Carl Nimrod

Doppler sonographic studies on the ophthalmic and central retinal arteries in the gravid woman.

The aim of this study was to establish normative data as gestation advances for pulsed Doppler evaluation of both the ophthalmic artery and the central retinal artery. After measuring intraocular pressure and blood pressure, pulsed Doppler ultrasonographic examination was performed on the ophthalmic and central retinal arteries in both eyes of 125 normal pregnant women. Nomograms, with 95% prediction intervals, have been generated for the Doppler indices, reflecting blood flow in both the ophthalmic and the central retinal arteries. The use of this technique in the management of pregnancy induced hypertension can now be better evaluated.

Maternal characteristics associated with pregnancy exposure to FDA category C, D, and X drugs in a Canadian population

To estimate the frequency of exposure to prescription Food and Drug Administration (FDA) category C, D, and X drugs in pregnant women, and to analyze the maternal characteristics associated with such an exposure.

Evaluation of fetal cardiac dysrhythmias with two-dimensional, M-mode, and pulsed Doppler ultrasonography

Forty-three patients with fetal cardiac dysrhythmia were referred to a tertiary ultrasound department for further evaluation. The patients were subdivided according to the type of dysrhythmia diagnosed. All patients with irregular fetal heart rate had a good perinatal outcome. Of the six patients with fetal tachycardia, two required in utero therapy with maternal digoxin, and one of these fetuses had a cardiac tumor. The eleven patients with fetal bradycardia had the worst perinatal outcome, with four deaths occurring. The results suggest that all patients with fetal tachycardia or bradycardia should have a complete fetal cardiac assessment in a center experienced with the management of such cases.

Patterns of pregnancy exposure to prescription FDA C, D and X drugs in a Canadian population

Objective:To examine prescription Food and Drug Administration (FDA) C, D and X drugs in general obstetric population.Study Design:Historical cohort study.Result:A total of 18 575 women who gave a birth in Saskatchewan between January 1997 and December 2000 were included. Among them, 3604 (19.4%) received FDA C, D or X drugs at least once during pregnancy. The pregnancy exposure rates were 15.8, 5.2 and 3.9%, respectively, for category C, D and X drugs, and were 11.2, 7.3 and 8.2%, respectively, in the first, second and third trimesters. Salbutamol (albuterol), trimethoprim/sulfamethoxazole (co-trimoxazole), ibuprofen, naproxen and oral contraceptives were the most common C, D, X drugs used during pregnancy.Conclusion:About one in every five women uses FDA C, D and X drugs at least once during pregnancy, and the most common prescription drugs in pregnancy are antiasthmatic, antibiotics, nonsteroid anti-inflammation drugs, antianxiety or antidepressants and oral contraceptives.

Determination of intervillous flow in early pregnancy

The process of placentation in the macaque has been extensively studied and found to resemble closely that observed in the human. In this model, histopathologically, intervillous flow is anticipated from week 3 post-conception. We set out to document the nature and onset of intervillous flow in the macaque in vivo using colour Doppler imaging (CDI), colour Doppler energy (CDE) and pulsed-wave Doppler (PWD). Pregnant females were assessed between 15-50 days gestation (term = 165 days) with an Acuson 128/XP10 high-resolution ultrasound scanner, using a 7-MHz linear array probe. The placenta, subjacent decidua and myometrium were assessed using CDI and CDE. Specific regions of flow were interrogated using PWD; the resulting flow velocity waveforms were stored and quantified using conventional Doppler indices. B-mode sonography was able to demonstrate the well-defined placental-decidual interface observed in this species; CDI and CDE clearly visualized the uteroplacental vasculature. Spiral arteries were followed to their point of discharge into the intervillous space, and PWD at these sites obtained a characteristic flow velocity waveform. The indices obtained confirmed a flow of low resistance and pulsatility throughout the gestation studied. Flow within the intervillous space was noted from day 20 of gestation.

Bed Rest and Activity Restriction for Women at Risk for Preterm Birth: A Survey of Canadian Prenatal Care Providers

OBJECTIVE To explore the practices of Canadian obstetricians, family physicians, and midwives in recommending bed rest or activity restriction for women at risk for preterm birth (PTB) and to assess the decisional conflict experienced by care providers when they recommend these therapies. METHODS A self-administered mail survey of prenatal care providers was carried out using Dillmans Tailored Design Method. Analysis included descriptive statistics and analysis of variance. RESULTS The survey was distributed to 1441 potential participants; of these, 1172 were eligible participants, and 516 (44.2%) completed the survey. For women at risk of PTB, 60 of 170 obstetricians (35%), 88 of 206 family practitioners (42.7%), and 30 of 140 midwives (21.4%) recommended bed rest in hospital; 110 of 170 obstetricians (64.7%), 144 of 206 family practitioners (69.9%), and 73 of 140 midwives (52.1%) recommended bed rest at home. These recommendations occurred despite the response from about two thirds of each professional group that the effectiveness of bed rest was in the fair-to-poor range in helping to prevent PTB. The mean score on the Provider Decision Process Assessment Instrument, measuring decisional conflict for all care provider groups, was 30 (SD 7.4) (possible score range 12-60). There were no significant differences in decisional conflict scores among provider groups (F [2,347] = 2.24; P = 0.11). CONCLUSION Care providers have been discouraged from routinely recommending bed rest for women at risk of PTB because of potential adverse side effects. This study demonstrates that most Canadian prenatal care providers have not been persuaded to incorporate these recommendations into practice. Except for women with multiple gestation, there is inconsistent practice in recommending bed rest and activity restriction. Additionally, Canadian prenatal care providers have some decisional conflict about using this therapy. These results provide some of the first Canadian perspectives on the practice of prescribing therapeutic bed rest for PTB.

The management of thrombophilia during pregnancy: a Canadian survey.

OBJECTIVE To determine current Canadian practice patterns in the management of pregnant women with thrombophilia. METHODS Physician members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) who provide obstetrical care were invited to complete a closed-ended questionnaire in which they were presented 5 clinical scenarios involving thrombophilic pregnancies and asked to give their management recommendations. The 5 scenarios presented in the survey were of a pregnant woman with (1) asymptomatic factor V Leiden (FVL), (2) asymptomatic FVL and a family history of venous thromboembolism (VTE), (3) FVL and recurrent fetal loss, (4) FVL and a previous VTE, or (5) antiphospholipid antibody syndrome and recurrent fetal loss. RESULTS Of the 1448 eligible SOGC members invited, 18 had moved with no forwarding address, and 662 (46.3% of the remainder) responded. The majority (65%) of the respondents were obstetricians and 51% of them had a university-affiliated practice. In scenario 1, 26% of physicians indicated they would recommend some form of antepartum thromboprophylaxis, whereas in the remaining four scenarios, 58% to 84% would definitely recommend antepartum thromboprophylaxis. CONCLUSION Most clinicians favour intervening with thromboprophylaxis in pregnant thrombophilic women rather than observing without prophylaxis. This tendency spans a wide range of clinical scenarios, despite a lack of evidence to support such decisions. This survey highlights the need to provide clinicians and women with evidence for the safety and effectiveness of prophylaxis, before these interventions become the default recommendation by clinicians caring for this prevalent group of women.

Transverse cerebellar diameter in twin gestations

OBJECTIVE The purpose of this study was to evaluate the significance of transverse cerebellar diameter measurements in twin pregnancies. STUDY DESIGN A prospective, cross-sectional ultrasonographic study was done on 329 normal singleton fetuses and 47 normal twin pairs. Fetal biometric measurements including biparietal diameter, head circumference, abdominal circumference, femur length, and transverse cerebellar diameter were compared between concordant (n = 13) and discordant (n = 11) twins. RESULTS (1) There was no significant difference in transverse cerebellar diameter measurements between normal singleton and twin gestations. (2) There was no significant difference in transverse cerebellar diameter measurements in each twin pair. (3) Transverse cerebellar diameter was unaffected by the chorionicity or discordancy. (4) Predicted gestational age by transverse cerebellar diameter nomogram for singletons provided satisfactory correlation for twins. CONCLUSION Transverse cerebellar diameter may be a useful predictor of gestational age and may be independent of discordant growth in twins.

Antenatal diagnosis of restriction of the foramen ovale

Premature closure of the foramen ovale is a rare but serious clinical entity. Prenatal diagnosis with neonatal survival has been reported in the medical literature.• The following is the report of a case in which the diagnosis of restrictive foramen ovale was established an ~ tenatally. A rapid deterioration in fetal biophysical status required emergency obstetric intervention. The baby survived but has a mild motor deficit at 1 year of age.

In utero evaluation of fetal cardiac structure: A preliminary report

Fetal echocardiography as a tool for the prenatal diagnosis of cardiac structural abnormalities was utilized in 27 consecutive patients who were referred for evaluation. Four abnormalities were recognized prenatally and confirmed postnatally. A fifth was identified postnatally. The sensitivity and specificity of this diagnostic test were 80% and 100%, respectively. The utilization of this tool in a tertiary care setting by an adequately trained team has proved to be helpful and is recommended.