Fetal heart rate and fetal activity patterns after vibratory acoustic stimulation at thirty to thirty-two weeks' gestational age

Twenty pregnant women between 30 and 32 weeks' gestational age were studied to examine the effects of a 5-second external vibratory acoustic stimulus on the fetal heart rate, fetal heart rate variability, and fetal activity patterns. There was an immediate significant increase in the basal fetal heart rate for 10 minutes compared with controls. There was also a significant increase in the mean duration of fetal heart rate accelerations without any change in the number of fetal heart rate accelerations. There were no changes in long-term fetal heart rate variability, fetal breathing, and gross fetal body movements.

Human fetal responses to vibratory acoustic stimulation from twenty-six weeks to term

Eighty-three healthy pregnant women between 26 and 40 weeks' gestational age were studied to examine effects of a 5-second external vibratory acoustic stimulus on the fetal heart rate, fetal breathing, and gross fetal body movement patterns. There was an immediate fetal heart rate response, following stimulus, characterized by an increase in duration of fetal heart rate accelerations from 26 weeks to term with an increase in basal fetal heart rate after 30 weeks. There was also a delayed response after 33 weeks' gestation, which consisted of an increase in the number of fetal heart rate accelerations and the incidence of gross fetal body movements for up to 1 hour after a 5-second stimulus with the electronic artificial larynx. Term (36 to 40 weeks) fetuses made breathing movements more irregularly after vibratory acoustic stimulation. We suggest that human fetal responses to stimulation with the electronic artificial larynx may reflect a functional maturation of the fetal central nervous system.

Maternal and neonatal outcome in pregnancies with no risk factors

Between November 1979 and April 1984, 790 consecutive pregnant women who considered themselves as having a "normal" pregnancy were followed in private practice from 9 weeks' gestation until 6 weeks post partum. The women had no pre-existing disease or problem classified as a risk to the pregnancy at the time of their first visit, had a singleton pregnancy and gave birth at Notre-Dame Hospital, Montreal. Maternal complications occurred during the course of pregnancy in 181 women (23%). Complications were mostly related to obstetric conditions (10%), such as preterm labour, intrauterine growth retardation (IUGR) and antepartum hemorrhage, or to medical conditions (12%), the most prevalent of which was hypertension (77% of medical conditions). Neonatal complications occurred in 183 infants (23%). The corrected perinatal death rate was 2.5 per 1000. Prematurity, IUGR and dysmaturity/postmaturity accounted for nearly half of the complications. Hyperbilirubinemia occurred in 7% of the cases. Among women without any maternal complications during pregnancy, the frequency rate of neonatal complications was 19%, compared with 23% among the entire group of 790 women. Our results suggest that the absence of maternal complications does not protect the infant from a neonatal complication. Further refinement is needed to identify markers of obstetric, medical and neonatal complications in pregnancies with no risk factors.

Patterns of human fetal heart rate accelerations from 26 weeks to term

Computerized analysis of the distribution of 2598 fetal heart rate accelerations in 83 healthy fetuses at 26 to 40 weeks' gestation demonstrated that the currently used definition of an acceleration as greater than or equal to 15 beats/min for greater than or equal to 15 seconds is applicable only after 30 weeks' gestational age in fetuses with a basal fetal heart rate of less than or equal to 128 beats/min. A significant negative correlation was found between the mean hourly basal fetal heart rate and the mean amplitude of fetal heart rate accelerations from 30 weeks to term. There was also a significant maturational process in the pattern of fetal heart rate and fetal heart rate accelerations that occurred between 26 and 28 and between 30 and 32 weeks; this was characterized by a decrease in basal fetal heart rate, an increase in the amplitude of fetal heart rate accelerations, and an increase in long-term fetal heart rate variability.

Dialyzer reuse following manual reprocessing with a new sterilant, RenNew-D

Dialysis patients are at risk for toxicity from formaldehyde used in the reprocessing of dialyzers for reuse; therefore, replacing formaldehyde as a dialyzer sterilant would be advantageous. The potential for RenNew-D as a sterilizing agent was investigated in seven stable in-center hemodialysis patients over 20 consecutive dialyses with cuprammonium cellulose hollow-fiber dialyzers. Treatment with RenNew-D showed no toxicity to patients or dialyzers except for two blood leaks occurring in one patient. The mean number of dialyzer uses was 4.9. In all the dialyzers that passed functional testing small solute clearances were maintained with reuse. The ability of RenNew-D to improve the biocompatibility of reused dialyzers was documented with mean neutrophil counts falling to only 78% of initial values during first reuse of dialyzers processed with RenNew-D compared with a decrease in neutrophil count to 2% of initial values during first use of the same dialyzers. Our results suggest that RenNew-D may be a useful alternative to formaldehyde for the purpose of dialyzer reuse. A reuse procedure that includes processing with RenNew-D is associated with improved biocompatibility, possibly because of maintenance of the blood-derived membrane coating established during prior dialysis.

External vibratory acoustic stimulation near term: fetal heart rate and heart rate variability responses

Twenty-five pregnant women between 36 and 40 weeks' gestational age were studied to examine effects of a 5-second external vibratory acoustic stimulus on the fetal heart rate and fetal heart rate variability. There was an immediate significant increase in the basal heart rate, which persisted for 1 hour after the stimulus, compared to that of the control subjects. There was also a significant increase in the total time during which accelerations occurred for the first 20 minutes after the stimulus. There were no changes in computer-derived indices of fetal heart rate variability. Maternal blood pressure and heart rate were not altered following vibratory acoustic stimulus. We hypothesize that external vibratory acoustic stimulus causes a change from a state of sleep to a state of wakefulness in near term healthy fetuses.

Effects of vibratory acoustic stimulation on human fetal breathing and gross fetal body movements near term

Twenty-five pregnant women between 36 and 40 weeks' gestational age were studied to examine effects of a 5-second external vibratory acoustic stimulus on fetal breathing and gross fetal body movement patterns. When the study period was compared with the control period, there was an immediate significant decrease in the incidence of fetal breathing movements that persisted for 1 hour after the stimulus. Moreover the fetal breathing pattern was more irregular for the hour after the stimulus. There was also a significant but delayed increase in the incidence of gross fetal body movements that persisted for 1 hour after the stimulus. We hypothesize that an external vibratory acoustic stimulus causes a change from a state of sleep to a state of wakefulness in near-term healthy fetuses.

Stimulation of human fetuses with sound and vibration

Forty pregnant women between 30 and 42 weeks' gestational age were studied to examine the effects of external sound and vibration on the fetal heart rate. A significant increase in the mean duration and amplitude of the first acceleration after sound stimulus was found when these values were compared with the control values. Conversely the mean time to the first acceleration in the control period was greater than that in the stimulated period. There was a significant increase in the mean duration of fetal heart rate accelerations, the mean amplitude of fetal heart rate accelerations, and the total time spent in accelerations up to 15 minutes after the sound stimulus as compared with the control period. There was no change in the number of accelerations following the sound stimulus compared to control. These data suggest that vibratory acoustic stimuli may influence patterns of fetal heart rate during human pregnancy.

Dialyser reuse: a study in applied medical ethics

A dialysis unit's introduction of automated recycling of dialysers is described. The responses of the staff and the patients are outlined, along with the pertinent ethical issues. Suggestions regarding the educational processes necessary with any innovation in long-term medical care are discussed.

Consent to dialyzer reuse: is it ethically necessary?

It is argued that consent by the patient to reuse dialyzers which have been mechanically cleansed is not required provided adequate standards of practice and safety are utilized. Based on medical benefits, administrative order and cost saving we propose that specific informed consent for such reuse should not be mandatory and that it could at times be unhelpful, both to care givers and recipients.

Antibody dependent cell mediated cytotoxicity (ADCC) and complement dependent cytotoxicity (CDC) in 229 sera from human renal allograft recipients

Comparison between CDC and ADCC in a human allogeneic model using the same cytotoxicity marker, i.e. 51Cr release from labelled target cells, provided a better definition of the optimal technical conditions for revealing ADCC. Testing 229 sera from human renal allograft recipients after transplantation, we found that CDC is detected only during rejection (43% of cases) whereas ADCC can be found both in those recipients tolerating their grafts and in those undergoing rejection, more frequently in the former than in the latter (39% vs. 21%, p less than 0.05). These in vivo results and other in vitro experiments support the assumption that two distinct varieties of antibody can mediate the in vitro ADCC phenomenon, some directed against the A, B and C HLA loci and having a deleterious effect on the graft, and others capable of exerting a protective effect and which could be directed against D related HLA determinants.

Effects of fluoride on bone in chronic renal failure

Fluoride is concentrated in the bones of patients with chronic renal failure when fluoridated water is used during hemodialysis. Excessive osteoid is produced that is not normally mineralized and severe osteomalacia occurs. Electron microscopical examination of iliac crest bone biopsy specimens from four patients suggests that fluoride induces the synthesis of disarrayed collagen by the activated osteoblasts. Collagen fibers were found to be normal in size and in axial periodicity.