[From the prescription of contraceptives to their application. A study of the on-going use of contraceptive methods in immigrant circles during the post-partum period]. / De la prescription contraceptive à son application. Etude de la continuité des méthodes contraceptives en milieu migrant en période post-natale.

PURPOSE: The research presented here aimed at establishing a possible link between the level of integration of an immigrant population and the rate of continuity following a prescription for contraception given to women on leaving the maternity clinic. MATERIALS AND METHODS: From June 1995 to November 1996, a study was conducted in Valence among 71 women who came from Turkey, sub-Saharan Africa and the Maghreb. Out of 87 women interviewed at the maternity, 71 were seen a second time. As well as taking into consideration socio-demographical factors, the study compared the degree of integration with the use of the prescribed contraceptive method six months after leaving the maternity clinic. RESULTS: The study shows that there is no significant link between the level of integration and the continued use of a contraceptive method six months after birth. The only salient fact is that women who had lived less than 10 years in France systematically used a contraceptive method (P = 0.004, relative risk: 1.44, 95% confidence interval: 1.12-1.84). DISCUSSION: Our study would tend towards the following observation: the more recently the immigrant arrived, the more receptive they were towards proposals made by the medical personnel. We consider that rather than it being the case of either total confidence in, or distrust of, medical contraception, the cultural factor remains important and must be taken into account in any approach among this kind of population. It is more a question of community health education than of medical prescription.

Nursing information systems: applications in nursing curricula.

America's healthcare system is being transformed to meet a new set of priorities: cost-effectiveness, quality, and access. To meet these priorities, health practitioners of the 21st century will rely heavily on computer information systems to provide complete, easily accessed patient data. Incorporation of this technology in nursing programs will enhance the quality of the graduates who will then strengthen the availability of a qualified work force to employers.

[Positive diagnosis of Potter's syndrome by ultrasonography. A case report]. / Diagnostic positif du syndrome de Potter par l'échographie. A propos d'une observation.

Potter's syndrome is a rare disorder but on which should not be overlooked. Ultrasound signs such as oligoaminos, retarded intra-uterine growth. (R.I.U.G.) and failure to detect the bladder and kidneys constitute fairly clear signs. Early and specific diagnosis leads to therapeutic pregnancy termination. This allows the parents to avoid the painful and late birth of a malformed child.

Fetal acoustic stimulation testing. III. Predictive value of a reactive test.

The nonstress test (NST) is a helpful adjunct to the management of high-risk pregnancies. However, fetal sleep states may lead to falsely nonreactive tests. We assessed the usefulness of transabdominal acoustic stimulation of the fetus and demonstrated an approximately 50% reduction in the number of nonreactive tests and a shorter testing time. No change in the predictive reliability of a reactive test was observed. With regard to the intrapartum and neonatal outcome in women delivering within seven days of a reactive test, no difference between the incidence of meconium-stained amniotic fluid, depressed one- or five-minute Apgar scores or operative intervention for fetal distress could be identified. A reactive test evoked by acoustic stimulation is as reliable as the NST. It offers the additional benefits of reduced testing time and a lower incidence of nonreactive tests.

Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks' gestation.

An ultrasound approach was developed to identify normal amniotic fluid volume. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of the largest pocket in each quadrant was measured. The sum of these four quadrants was used to provide a single number for the amniotic fluid volume and termed the amniotic fluid index. This approach is simple, requires little time and gives a semiquantitative estimate of amniotic fluid volume. Based on our observations, the normal amniotic fluid index in term gestation is 12.9 +/- 4.6 cm. Evaluation of the relationship between amniotic fluid volume and fetal outcome is under investigation.

Fifteen years of experience with antepartum fetal testing.

The introduction of antepartum fetal heart rate testing occurred in the very early 1970s. This article describes the evolution of testing within the Los Angeles County/University of Southern California Medical Center and encompasses a 15-year time period between 1971 and 1985. During this time approximately 200,000 patients were delivered of their infants. Fetal surveillance increased from less than 1% to current levels of 16% of patients. The antepartum fetal death rate was evaluated as a measure of evaluating the usefulness of antepartum testing. The fetal death rate after antepartum testing in selected high-risk patients was significantly less than that found in those patients not tested. The questions that might be raised regarding broader application of this technique and potential benefits are stated.

Fetal acoustic stimulation testing. II. A randomized clinical comparison with the nonstress test.

Antepartum fetal heart rate testing, specifically the nonstress test, is of accepted value in the antenatal surveillance of high-risk pregnancies. Fetal rest-activity cycles coupled with arbitrary test intervals appear to lead to falsely nonreactive tests. Methods to alter fetal behavioral states have not been uniformly successful. A retrospective analysis of the adjunctive use of acoustic stimulation at our institution demonstrated a 50% reduction in the number of nonreactive tests. Consequently a prospective randomized clinical trial was undertaken to compare the standard nonstress test with the fetal acoustic stimulation test. Those patients randomized to the fetal acoustic stimulation test underwent transabdominal acoustic stimulation with a Model 5C electronic artificial larynx. The incidence of nonreactive tests was 14% in the control group and 9% in the study group (chi 2 = 11.09, p = 0.004). A significant reduction in testing time was also observed. The fetal acoustic stimulation test offers advantages over the traditional nonstress test by lowering the incidence of nonreactive tests and reducing testing time.

Factors influencing nonstress test results in multiple gestations.

The nonstress test remains the most widely used method of antepartum fetal health assessment in multiple gestations. However, few data are available on factors influencing its results in those cases. Our observation on 530 such tests has shown results similar to those in singleton gestations. Prematurity was associated with a higher rate of nonreactive tests; however, order and mode of presentation had no impact.

Fetal acoustic stimulation testing: a retrospective experience with the fetal acoustic stimulation test.

The nonstress test is of accepted value in the surveillance of high-risk pregnancies. In order to improve the efficiency of testing, the authors retrospectively evaluated the adjunctive use of acoustic stimulation testing (FAS-TEST) in 1241 patients who underwent 3464 antepartum fetal heart rate tests. The results were compared to those in the previous 6 months during which time 1307 patients underwent 3573 nonstress tests. The frequency of nonreactive tests was 12.6% in the nonstress test group and 6.1% in those patients who underwent the FAS-TEST. The antepartum fetal death rates were not significantly different when the two groups were compared. The FAS-TEST decreases the percentage of nonreactive tests in a high-risk population and, as a consequence, may reduce the testing time.

A prospective trial of the fetal biophysical profile versus the nonstress test in the management of high-risk pregnancies.

A randomized prospective trial study was developed to determine the diagnostic value of the fetal biophysical profile in relationship to the nonstress test. The diagnostic values of these tests were assessed in terms of the incidence of abnormal outcome. In addition comparisons between the positive and negative predictive values of each of these tests as well as the sensitivity and specificities of the test were reviewed. A total of 652 patients were entered into the study and a total of 1628 tests were performed. Of the group 279 pregnancies were managed by a biophysical profile protocol and 373 by the nonstress test protocol. Results of this study suggest that except for the negative predictive value in the sensitivities in the outcome parameters of low 5-minute Apgar scores the diagnostic values for all outcome parameters were consistently higher in the fetal biophysical profile as opposed to the nonstress test group. While higher, only two of the values, positive predictive value of overall abnormal outcome and negative predictive value of small for gestational age infants, were statistically significant. While this general trend suggests that the biophysical profile is more predictive in diagnosing fetal condition than the nonstress test, because statistical significance was not reached in all parameters further study is warranted.

The role of ultrasound assessment of amniotic fluid volume in the management of the postdate pregnancy.

Antepartum assessments of amniotic fluid volumes and their relationship to nonstress test patterns and pregnancy outcomes were retrospectively analyzed in 234 postdate pregnancies. The incidence of clinical oligohydramnios and a nonstress test revealing fetal heart rate deceleration or bradycardia was found to increase as the sonographic estimates of the amniotic fluid volume decreased. Furthermore, the postdate pregnancy with sonographic evidence of an adequate amniotic fluid volume had a significantly better perinatal outcome than the pregnancy without an adequate fluid volume. These results suggest that the postdate pregnancy with evidence of reduced amniotic fluid volume should be considered for a trial of labor with continuous electronic fetal monitoring.

Antepartum fetal heart rate testing. XII. The effect of manual manipulation of the fetus on the nonstress test.

A prospective study of 790 patients was performed in order to examine the role of manual manipulation of the fetus in the nonstress test. The patients were assigned randomly to two groups based on the last two digits of their hospital number. The odd-numbered patients underwent manual manipulation of the fetus prior to the onset of the nonstress test; the even-numbered patients did not. There was no significant difference between the two groups with respect to the indications for testing and the total number of tests. There was no statistically significant difference between the two groups with respect to the ratio of reactive to nonreactive nonstress tests and the mean duration of testing. Simple manual manipulation of the fetus does not seem to change the outcome in antepartum fetal heart rate testing when the nonstress test is the primary one.

The role of nonstress tests, fetal biophysical profile, and contraction stress tests in the outpatient management of insulin-requiring diabetic pregnancies.

Antepartum fetal surveillance methods applicable in a home glucose-monitored population of pregnant diabetic women have been evaluated. A testing sequence of nonstress heart rate testing, backed up by either the fetal biophysical profile or contraction stress testing employed at a twice weekly interval, in 107 outpatients was compared with the management of 140 historic control patients by weekly nonstress tests and daily plasma estriols. There were 617 of 672 (91.8%) reactive nonstress tests in outpatients compared to 566 of 626 (90.4%) reactive tests in hospitalized control patients. Of 13 contraction stress tests performed in the outpatient group, only one was positive. Although 2,670 estriol determinations were done on hospitalized control patients, none was used for outpatients. No losses were attributed to unexplained antenatal stillbirth in either group. A fetal biophysical score of 8 was found to be at least as reliable as a reactive nonstress test. Antenatal surveillance in the well-controlled, insulin-requiring diabetic woman can be safely achieved with a testing sequence that consists of twice weekly nonstress tests backed up by the fetal biophysical profile and contraction stress tests.

Further experience with the fetal biophysical profile.

At Los Angeles County/University of Southern California Medical Center, the authors performed biophysical profile testing on 186 fetuses within one week of delivery. One component of the biophysical profile is the nonstress test. The other four components are fetal parameters observed with real-time ultrasonography: fetal breathing movements, fetal movements, fetal tone, and amniotic fluid volume. Clinicians managed the patients on the basis of the nonstress test result, and the authors did not report the other biophysical profile results. Measures of outcome included perinatal mortality, fetal distress in labor, low five-minute Apgar score, and birth weight small for gestational age. Results indicate that fetal biophysical parameters other than the response, or lack of response, of the fetal heart rate to fetal movements may have predictive value in assessing the state of fetal health. In the future, real-time ultrasonography may prove to be a reliable adjunct to antepartum electronic fetal heart rate monitoring.

Antepartum fetal heart rate testing. V. The nonstress test--an outpatient approach.

A total of 567 tests were performed in a 1 year period on 399 patients in an outpatient clinic setting to test the feasibility of an office approach to antepartum heart rate testing. Of these tests, 510 were reactive and 57 were nonreactive (NR); 15 NR tests had associated spontaneous CST's; 39 NR tests and one reactive test with an equivocal spontaneous CST were repeated in 2 to 4 hours; 30 tests were reactive and nine tests remained NR. An oxytocin-induced CST was needed to clarify fetal status in only nine of 607 tests. With this approach, the NST may be quite appropriate for office use.