benefit. The absence of FBS in the majority of units surveyed and the low rate of umbilical cord blood sampling is of concern.

Ultrasound screening: how effective is the service?

This study describes the standards, training and audit systems in units offering ultrasound screening services in Ireland. A national survey of 21 of all maternity units offering an obstetric ultrasound service in Ireland was undertaken. The questionnaire used was designed by the UK Screening committee and sought information on nine key areas associated with service provision including protocols for screening, the antenatal ultrasound package available and management following the identification of a fetal abnormality. This paper reports on the availability of information for women, record keeping, standards and training, and monitoring of quality. All units responded to the survey. Deficiencies in the Irish service include limited information available for women who are participating in screening, poor monitoring of ultrasound programmes, suboptimal equipment and a lack of guidelines and standards relating to the conduct of ultrasound examinations Significant improvements are required in order to deliver a national service of a satisfactory standard. Key recommendations include establishing a national working group to develop national standards to audit the service, and to guarantee that staff training is sufficient to ensure effective practice.

Functional subdivision of the venom gland musculature and the regulation of venom expulsion in rattlesnakes.

A combination of histology, whole muscle force physiology, glycogen depletion, and venom expulsion analyses using transonic probes to measure venom flow and fluid pressure transducers to measure venom pressure was performed on the m. compressor glandulae and m. pterygoideus glandulae. The m. pterygoideus glandulae has less than one-third the cross-sectional area of the m. compressor glandulae, and produces approximately one-fifth the total twitch and tetanic force; however, in situ surface stimulation of the muscle produces venom flow and pressure levels that are similar to those produced by the m. compressor glandulae. The similarity in venom output following stimulation reflects in part the functional role of the larger m. compressor glandulae in jaw adduction, but also the functional subdivisions within this muscle. The m. compressor glandulae is divided into a series of columnar fascicles that run from the surface of the muscle to the venom gland. The combined results of clearing and staining and glycogen depletion studies suggest that these fascicles may represent functional compartments. Identical stimulations applied to different regions of the m. compressor glandulae result in up to a six-fold difference in venom expulsion. This functional specialization may play a role in the regulation of venom flow during offensive and defensive strikes.

Handheld Flyback driven coaxial dielectric barrier discharge: Development and characterization.

The development of a handheld single and triple chamber atmospheric pressure coaxial dielectric barrier discharge driven by Flyback circuitry for helium and argon discharges is described. The Flyback uses external metal-oxide-semiconductor field-effect transistor power switching technology and the transformer operates in the continuous current mode to convert a continuous dc power of 10-33 W to generate a 1.2-1.6 kV 3.5 micros pulse. An argon discharge breakdown voltage of approximately 768 V is measured. With a 50 kHz, pulse repetition rate and an argon flow rate of 0.5-10 argon slm (slm denotes standard liters per minute), the electrical power density deposited in the volume discharge increases linearly at a rate of 75+/-20% mW/cm(3) per 1 slm of gas. Electrical power transfer efficiency between the secondary Flyback coil and the discharge volume increases from 0.1% to 0.65%. Neutral argon gas forced convection analysis yields a similar energy loss rate to the electrical discharge process. Optical emission spectroscopy studies of the expanding discharge plume into ambient air reveal that the air climatically controls the plume chemistry to produce an abundance of neutral argon atoms and molecular nitrogen.

Ultrasound screening for fetal abnormality in Ireland: a national survey.

BACKGROUND: Since 1997, the RCOG have recommended that ultrasound screening for fetal abnormality in pregnancy should be offered to all women. AIM: This study describes the practices and service provision of ultrasound screening for fetal abnormality in Ireland. METHODS: A national survey of all maternity units providing an obstetric ultrasound service (n = 21) was undertaken. RESULTS: All units responded to the survey. First trimester ultrasound for dating was performed routinely in 57% of units. Second trimester ultrasound screening for fetal anomaly was available either routinely or selectively in all units. Wide variations in the management of a pregnancy after an adverse diagnosis were observed. CONCLUSION: This survey indicates a wide variation in the use of ultrasound to screen for fetal abnormality. Recommendations are made to improve the service through the use of a standard protocol to examine fetal structures. A national debate on screening for fetal abnormality is required urgently.

Biointeraction of sodium selenite and aflatoxin B1 in the Mongolian gerbil.

The interaction of sodium selenite (Na2SeO3) and aflatoxin B1 (AFB1) was studied in 6-wk-old male Mongolian gerbils. Each of four groups of gerbils were fed one of the following diets during a 12-wk experimental period: control (commercial Chow), 5.0 ppm Na2SeO3, 12.8 ppm AFB1, or 5.09 ppm Na2SeO3 + 12.8 ppm AFB1. Animals receiving Na2SeO3 in the diet, alone and with AFB1, had a significantly lower mean total weight gain during the experiment than did control animals. Animals receiving both compounds together displayed a very high level of physical activity compared to the three other groups. Blood analysis showed no change in total leukocytes, but the relative percentage of lymphocytes increased and the percentage of neutrophils decreased concurrently in the order: control less than AFB1 less than Na2SeO3 + AFB1 les than Na2SeO3. A significant reduction in organ weight relative to body weight was observed in the liver, kidney, and lung of the animals fed AFB1 alone but only in the liver of those fed both Na2SeO3 and AFB1. No similar alterations were observed in the Na2SeO3 group. Histopathological examination revealed considerably less hepatic damage in animals fed Na2SeO3 with AFB1 than in those receiving either compound alone. Renal and intestinal damage, however, was most severe in this double-treatment group. Hepatic protein analysis revealed two protein peaks in the Na2SeO3 + AFB1 group that were absent in all other groups. It was concluded that these proteins may be selenoproteins directly or indirectly involved in the lower incidence of histopathological damage in this group.

A descriptive epidemiology of netball injuries during competition: a five year study.

OBJECTIVE: To investigate the relation between injury profiles - including assessment, treatment, severity, and the perceived reason for the injury - and participation in competitive netball. METHODS: Between 1985 and 1989, approximately 11,228 netball players participated in a 14 week netball competition held at the major competitive centre in Western Australia; 608 netball players presented to the first aid room with an injury and were assessed and treated by the same physiotherapist and St John First Aid officer. RESULTS: The overall incidence rate during competition was 5.4%, with more injuries occurring in the A grade level of play. Ankle injuries (84%) were most frequent, with 67% of these injuries diagnosed as lateral ligament sprains while a further 10% of players who suffered this classification of injury sustained a fracture to the ankle or foot. Few injuries occurred at the knee joint (8.3%) and only 1.8% of these injuries were diagnosed as an injury to the anterior cruciate ligament. The direct probability of a netball players' risk estimate was 0.054 per person per match which implied that netball was a relatively safe game. Injuries sustained during practice were not included in this study. CONCLUSIONS: Netball is a relatively safe game though the potential for injury increases with the level of competition.

The Alton Dean pressure infusor: an evaluation.

An automatically pressurised infusor system, the Alton Dean infusor, has been compared with two types (cloth and plastic) of commonly used pneumatically pressurised bags. All the infusors had reasonably accurate pressure gauges but pressure could only be consistently maintained with the cloth infusors or with the Alton Dean infusors when connected to a compressed air supply. Sequential fast infusions were possible with all infusors, but simultaneous infusions could be limited in number when the pressure infusor was connected directly to pipeline gas. One of the Alton Dean pressure infusors tested had a leak in the pressurisation system, and the pressure adjustment valves were difficult to manipulate. These may require modification.

Propofol infusion for sedation in the intensive care unit: preliminary report.

Propofol (2,6,di-isopropylphenol) was given by continuous intravenous infusion to provide sedation after cardiac surgery in 30 patients and its effects compared with those of midazolam given to a further 30 patients. Propofol infusion allowed rapid and accurate control of the level of sedation, which was satisfactory for longer than with midazolam. Patients given propofol recovered significantly more rapidly from their sedation once they had fulfilled the criteria for weaning from artificial ventilation and as a result spent a significantly shorter time attached to a ventilator. There were no serious complications in either group. Both medical and nursing staff considered the propofol infusion to be superior to midazolam in these patients. These findings suggest that propofol is a suitable replacement for etomidate and alphaxalone-alphadolone for sedating patients receiving intensive care.

"Micrognathozoa: A new class with complicated jaws like those of rotifera and Gnathostomulida:" journal of morphology, volume 246, number 1, october 2000

The cover caption for the October issue of Journal of Morphology (Volume 246, Number 1) incorrectly listed the size of the cover specimen, Limnognathia maerski, as 128 cm in length. This is incorrect. The correct length is 128 &mgr;m. The correct cover caption is: The type species, Limnognathia maerski nov. gen. et sp. of a new group of animals, Micrognathozoa, from Greenland was photographed using differential interference contract microscopy, Nomarski technique. Anterior of the specimen is at the top of the figure. Different internal structures such as the pharyngeal apparatus with jaws and the ovaria with eggs are seen in three dimensions. The long, stiff sensoria are best seen when the animal is living as here in this photomicrograph. This specimen is only 128 &mgr;m in length. The color in this image is not the true color of the transparent animal but is a reflection of the Nomarski technique. Photomicrograph by Reinhardt M. Kristensen. See R. M. Kristensen and P. Funch, page 1. The Editor regrets this error.