Massive fetomaternal hemorrhage in a monochorionic-diamniotic twin pregnancy: a case report.

Fetomaternal hemorrhage (FMH) result into severe, life-threatening fetal anemia and cause intrauterine death of the fetus. It is tough for an early diagnosis of FMH before pregnancy and few authors reported FMH in a twin pregnancy. Therefore, we reported a case of massive FMH. The patient felt a decrease in fetal movements at 33+5 gestational weeks. Cardiotocography showed sinusoidal heart rate patterns in one fetus. The fetal hemoglobin level in maternal blood was 6.4% (normal range for single pregnancy, 0.0%-2.0%). Since the patient was diagnosed with fetal distress, cesarean section was performed and both babies delivered to receive neonatal treatment. Severe anemia was apparent in both neonates, based on red blood cell count, hemoglobin concentration, and hematocrit of 0.75 × 1012/L and 0.61 × 1012/L, 2.8 g/dL and 2.4 g/dL, and 10.0% and 8.4%, respectively. The neonates were admitted to the intensive care unit for prematurity care and presently are well. In our experience, an early diagnosis of FMH contributed to saving fetus. Obstetricians should highlight fetal movements counting to every patient. Once massive FMH occurs in monochorionic twins, both fetuses may develop severe anemia and require emergency intervention.

Virulence of Japanese Encephalitis Virus Genotypes I and III, Taiwan.

The virulence of genotype I (GI) Japanese encephalitis virus (JEV) is under debate. We investigated differences in the virulence of GI and GIII JEV by calculating asymptomatic ratios based on serologic studies during GI- and GIII-JEV endemic periods. The results suggested equal virulence of GI and GIII JEV among humans.

[A project to reduce mistakes in collecting specimens].

Specimen collection is an important task of nursing care. Any failure to collect the whole missing of a specimen may affect diagnosis and treatment. It will also increase the workloads of staff and the cost of medicines. From April to July 2002, a total of 3,382 specimens were collected in A112 ward in Taipei Veterans General hospital. There were 43 wrong specimens, 1.27% of the total. Analysis showed that the reasons for the error were as follows: (1) The level of knowledge about the test tubes and about the volume of specimens was low. (2) The procedure for dealing with application from was not appropriate. (3) The box in which specimens were kept was not appropriate. (4) The checklist was bad. The PDCA process used in this project reduced the rate of wrong specimens. The strategy was designed with three dimensions: staff, facilities, and procedure. After it was implemented, the rate of wrong specimens dropped from 1.27% to 0.49%, the improvement rate was 61.4%, and the rate of achievement was 101.3%. This project not only reduced the rate of wrong specimens, but also made the process easier and more safisfying for staff.