Cost Effectiveness of Routine Intrapartum Rubella Screening in a High-Risk Population

The value of intrapartum rubella screening in a population of patients who present with no prenatal care (with patient discharge prior to immune status determination) has not been examined. We obtained rubella titers on 638 consecutive no-prenatal-care patients who presented to the University of California, San Diego labor and delivery suite from January 1, 1992 to December 31, 1992. Maternal and neonatal records were available for 621 patients, and these were examined for demographic data and follow-up vaccination where appropriate. Five hundred eighty of 621 (93.4%) patients were rubella immune. Of the 41 rubella-nonimmune patients, only three returned for the 6-week postpartum checkup, and none were immunized. Further analysis according to race demonstrated that 514 of 549 Hispanics (93.6%), 39 of 39 African Americans (100%), and 22 of 26 Caucasians (84–6%) were rubella immune. No demographic characteristics (maternal age, parity, race) further identified a subpopulation of patients who might benefit from either routine screening of outright rubella vaccination. The total patient charge of screening the 638 patients was $24,563. Routine intrapartum rubella screening was not cost effective in this no-prenatal-care population primarily owing to inadequate patient follow-up. If routine screening is to be performed in this population, then intensive outpatient follow-up is required to achieve adequate vaccination rates in nonimmune individuals.     

The Routine Screening of Obstetric and Gynaecological Patients for Gonorrhoea

Summary: Between 1970 and 1973, 3,389 public hospital patients (both obstetrical and gynaecological) were screened for gonorrhoea. An unexpectedly high figure (2.4%) was obtained in the "single" group (single, separated, divorced, de facto). In the married group, the incidence was 0.7%. Results of other screening programmes throughout the world are reviewed. Relatively few of these have been reported outside North America; in those that have, the yields have been disproportionately low. The reasons for this are thought to be linked to culture methodology.
Greater use of routine screening, particularly of individuals who are not in a stable marital situation, is advocated in city obstetrical and gynaecological clinics, even in areas with a medium incidence of gonorrhoea     

上海市妇女孕期用药情况调查

本文调查了孕期妇女的用药情况。共收集上海市区四个医院产科1,487例年龄在20～41岁的孕妇。调查结果显示:每人用药0～13种,平均每人用药1.8种;其中用药者为754例(50.7%),每人平均用药3.5种。用药次数:孕早期每人1.81次,全孕期3.57次。本文分析了各组药物的孕前三个月及全孕期的用药率,并与文献报道作了比较。用药幅度不大,但仍有一定数量的用药率,包括一些孕期禁用的药物,应引起重视。     

Including a Screening and Brief Alcohol Intervention Program in the Care of the Obstetric Patient

Alcohol is the drug most commonly abused by pregnant women and the leading cause of preventable birth defects across the United States. Screening, Brief Intervention, and Referral for Treatment is a program developed by the Emergency Nurses Association that has demonstrated success in treating patients who have alcohol use disorders. This interventional program can be useful to perinatal nurses caring for pregnant women with alcohol use disorders in a variety of settings.     

Drug screening and criminal prosecution of pregnant women

According to the U.S. Supreme Court, the Fourth Amendment rights of 10 women were violated by a hospital that provided them prenatal care. The incidence of prenatal drug testing for criminal prosecution with or without a woman's knowledge is increasing. Concurrently, funding and availability of drug treatment programs for pregnant women are declining. Nurses and physicians who act as advocates for the state rather than the patient damage the patient-provider relationship and breach their ethical responsibility to the patient.     

尿钙检测对妊高征的预测价值

测定了１８４例正常妊娠妇女及３０例妊高征患者２４小时尿钙总量，尿钙含量及钙／肌酐比值。结果：妊高征患者尿钙总量，尿钙含量及钙／肌酐比值均明显低于正常妊娠妇女。其中１８４例正常妊娠妇女中有２１例发展为妊高征。以尿钙含量为３ｍｍｏｌ／Ｌ及钙／肌酐比值０．０４为界限值，预测妊高征的敏感性分别为７６．２％及８１．０％，特异性分别为９７．５％及９８．２％。提示：尿钙的变化可作为妊高征的预测指标。     

血栓弹力图在高危妊娠中的研究进展

血栓弹力图(thrombelastography,TEG)是一种反映全血凝血功能的图像,是一种能从整体上动态评价凝血和纤溶过程的检测手段。妊娠期凝血-抗凝系统及纤溶-抗纤溶系统的变化使妊娠妇女的凝血系统处于高凝状态,这种高凝状态既是一种生理性保护机制,又是诱发凝血功能障碍的高危因素。一旦这种高凝状态的动态平衡被打破,可参与产科并发症的发生,严重威胁着孕产妇和胎儿的安全。TEG能够真实、全面地反映妊娠期妇女凝血功能的变化,对复发性流产、妊娠期高血压疾病、羊水栓塞、产后出血和产科血栓栓塞性疾病等高危妊娠及妊娠期并发症的预测及病情评估具有重要的临床价值,为指导临床决策、早期干预、缓解或延迟并发症和预防不良妊娠结局提供科学依据。     

The Predictive Value of Biophysical Profiles and Doppler Veloeimetry for Fetal Acidosis in a Low Risk Population

Summary: Antenatal fetal monitoring is the principal means of distinguishing the fetus requiring imminent delivery from that which is coping well in utero. The ability to detect fetal compromise, defined by fetal acidosis, in a low-risk population was evaluated in a prospective study of 50 women undergoing a Caesarean section in the absence of labour. The sensitivity and positive predictive value of a modified biophysical profile (BPP) or Doppler veloeimetry to detect a fetus subsequently born with an umbilical artery pH of less than 7.20 was poor. The incidence of fetal acidosis in the population under study was 8%. Interpretation of antenatal fetal assessments must be tempered by the clinical features of each case. Decisions to deliver should take into account the low sensitivity of these tests in the absence of other complicating factors.     

Prenatal Education in a High-Risk Population: The Effect on Birth Outcomes

ABSTRACT: This case-control investigation examined the relationship between absence of specific educational content during prenatal care and risk of adverse birth outcomes. A total of 1484 women from three regions with high rates of low birthweight and infant mortality participated in structured postpartum interviews. Analyses were performed for both the full sample and three regional subsamples. For the full sample an adjusted risk ratio of 2.87 (95% CI = 1.75, 4.71) was noted between risk of preterm low birthweight and lack of advice to call the health provider if preterm labor were suspected. For one subsample an adjusted risk ratio of 2.50 (95% CI = 1.11, 5.60) was noted between the risk of preterm low birthweight and lack of education on the signs and symptoms of preterm labor. This study reinforces a body of literature that stresses the importance of appropriate prenatal care in preventing preterm low birthweight. It further suggests that adequacy measures of prenatal care should reflect quality and content as well as timing and number of prenatal visits.     

妊娠早期子宫动脉的多普勒监测对子痫前期的预测价值

提前识别孕妇患子痫前期的风险,可以降低孕产妇和胎儿的发病率和死亡率。子宫动脉多普勒频谱分析在妊娠中期预测子痫前期的研究已较广泛。利用妊娠早期子宫动脉多普勒来预测子痫前期成为了近年的研究热点。子宫动脉多普勒参数作为单独的标志物,其敏感度不高。妊娠早期子宫动脉多普勒参数(如搏动指数)与母体特征及相关生化标志物(如妊娠相关血浆蛋白A、胎盘生长因子)相结合,对早发型子痫前期的检测率高于90%。但结合生化标志物增加了成本,未来研究的方向是筛选最佳组合的预测模型来早期预测子痫前期。     

妊娠合并肝衰竭的产科处理

妊娠合并肝衰竭严重影响母亲和胎婴儿健康,治疗上缺乏特效药物和手段,积极恰当的产科处理可改善患者预后、降低母亲和胎儿死亡率。临床上应以个体化治疗为原则,针对肝衰竭的病因、病情的严重程度、孕妇和胎儿情况选择终止妊娠的时机和方式,同时做好分娩期的综合处理。     

Obstetrical Factors Associated with Nuchal Cord in a High-Risk Population

The obstetrical factors associated with nuchal cord at birth were retrospectively studied in 520 high-risk patients with gestational ages ranging from 24 to 42 weeks. The overall frequency of nuchal cord at birth was 16.7% (87 of 520). The frequencies of nuchal cord in preterm and term gestations were 14.7 and 22%, respectively. Factors associated with increased incidence of nuchal cord at birth were vertex presentation, vaginal birth, and term gestation. When the data were analyzed according to route of delivery and gestational age, it was found that the group of neonates born vaginally at term had the highest incidence of nuchal cord (17 of 51 or 33.3%, P <. 05) as compared to infants born at term by cesarean section (14 of 90 or 15.5%), preterm born vaginally (24 of 140 or 17.1%), and preterm born by cesarean section (32 of 239 or 13.3%). These data suggest that vaginal birth at term is the most significant factor associated with increased frequency of nuchal cord. Although a lower mean cord artery pH and higher pCO₂ were noted among preterm fetuses with nuchal cord born vaginally, there was no increase in frequency of acidemic fetuses (cord arterial pH <7.15), fetal distress, low Apgar scores, or perinatal deaths.     

产科危重症合并多系统器官功能障碍综合征与母婴结局

目的 :探讨产科危重症合并多系统器官功能障碍综合征 (MODS)与母婴结局的关系 ,以提高产科危重症合并MODS的救治水平。方法 :对 4 8例产科危重症按 1995年重修MODS疾病评分标准进行诊断分析 ,并行多学科综合监护和救治。结果 :4 8例产科危重症 ,产妇死亡 12例 (2 5 .0 % ) ,围生儿死亡 14例 (2 9.17% ) ,母、婴病死率随脏器衰竭数目的增加而增加 (P <0 .0 0 5 ,P <0 .0 5 ) ,与终止妊娠的方式无关 ;围生儿死亡与终止妊娠的时机有关 ,孕周越小病死率越高(P <0 .0 0 5 )。结论 :产科危重症合并MODS的母婴死亡率高 ,抢救难度大 ,采用MODS评分进行产科危重症监护 ,结合产科处理与多学科综合救治方法 ,有利于提高临床监护效果 ,从而提高抢救成功率     

Placental Growth Factor: As an Early Second Trimester Predictive Marker for Preeclampsia in Normal and High-Risk Pregnancies in a Turkish Population

Objective

Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test.

Materials and Methods

In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group.

Results

In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml.

Conclusion

Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.     

Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis

OBJECTIVE: The purpose of this study was to determine whether routine hepatitis C virus screening in pregnancy is cost-effective. STUDY DESIGN: A decision tree with Markov analysis was developed to compare 3 approaches to asymptomatic hepatitis C virus infection in low-risk pregnant women: (1) no hepatitis C virus screening, (2) hepatitis C virus screening and subsequent treatment for progressive disease, and (3) hepatitis C virus screening, subsequent treatment for progressive disease, and elective cesarean delivery to avert perinatal transmission. Lifetime costs and quality-adjusted life years were evaluated for mother and child. RESULTS: In our base case, hepatitis C virus screening and subsequent treatment of progressive disease was dominated (more costly and less effective) by no screening, with an incremental cost of 108 US dollars and a decreased incremental effectiveness of 0.00011 quality-adjusted life years. When compared with no screening, the marginal cost and effectiveness of screening, treatment, and cesarean delivery was 117 US dollars and 0.00010 quality-adjusted life years, respectively, which yields a cost-effectiveness ratio of 1,170,000 US dollars per quality-adjusted life year. CONCLUSION: The screening of asymptomatic pregnant women for hepatitis C virus infection is not cost-effective.