Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort

The objectives of the study were (1) to perform a systematic review of the available umbilical vein blood flow volume (UV-Q) reference ranges in uncomplicated pregnancies; and (2) to compare the findings of the systematic review with UV-Q values obtained from a local cohort. Available literature in the English language on this topic was identified following the PRISMA guidelines. Selected original articles were further grouped based on the UV sampling sites and the formulae used to compute UV-Q. The 50th percentiles, the means, or the best-fitting curves were derived from the formulae or the reported tables presented by authors. A prospective observational study of uncomplicated singleton pregnancies from 20⁺⁰ to 40⁺⁶ weeks of gestation was conducted to compare UV-Q with the results of this systematic review. Fifteen sets of data (fourteen sets belonging to manuscripts identified by the research strategy and one obtained from our cohort) were compared. Overall, there was a substantial heterogeneity among the reported UV-Q central values, although when using the same sampling methodology and formulae, the values overlap. Our data suggest that when adhering to the same methodology, the UV-Q assessment is accurate and reproducible, thus encouraging further investigation on the possible clinical applications of this measurement in clinical practice.

Is antiarrhythmic therapy safe in twin pregnancies?

AIM

The optimal treatment for foetal supraventricular tachycardia (SVT) in twin pregnancies is unclear because of the possible impact on the second twin. This review compared a foetus we treated with antiarrhythmic drugs with the previous case studies.

METHODS

Our case was a dichorionic diamniotic twin pregnancy, where one twin developed foetal hydrops secondary to SVT at 22 weeks of gestation. We searched PubMed to look for previous cases of SVT in twin pregnancies.

RESULTS

Treatment with transplacental antiarrhythmic therapy from 22 to 36 weeks of gestation successfully resolved the SVT in our affected twin without any impact on the healthy twin or mother. We only found seven similar cases of SVT in twin pregnancies from 1999 to 2017. Although there was no consensus on the treatment that should be provided, none of the studies reported side effects in the twins or the mothers.

CONCLUSION

Despite a lack of data on SVT in twin pregnancies, our case, and the previous cases we identified, allowed us to conclude that transplacental antiarrhythmic treatment can successfully achieve cardioversion in the affected twin. It can do this without side effects for the healthy foetus or the mother, even if the treatment lasts for a long period of time.

Finasteride and fertility: case report and review of the literature

Although millions of men have taken or are taking finasteride, there are no documented cases of successful pregnancy in the literature after discontinuation of the drug. Early studies did not show significant influence of finasteride on semen parameters, whereas some recent observations have suggested that in subfertile patients, the effects of the drug might be amplified. Therefore, counseling is particularly difficult for men taking finasteride and planning pregnancy. We report the case of a couple whose male partner had used finasteride for approximately 10 years and who presented for primary infertility. The first semen analysis, carried out 3 months after finasteride cessation, revealed severe oligospermia. One month later, sperm concentration increased, and the following month, the couple spontaneously conceived. A healthy baby was delivered at full term. To the best of our knowledge, this is the first case of successful full-term pregnancy and live birth after long-term use of finasteride, which suggests that treatment with finasteride, even after several years, does not prevent normal conception. However, caution should be advised with the use of finasteride in male partners of couples who are attempting to become pregnant.

Pattern of fluid consumption in a sample of Saudi Arabian adolescents aged 12-13 years

OBJECTIVE

To study the pattern of fluid consumption in a group of Saudi adolescent boys and girls aged 12-13 years.

DESIGN

Prospective study.

METHODS

Three hundred forty-four boys and girls attending school in Riyadh recorded their fluid intake for three consecutive days, including one weekend day, in April and May 2002. Types of drink/beverage and total amount consumed were analysed and ranked in order of amount/quantity of consumption. Independent samples t-test was used to compare between genders.

RESULTS

Mean daily fluid intake was 1,917 mL (SD 287). Drinking water provided 37%, whereas carbonated soft drinks and fruit juice/drink accounted for 26% and 25%, respectively. Seven percent of total fluid intake amounting to 134 mL came from milk and 5% (103 mL) was from tea/coffee. Fluid intake was higher in boys (2,006 mL) than in girls (1,821 mL) (P=0.049). This was also true for carbonated soft drinks (P=0.050) and tea/coffee (P=0.000). Girls consumed more milk (P=0.001) and fruit juice/drink (P=0.001) than boys.

CONCLUSION

Both carbonated soft drink and fruit juice/drink accounted for the largest proportion of total fluid intake by the sampled Saudi adolescents to the detriment of nutritious milk.

Intra-nasal midazolam in conscious sedation of young paediatric dental patients

OBJECTIVES

To compare the effects of 3 different doses of intra-nasal midazolam in the conscious sedation of young paediatric dental patients and to compare the effectiveness of the sedation in the fasting and non-fasting child.

DESIGN

Double blind random controlled trial.

SAMPLE AND METHODS

Thirty-eight uncooperative young children aged 2-5 years (mean age 4.02 years) were randomly assigned to one of 3 groups. The groups and the doses of midazolam administered intra-nasally were A: 0.3 mg/kg, B: 0.4 mg/kg, and C: 0.5 mg/kg body weight. Each child in each group had two visits for restorative treatment: one without food (fasting) and the other with soft drink and light food (non-fasting) before treatment. Child behaviour and sedative effects were evaluated using the scoring system of Houpt. The vital signs were monitored continuously using a pulse oximeter and Dinamap machine.

RESULTS

There was rapid onset of sedation with the maximal effect between 8 and 15 minutes. This sedation lasted for 25-40 minutes in Groups A and B and for 60 minutes in Group C. Conscious sedation and dental treatment were achieved in 79%, 96% and 100% of the children in Groups A, B and C, respectively. Consistently higher Houpt scores were seen in Groups B and C, with statistically significant differences between Groups A and C, and B and C (Tukey's range test, P < 0.05). There were no significant differences in the general behaviour of the child, the onset and the duration of sedation between the fasting and the non-fasting child (nonparametric ANOVA P > 0.05). All the vital signs were within normal physiological limits and there were no significant adverse effects either with or without fasting.

CONCLUSIONS

All 3 doses of intranasal midazolam were effective in modifying the behaviour of the uncooperative child patient to accept dental treatment. This was irrespective of fasting.

Prevalence of the Carabelli trait in Saudi Arabian children

This study was carried out to evaluate the prevalence of trait of Carabelli in Saudi Arabian children. 250 children, aged 7 to 10 years were examined. The criterion of inclusion was caries free maxillary second deciduous and first permanent molars. The prevalence of the trait was 58.7% with almost similar distribution between males and females. The tubercular variety was the commonest type, which was significantly more in males than females. The frequency of the trait was similar to that of Malaysians but less than for other population groups.