A perinatal continuing education program: its effects on the knowledge and practices of health professionals.

OBJECTIVES: To determine whether there was an increase in knowledge when an interdisciplinary group of health care providers participated in the same comprehensive perinatal continuing education program and to determine whether care practices followed before the program differed from those followed 1 year after its completion. DESIGN: Administration of a 100-item comprehensive pretest and a similar posttest measuring knowledge before the continuing education program and 1 year after taking it, as well as an ex post facto audit of medical records of newborns who were sick and at risk. SETTING: Hospitals throughout the state of Oklahoma that provide perinatal care. Test data were derived from health care providers in 24 hospitals; data on care practices were obtained from 12 hospitals. INTERVENTION: A comprehensive program of perinatal continuing education. PARTICIPANTS: Physicians, nurses, and other providers of perinatal health care. MAIN OUTCOME MEASURES: Scores on a 100-item test measuring knowledge of perinatal care and newborn care practices taught in the educational program. RESULTS: Pretest and posttest scores demonstrated an increase in scores at the p < 0.001 level for each group of providers studied. There was a statistically significant increase in use of two care practices and a definite trend toward an increase in the use of three others. CONCLUSION: A continuing education program delivered to a multidisciplinary group of health care providers can increase knowledge and improve perinatal care to newborns who are sick and at risk.

A statewide, toll-free telephone service to improve obstetric care.

The University of Oklahoma Health Sciences Center began in 1993 to provide a statewide, toll-free telephone service for pregnancy counseling to primary care physicians. The service was available 24 hours each day, and responses were made by the on-call maternal-fetal medicine specialist. This report summarizes our first full year of operation. Inquiries came from 34 (63%) of the state's 54 counties having physicians who provide obstetric care. One hundred twenty-eight physicians made 523 inquiries (median 3, range 1-15). Information was sought about prenatal genetic disorders, risks from drugs, exposure to infection, environmental hazards, and active obstetric or medical complications. Funds from targeted ultrasounds, genetic amniocenteses, more detailed counselling, and maternal transfers provided support for this expanding educational resource.

Conjoined twins.

Conjoined twins, otherwise known as Siamese twins, have fascinated physicians and laymen alike for centuries. The minimal diagnostic criteria for conjoined twins is the fusion of some portion of mononuclear or monozygotic twins.

Perinatal mortality in Oklahoma.

OBJECTIVE: To identify areas of need in Oklahoma's perinatal care system by analysis of trends in perinatal mortality from 1939 through 1991. DATA: Derived from birth certificates and annual tabulation published by the Maternal Child Health Division, Oklahoma State Department of Health. RESULTS: Every measure of perinatal mortality has declined in the period studied. CONCLUSIONS: (1) Oklahoma's perinatal mortality rate is declining. (2) Preventable deaths still occur. (3) Programs are in place to appropriately deal with the problems that lead to preventable deaths. (4) These programs must be allowed to continue or expand their efforts to further reduce preventable perinatal death.

Studies in fetal malnutrition.

Fetal malnutrition, a worldwide problem, is accompanied by varying degrees of lifelong morbidity for the child. Only 25% of fetal malnutrition is accomplished by maternal risk factors known to cause intrauterine growth retardation (ie, chronic hypertension, advanced diabetes mellitus, or severe preeclampsia). If the malnourished fetus could be detected early in pregnancy, nutritional intervention might be successful in improving fetal growth rate and in avoiding the morbidity due to malnutrition. This communication reviews the almost 40 years of studies by Jack Metcoff, MD, and coworkers to unravel the causes of fetal malnutrition and their efforts to prevent it.

Twin pregnancy: an appraisal of management options.

For term twins, delivery in a referral center is probably not important to survival, but the method of delivery might be, depending upon the development of fetal distress and the immediate availability of cesarean section.

Smoking in pregnancy: relation of birth weight to maternal plasma carotene and cholesterol levels.

Not all mothers who smoke during pregnancy deliver small infants. Nutritional supplementation during pregnancy apparently protects the fetuses of some mothers. Our previous studies showed that plasma levels of carotene and cholesterol were correlated with birth weight. The present study examined the association between mid-pregnancy plasma levels of carotene and cholesterol and subsequent birth weight. In a prospective study of 388 women (47.8% smokers), levels of plasma nutrients and demographic and anthropometric measurements were obtained at 19 and 36 weeks' gestation and related to indices of infant size at birth. In non-smokers, the level of plasma cholesterol at mid-pregnancy correlated positively with birth weight. In contrast, in mothers who smoked more than ten cigarettes daily, the relationship of cholesterol to birth weight was dependent on the simultaneously observed level of plasma carotene. When plasma cholesterol and carotene concentrations were both low at mid-pregnancy, birth weight was low. On the other hand, when the carotene level was high and the cholesterol level low, birth weight was at least equivalent to that of non-smokers. The interactive effect of smoking, cholesterol, and carotene on birth weight was significant (P = .017) after adjusting for gestational age, sex, prenatal care, race, previous low birth weight infants, parity, weight at mid-pregnancy, and total weight gain during pregnancy. Among smokers, the smallest infants were born to mothers having the greatest decrease in plasma carotene between 19-36 weeks' gestation. Smokers whose plasma carotene remained constant or increased had larger infants; a similar association was not observed for cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative glomerular morphology of the normal and diabetic baboon kidney.

This is a study of quantitative glomerular morphology in 14 normal and 6 long-term diabetic female baboons between 3 and 25 years of age. In the normal female baboon, peripheral glomerular capillary basement membrane thickness increased until around 10 years of age, reached a plateau between 10 and 20 years of age, and possibly decreased at 25 years of age. Mean value for young (3 to 7 years of age) and older (10 to 25 years of age) controls were 266 nm and 329 nm respectively. Fractional volumes of mesangial matrix (8.9%) and mesangial cells (6.8%) were not affected by age. Glomerular basement membrane thickness and the volume of mesangial matrix increased progressively in female baboons with poorly controlled pancreatectomy-induced diabetes, while the volume of mesangial cells remained unchanged. After 106 to 145 months of diabetes, glomerular basement membrane thickness and the volume of mesangial matrix were 558 nm and 18.7% respectively. These values were significantly greater than those of the age-matched controlled (p = less than 0.05). By light and electron microscopy, the normal baboon glomerular morphology, morphometric measurements and changes with age were similar to those in man. The renal changes in diabetic baboons were also similar in morphology and rate of development to those of mild to moderate diffuse diabetic glomerulosclerosis in humans, indicating that the baboon is an ideal model for the long-term study of diabetic glomerulosclerosis. The presence of considerable interanimal variability in the degree of glomerulosclerosis attained after prolonged diabetes suggested that glomerulosclerosis progressed at different rates in these models. The reason for this was not apparent.

Effect of food supplementation (WIC) during pregnancy on birth weight.

Of 824 women screened, 410 were enrolled at midpregnancy in a prospective, randomized, controlled nutrition intervention study. Of these, 226 were predicted as likely to have small or large babies, 184 to have average-sized babies. Two hundred thirty eight mothers received USDA Women, Infants and Children (WIC) Food Supplementation vouchers from midpregnancy, 172 did not. Leukocyte protein synthesis (as a cell model) was significantly higher (p = 0.009) by 36 weeks gestation in supplemented mothers. Mean birth weight of their babies was greater, 3254 vs 3163 g, (+91 g) p = 0.039, adjusted for sex, gestational age, prenatal visits, pregnancy interval, smoking, and previous low birth weight infants. Controlling for entry weight obviated the significance of the difference, except for WIC supplemented smokers (greater than 10 cigarettes/day) whose babies were significantly heavier by +168 g (p = 0.017) than those of unsupplemented smokers. WIC partially protects fetal growth in smokers.

PIP: Low birth weight and small for gestational age (SGA) babies demonstrate a greater incidence of cogenital malformation, perinatal death or morbidity, imparied postnatal growth, and neurologic disabilities. Consequently, studies have been designed to increase birth weight. These studies indicate that supplementation during both the 2nd period of most rapid fetal growth and 3rd trimesters have the greatest effect in increasing birth weight. Subjects were 824 women attending the prenatal clinics at the Oklahoma Memorial Hospital (OMH). Of the 824 women screened, 410 were enrolled at midpregnancy in a prosepctive, randomized, controlled nutrition intervention study. Of these, 226 were predicted as likely to have small or large babies, 184 to have average-sized babies. 238 mothers received USDA Women, Infants and Children (WIC) Food Supplementation vouchers from midpregnancy; 172 did not. WIC vouchers were for supplements of milk, eggs, and cheese and were intended to provide 40-50 g of protein and 900-1000 kcal daily. These were intended to augment the NRC Recommended Dietary Allowances for pregnancy and add to the regular diet of 1.1 g protein/kg/d and 28 kcal/kg/d. Leukocyte protein synthesis (as a cell model) was significantly higher (p=0.009) by 36 weeks gestation in supplemented mothers. By this time, a reduction in plasma alanine and B-globulin levels became evident. Mean birth weight of their babies was greater, 3254 vs 3163 g, (+91g) p=0.039, adjusted for sex, gestational age, prenatal visits, pregnancy interval, smoking, and previous low birth weight infants. Controlling for entry weight obviated the significance of the difference, except for WIC supplemented smokers (10 cigarettes/day) whose babies were significantly heavier by +168 g (p=0.017) than those of unsupplemented smokers. WIC partially protects fetal growth in smokers.