Methods:The analysis was performed for the 90 patients during first period of labor who have been hospitalized in II Gynecology and Obstetrics Clinic of Medical University in Wroclaw. All the patients have been monitored in Labor Room with continuous electronic CTG monitoring with computerized analysis of FHR tracings. Doppler ultrasound examination in fetal umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) has been performed with portable ultrasound system Voluson I. After cutting off the umbilical cord gas analysis from umbilical artery or vein has been made. Results: There is a statistically significant correlation between pH, pCO2, HCO3 and BE parameters of postpartum gas analysis and Doppler flow parameters in UA and cerebral to placental blood flow ratio (CPR-PIMCA/PIUA). The most significant value in differentiation of fetal condition has respectively been proven for the S/D, RI, PI parameter from UA and CPR ratio. ROC analysis has revealed S/D UA sensitivity reaching 64%, RI UA-57%, PI UA-50%, CPR-43%, with specificity 93%. For the MCA Doppler flow parameters and computerized analysis of CTG tracings sensitivity has reached 7%. Only in the group of patients with abnormal outcomes of computerized analysis of CTG tracings confirmed by abnormal intrapartum Doppler ultrasound examination the postpartum state of a neonate was connected with deterioration of parameters of postpartum gas analysis. Conclusions: Umbilical artery parameters S/D, PI, RI and CPR ratio are statistically significant in predicting fetal condition based on postpartum umbilical cord gas analysis and are useful in verification of abnormal parameters of computerized analysis of CTG tracings.
with no history or an uncertain history of exposure to chicken pox pre-pregnancy is not currently a national screening recommendation in the UK.In the North-west of London, over 80% of our drainage population is non-Caucasian and the rate of seronegativity at the start of pregnancy may be higher.The aim of our review was to ascertain prevalence of primary varicella infection in pregnancy in our population and compare management with RCOG recommendations. Methods: A retrospective review was carried out for the period February 2012-February 2013 using our fetal medicine software 'Astria' and blood results were accessed using local trust-wide online results system.Details were cross checked with a register maintained in the fetal medicine unit (FMU). Results: Out of 30 women identified with varicella exposure, data for 28 was available.64% of these women were in the 20-30 years age group and 57% were primiparous.50% were exposed at a gestation of <13 weeks, 25% between 13-20 weeks and around 11% at >20 weeks.14 out of 28 women were found to be non-immune (50%). VZIg was only documented as given in 9 of these cases. Nine women went on to develop chicken pox but only 7 were given Aciclovir. All these women were referred to FMU and overall 72 scans were performed for them. 75% of them were normal. Detected abnormalities included: Increased nuchal fold thickness (2), Echogenic bowel (2), Oligohydramnios (1), Polyhydramnios (1) and Ventricular ectopic beats (1). Conclusions: Although a recent study demonstrated cost effectiveness of antenatal varicella screening, this is not currently part of UK screening programme.Ultrasound monitoring of exposed pregnancies places considerable burden on FMU workload.Compliance with unit policy in prompt availability of VZIg and Aciclovir for suitable women in our unit was suboptimal.
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