Qualitative assessment of maternal uterine and fetal umbilical artery blood flow and resistance in laboring patients by Doppler velocimetry

The purpose of this study is to evaluate the effect of uterine contractions during labor on both the uterine and the umbilical circulations. Twenty-seven patients in active labor were studied by continuous-wave Doppler velocimetry. Umbilical, left uterine, and right uterine arterial waveforms were obtained before, during, and after peak uterine contractions, and the ratio of maximum systolic and minimum diastolic velocities was calculated. Fifteen patients showed absent flow in end diastole on the uterine artery waveform and had significantly higher intra-amniotic pressures (64.5 +/- 3.5 mm Hg) during the peak amplitude of the uterine contraction compared with the 12 patients with maintained end diastolic flow (46.5 +/- 2.6 mm Hg; p less than 0.05). During the peak amplitude of the uterine contractions the 12 patients maintaining end-diastolic flow had significantly higher systolic/diastolic ratios in the uterine artery (6.5 +/- 1.5) compared with either before or after a contraction (2.1 +/- 0.15 and 2.0 +/- 0.2, respectively; p less than 0.05). Also, these 12 patients showed a linear relationship between the systolic/diastolic ratio and the intrauterine pressure. However, no differences were observed in the umbilical artery systolic/diastolic ratios before, during, or after a contraction in the intensity range studied. On the contrary, during contractions an increase in uterine artery resistance occurs with decreased or absent end-diastolic flow, which bears an inverse linear relationship to the intensity of the contraction. This suggests that during uterine contractions the human fetus continues to have uninterrupted fetoplacental blood flow, whereas the degree of interruption or reduction in uteroplacental blood flow is dependent on the intensity of uterine contraction.     

Physiological anticoagulants and activated protein C resistance in childhood stroke

Immunological and functional protein S, protein C and antithrombin III levels and anticoagulant responses to activated protein C were measured in 24 patients with stroke in childhood. No hereditary deficiencies were found. The protein S levels in healthy controls of younger age did not differ from the adult levels. For optimal screening of protein S deficiency, measurements using functional as well as immunological assays are recommended. Appropriate criteria for the diagnosis of the deficiencies must be carefully applied if unnecessary anxiety and inappropriate treatment of children are to be avoided.     

Clinical Assessment of Gestational Age

There is disagreement among authors as to what criteria are most reliable in assessing postnatal fetal age. A comparison–for objectivity, accuracy, and frequency of use– of specific criteria was made using three independent examiners at different educational levels: a second-year medical student, a perinatal nurse practitioner, and a pediatrics resident. It was shown that trained examiners develop favorite criteria which differ among examiners and thus sacrifice accuracy; however, accurate assessment of fetal age can be accomplished by an examiner with minimum clinical knowledge.     

Working With Parents Through a Devastating Experience-The Birth of a Mongoloid Child

The author believes that professional advice given the parents of a mongoloid infant determines their initial decision on institutionalization. Multidisciplinary counseling by the health team can help parents decide on a course of action that will prove satisfactory in the long run. Consultation should include health t e r n efforts to help parents work through the mourning process and presentation of a) an objective, comprehensive view of the child's condition, b) information on integrating a mongoloid into the family unit, and c) outside resources available to the parents. Deliberation with the parents to help them reach their own decision is essential.