RESUMO
OBJECTIVES: To determine maternal responses to detection of a minor structural variant, the choroid plexus cyst (CPC), in their fetus on prenatal ultrasound. STUDY DESIGN: We interviewed 34 pregnant women with an isolated CPC detected on mid-pregnancy ultrasound about their objective experience at diagnosis, emotional response and subsequent reactions. Audiotaped, transcribed responses were evaluated by two independent raters and analyzed qualitatively and quantitatively. RESULTS: All women reported negative emotional responses including shock, distress, fear and decreased attachment, despite counseling by 82% of providers that the CPC was probably benign. Three women underwent amniocentesis purely for reassurance after CPC detection. Most (79%) sought information beyond what their physician provided, frequently on the internet. One half of women reported that intense negative responses were temporary. However, weeks after diagnosis, 62% continued to believe that the CPC presented some danger to their baby. CONCLUSIONS: Detection of CPC prenatally can evoke profound, negative maternal emotional responses despite accurate provider counseling. Practitioners should consider these responses when counseling parents about these and other structural variants of unclear functional significance.
Assuntos
Atitude Frente a Saúde , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/psicologia , Plexo Corióideo/diagnóstico por imagem , Emoções , Mães/psicologia , Ultrassonografia Pré-Natal , Adaptação Psicológica , Adulto , Compreensão , Cultura , Pai/psicologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Entrevista Psicológica , Masculino , Apego ao Objeto , Educação de Pacientes como Assunto , Relações Médico-Paciente , Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal/psicologiaRESUMO
OBJECTIVE: To determine whether an isolated finding of a choroid plexus cyst (CPC) during routine ultrasound is associated with altered fetal growth or development. STUDY DESIGN: Prospective, case-control study comparing 35 CPC cases to 67 controls. Neurobehavioral development assessment included 50 min long serial recordings of heart rate, motor activity and their interrelation at 24, 28, 32 and 36 weeks gestation. Growth measurement was based on three ultrasound evaluations of femur length, biparietal diameter, head circumference and abdominal circumference at initial exam, 28 and 36 weeks. RESULTS: Longitudinal analyses revealed no differences in fetal heart rate, variability or accelerations; the number or duration of fetal movements or total motor activity; nor fetal movement-fetal heart rate coupling. CPC cases had slightly smaller head and abdominal circumferences at 28 weeks, but these differences had disappeared by 36 weeks. CPC detection was more common when routine exams were conducted earlier (18.8 versus 19.5 weeks; P<0.01). CONCLUSION: Despite the presumption that CPCs with normal karyotypes are benign variants, little empirical support exists. These results indicate that CPCs detected by prenatal ultrasound do not pose or reveal a threat to fetal development.
Assuntos
Encefalopatias/fisiopatologia , Plexo Corióideo/diagnóstico por imagem , Cistos/fisiopatologia , Desenvolvimento Fetal/fisiologia , Doenças Fetais/fisiopatologia , Adulto , Encefalopatias/complicações , Encefalopatias/diagnóstico por imagem , Cistos/complicações , Cistos/diagnóstico por imagem , Feminino , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Humanos , Gravidez , Resultado da Gravidez , Prognóstico , Ultrassonografia Pré-NatalRESUMO
The outcome of infants with duodenal atresia diagnosed antenatally is compared with that of infants diagnosed after birth. The incidence of neonatal morbidity was higher and preoperative conditions were poorer in the second group.
Assuntos
Obstrução Duodenal/congênito , Atresia Intestinal/diagnóstico , Diagnóstico Pré-Natal , Ultrassonografia , Peso ao Nascer , Anormalidades Congênitas/diagnóstico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Cariotipagem , GravidezRESUMO
Bulimia nervosa is an eating disorder characterized by secretive binge eating and purging with induced vomiting, laxatives, and diuretics. The disorder primarily afflicts young white women between 18-35 years of age. We report the case of a 30-year-old pregnant woman with a 17-year history of bulimia that involved up to six episodes of binging and purging daily. A multidisciplinary approach enabled outpatient management throughout gestation. The pregnancy resulted in the delivery of a normal 3000-g female infant at term. The ramifications for maternal and fetal well-being and the goals of therapeutic management are discussed.
Assuntos
Bulimia/terapia , Complicações na Gravidez/psicologia , Cuidado Pré-Natal , Adulto , Feminino , Humanos , Equipe de Assistência ao Paciente , Gravidez , Complicações na Gravidez/terapiaRESUMO
This study documents the development of fetal heart rate (FHR) change in response to fetal movement (FM) in healthy fetuses from 20 weeks' gestational age through term. Thirty-one fetuses received 50 min of Doppler-based monitoring at 20, 24, 28, 32, 36 and 38-39 weeks. FHR and FM were continuously digitized. A coupling index was computed as the percentage of FMs associated with increases in FHR of 5 beats/min or more within -5 or +15 s of movement onset. The latency between FM onset and FHR change was also computed, as were the amplitude and duration of all movements. FM and FHR became more integrated with advancing gestation. Coupling increased and the latency between FM and FHR changes decreased. Maternal age, blood pressure and fetal sex did not affect FM-FHR coupling, but fetuses of women who reported greater stress in their daily lives and had faster heart rates displayed reduced coupling. These data suggest that the development of FM-FHR coupling reflects the development of the central nervous system during gestation, and that development may be affected by maternal factors.
Assuntos
Movimento Fetal/fisiologia , Frequência Cardíaca Fetal/fisiologia , Troca Materno-Fetal/fisiologia , Sistema Nervoso/embriologia , Estresse Fisiológico/fisiopatologia , Adulto , Desenvolvimento Embrionário e Fetal/fisiologia , Feminino , Monitorização Fetal , Idade Gestacional , Humanos , Análise dos Mínimos Quadrados , Sistemas On-Line , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Valores de Referência , Reprodutibilidade dos TestesRESUMO
Despite substantial interest in the effects of stress on pregnancy, few instruments are available to measure pregnancy-specific stressors. Moreover, research has typically focused on the distressing, negative aspects of pregnancy. This report examines the reliability and validity of the Pregnancy Experience Scale (PES), a 41-item scale that measures pregnancy-specific daily hassles and uplifts. The PES was administered to two cohorts of low risk women at 24, 30, and 36 weeks (n = 52) or 32 and 38 weeks (n = 137). Women perceived their pregnancies to be significantly more intensely and frequently uplifting than hassling. Internal scale reliability was high (alpha = 0.91 to 0.95). Frequency and intensity scores for hassles and uplifts were stable over time (r's = 0.56 to 0.83) and patterns of convergent and discriminant validity emerged between the PES and existing measures of general affective intensity, daily stressors, depressive symptoms, and anxiety. These results indicate that (1) failure to measure pregnancy-specific stress will underestimate the degree to which pregnant women experience distress and (2) measurement of only the negative aspects of pregnancy will overestimate distress and fail to portray the degree to which women are psychologically elevated by their pregnancies. Measurement of hassles relative to uplifts may provide the most balanced assessment of pregnancy appraisal.
Assuntos
Complicações na Gravidez , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto , Estudos de Coortes , Análise Fatorial , Feminino , Seguimentos , Humanos , Gravidez , Psicologia , Psicometria , Reprodutibilidade dos Testes , Estresse Psicológico/diagnósticoRESUMO
Meteorological simulations centered around the border cities of El Paso and Ciudad Juárez have been performed during an ozone episode that occurred on August 13, 1996 during the 1996 Paso del Norte Ozone Study field campaign. Simulations were performed using the HOTMAC boundary-layer meteorological model using a 1, 2, 4 and 8-km horizontal grid size nested mesh system. Investigation of the vertical structure and evolution of the atmospheric boundary layer for the August 12-14 time period is emphasized in this paper due to its suspected importance in precipitating the ozone episode [Sci Total Environ (2001)]. This period was characterized by a slowly-evolving high pressure system over the region, a persistent upper-level jet at 2500-3500 m above ground level (agl), deep daytime mixed layer heights of 3500 m depth and unusually deep nighttime stable layers extending up to 2500 m above the ground. The fact that the boundary-layer growth stalled on the morning of August 13 relative to that on August 12 has been suggested as a possible reason for the ozone episode on the 13th. In addition, relatively weak surface-level winds were measured on August 13. Using both model results and experimental data we hypothesize explanations for the slower mixed-layer growth on the morning of the 13th and the stronger surface-level winds found on the 12th and 14th.
Assuntos
Poluição do Ar/análise , Conceitos Meteorológicos , Modelos Teóricos , Movimentos do Ar , Cidades , MéxicoRESUMO
OBJECTIVE: To determine the agreement between nurse and physician interpretation of biophysical profile scores. DESIGN: A prospective evaluation of videotaped biophysical profiles was independently scored by four nurse and four physician interpreters and compared to that of an expert physician. SETTING: The fetal assessment center of a large tertiary-care center; study included women from public and private practices. PATIENTS: Twenty-three women with high-risk pregnancies who were regularly scheduled for a biophysical profile. Women pregnant with multiple fetuses or whose fetuses were less than 28 weeks' gestational age or had severe fetal anomalies were excluded. MAIN OUTCOME MEASURE: The proportion of agreement between the physicians and nurses and the physician expert was calculated for each biophysical profile criterion. RESULTS: The kappa statistic was used to evaluate the proportion of agreement with the "gold standard." When compared with the expert, physicians showed 60% moderate or substantial agreement, and the nurses showed 80% moderate or substantial agreement. CONCLUSIONS: Nurses' interpretations of biophysical profiles were at least as reliable as physicians' when compared with an expert reviewer.
Assuntos
Enfermagem Obstétrica/normas , Obstetrícia/normas , Ultrassonografia Pré-Natal/normas , Adolescente , Adulto , Baltimore , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Gravação de VideoteipeRESUMO
Minimal use of homologous blood is a desirable goal for both patients and health care providers. This article discusses one adjunctive technique that is used for the orthopaedic patient, postoperative blood salvage and reinfusion, and the implications for nurses.
Assuntos
Transfusão de Sangue Autóloga/métodos , Enfermagem Ortopédica/métodos , Cuidados Pós-Operatórios/métodos , Transfusão de Sangue Autóloga/instrumentação , Transfusão de Sangue Autóloga/enfermagem , Humanos , Planejamento de Assistência ao PacienteRESUMO
Associations between maternal salivary testosterone at 36 weeks' gestation with birth weight and infant weight gain through 6 months of age were examined in a group of 49 healthy, pregnant women and their offspring. The diurnal decline of maternal testosterone was conserved in late pregnancy, and levels showed significant day-to-day stability. Elevated maternal morning testosterone level was associated with lower birth weight Z-scores adjusted for gestational age and sex, and greater infant weight gain between birth and 6 months. Although maternal testosterone levels did not differ by fetal sex, relations were sex-specific such that maternal testosterone had a significant impact on weight for male infants; among female infants associations were nonsignificant. Results highlight the opposing influence of maternal androgens during pregnancy on decreased growth in utero and accelerated postnatal weight gain.
Assuntos
Mães/psicologia , Pobreza/psicologia , Complicações na Gravidez/psicologia , Classe Social , Estresse Psicológico/psicologia , Negro ou Afro-Americano/psicologia , Escolaridade , Emprego/psicologia , Feminino , Identidade de Gênero , Idade Gestacional , Humanos , Estudos Longitudinais , Gravidez , Complicações na Gravidez/diagnóstico , Segundo Trimestre da Gravidez , Estresse Psicológico/diagnóstico , Inquéritos e QuestionáriosAssuntos
Desenvolvimento Embrionário e Fetal/fisiologia , Sofrimento Fetal/etiologia , Complicações na Gravidez , Classe Social , Estresse Psicológico/complicações , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Sofrimento Fetal/diagnóstico , Movimento Fetal , Idade Gestacional , Frequência Cardíaca Fetal , Humanos , Estudos Longitudinais , Gravidez , Estresse Psicológico/psicologiaRESUMO
OBJECTIVES: To compare fetal biometry measurements obtained in a Peruvian population with reference fetal size charts obtained in Peruvian and non-Peruvian populations. METHODS: Fetal biometry measurements collected prospectively in 195 uncomplicated pregnancies were included in the presented analysis. At 20, 24, 28, 32, 36 and 38 weeks' gestation, fetal head circumference, abdominal circumference and femur diaphysis length were measured. Fetal biometry measurements were compared with fetal size charts obtained from another Peruvian and two non-Peruvian populations from North America and Europe. RESULTS: When compared with ultrasound-based reference fetal size charts obtained from North American and European populations, fetuses from the studied population appeared to grow more slowly with advancing gestational age. This trend was not observed when a Peruvian population, similar to the one studied here, was used as a reference. CONCLUSIONS: The results suggest that fetal growth in this Peruvian population may not be adequately assessed by using reference charts obtained from other populations and have implications for the use of growth standards in antenatal management.
Assuntos
Etnicidade , Desenvolvimento Fetal , Abdome/diagnóstico por imagem , Abdome/embriologia , Antropometria/métodos , Cefalometria , Feminino , Fêmur/diagnóstico por imagem , Fêmur/embriologia , Idade Gestacional , Cabeça/diagnóstico por imagem , Cabeça/embriologia , Humanos , Masculino , Peru , Áreas de Pobreza , Gravidez , Estudos Prospectivos , Valores de Referência , Ultrassonografia Pré-NatalRESUMO
A cohort study with four groups of pregnant women was designed to evaluate if a decrease in the concentration of fibronectin (FN) in amniotic fluid plays a role in the genesis of premature rupture of the membranes (PROM) and/or intra-amniotic infection: group 1, 15 patients with PROM and intra-amniotic infection; group 2, 15 patients with PROM but without intra-amniotic infection; group 3, 15 patients with preterm labor without PROM or intra-amniotic infection; and group 4, 15 patients who underwent elective amniocentesis for fetal lung maturity studies. No significant differences in amniotic fluid concentrations of FN among any of the four groups was observed (F = 0.146; P = 0.931). These results suggest that a deficiency of FN in amniotic fluid is not a critical factor in determining which patients may be affected by PROM or which of them will develop an intra-amniotic infection.
Assuntos
Líquido Amniótico/análise , Fibronectinas/análise , Complicações Infecciosas na Gravidez/metabolismo , Amniocentese , Líquido Amniótico/microbiologia , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Ruptura Prematura de Membranas Fetais/metabolismo , Humanos , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/metabolismo , Gravidez , Complicações Infecciosas na Gravidez/etiologiaRESUMO
OBJECTIVE: Previous studies have shown that twins, when monitored simultaneously, show a remarkably high incidence of coincident fetal heart rate accelerations (about 58%). The current study examines synchrony of behavior patterns in twins. STUDY DESIGN: We examined 37 fetal monitor strips from 15 sets of twins with simultaneous fetal heart rate and fetal movement recorded by means of Doppler techniques (Toitu MT-430 fetal actocardiograph). The strips were analyzed for coincidence of fetal heart rate accelerations and fetal movement episodes and then conceptually for synchrony of fetal behavior patterns on the basis of descriptions of behavioral states by Prechtl. RESULTS: Thirty-six percent of fetal heart rate accelerations were found to be simultaneous. Forty-three percent of movement epochs were considered simultaneous. We found that twins exhibited synchronous behavior patterns (basically sleep or awake state) 94.7% of the time. CONCLUSION: Twin-twin interactions are more consistently related than suspected when observation is limited to heart rate alone, and the synchrony and role of fetal behavior states must be considered when twin interactions and behavior are studied.
Assuntos
Comportamento , Movimento Fetal , Feto/fisiologia , Frequência Cardíaca Fetal , Gravidez Múltipla , Gêmeos , Adulto , Feminino , Monitorização Fetal , Humanos , Lactente , GravidezRESUMO
In the third trimester, the amniotic fluid index (AFI) may be affected by maternal fluid status. As the ambient temperature increases, there is an increase in insensible fluid loss and the potential for dehydration. We hypothesize that as temperature increases there would be a concomitant decrease in AFI. From June 11 to August 16, 1993, during a period of unusual high heat, 42 women with singleton pregnancies between 27 and 40 weeks' gestation undergoing serial antenatal testing had AFI determinations recorded at least weekly. The daily high ambient temperature in our urban area was subsequently obtained. A 2-, 3-, and 4-day mean temperature prior to the test date was compared to AFI using a Spearman-rank Correlation. The daily high temperature ranged from 71 to 104 degrees F and AFI values ranged from 1.7 to 24.7 cm during the study period. There was a significant correlation between the 2-, 3-, and 4-day mean temperature and AFI, with the 4-day mean being the most significant (r = 0.31, p < 0.001). Fluctuations in ambient temperature are inversely correlated to changes in AFI. This relationship should be taken into account when interpreting the AFI as a measure of fetal well-being.
Assuntos
Líquido Amniótico/fisiologia , Temperatura Corporal , Adulto , Desidratação/diagnóstico , Desidratação/etiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Antenatal ascertainment of fetal sex is a common feature of modern pregnancies. Women who opt not to learn fetal sex typically employ a variety of methods to forecast it. This study investigated the validity of prevalent folklore used to identify fetal sex before birth. METHOD: One hundred four pregnant women, who did not know the sex of the fetus, were administered a questionnaire to explore their perceptions of fetal sex and the basis for these predictions. RESULTS: Fetal sex was not systematically related to the shape of the woman's abdomen, prevalence of morning sickness, or comparisons with previous pregnancies. However, women who had more than twelve years of education correctly predicted fetal sex greater than chance (71% correct), in contrast to less educated women (43% correct). Contrary to expectations, women whose forecasts were based on psychological criteria (i.e., dreams or feelings) were more likely to be correct than those employing prevalent folklore criteria (i.e., the way a woman was carrying the pregnancy). CONCLUSIONS: In general, women were not good predictors of fetal sex. The mechanisms that promote maternal accuracy in predicting fetal sex for highly educated women are unknown. It is reasonable to expect that maternal perceptions of fetal sex contribute to the process of fetal attachment.
Assuntos
Atitude Frente a Saúde , Folclore , Gravidez/psicologia , Análise para Determinação do Sexo/normas , Adulto , Escolaridade , Feminino , Previsões , Humanos , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study evaluates the validity of Doppler-detected fetal movement by a commercially available monitor and investigates whether characteristics of maternal body habitus and the intrauterine environment affect its performance. METHODS: Fetal movement was evaluated in normal pregnancies using both ultrasound visualization and a fetal actocardiograph (Toitu MT320; Tofa Medical Inc., Malvern, PA). Data were collected for 32 min on 34 fetuses stratified by gestational age (20-25 weeks; 28-32 weeks; 35-39 weeks). Fetal and maternal characteristics were recorded. Comparisons between ultrasound-detected trunk and limb movements and actograph records were conducted based both on 10-s time intervals and on detection of individual movements. RESULTS: Time-based comparisons indicated agreement between ultrasound and actograph 94.7% of the time; this association rose to 98% when movements of less than 1 s duration were excluded. Individual movements observed on ultrasound were detected by the actograph 91% of the time, and 97% of the time when brief, isolated movements were excluded. The overall kappa value for agreement was 0.88. The actograph was reliable in detecting periods of quiescence as well as activity. These findings did not vary by gestational age. The number of movements detected by the actograph, but not the single-transducer ultrasound, significantly increased over gestation. Maternal age, parity, weight, height, or body mass index were not consistently associated with actograph validity. Characteristics of the uterine environment, including placenta location, fetal presentation, and amniotic fluid volume also did not affect results. CONCLUSIONS: The Toitu actograph accurately detects fetal movement and quiescence from as early as 20 weeks gestation and has utility in both clinical and research settings. Actographs are most useful for providing objective and quantifiable measures of fetal activity level, including number and duration of movements, while visualization through ultrasound is necessary for studies of movement quality, source, or mechanics.
Assuntos
Ecocardiografia , Coração Fetal/fisiologia , Movimento Fetal/fisiologia , Feto/fisiologia , Ultrassonografia Pré-Natal , Análise de Variância , Desenvolvimento Embrionário e Fetal , Feminino , Idade Gestacional , Humanos , Gravidez , Reprodutibilidade dos Testes , Ultrassonografia DopplerRESUMO
OBJECTIVE: In this study, we wanted to model the emergence of coupling between fetal cardiac and somatic activity in normal and at-risk fetuses. STUDY DESIGN: One hundred six fetuses of uncomplicated pregnancies were longitudinally monitored at 20, 24, 28, 32, 36, and 38 weeks of gestation by using a fetal actocardiograph and computerized data collection. Twenty-six fetuses of complicated pregnancies were also included. Statistical time series analysis techniques were used to examine the relation between fetal movement and fetal heart rate. RESULTS: A linear increase was found in the magnitude of the cross-correlation function between fetal movement and fetal heart rate as gestation advanced, with coalescence around a peak lag of 5 seconds by 32 weeks. Fetuses that delivered before term evidenced accelerated fetal movement and fetal heart rate coupling, whereas fetuses affected by deleterious conditions showed a decline in developmental trajectory. CONCLUSIONS: The cross-correlation between fetal cardiac and somatic activity is an indicator of neuroregulation in human fetuses.
Assuntos
Movimento Fetal , Frequência Cardíaca Fetal , Sistema Nervoso/embriologia , Desenvolvimento Embrionário e Fetal , Feminino , Doenças Fetais/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido PrematuroRESUMO
This study examines prenatal-to-postnatal stability in heart rate and variability from mid-gestation through the first year of life. Fetal heart rate data were collected from 52 healthy fetuses at 24, 30, and 36 weeks gestation, and again at 2 weeks and 12 months of age. Fetal heart rate measures were stable during gestation and positively associated with neonatal and infant measures. Maternal pulse rate and oxygen saturation were moderately associated with fetal heart rate. Together, fetal cardiac (heart rate and variability) and maternal physiologic measures (blood pressure and oxygen saturation) explained 40 and 48% of the variance in heart rate and variability, respectively, at 1 year of age. These common measures of individual differences in autonomic function are enduring characteristics that originate during fetal development.