Hemodynamic studies of isolated absent ductus venosus.

OBJECTIVE: The objective of this article is to evaluate hemodynamic changes among fetuses with isolated absent ductus venosus (IADV) diagnosed by prenatal ultrasonography. PATIENTS AND METHODS: Fetuses with prenatal diagnosis of IADV were recruited and followed. Hemodynamic assessment was performed in all cases, including measurement of cardiac dimensions, shortening fraction, myocardial performance index, preload index in the inferior vena cava and the presence of venous pulsations in the umbilical vein (UV). RESULTS: Nine fetuses of IADV were assessed, including six cases with extra-hepatic UV drainage and three with intra-hepatic drainage. All fetuses with extra-hepatic UV drainage showed an elevated preload index in the inferior vena cava, venous pulsations in the UV and cardiomegaly. Of them, four had hydrops, two showed poor cardiac function and three resulted in perinatal mortality. Three cases with intra-hepatic drainage had continuous flow in the UV, normal in all hemodynamic parameters and all survived. CONCLUSION: Hemodynamic assessment of fetuses with IADV was helpful in predicting the development of hydrops and perinatal mortality. The poor prognostic factors included cardiac overload, cardiomegaly, poor myocardial performance, increased preload, the presence of venous pulsations and extra-hepatic UV drainage. © 2015 John Wiley & Sons, Ltd.

Pregnancy outcomes among women with hemoglobin E trait.

OBJECTIVE: To compare the maternal and fetal outcomes between pregnant women complicated with hemoglobin E (HbE) trait and normal controls. PATIENTS AND METHODS: A retrospective cohort study was conducted by assessment of the database of maternal-fetal medicine units from January 2003 to December 2013 to identify singleton pregnant women complicated by HbE trait. Pregnancies with medical complications or fetal anomalies were excluded. The normal controls were low-risk pregnancies and were non-carrier status for thalassemia and hemoglobinopathy. RESULT: During the study period, 1073 women with HbE trait and 2146 normal controls were included. The baseline characteristics of the two groups were comparable except that the number of prenatal visit was statistically higher in study group (8.55 ± 3.03 versus 7.85 ± 4.33, p = <0.001). Most pregnancy outcomes were not significantly different. However, the rate of asymptomatic bacteriuria was minimally higher in the study group, 3.5% versus 2.3%; p = 0.042 (relative risk 1.19; 95%CI: 0.98-1.43). Note that the rates of gestational diabetes tend to be higher in the group of HbE trait (7.6% versus 6.8%), but did not reach a statistical level. CONCLUSION: The HbE trait does not significantly increase risk of common adverse pregnancy outcomes, except for minimal increase in asymptomatic bacteriuria.

A placebo-controlled, double-blind, randomized study of single-dose intravenous diclofenac for pain relief after a cesarean section.

BACKGROUND: This study was conducted to avoid the pain of an intramuscular injection of diclofenac after a cesarean section, by modifying it to an intravenous infusion by diluting it with 5% dextrose in 100 mL of water. OBJECTIVE: The aim of this study was to determine the efficacy of a single-dose modified diclofenac being given intravenously, instead of intramuscularly, for pain relief after a cesarean section. STUDY DESIGN: A double-blind, randomized controlled trial was conducted. PARTICIPANTS: We enrolled 30 patients who underwent cesarean sections with Pfannenstiel skin incision. METHODS: All patients received 2.2-2.5 mL of 0.5% bupivacaine with 0.2 mg morphine for spinal anesthesia. The participants were equally and randomly allocated to two groups to receive intravenous diclofenac or placebo at 12 hours postoperatively. Both groups received the same regimen for postoperative pain control. MAIN OUTCOME MEASUREMENTS: The severity of postoperative pain was measured directly using a verbal numerical rating scale (0-10) and a pain-relief scale (1-4), and indirectly from the amount of tramadol used. RESULTS: The characteristics of the two groups of patients were similar. The mean postoperative pain relief at 24 hours in the study group was better than that in the control group (3.14 ± 0.66 vs. 2.13 ± 0.99; p < 0.05). The severity of postoperative pain at 24 hours and the amount of tramadol used were not different between groups. CONCLUSION: Intramuscular diclofenac (75 mg), modified by diluting it with 5% dextrose in 100 mL of water, for intravenous administration in combination with spinal morphine (0.2 mg) provided good analgesia after a cesarean section within 24 hours when assessed by the pain-relief scale; however, the mean pain intensity was not different.