Value of amniocentesis versus fetal tissue for cytogenetic analysis in cases of fetal demise.

OBJECTIVE: Use of fetal tissue for cytogenetic analysis in cases of second- and third-trimester fetal demise frequently results in unacceptably high failure rates. We reviewed our ongoing use of amniocentesis prior to uterine evacuation to determine if this provided a better source of cells for cytogenetic analysis. METHODS: We compared cytogenetic results using fetal tissues obtained following uterine evacuation to our ongoing use of amniotic fluid cell obtained by transabdominal amniocentesis prior to uterine evacuation from 2003 to 2008. RESULTS: In 49 of the 63 cases evaluated by fetal tissue biopsies performed after uterine evacuation, a karyotypic analysis was obtained (77.8%). Among the 38 cases evaluated by amniocentesis, an amniotic fluid sample and fetal cytogenetic results were obtained in all 38 (100%) cases. CONCLUSION: Our findings indicate that amniocentesis is a more reliable source of cytogenetic information than fetal tissue in cases of second- and third-trimester fetal demise.

Ready or not--intrapartum prevention of perinatal HIV transmission in Illinois.

OBJECTIVES: The overall readiness of Illinois birthing hospitals to comply with the 2003 Illinois HIV Perinatal Prevention Act and prevent perinatal HIV transmission, and the hospital characteristics that predict readiness were examined. METHODS: Nurse Managers of all 137 Illinois birthing hospitals were surveyed regarding current labor and delivery (L&D) practices for HIV status identification, documentation, testing and zidovudine (AZT) availability in March 2004. Bivariate and multivariable regression analysis was performed. RESULTS: All 137 hospitals returned the surveys. Almost forty seven percent of Illinois birthing hospitals had adequate maternal HIV status documentation on arrival in L&D, 72.3% documented prenatal HIV results in the L&D chart, 65.7% documented prenatal HIV in the newborn chart, 38.7% ordered HIV tests on L&D if no prenatal HIV status was available, and 61.3% had AZT available. Only 17 hospitals (12.4%) met requirements for overall readiness to prevent perinatal HIV transmission. Sixteen hospitals (11.6%) met a minimal level of readiness (prenatal HIV status documentation and AZT availability). CONCLUSIONS: Despite passage of legislation to increase perinatal HIV testing and reduce transmission, Illinois birthing hospitals had an overall low level of readiness to implement the intrapartum interventions that are an essential part of eradicating pediatric HIV infection. Perinatal reduction protocols and implementation guidelines would improve the overall readiness of Illinois birthing hospitals to prevent perinatal HIV transmission.

Factors that influence the acceptability of collecting in-home finger stick blood samples in an urban, low-income population.

OBJECTIVES: To examine the acceptability of non-medical, community-based interviewers obtaining blood samples during in-home interviews from low-income study participants. METHODS: Two separate focus groups were conducted, one with ten non-medical community-based interviewers and the other with eight research participants from a low-income population. (Both the interviewers and the research participants had previously taken part in a research project over the course of five years.) RESULTS: Participants and interviewers were comfortable with finger stick blood samples performed in the home. The interviewers felt that adequate training was critical. Participants identified key issues: blood would not be used for other purposes and that the interviewers would be trained to handle blood safely. Both groups felt that it was crucial to communicate the study purpose and results. Recommendations from the focus groups were implemented and the acceptance rate for blood sampling was 99.5% (205/206). CONCLUSION: Proper training of interviewers, organization of supplies, and communication with participants can be combined to maximize acceptance of in-home, finger stick blood sample collection by community-based interviewers among a low-income population.