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Using a computerised analysis, the cardiotocograph (CTG) from women who use methadone (n = 25) when compared with women who do not use methadone (n = 25) showed a significant reduction in the fetal heart baseline rate, with a significant reduction in number of accelerations and episodes of high variation. The short-term variation, number of decelerations and episodes of low variation were not different between the two groups. The time taken to meet the standardised criteria was not different, and it is possible that a computer-assisted CTG analysis could be more accurate than a naked eye interpretation.Keywords CTG, methadone, pregnancy.Please cite this paper as: Navaneethakrishnan R, Tutty S, Sinha C, Lindow S. The effect of maternal methadone use on the fetal heart pattern: a computerised CTG analysis. BJOG 2006; 113:948-950. IntroductionMethadone is an opiate commonly used in substitution therapy for heroin-dependent pregnant women. It is known to cross the placenta, and previous workers have suggested that changes in the fetal heart parameters can be seen in a nonstress cardiotocograph (CTG). [1][2][3] The evaluation of the CTG is an important tool to ensure fetal wellbeing in these high-risk pregnancies, and if there are consistent predictable changes to the fetal heart pattern, the changes should be identified and taken into account when a woman using methadone has a CTG performed. Interpretational differences between doctors make objective evaluation difficult; however, computer-aided CTG analysis makes an objective evaluation possible.This study was conducted to document any change in fetal heart patterns in methadone-using women compared with women not using methadone when tested with a nonstress CTG and evaluated using a computer-assisted analysis. MethodsThe CTG characteristics from women using only methadone were compared with a gestational-age-matched and paritymatched control group of women who were not using opiates. Women using methadone were recruited from the antenatal clinic at a gestational age between 28 weeks and 40 weeks.Women who had any condition that may affect fetal heart parameters such as medication, hypertension, diabetes, abnormal umbilical artery Doppler waveforms or liquor volume abnormalities were excluded. The control group of women were recruited from those attending a routine antenatal clinic or who had attended the antenatal day unit for a problem unrelated to pregnancy. Their consent was obtained for CTG, Doppler and liquor volume estimation. The CTG analysis was performed objectively using the computerised package by Sonicaid TM Fetalcare Ò (Huntleigh Healthcare Limited, Cardiff, UK) 4 to avoid inter-observer and intra-observer errors. The results were interpreted using SPSS version 9 statistical package (SPSS Inc., Chicago, IL, USA) using Mann-Whitney U test for all parameters. ResultsFifty women were studied, 25 in each group. The mean gestational age in the methadone group was 35.2 weeks and in the control group 35.7 weeks, and majority of the women were nulliparous in ...

INTRODUCTION: Primary care is responsible for the 17% of the population with mild to moderately severe mental illness. Total Healthcare Otara (THO), with 49% of its patients of Pacific ethnicity, presents an opportunity to study the primary care management of depression, inclusive of Pacific people. While it had been assumed that Pacific people in New Zealand suffer less mental illness, Te Rau Hinengaro: The New Zealand Mental Health Survey showed this is not the case. AIM: The aim of the study was to examine a Chronic Care Management (CCM) programme for depression in a predominantly Pacific practice. METHODS: A clinical audit of the CCM depression programme used by THO between 31 March 2009 and 30 September 2010. Participants were patients aged 18–64 years who scored =15 on the Patient Health Questionnaire-9 (PHQ-9). Computer templates completed for each consultation, including serial PHQ-9s, were analysed over time and across different ethnic groups. RESULTS: Cook Island Maori patients participated in the CCM depression programme in proportionally greater numbers than their enrolment in THO, while Samoan and Tongan patients participated significantly less. The mean PHQ-9 score fell rapidly over the first few visits and then levelled off, without reaching the normal range. Dropout rate was 60% after the third consultation irrespective of ethnicity or gender. DISCUSSION: There is a need for ethnic-specific research into depression in Pacific ethnic groups. A significant immediate improvement in PHQ-9 on entering the CCM depression programme suggests enrolment is therapeutic. However, further research into the CCM depression programme is needed, particularly the reasons for non-attendance. KEYWORDS: Case management; depression; oceanic ancestry group; Pacific Islands; primary health care

This study suggests that the current practice of calculating the risk of Down syndrome from second trimester biochemistry in women using opiate can be performed using data derived from a normal population.