Albert Huch

Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study

Abstract Objective: To evaluate whether measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes mellitus than the 1 hour 50 g glucose challenge test. Design: Prospective population based study. Setting: Outpatient clinic in a university hospital. Participants: 520 pregnant women (328 (63%) white, 99 (19%) Asian, 31 (6%) African, 62 (12%) others) with mean age 28.4 (SD 0.2; range 17-45) years. All underwent a glucose challenge test between the 24th and 28th gestational week, followed by a diagnostic 3 hour 100 g oral glucose tolerance test within one week. This was done irrespective of the result of the challenge test. Main outcome measure: Receiver operating curves were used to determine the best cut off values for screening with fasting plasma glucose concentrations. Results: Fasting plasma glucose concentration at a threshold value of 4.8 mmol/l and the glucose challenge test with a threshold value of 7.8 mmol/l yielded sensitivities of 81% and 59% respectively and specificities of 76% and 91% respectively. Measuring fasting plasma glucose concentration as a screening procedure required a diagnostic test in 30%, compared with 14% when the challenge test was used. Conclusions: Measuring fasting plasma glucose concentrations using a cut off value of ≥4.8 mmol/l is an easier screening procedure for gestational diabetes than the 50 g glucose challenge test and allows 70% of women to avoid the challenge test. Key messages Identifying women susceptible to gestational diabetes is particularly important not only to prevent perinatal morbidity but also to improve long term outcomes for the mother and her child Measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes than the 1 hour 50 g glucose challenge test With a threshold value of 4.8 mmol/l it yields a sensitivity of 81% and a specificity of 76% Measuring fasting plasma glucose concentration allows 70% of women to avoid a glucose challenge test

Fetal ultrasound biometry: 1. Head reference values

Objective To create reliable reference ranges and calculate Z scores for fetal head ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.

Fetal ultrasound biometry: 2. Abdomen and femur length reference values

Objective To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.

Parenteral iron therapy in obstetrics: 8 years experience with iron -sucrose complex

Fe is an essential component of haem in myoglobin and accounts for 70 % of haemoglobin. The balance of Fe, unlike that of other metals such as Na or Ca, is regulated solely by gastrointestinal absorption, which itself depends on the bioavailability of Fe in food, i.e. the chemical Fe species. Factors that maintain Fe homeostasis by modulating Fe transfer through the intestinal mucosa are found at the luminal, mucosal and systemic levels. Fe deficiency and its consequence, Fe-deficiency anaemia, form the commonest nutritional pathology in pregnant women. The current gold standard to detect Fe deficiency remains the serum ferritin value. Previously there was general consensus against parenteral Fe administration, i.e. parenteral Fe was only recommended for special conditions such as unresponsiveness to oral Fe, intolerance to oral Fe, severe anaemia, lack of time for therapy etc. However, especially in hospital settings, clinicians regularly face these conditions but are still worried about reactions that were described using Fe preparations such as Fe-dextrans. A widely used and safe alternative is the Fe-sucrose complex, which has become of major interest to prevent functional Fe deficiency after use of recombinant erythropoietin Numerous reports show the effectiveness and safety of the Fe-sucrose complex. Good tolerance to this Fe formulation is partly due to the low allergenic effect of the sucrose complex, partly due to slow release of elementary Fe from the complex. Accumulation of Fe-sucrose in parenchyma of organs is low compared with Fe-dextrans or Fe-gluconate, while incorporation into the bone marrow for erythropoiesis is considerably faster. Oral Fe is only started if haemoglobin levels are below 110 g/l. If levels fall below 100 g/l or are below 100 g/l at time of diagnosis, parenteral Fe-sucrose is used primarily. In cases of severe anaemia (haemoglobin <90 g/l) or non-response to parenteral Fe after 2 weeks, recombinant erythropoietin is considered in combination. By using parenteral Fe-sucrose in cases of severe Fe deficiency, anaemia during pregnancy is treated efficiently and safely according to our results and rate of blood transfusion could be reduced considerably to below 1 % of patients per year.

rh-Erythropoietin stimulates immature reticulocyte release in man

The pharmacodynamics of single intravenous dosing with recombinant human erthropoietin (rhEPO) was investigated in eight healthy volunteers (150U/kg, n = 2; 300 U/kg, n = 6) with respect to reticulocyte subdivisions (by fluorescence flow cytometry) and serum ferritin over 6.5 d. The present study shows that bolus rhEPO injection produces an immediate release of high and middle fluorescence (immature) reticulocytes with a high RNA content from the marrow into the circulation, whereas the low fluorescence (more mature) reticulocytes were at first not affected. Serum ferritin decreased markedly within 24 h, reaching a nadir 50% of baseline after 120h (5 d), with no increase in haemoglobin. Our data suggests that rhEPO triggers premature expulsion of immature reticulocytes from the bone marrow into the circulation independent of its effect in stimulating erythropoiesis and that rhEPO has an effect on serum ferritin concentration which in this dynamic situation is dependent not only on the iron stores.

Intrapartum reflectance pulse oximetry: effects of sensor location and fixation duration on oxygen saturation readings

Objective. To determine the effects of sensor location and suction fixation duration on measurements of intrapartum fetal oxygen saturation (SpO2) with a new reflectance pulse oximetry system. Design. Fetal SpO2 values (n = 18) were determined in the first stage of labor before and after moving the sensor to another part of the fetal head. Results. Mean fetal SpO2 values did not differ with sensor location (95% CI: −3.59 to 1.48). The duration of measurement period 1, before moving the sensor, was 104 ± 44 (range 30–240) min. No time-dependent changes in SpO2 values were seen (r = 0.17). Conclusion. Suction is an effective and noninvasive method of securing the reflectance pulse oximetry sensor to the fetal head in the first stage of labor and does not interfere with reproducible SpO2 values over several hours.

Dandy–Walker malformation: prenatal diagnosis and outcome

Prenatal ultrasound identified Dandy–Walker malformation (DWM) in ten singleton pregnancies with concurrent central nervous system (CNS) anomalies and extra‐CNS anomalies in eight cases. DWM was confirmed by postnatal magnetic resonance imaging (MRI) or pathological examination in nine cases. Karyotypes were normal in the seven infants tested. Postnatal neurological and developmental testing in the five survivors showed a spectrum of clinical outcome from minor defects to severe handicap. Postnatal investigation also disclosed additional CNS and extra‐CNS findings not detected on ultrasound, as did autopsy in the other five infants. However, ultrasound diagnosis of DWM is accurate and is an indication for exhaustive screening for concurrent anomalies both within and outside the CNS and in chromosome structure and number, as the prognosis is heavily dependent on associated malformations and karyotype. Copyright

Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage

OBJECTIVE To describe a novel, effective, and minimally invasive surgical technique for avoiding excess blood loss and hysterectomy in intractable postpartum hemorrhage. Previously described techniques—uterine artery ligation at various levels, hypogastric (internal iliac) artery ligation, uterine compression—all require an abdominal approach. METHODS This procedure, which is quickly learned, is performable in the delivery room with minimal preparation, with or without bladder retraction. A 2‐cm horizontal incision is made in the anterior cervix 1 cm beneath the estimated vaginocervical fold and the bladder reflected in the natural plane. Firm but gentle downward traction on the uterus to the contralateral side of the intended ligature maximizes cephalad and lateral access, permitting bilateral uterine artery ligation from laterally under direct vision and/or indirect transcervical palpation. RESULTS Between November 1997 and June 2001, 13 women with intractable postpartum hemorrhage chose the vaginal route over laparotomy as a uterus‐preserving procedure. Hysterectomy proved necessary in only one case (8%) because of placenta percreta. One woman has since delivered a healthy term infant by cesarean, and uterine vascularization was unimpaired. CONCLUSION The vaginal route offers a novel, simple, effective, and minimally invasive technique for treating intractable puerperal hemorrhage by uterine artery ligation. Timely intervention avoids hysterectomy and consumption coagulopathy and preserves reproductive potential.

Reflectance pulse oximetry--principles and obstetric application in the Zurich system.

Transmission and reflectance are the two main modes of pulse oximetry. In obstetrics, due to the absence of a transilluminable fetal part for transmission oximetry, the only feasible option is the reflectance mode, in which sensor and detector are located on the same surface of the body part. However, none of the reflectance pulse oximeters developed for intrapartum use are fully satisfactory, as indicated by the fact that none have entered routine use. We have designed, developed, constructed and tested a reflectance pulse oximeter with the possibility to adjust the electronic circuits and signal processing in order to determine the effects of various parameters on signal amplitude and wave-form and to optimize the sensitivity and spatial arrangement of the optical elements.Following an explanation of the principles of reflectance pulse oximetry, we report our experience with the design, development, construction and field-testing of an in-house reflectance pulse oximetry system for obstetric application.

The relationship between cervical dilatation, interleukin-6 and interleukin-8 during term labor

Background. To determine interleukin‐6 and interleukin‐8 levels in amniotic fluid, retroplacental blood and maternal serum and relate these values with cervical dilatation in term labor.