Home care of high risk pregnant women by advanced practice nurses: nurse time consumed.
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This study examined the time spent by advanced practice nurses (APNs) in providing prenatal care to women with high risk pregnancies. The results indicate that the overall mean APN time spent in providing prenatal care was 51.3 hours per woman. The greatest amount of time was spent in the clinic and women with pregestational diabetes consumed the most APN time and required the most contacts. Historically, home care services have been measured by number of visits or contacts. This study assists home care nurses and administrators to consider additional measurements including time spent. (+info)
Fetal growth rate and adverse perinatal events.
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OBJECTIVE: To study fetal weight gain and its association with adverse perinatal events in a serially scanned high-risk population. SUBJECTS AND METHODS: A total of 200 pregnant women considered at increased risk of uteroplacental insufficiency had a total of 1140 scans in the third trimester, with a median of six scans in each pregnancy. The average fetal growth rate was retrospectively calculated for the last 6 weeks to birth, and expressed as daily weight gain in grams per day. Adverse pregnancy outcome was defined as operative delivery for fetal distress, acidotic umbilical artery pH (< 7.15), or admission to the neonatal intensive care unit (NICU). RESULTS: Fetuses with normal outcome in this high-risk pregnancy population had an average antenatal growth rate of 24.2 g/day. Compared to pregnancies with normal outcome, the growth rate was slower in those that required operative delivery for fetal distress (20.9 g/day, p < 0.05) and those that required admission to the NICU (20.3 g/day, p < 0.05). The growth rate in pregnancies resulting in acidotic umbilical artery pH also seemed lower, but this did not reach statistical significance. CONCLUSIONS: Impaired fetal weight gain prior to birth is associated with adverse perinatal events suggestive of growth failure. (+info)
Can transvaginal fetal biometry be considered a useful tool for early detection of skeletal dysplasias in high-risk patients?
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OBJECTIVE: To evaluate the possibility of an early diagnosis of skeletal dysplasias in high-risk patients. METHODS: A total of 149 consecutive, uncomplicated singleton pregnancies at 9-13 weeks' amenorrhea, with certain menstrual history and regular cycles, were investigated with transvaginal ultrasound to establish the relationship between femur length and menstrual age, biparietal diameter and crown-rump length, using a polynomial regression model. A further eight patients with previous skeletal dysplasias in a total of 13 pregnancies were evaluated with serial examinations every 2 weeks from 10-11 weeks. RESULTS: A significant correlation between femur length and crown-rump length and biparietal diameter was found, whereas none was observed between femur length and menstrual age. Of the five cases with skeletal dysplasias, only two (one with recurrent osteogenesis imperfecta and one with recurrent achondrogenesis) were diagnosed in the first trimester. CONCLUSIONS: An early evaluation of fetal morphology in conjunction with the use of biometric charts of femur length against crown-rump length and femur length against biparietal diameter may be crucial for early diagnosis of severe skeletal dysplasias. By contrast, in less severe cases, biometric evaluation appears to be of no value for diagnosis. (+info)
Fetal yawning activity in normal and high-risk fetuses: a preliminary observation.
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OBJECTIVE: To study yawning activity in healthy fetuses and in fetuses at high risk. METHODS: Yawning activity was studied in 16 healthy and 22 high-risk fetuses. Studies were performed in the postprandial state at 09.00 and 12.00 in a quiet room with the woman in the lateral recumbent position. All ultrasound examinations were performed using a 3.5-MHz Acuson 128 PX curvilinear probe. Fetal lips, mouth, tongue, pharynx, larynx, trachea and esophagus were surveyed in serial coronal and sagittal planes. All fetal mouthing movements were analyzed by a review of the videotape in slow motion. RESULTS: In both normal and high-risk fetuses, yawning was represented by isolated mouthing movements and consisted of slow opening of the mouth with simultaneous downward movements of the tongue. This phase occupied 50-75% of the yawning cycle. After reaching its maximum opening, the mouth remained wide open for 2-8 s and returned to its resting position within seconds. Growth-restricted fetuses demonstrated yawning patterns consisting of isolated yawns similar to those seen in healthy fetuses. Unusual bursts of fetal yawning activity were recorded in anemic fetuses. CONCLUSION: Yawning activity in anemic fetuses may represent a compensatory process to increase venous return to the heart. (+info)
The role of medical problems and behavioral risks in explaining patterns of prenatal care use among high-risk women.
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OBJECTIVE: To examine the associations between maternal medical conditions and behavioral risks and the patterns of prenatal care use among high-risk women. DATA SOURCE/STUDY DESIGN: Data on over 25,000 high-risk deliveries to African American and white women using multinomial logistic regression to predict the odds of adequate-plus care relative to three other categories of care. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from records maintained by the University of Florida/Shands Hospital maternity clinic on all deliveries between 1987 and 1994; records for white and for African American women were subset to examine racial differences in medical conditions, health behaviors, and patterns of prenatal care use. PRINCIPAL FINDINGS: Net of sociodemographic and fertility-related characteristics, African American and white women with late antepartum conditions and hypertension problems had significantly higher odds of receiving adequate-plus care, as well as no care or inadequate care, relative to adequate care. White women with gynecological disease and medical/surgical problems were significantly less likely to receive no care or inadequate care, as were African American women with gynecological disease. CONCLUSIONS: Maternal medical conditions explain much but not all of the adequate-plus prenatal care use. More than 13 percent of African American women and 20 percent of white women with no reported medical problems or behavioral risks used adequate-plus care. Additional research is needed to understand this excess use and its possibilities in mediating birth outcomes. (+info)
Maternal age- and gestation-specific risk for trisomy 21.
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OBJECTIVE: To provide estimates of maternal age- and gestational age-related risks for trisomy 21. METHODS: The prevalence of trisomy 21 was examined in 57,614 women who had fetal karyotyping at 9-16 weeks of gestation for the sole indication of maternal age of 35 years or more. On the basis of the maternal age distribution and the reported maternal age-related risk for trisomy 21 at birth, the expected number of trisomy 21 cases was calculated for each gestational age subgroup (9-10 weeks, 11-14 weeks and 15-16 weeks). The ratio of the observed to expected number of cases of trisomy 21 was then calculated and regression analysis was applied to derive a smoothened curve. The formula for maternal age- and gestational age-related risk was then applied to a population of 96,127 pregnancies that were examined at 10-14 weeks to calculate the expected number of trisomy 21 pregnancies, and this number was compared to the observed number of 326. RESULTS: In the 57,614 pregnancies there were 538 cases of trisomy 21. The relative prevalences of trisomy 21, compared to a prevalence of 1.0 at 40 weeks, was 10 exp(0.2718 x log(10)(gestation)2 - 1.023 x log10(gestation) + 0.9425). On the basis of the estimated maternal age- and gestational age-related risks, the expected number of trisomy 21 cases at 10-14 weeks of gestation in the 96,127 pregnancies was 329 (95% confidence interval 291-361), which was not significantly different from the observed number of 326 cases (chi2 = 0.02). CONCLUSION: The risk for trisomy 21 increases with maternal age and decreases with gestation. The prevalence of trisomy 21 at 12 and 16 weeks of gestation is higher than the prevalence at 40 weeks by 30% and 21%, respectively. (+info)
Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at-risk patient population.
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The objective of this study was to determine the relative risk for aneuploidy in the presence of a cardiac intraventricular echogenic focus in a patient population at high risk for aneuploidy. A retrospective cohort study was conducted on patients referred to a fetal diagnostic center who were undergoing amniocentesis. Records and second trimester sonograms were reviewed. Approximately 5100 comprehensive prenatal sonograms were obtained over a 2 year study period. Karyotyping by amniocentesis was done in 2412 women; 84 of the karyotypes (3.5%) were abnormal. Fetuses with no ultrasonographic findings suggestive of aneuploidy had a 1.4% (28 of 1940) prevalence of significant chromosomal abnormalities. An intraventricular echogenic focus was found in 149 of the women with karyotype analysis; 15 had an abnormal karyotype. Fetuses with intraventricular echogenic foci had a relative risk of 3.30 of aneuploidy when compared to fetuses without echogenic cardiac foci. The presence of an isolated intraventricular echogenic focus carried a relative risk of 4.08 compared to those fetuses in which ultrasonography had no finding associated with aneuploidy. In conclusion, these preliminary data indicate that presence of an intraventricular echogenic cardiac focus carries an increased risk of fetal aneuploidy. (+info)
Influence of parity on the obstetric performance of mothers aged 40 years and above.
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We reviewed the delivery records of 205 mothers aged 40 years and above who delivered from 1st January 1994 to 31st December 1996 to examine the influence of parity on their obstetric performance. There were 51 (24.9%) primiparous mothers. The incidences of antenatal complications (antepartum haemorrhage, hypertensive disorder, glucose intolerance, prematurity), labour performance (type of labour, mode of delivery) and neonatal outcome (birth weight, Apgar scores, neonatal intensive care unit admission, perinatal mortality) were compared between the 51 (24.9%) primiparous and the 154 (75.1%) multiparous mothers. Higher incidences of antepartum haemorrhage (17.6 versus 5.8%, P = 0.0188), hypertensive disorder (17.6 versus 5.2%, P = 0.015), labour induction (33.3 versus 14.3%, P = 0.004) and Caesarean section delivery (58.8 versus 20.8%, P < 0.0001) were found among the primiparous mothers than the multiparous group. Neonatal outcome, however, was similar in both groups. We conclude that the primiparous mothers aged 40 years and above had more complicated antenatal and labour courses than multiparous mothers. On the other hand, the neonatal outcomes of two groups were comparable. (+info)