Michael J. McGrath

Exercise, posture, and back pain during pregnancy

In this article the effect of exercise on pregnancy-related back pain is reported. Sixty five pregnant volunteers were included in the study, of whom 27 were enrolled in exercise classes designed according to Canadian guidelines, and 38 acted as sedentary controls. Back pain and functional limitations were assessed every 4 weeks during pregnancy and 4 months postpartum by questionnaires. No significant differences in back pain or functional limitations reported by the two groups were found. The biomechanical factors measured in this study, weight, back posture, and laxity, were unable to explain most of the variation in pain reported. RELEVANCE: This study showed that fitness classes for pregnant women designed according to Canadian guidelines had no detectable effect on back pain during pregnancy. If prevention of pregnancy-related back pain is sought through exercise, design of fitness programmes for pregnant women should be reconsidered.

Randomised, double‐blind, placebo controlled pilot study assessing nitroglycerin as a tocolytic

Thirty‐three women in preterm labour were randomised in a double‐blind fashion to receive either transdermal nitroglycerin (n= 17) or placebo (n= 16). Both groups had significant (P < 0.001) change in the cervix prior to randomisation. The primary outcome measure was delivery within 48 hours of randomisation. Fewer women randomised to nitroglycerin treatment (6/17) were delivered within 48 hours, compared with the placebo treatment (10/16) (RR 0.56, 95% CI 0–27 to 1.19). This pilot study lends support to two case series published that suggest that transdermal nitroglycerin may be promising as a safe, effective means for tocolysis.

Exercise, posture, and back pain during pregnancy: Part 2. Exercise and back pain

One of the expected benefits of exercise programmes for pregnant women is to reduce or prevent back pain by improving posture. The aim of this project was to evaluate the effect of fitness classes for pregnant women on posture and back pain. In this article, postural aspects are reported. Sixty five pregnant volunteers were included in the study, of whom 27 were enrolled in exercise classes designed according to Canadian guidelines and 38 acted as sedentary controls. Posture was assessed every 4 weeks during pregnancy and 4 months postpartum by measuring curvatures of the lumbar and thoracic spines in a standard relaxed standing position from lateral photographs. Laxity of knee ligaments was also monitored using a clinical arthrometer. Weight gain could explain part of lordosis increase during pregnancy but the effect was not very strong. No effect of exercise on posture was detected. RELEVANCE: This study showed that fitness classes for pregnant women designed according to Canadian guidelines had no detectable effect on posture during pregnancy.

Fatal hypertrophic cardiomyopathy in the fetus of a woman with diabetes

BACKGROUND Hypertrophic cardiomyopathy is recognized in infants of diabetic mothers, and when it occurs it is generally benign and transient. We describe a case of fetal cardiac death caused by hypertrophic cardiomyopathy in an infant of a diabetic mother. CASE Hydrops fetalis caused by hypertrophic cardiomyopathy resulted in the death of a macrosomic male fetus of a young woman who had well-controlled diabetes mellitus and was treated with insulin therapy during pregnancy. CONCLUSION It is important to monitor fetal heart function in macrosomic infants of diabetic mothers. Hypertrophic cardiomyopathy might explain otherwise unexplained fetal deaths in women with diabetes.

The prediction of intrapartum fetal metabolic acidosis by fetal heart rate monitoring

Fetal heart rate characteristics during the 8 hours prior to delivery have been studied in 200 patients in whom the fetus had evidence of a metabolic acidosis at delivery, and compared to those in 200 patients in whom the fetus had a normal acid-base at delivery. Baseline fetal heart rate moderate bradycardia and tachycardia, decreased baseline variability, and decreased fetal heart rate accelerations are predictors of intrapartum fetal hypoxia with metabolic acidosis. Marked patterns of total decelerations and late decelerations are predictive of intrapartum fetal hypoxia with metabolic acidosis. The probability of fetal metabolic acidosis in the presence of a marked pattern of total decelerations is 25%, and with late decelerations it is 48%, in a population of high-risk pregnancies.

A report of recurrent anencephaly with trisomy 2p23-2pter: Additional evidence for the involvement of 2p24 in neural tube development and evaluation of the role for cytogenetic analysis

A woman carrying a balanced reciprocal translocation, 46,XX,t(2;5)(p23;p15)pat, was ascertained following the delivery of an anencephalic fetus whose karyotype was 46,XY,5p+. She subsequently had two pregnancies with a similar unbalanced karyotype (trisomy 2p23‐2pter and monosomy 5p15‐5pter), one of which was also anencephalic. She has three living children, two of whom are balanced translocation carriers. This history raises questions regarding the necessity of cytogenetic assessment of cases identified by ultrasound with ‘isolated’ neural tube defects. The observation of duplication of the 2p23‐2pter region in conjunction with anencephaly also adds to the growing body of evidence suggesting an association of this region and neural tube development.

Analysis of self-reported problematic tasks for pregnant women

The objective of this study was to identify major components of, and influential factors in, problematic tasks performed by pregnant women employed in education, health care and service areas. Seventy-two pregnant women were surveyed using specially designed questionnaires consisting of an Initial Survey, a Job Analysis Questionnaire and a Task Description Questionnaire. Forty-four subjects (60%) had difficulty performing at least one work task and reported 105 tasks that were problematic at work. Reaching above the head, bending forward, bending and twisting, pushing, repeating actions and working at a fast pace were identified as the task components requiring the greatest level of effort. Excessive effort, excessive time, getting tired, repetitive actions, stress and fear of injury were identified as factors that had strong associations with the six major task components. Findings of this study suggest that these task components and factors should be considered when designing, assigning or analysing tasks for working pregnant women.

Fatigability of back extensor muscles and low back pain during pregnancy

BACKGROUND Back pain is the most frequently reported musculo-skeletal problem during pregnancy. High muscle fatigability has been associated with back pain in the general population. During pregnancy, the gradual increase in loads may have a training effect, increasing strength and endurance of back muscles. This adaptation however may be too slow, or insufficient to be significant in light of other changes during pregnancy. METHODS Thirty-two pregnant women performed a fatigue test which consisted of maintaining a fixed load of 70 Nm for 60 s while the surface EMG of the longissimus lumborum and multifidus muscles were recorded bilaterally at 14, 24 and 34 weeks of pregnancy. The measure of fatigability was the highest absolute slope of the median frequency of the power spectrum of the EMG of the four muscles. Occurrence and severity of back pain were reported on questionnaires at 14, 19, 24, 29 and 34 weeks. Binomial logistic regressions between back pain occurrence and the median frequency slopes were calculated. FINDINGS None of the five logistic analyses demonstrated an improvement of the one-predictor model over the constant-only model, which indicates that the degree of fatigability of back extensor muscles did not predict the occurrence of back pain in our sample. INTERPRETATION Fatigability of back extensor muscles was not found to be a predictor of back pain during pregnancy. This result should be taken with caution due to the small number of participants and broad definition of back pain used, and should be confirmed by studies with a larger number of participants.

The probability of fetal metabolic acidosis during labor in a population at risk as determined by clinical factors

The clinical data derived from 2,772 pregnancies managed in an intrapartum intensive care unit have been analyzed to establish which criteria will indicate in a more definite manner the probability that fetal metabolic acidosis will occur during labor and delivery. All antepartum and intrapartum clinical factors indicate a pregnancy and fetus with an increased probability of fetal metabolic acidosis. However, there is a remarkably consistent relationship between decreasing fetal weight in each week of gestational age and in increasing probability of fetal metabolic acidosis that will permit the magnitude of the risk to be determined with greater precision. The following clinical guidelines are proposed: (1) Current antepartum and intrapartum risk factors are appropriate for the selection of patients for intrapartum intensive care. (2) An accurate gestational age and an estimate of fetal weight within 200 gm will provide an indication of the probability of fetal metabolic acidosis in the individual fetus ranging from 15% to 50%. (3) The presence of meconium in the amniotic fluid increases the probability of metabolic acidosis as defined by fetal weight in relation to gestational age.

Anaesthetic management of emergency Caesarean section followed by pulmonary embolectomy

This report discusses the anaesthetic management of a patient undergoing emergency Caesarean section followed by an open pulmonary embolectomy with cardiopulmonary bypass. This case was complicated by the major physiological alterations associated with pregnancy and delivery, massive blood loss, cardiac dysrhythmias, hypotension, and cardiac arrest. Both patients, mother and child, made a full recovery.RésuméCe papier discute de la conduite anesthésique chez une patiente subissant une cesarienne d’urgence suivie d’embolectomie pulmonaire et circulation extra corporelle. Ce cas fut compliqué par des alterations physiologiques majeures associees à la grossesse, l’accouchement, la perte massive de sang, arythmie cardiaque, hypotension et arret cardiaque. La mère et l’infant ont eu une recouvrance totale satisfaisante.