Janet Burlingame

Noninvasive cardiac monitoring in pregnancy: impedance cardiography versus echocardiography.

Objective:The objective of this study was to report thoracic impedance cardiography (ICG) measurements and compare them with echocardiography (echo) measurements throughout pregnancy and in varied maternal positions.Method:A prospective cohort study involving 28 healthy parturients was performed using ICG and echo at three time points and in two maternal positions. Pearson’s correlations, Bland–Altman plots and paired t-tests were used for statistical analysis.Result:Significant agreements between many but not all ICG and echo contractility, flow and resistance measurements were demonstrated. Differences in stroke volume (SV) due to maternal position were also detected by ICG in the antepartum (AP) period. Significant trends were observed by ICG for cardiac output and thoracic fluid content (TFC; P<0.025) with advancing pregnancy stages.Conclusion:ICG and echo demonstrate significant correlations in some but not all measurements of cardiac function. ICG has the ability to detect small changes in SV associated with maternal position change. ICG measurements reflected maximal cardiac contractility in the a AP period yet reflected a decrease in contractility and an increase in TFC in the postpartum period.

The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system

Objective:The objective of this study was to demonstrate the increasing importance of heart disease as a cause of pregnancy-related mortality in Hawaii and the rest of the United States.Study Design:Hawaiis Department of Public Health identified all pregnancy-associated death certificates from 1991 to 2007. Hospital records and autopsy reports were reviewed to determine whether deaths were pregnancy-related.Result:From 1991 to 2007, Hawaii registered 156 deaths occurring within 1 year of pregnancy, which represented 4.2% of the total number of women who died in the same 17 to 46 years age group and 9.0% of the total number of women who died in the same 17 to 34 years age group. The pregnancy-related mortality ratio was 22.4 and the pregnancy-associated mortality ratio was 50. The leading cause of pregnancy-associated mortality was heart disease (20.5%) followed by cancer (18.6%) and suicide/homicide (12.2%). Pregnancy-related deaths (n=70) were attributed to heart disease (45.7%) followed by sepsis (14.2%) and hemorrhage (12.9%). The new Hawaii death certificate beginning in 2006 increased the detection of both pregnancy-related and -associated deaths.Conclusion:Heart disease is the most common cause of pregnancy-related mortality in Hawaii, and with improved ascertainment, may be determined to be the most common cause of pregnancy-related mortality in the rest of the United States.

Can we really diagnose diabetes during pregnancy

Abstract Objective: To identify the accuracy of diagnosing postpartum diabetes and glucose intolerance using antepartum glycosylated hemoglobin (HbA1c) and fasting glucose values. Study Design: A retrospective Hawaiian cohort of women with gestational diabetes during 2004–2011 were evaluated. Antepartum HbA1c and postpartum 75-g glucose tolerance tests were obtained. Results: An antepartum HbA1c value of ≥6.5% had a 45.7% sensitivity, a 96% specificity and a 40% positive predictive value (PPV) for predicting postpartum diabetes. An antepartum HbA1c value of ≥6.5% had a 6.6% sensitivity, a 94.2% specificity and a 27% PPV for predicting postpartum impaired glucose tolerance. An antepartum HbA1c value of ≥6.5% had a 10.3% sensitivity, a 95.7% specificity and a 33.3% PPV for predicting postpartum impaired fasting glucoses. Conclusion: We could not demonstrate a clinically useful PPV for diagnosing postpartum diabetes or glucose intolerance using an antepartum elevated HbA1c value of ≥6.5% or a fasting glucose level of ≥90 mg/dL.

Fetal Ultrasound as a Window into Maternal Health

Healthcare providers commonly use obstetric ultrasound to assess fetal well-being. However, the potential for fetal findings to manifest maternal disease is often underappreciated. This article will review the relationships between obstetric ultrasound findings and underlying maternal medical conditions in three settings: (1) fetal growth abnormalities related to underlying maternal disease, (2) congenital malformations secondary to diabetes and maternal exposure to chemical and infectious teratogens, and (3) congenital heart block due to maternal autoimmune disease. The obstetric ultrasound should be a tool used for the care and evaluation of the maternal as well as the fetal patient.