Construction of a local standard symphysis fundal height curves for monitoring intrauterine fetal growth.

The aim of the present study was to construct standard symphysis fundal height percentile curves to be used as a reference chart in monitoring fetal growth. The construction was based on 1185 observations (symphysis fundal height measured to the nearest 0.5 cm by a malleable elastic tape) obtained from follow up of 105 cases of healthy pregnant women who were: sure of date of their last menstrual period, confirmed by early dating scan "before 20th gestational week", experienced a very strict normal course of pregnancy, giving birth to normal term newborn with appropriate weight for gestational age and sex. The selection of the study sample went through several screening levels starting by 4088 cases and ending by 105 cases. The measurements were taken biweekly from the 18th week of gestation to delivery "37-42 weeks of gestation." Tenth, 25th, 50th, 75th, 90th and 95th percentiles were calculated and represented graphically. Mean, mean-1 SD, mean-2 SD, mean +1 SD, mean + 2 SD were also calculated and represented graphically. The curve of best fit was determined by polynominal regression. The resulted percentile curves and mean values were found to be comparable to those in both developed and developing countries. It was recommended to incorporate the reference charts of symphysis fundal height into the maternity services after using it in routine antenatal examination for large number of cases and establishing its sensitivity and specificity.     

Policies toward medical technology: the case of electronic fetal monitoring.

Electronic fetal monitoring (EFM) is an example of a medical technology that has been widely accepted since its introduction in the mid-1960s. However, review of the literature does not provide convincing evidence of EFM efficacy, and four recent, controlled, clinical trails show little if any benefit in terms of preventing death or long-term disability of the baby. Public and private policies have largely acted to encourage use of EFM, and none have acted to slow or prevent its spread. This need for mechanisms to assure the timely evaluation of new medical technologies before they are accepted as a medical practice has led to a new medical devices program in the Food and Drug Administration, consensus development groups at the National Institutes of Health, and congressional legislation to establish a new National Center for Health Care Technology.     

Domiciliary midwifery support in high-risk pregnancy incorporating telephonic fetal heart rate monitoring: a health technology randomized assessment

We conducted a health technology assessment of the care of women with high-risk pregnancies in the South Wales valleys. Women in the control arm were intended to receive conventional care with standard midwifery visits. Women in the intervention arm received additional or longer visits and domiciliary fetal heart rate telemonitoring. Eighty-one mothers were randomized. There were significant differences in midwifery intervention resources between domiciliary and control groups, with the former receiving a mean of 3.7 visits lasting 33.5 min, compared with 1.4 visits lasting 12.8 min for the latter. There were slightly more spontaneous labours and fewer Caesarean sections in the domiciliary group. Maternal satisfaction and anxiety were high in both groups. Domiciliary care increased the service costs by 21.02 Pounds per woman in terms of extra midwife travel and visiting time, and by a further 18.38 Pounds per woman in home monitoring equipment costs. This, however, was more than offset by health service savings from fewer clinic visits (35.60 Pounds) and fewer clinic ultrasound scans (9.01 Pounds). Adding the reductions in lost productivity to women and their partners (34.51 Pounds) suggests that domiciliary care was cheaper than conventional care, even if it did not greatly reduce inpatient days (a reduction nonetheless saving 184.24 Pounds). While clinical processes were similar in both groups, there were useful practical advantages and savings for patients and the health service from the domiciliary intervention.     

Surveillance and monitoring of cardiovascular disease: assessment of trends.

This paper describes the current state of surveillance and monitoring of acute, chronic and asymptomatic cardiovascular disease with particular reference to the situation in Czechoslovakia. It goes on to discuss some of the difficulties involved in obtaining adequate data on which to base surveillance and of creating a coherent central information system. The importance of combining registration or notification with active intervention is emphasized, and the possible suggested of introducing simple techniques of cardiovascular investigation into health screening procedures or consultations established primarily for another purpose.     

Nutrition promotion: the role of monitoring physical growth.

Growth monitoring has been included as one of the basic strategies for child survival. In this paper, the rationale for this is reiterated both for individual as well as population nutritional surveillance. Methods for and approaches to growth monitoring are described. In addition, potential problems in implementing growth monitoring projects and interpreting the results are discussed. Despite its lack of sensitivity and specificity as a diagnostic tool, its advantages in terms of low cost, simplicity, reliability and social acceptability justify its use in nutritional surveillance, particularly in populations at risk of malnutrition.     

Caffeine consumption during pregnancy and fetal growth.

BACKGROUND: The purpose of this study was to examine the association between maternal caffeine consumption and low birthweight, intrauterine growth retardation, and prematurity, adjusting for multiple confounders. METHODS: Data obtained from birth certificates and interviews on 1,230 women with singleton live births were analyzed to evaluate the potential influence of caffeine consumption during the first trimester on fetal growth. RESULTS: The crude odds ratio for intrauterine growth retardation in infants of women reporting heavy caffeine consumption (greater than 300 mg/day) was 3.86 (95% CI = 1.80, 8.40) which decreased to 2.90 (95% CI = 1.23, 6.87) after controlling for confounding factors. The adjusted odds ratio for low birthweight and heavy maternal caffeine consumption was also elevated (OR = 2.05; 95% CI = 0.86, 4.88). Women who reduced their caffeine intake from greater than 300 mg/day to less than that early in pregnancy had lower risks of delivering infants with either intrauterine growth retardation or low birthweight than women who continued to consume that amount. Preterm delivery appeared to be unrelated to caffeine consumption. CONCLUSIONS: Taken together with studies reporting similar findings, these results suggest that heavy caffeine consumption increases the risk for fetal growth retardation.     

Quality assessment and monitoring. Retrospect and prospect

A commentary on the papers in the two special issues on Quality Assurance which shows how they contribute to some important conceptual, methodological, and policy issues. These issues pertain to the definition of quality; the distinction between quality assessment and program evaluation; the role of the market in regulating the quality of care; the role of more direct consumer participation in defining and assessing quality; professional responsibility for quality; the applicability of the structure-process-outcome paradigm to quality assessment; the format, methods of formulation, and validity of the criteria; probability sampling and purposive selection of the topics to be assessed; problems of scaling and measurement; the applicability of industrial control methods to quality monitoring; bringing about behavior change in response to the findings of quality monitoring; measuring the costs and benefits of quality assessment methods, including a consideration of their screening efficiency; and the relationship between quality monitoring and cost containment through competition or by other means.     

Risk assessment for fetal toxicity

This paper reviews the problem of performing risk assessments using data on fetal toxic effects. It briefly discusses the usual dose-response models and their inappropriateness for application to such data. The paper then considers tests for determining whether the fetal toxic effect is increased over that of the control group. Assuming an increase has been shown, the use of a fetal toxicity, dose-response model for risk assessment is discussed. The paper then applies these methods to data from an experiment using female mice mated with irradiated males. Finally, the paper discusses the need for further statistical research in this important area.