The regionalization concept in perinatal medicine has opened many new areas of information and practice for obstetrical nurses. One of these areas is in electronic fetal monitoring. Since the technique is relatively new to most nurses, the need for in-hospital training is tremendous. This article describes the first steps taken in establishing such an educational program, the expansion of that program to statewide coverage, and the incorporation and expansion of such a program to meet the needs of the area in the regionalization of perinatal health care.

Education, Nursing, Continuing↗

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Perinatal nursing education in Tennessee: a regional approach.

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Education, Continuing↗

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In utero repair of myelomeningocele: a comparison of endoscopy and hysterotomy.

OBJECTIVE: To compare endoscopic coverage of myelomeningocele with a maternal split-thickness skin graft in utero to definitive neurosurgical closure through a hysterotomy. METHODS: Four fetuses with isolated myelomeningocele underwent endoscopic coverage of the defect with a maternal split-thickness skin graft in a CO(2) environment at 22-24 weeks' gestation. Subsequently, 4 fetuses underwent standard neurosurgical closure of their myelomeningoceles at 28-29 weeks' gestation. RESULTS: The mean operating time for the endoscopic procedures was 297 +/- 69 min. Two fetal losses occurred as a result of chorioamnionitis and placental abruption, respectively. A third baby delivered at 28 weeks' gestation after prolonged disruption of the membranes. The 2 survivors required standard closure of the myelomeningocele after delivery. The mean operating time for the hysterotomy procedures was 125 +/- 8 min. No mortality occurred, and all the infants delivered between 33 and 36 weeks with well-healed myelomeningocele scars. At present, the functional levels of all infants approximate the anatomical levels of the lesions. CONCLUSION: With current technology, in utero repair of congenital myelomeningocele through a hysterotomy appears to be technically superior to procedures performed endoscopically.

Adult↗

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The effect of lumbar epidural anesthesia on fetal heart rate baseline variability.

Baseline fetal heart rate (FHR) variability has become an important parameter in the diagnosis of fetal distress when electronically monitoring the fetus. Loss of the baseline variability has been noted to be associated with fetal distress, and in association with late deceleration or severe variable deceleration patterns has been shown to be ominous. Baseline FHR variability, however, has been modified not only by fetal distress but also by prematurity and the administration of certain drugs to the mother. Because FHR is often monitored during labor in parturients given lumbar anesthesia, the question of the effect of this procedure on FHR variability arose. Fifteen such patients with no antepartum or intrapartum complications were studied in active labor. All were monitored by electrocardiography on a continuous basis, FHR being studied before and after epidural anesthesia with lidocaine, with and without epinephrine. Of the 15 patients, tracings in 8 (53 percent) revealed a minimal or moderate change in baseline variability within several minutes of drug injection. This change in variability was recorded from 4 to 18 minutes, after which time the pre-epidural FHR variability was reestablished. Although the mechanism for this result was not definitively determined, such variability in FHR does not in itself seem significant of fetal distress but suggests supportive measures for the patient.

Anesthesia, Epidural↗

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Planning for sex, marriage, contraception, and pregnancy.

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Adolescent↗

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The umbilical artery Doppler ultrasonographic gradient: confirmation, cause, and comparison of continuous-wave and duplex ultrasonographic pulsed-wave measurements.

The umbilical artery Doppler ultrasonographic gradient has been described, and the need for site-specific nomograms has been pointed out. However, controversy still exists about the cause of this phenomenon and the optimal site for obtaining umbilical artery Doppler ultrasonographic measurements. Cross-sectional measurements of umbilical artery flow velocity waveform (FVW) systolic/diastolic (S/D) ratios were therefore made in 35 gravid women during the second or third trimester of pregnancy with both duplex pulsed-wave (PW) and free-standing continuous-wave (CW) Doppler ultrasonographic equipment. Multiple duplex PW Doppler ultrasonographic signals were recorded at the abdominal cord insertion, placental cord insertion, and free cord sites. Multiple CW Doppler FVWs were obtained from four quadrants, in decreasing order of ease of measurement. Repeated-measures analysis of variance demonstrated a statistically significant decrease in mean and median values of the umbilical artery S/D ratio from the abdominal cord insertion site to the placental cord insertion site. The reduction in the value of the S/D ratio as the placental cord insertion site is approached results more from a decrease in the peak systolic maximum velocity envelope than from an increase in diastolic velocities. Moreover, mean and median CW Doppler ultrasonographic values correlate most closely with corresponding PW measurements of the free cord segment. These data confirm the presence of the umbilical artery Doppler ultrasonographic gradient. Decreasing values of the S/D ratio from the fetal abdomen to the placenta are a result of attenuation of the systolic maximum velocity envelope.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗