Longitudinal study of aortic isthmus Doppler in appropriately grown and small-for-gestational-age fetuses with normal and abnormal umbilical artery Doppler

OBJECTIVE

To establish reference ranges using longitudinal data for aortic isthmus (AoI) Doppler indices in appropriate-for-gestational-age (AGA) fetuses and to document the longitudinal trends in a cohort of small-for-gestational-age (SGA) fetuses with normal umbilical artery Doppler and in fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery Doppler.

METHODS

AoI Doppler reference ranges were established from longitudinal data on 72 AGA singleton fetuses. Reliability of AoI Doppler flow measurements at two different sites and reproducibility between two operators was reviewed. A prospective longitudinal study of AoI Doppler indices in 48 SGA fetuses with normal umbilical artery Doppler and 10 IUGR fetuses was performed.

RESULTS

The AoI pulsatility index (PI) and peak systolic velocity (PSV) in AGA fetuses showed a significant increase with gestational age. Analysis of intra- and interoperator variability revealed no significant mean difference in measurements of AoI-PI or AoI-PSV. Observations of AoI-PI and AoI-PSV from SGA fetuses did not differ significantly from those of AGA or IUGR fetuses. Retrograde flow in the AoI did not predate changes in the ductus venosus in IUGR fetuses.

CONCLUSIONS

Reference ranges for fetal AoI Doppler parameters in AGA fetuses constructed using longitudinal data are consistent with those obtained from cross-sectional data. The AoI Doppler parameters in SGA fetuses did not differ from those in AGA fetuses. Preterm IUGR fetuses did not manifest alterations in AoI-PI or AoI-PSV prior to changes in biophysical profile or ductus venosus Doppler. Further large-scale prospective studies are needed to determine whether AoI Doppler parameters are of any value in timing delivery or reducing adverse neurodevelopmental outcome.

Maternal obesity and inpatient medication usage

What is already known about this subject •  Maternal obesity is associated with an increased use of healthcare resources including medication costs in an outpatient setting. What this study adds •  This study shows an increase in inpatient medication usage associated with maternal obesity. This is the case in the antenatal period but not in the peripartum period.

SUMMARY

Maternal obesity is associated with increased medical and obstetric complications. We compared the inpatient antenatal and peripartum medication usage in obese women to that in women in the normal body mass index (BMI) category. White European women with a singleton pregnancy were enrolled after a glucose tolerance test excluded diabetes mellitus at 28 weeks gestation. Weight and height were measured in the first trimester and BMI calculated. Records of medications administered were collated from patient drug charts. Of the 284 women studied, there were 97, 85 and 102 women in the normal, overweight and obese categories, respectively. Delivery details across the weight categories did not vary significantly and Caesarean section rates were 22.7, 22.4 and 26.5%, respectively. The length of hospital stay postpartum for each category was similar. The administration of antenatal medication showed a trend towards increasing usage with increasing BMI category with increases in analgesic and antibiotic use. There was no difference in peripartum medication usage. The study showed that maternal obesity was associated with an increased inpatient usage of medication in the antenatal period. This has implications for healthcare costs particularly if the prevalence of maternal obesity continues to increase.

Maternity services for obese women in Ireland

Nearly one in five women booking for antenatal care in Ireland is obese. The purpose of this survey was to audit the services and facilities for obese pregnant women in the country's maternity units. In June 2010, a detailed questionnaire was sent to all 20 units which included questions on services, equipment and facilities for obese women. All 20 units responded: 17 (85%) were calculating and recording Body Mass Index in pregnancy. Only 15 (75%) were screening obese women for gestational diabetes mellitus and 2 (10%) were omitting thromboprophylaxis for caesarean section in obese women. Only 3 (15%) had clinical guidelines for obesity and pregnancy. The facilities and equipment, particularly for severely obese women, were inadequate in the majority of units. This survey showed variations nationally in obstetric practices and facilities. It highlights the need to develop, disseminate and implement standardised guidelines on maternal obesity.

Bringing together technology and market roadmaps

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Marriage guidance for collaborators

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Are Maori under-served for cardiac interventions?

AIMS

To examine hospitalisation rates for selected heart-disease-related diagnoses by age, gender, ethnicity and deprivation.

METHODS

Four years' data on publicly-funded hospital discharges for: (i) heart failure and (ii) cardiac interventions were cross-classified by age group, gender, ethnicity (Maori/non-Maori) and deprivation (NZDep96). Population hospitalisation rates were calculated and displayed in multi-dimensional trellis graphs.

RESULTS

The graphs show patterns of hospitalisation for chosen variables simultaneously. The expected increase in heart failure with age is found, as is an increase for the cardiac group up to ages 65-74 years. Clear gender differences were found. A further increase of heart failure with higher deprivation is evident throughout. For cardiac interventions, the relationship with deprivation is complex. Differences by ethnicity are disturbing. Hospitalisation rates for heart failure for Maori are typically more than double the non-Maori rates. In contrast, for the cardiac group Maori intervention rates are much lower.

CONCLUSIONS

Graphical analysis that displays age, gender, ethnicity and deprivation simultaneously provides great insight into hospitalisation rates. Ethnic differences are particularly concerning and raise important questions about how well Maori needs are being met and how equitable is access to cardiac interventions for Maori.