USE OF NORPLANT IN WOMEN WITH OR AT-RISK FOR NONINSULIN-DEPENDENT DIABETES

This review addresses the use of Norplant in women with or at-risk for noninsulin-dependent diabetes mellitus (NIDDM). Background information on NIDDM is given, including pathogenesis, effect on glucose and lipid metabolism, and management. The effect of exogenous estrogen and progestogens on glucose tolerance is briefly discussed. In reviewing the effects of Norplant on glucose metabolism, studies on women with normal glucose tolerance were reviewed, along with the one study of Norplant use in women with a past history of gestational diabetes. Norplant does have a minor effect on glucose metabolism. Studies are contradictory regarding lipid metabolism but most suggest that Norplant does not have a negative effect on the high density lipoprotein/total cholesterol ratio. Factors influencing contraceptive choice are reviewed. Protocols for management of Norplant in women with or at-risk for NIDDM are then presented, followed by a case study and a brief discussion.     

EVALUATION OF A NONINVASIVE TRANSCRANIAL DOPPLER AND BLOOD PRESSURE-BASED METHOD FOR THE ASSESSMENT OF CEREBRAL PERFUSION PRESSURE IN PREGNANT WOMEN

Objective: We have developed a Doppler method for the estimation of cerebral perfusion pressure (CPP) using noninvasive techniques. Our objective was to evaluate our new method in pregnant women.

Methods and Materials: Laboring women with a lumbar epidural in situ had transcranial Doppler interrogation of the maternal middle cerebral artery (MCA) to measure systolic, diastolic, and mean velocities. A pressure transducer was connected to the epidural catheter and pressure was recorded. Systolic (SBP), diastolic (DBP), and mean (MAP) blood pressure were taken with a Dinamap monitor. Doppler estimated CPP (mm Hg) = [V_mean/ V_mean- V_diastolic](MAP – DBP) and directly measured CPP = MAP – Epidural pressure data were plotted on a Bland–Altman graph with limits of agreement. The mean difference (the mean of the sum of both positive and negative differences) and absolute difference (the mean of the sum of the absolute differences) were calculated. In addition, linear and polynomial regression analyses were performed.

Results: Twenty laboring women were studied. All had normal pregnancies. The mean maternal age was 28 ± 7 years and the mean gestational age was 39 ± 2 weeks. The mean maternal MAP was 77 ± 12 mm Hg. The Bland–Altman plot showed a mean difference of 2.2 mm Hg at a mean CPP of 65 ± 12 mm Hg; with a standard deviation of 4.8 mm Hg, the absolute difference was 3.9 ± 3.0 mm Hg at a mean CPP of 65 ± 12 mm Hg. The regression analysis showed an r = 0.92, r² = 0.86, and p < 0.0001.

Conclusions: Our formula allows the estimation of CPP using a simple calculation and noninvasively acquired data. This method may be of use for frequent, easy, and accurate CPP and intracranial pressure estimation and may, as such, have significant research and clinical applications.     

HOSPITAL SETTING FOR BIRTH AND USE OF MEDICAL PROCEDURES IN LOW-RISK WOMEN

This study examined the use of selected medical procedures in low-risk women during childbirth. Data from the 1980 National Natality Survey merged with an American Hospital Association annual survey for the same year were used to assess the frequency with which low-risk women in the United States received certain childbirth procedures and to determine whether their use varied by the hospital setting for birth. Stratified analysis was used to assess the relation of hospital level for delivery with the use of electronic fetal monitoring, labor induction, and primary cesarean delivery in low-risk women, with control for potential confounding factors. As the level of available perinatal technology increased, the use of these procedures increased. Results of the study suggest that low-risk women may have received excess interventions and confirm the need for further examination of care procedures for this group.     

FORENSIC DOCUMENTATION OF BATTERED PREGNANT WOMEN

Patients hurt during intimate partner abuse are crime victims who may seek legal relief and protection from one or more court systems. What the health care provider documents or does not document may have tremendous forensic implications; yet, most health care providers have received little formal training in clinical forensics. Being subpoenaed to court as a witness can trigger fear and anxiety. This article reviews the basic principles of clinical forensic documentation, evidence collection and preservation, forensic photography, and accurate wound identification, as well as tips on working with police and on testifying in court.