Dynamics of the use of magnetocardiography in the study of the cardiac conduction system of the chick embryo.

INTRODUCTION: Human fetal magnetocardiography (fMCG) has been done for several decades to evaluate fetal arrhythmias using a superconducting quantum interference device (SQUID) magnetometer, but there is little work in embryonic/fetal animal models. This study uses an optically-pumped magnetometer (OPM) to obtain an fMCG in the chick embryo. METHODS: White Leghorn chick embryos were examined from incubation Day #10-19. Different examination chambers were tested to optimize embryonic thermal stability and magnetic signal acquisition. All examinations were done with magnetic shielding. The OPM sensors were placed next to the egg shell. The embryo's position was localized by transilluminating the intact egg or ultrasound imaging the egg with an open air cell to optimize sensor placement. The raw data for each embryo was postprocessed to obtain a fMCG composite waveform. RESULTS: fMCG's were obtained in embryos from Day #12 to 19. The best success with intact eggs was obtained using five sensors; one at the bottom and four around the lower perimeter of the egg at 90° intervals with the egg oriented vertically and the air cell up. Using ultrasound imaging with the air cell open only two sensors were necessary, one at the bottom and one laterally next to the embryo. fMCGs were analyzed for heart rate and rhythm, each portion of the PQRST waveform, and the PR interval, QRS complex, RR interval, and QT interval. CONCLUSIONS: This study validates the chick embryo as an animal model to study in a longitudinal and noninvasive fashion the fetal cardiac conduction system by using OPM magnetocardiography.

A Review of Pregnancy-Related Maternal Mortality in Wisconsin, 2006-2010.

INTRODUCTION: Maternal mortality is a key indicator of maternal health and the general state of health care. This report summarizes maternal deaths in Wisconsin from January 2006 through December 2010. METHODS: Maternal deaths were identified using death certificates and supporting links with infant birth and fetal death certificates. Suspected pregnancy-related maternal deaths were abstracted by a Wisconsin Maternal Mortality Review Team nurse abstractor. The entire team reviewed and analyzed these cases. If the death was deemed pregnancy related, a cause of death was determined, potential factors of avoidability were assessed, and recommendations for possible quality improvement were made. RESULTS: Fifty cases were reviewed and 21 cases were determined to be pregnancy related. The Wisconsin pregnancy-related maternal mortality ratio was 5.9 deaths per 100,000 live births (3.9-9.0, 95% CI), with markedly higher rates for non-Hispanic black women. The most common cause of death was cardiovascular related, with 5 of the 7 deaths being ascribed to peripartum cardiomyopathy. Chronic medical problems were associated with 55% of pregnancy-related maternal deaths excluding obesity. Nineteen percent of the pregnancy-related deaths reviewed were considered to be avoidable, and almost half (48%) had substantive recommendations made to improve maternal health. CONCLUSION: Even though the Wisconsin pregnancy-related maternal mortality ratio is well below the national average, there remain stark racial disparities in maternal deaths and a number of avoidable pregnancy-related deaths that should be targeted for prevention.

Ultrasound imaging in research and clinical medicine.

The use of ultrasound imaging in clinical obstetrics continues to grow at an almost exponential rate. Ultrasound imaging in developmental biology has only begun to be used to enhance the traditional methodologies to study the developing embryo/fetus. The various modalities of ultrasound imaging are reviewed as they apply to current uses in clinical obstetrics and developmental biologic research. New modalities are also discussed in both clinical obstetrics and developmental biologic research as well as the current limitations of ultrasound imaging faced in both of these fields.

The teratology society 2012-2017 strategic plan: pushing the boundaries.

The Teratology Society held its fourth strategic planning session in Albuquerque, NM, April 10-12, 2012, and launched the 2012-2017 Strategic Plan in conjunction with the 2012 annual meeting in Baltimore, MD. Building on the energy of the successful implementation of prior strategic plans (San Diego, 2007; Nashville,TN 2002; Cincinnati, OH 1998), session participants worked to identify barriers to success as a scientific society, as well as impending challenges and opportunities to which the Society needs to respond. The following report provides an overview of the Strategic Planning process, objectives, activities, and conclusions. A total of 23 members were present at the session, and the group included representation from Council, various committees, and different member constituencies. This plan, Pushing the Boundaries, and its three strategic intents: Broaden Our Identity, Expand Our Membership, and Increase Our Influence, will drive the direction of the Teratology Society for the next five years.

Microbubble contrast imaging of the cardiovascular system of the chick embyro.

Ultrasound imaging of the chick embryo cardiovascular system is limited to B-scan and Doppler technologies. This study demonstrates microbubble contrast imaging of the embryonic cardiovascular anatomy and physiology. Day 8-19 (Hamburger & Hamilton Stage 34-43) chick embryos are examined in ovo using high-frequency ultrasound imaging through an opening in the blunt end (air cell) of the egg. A chorioallantoic vein is cannulated, and small boluses of octofluoropropane lipid microspheres (Definity®) are injected to visualize the chick embryo cardiovascular system. The entire chick embryo cardiovascular system including the two embryologic arteriovenous (AV) shunts can be visualized. More accurate physiologic measurements of ejection fractions and cardiac output measurements can be obtained using this technology. Microbubble contrast ultrasound imaging in the chick embryo greatly expands the ability to study cardiovascular development. Also, the two natural embryonic A-V shunts provide an excellent model to study the bioeffects of microbubbles in the arterial system.

A novel laparoscopic tissue retrieval device.

BACKGROUND AND OBJECTIVES: A persistent problem in operative laparoscopy is the removal of laparoscopically resected tissue specimens. This study is a consecutive series demonstrating a device designed to facilitate the removal of laparoscopically resected tissue specimens. METHODS: Forty-two patients met the criteria for inclusion in this study. These patients included gynecologic operative laparoscopy patients with a laparoscopically resected tissue specimen placed in a tissue retrieval sac. The sac could not to be removed from a subumbilical trocar incision with axial traction. The device was placed and an attempt was made to remove the sac/specimen. When successful, the wound was inspected for a fascial defect and closed, and if unsuccessful the wound was enlarged to remove the tissue specimen. RESULTS: Thirty-four patients had successful removal of the laparoscopic tissue specimen. In 8 patients, the device was not successful. No adverse intraoperative outcomes occurred. Three patients had superficial postoperative wound infection treated successfully with outpatient oral antibiotic therapy. There were no other postoperative complications. CONCLUSION: This novel medical device allows an easy and effective means to remove trapped laparoscopic tissue retrieval sacs. Prudent use of this device appears to convey no increased risk of adverse surgical outcomes.

High frequency ultrasound imaging of the growth and development of the normal chick embryo.

The purpose of this study is to delineate with high frequency ultrasound imaging the normal growth and development of the chick embryo throughout its incubation period. White Leghorn chick embryos were imaged through an opening in the egg air cell from incubation day 0-19 (Hamburger & Hamilton stage 1-45) using a 13 MHz clinical high frequency linear small parts transducer. Multiple anatomic growth parameters were measured. Normal growth was confirmed with Hamburger and Hamilton staging. A timeline was constructed showing when each anatomic growth parameter could be visualized. Means and standard deviations of each parameter were plotted against incubation days studied to create nomograms and numerical tables of normal growth and development of the chick embryo. With this set of data, abnormal growth and development of the chick embryo can now be assessed.

Preliminary investigation of the use of high frequency ultrasound imaging in the chick embryo.

BACKGROUND: The purpose of this study was to investigate the feasibility of using high frequency ultrasound to study the chick embryo in a noninvasive and longitudinal fashion. METHODS: A total of 10 SPF White Leghorn chick embryos (GDs 11-17; Hamburger and Hamilton stage 37-43) were consecutively examined with a GE Logiq 400 ProSeries ultrasound unit using an 11-MHz small parts ultrasound probe. Access for ultrasound visualization of the embryos was accomplished by opening a 2-3-cm window either in the air cell over the blunt end of the egg or laterally over the embryo-dependent side of the egg. Warmed ultrasound coupling gel was used for imaging, and thermal regulation was maintained with infant heel warmers. The ultrasound images were recorded directly on digital video using a Sony TRV 900 DV camcorder. The images were directly converted to jpeg and mjeg2 files for further analysis. RESULTS: Effective visualization of each embryo was possible on each day of the study period. The embryos were best visualized through the opening made in the air cell at the blunt end of the egg. The extent of the anatomic survey of the chick embryo was dependent upon the position of the embryo in the egg relative to the opening in the air cell. Doppler color flow mapping studies were obtained of the embryonic and extraembryonic circulation. CONCLUSIONS: This preliminary investigation clearly shows the feasibility of high frequency ultrasound imaging to study chick embryo development in a longitudinal and noninvasive fashion. Further studies are presently ongoing regarding earlier embryo development, as well as to determine the stability and dynamics of the methodology.

Pregnancy-associated deaths and pregnancy-related deaths in Wisconsin, 1998-2001.

BACKGROUND: Although the risk of dying during childbirth or from complications afterward has been greatly reduced during the past 100 years, the current rate of approximately 1 death in 10,000 live births is still too high. The goal of the US Department of Health and Human Services is to reduce this rate by more than half by the year 2010. OBJECTIVE: To present Wisconsin data regarding pregnancy-associated deaths and pregnancy-related deaths. METHODS: Cases in which a woman had died during pregnancy or within 1 year of the end of her pregnancy were identified, and case-specific data were collected. The Wisconsin Maternal Mortality Review Team then conducted systematic reviews of the information, summarized issues related to maternal mortality, considered the relationship to pregnancy and factors of avoidability, and made recommendations to improve maternal health and survival. Finally, pregnancy-associated and pregnancy-related mortality ratios were calculated. RESULTS: From 1998 through 2001, 23 Wisconsin women died as a result of their pregnancy or from complications up to a year later. This gives a Wisconsin pregnancy-related mortality ratio of 8.4 per 100,000 live births. This ratio was higher in African American women and in women who smoked. The primary cause of death was embolic disease. Almost half of the pregnancy-related deaths (48%) occurred during the postpartum period, and nearly one-quarter (22%) were avoidable. CONCLUSIONS: The disparity in pregnancy-related mortality ratios among ethnic groups and the finding of avoidable deaths are areas that should be targeted by health care providers and public health workers. Six areas on which to focus include the following: addressing racial disparities, assuring the performance of autopsies, lifestyle changes related to obesity and smoking, and management of embolic and cardiovascular disease, as well as postpartum hemorrhage.