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Nasr El-Din WA, Potu BK, Fadel RA, Salem AH, Sequeira RP, Almarabheh A, El-Fark MMO. Impact of maternal topiramate ingestion on ossification of skull and appendicular bones in rat fetuses. Morphologie 2024; 108:100702. [PMID: 37890283 DOI: 10.1016/j.morpho.2023.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 10/29/2023]
Abstract
The skull and appendicular bones are derived from different embryological sources during their development. The impact of prenatal exposure of topiramate on ossification of these bones is not adequately studied. The goal of this study was to assess the ossification patterns of the craniofacial bones and bones of the forelimbs and hindlimbs in 20-day-old rat fetuses after maternal exposure to topiramate at doses equivalent to human therapeutic doses. Three groups of Sprague-Dawley pregnant rats were used: control, topiramate 50mg/kg/day (T50) and topiramate 100mg/kg/day (T100). Topiramate was given by oral gavage from day 6 to day19 of gestation. Ossification was evaluated in the bones of 20 days fetuses after staining with Alizarin red. Results showed a significant reduction in complete ossified centers of the metacarpal, metatarsal and craniofacial bones in topiramate-exposed fetuses at both doses when compared to the control group. Also, a significant decrease in the length of ossified part of the long bones of the forelimbs and hindlimbs in topiramate-exposed fetuses at both doses was noted when compared to the control group. Crown-rump length and fetal weight were significantly decreased in topiramate treated groups compared to the control group. In all examined groups, there was a positive correlation between the crown-rump length and the lengths of humerus and femur. No abnormalities in the ossified bones and no significant changes in their ossification pattern were observed between the treated groups. In conclusion, prenatal administration of topiramate in doses equivalent to human therapeutic doses delayed ossification and development of craniofacial and appendicular bones in rat fetuses and their effects are not dose dependent at doses investigated. The implications of these findings in women who require topiramate therapy in pregnancy merit further evaluation.
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Affiliation(s)
- W A Nasr El-Din
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - B K Potu
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
| | - R A Fadel
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - A H Salem
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - R P Sequeira
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - A Almarabheh
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - M M O El-Fark
- Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Nahian A, Mahomed K. Decreased fetal movements - An audit of predictors and an evaluation of management based on a locally developed flow chart. Eur J Obstet Gynecol Reprod Biol 2023; 290:67-73. [PMID: 37738889 DOI: 10.1016/j.ejogrb.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Decreased fetal movements (DFM) is associated with adverse pregnancy outcomes. We aimed to look at the risk factors associated with DFM and outcomes of women who presented with and without DFM and outcomes before and after the implementation of a locally developed flow chart based on an evidence-based guideline. STUDY DESIGN This was a retrospective audit of 1165 women ≥ 28 weeks' gestation with a singleton pregnancy who presented with concerns regarding DFM. We compared labor and neonatal outcomes to 4706 in a control group who did not present with concerns regarding FM. We also compared the same pregnancy outcomes before and after the implementation of hospital guidelines on the management of DFM. Statistical analyses were performed primarily using Chi square analysis and relative risk. RESULTS AND CONCLUSIONS 1165 women presented 1645 times with DFM. Women presenting with DFM were younger, (82.8% vs 79.0%, p= <0.01 were 20 to 34-years old), tended to have a higher BMI (42.9% vs 34.4%, p=<0.001 with BMI ≥ 30) and were more likely to have mental health conditions (31.1% vs 24.2%, p=<0.01). There was no difference in the composite neonatal outcome including stillbirth, 5 min APGAR < 7 and Special Care Nursery (SCN) admission between DFM and control (22.9 vs 24.8% respectively, P = 0.18). There was no difference in perinatal outcomes pre- and post-implementation of the hospital guidelines on DFM management. Women presenting with DFM were more likely to have an induction (40.7% vs 29.9% p=<0.01) but not more likely to have a caesarean section (30.9% vs 28.8% respectively, p = 0.16). There were increasing rates of IOL with increasing number of presentations for DFM. Adoption of and adherence to locally developed guidelines was an opportunity to ensure all clinicians provide consistent advice on management and timing of birth for women presenting with DFM.
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Affiliation(s)
- Antara Nahian
- Department of Obstetrics, Ipswich Hospital. 1 Chelmsford Ave, Ipswich, Queensland 4305, Australia.
| | - Kassam Mahomed
- Department of Obstetrics and Gynaecology, Ipswich Hospital and University of Queensland, Chelmsford Avenue, Ipswich, QLD 4305, Australia.
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Ficarola F, Svelato A, Angioli R, Rossi R, D'Avino S, DE Luca C, Rinaldo D, Ragusa A. Reduced fetal movements: the case of Fetomaternal Hemorrhage. Case series and proposal of a management protocol. Minerva Obstet Gynecol 2021; 74:386-392. [PMID: 34904586 DOI: 10.23736/s2724-606x.21.04972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fetomaternal hemorrhage (FMH) was reported more than 60 years ago for the first time defined by the transfer or transfusion of fetal blood into the maternal circulation before or during delivery. The transfused volume is usually very small but when this value exceeds, it may be clinically significant. Antenatal diagnosis of severe FMH is difficult and it can be suspected in case of reduction of fetal movements, abnormal cardiotocography and ultrasound. FMH is associated to different adverse outcomes and admission to neonatal intensive care. The low incidence of FMH limits the studies, thus being able to rely only on diagnosis and retrospective studies. We present case series of FMH and analyze the steps with the purpose of defining a flow-chart for early diagnosis and management of FMH.
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Affiliation(s)
- Fernando Ficarola
- Department of Obstetrics and Gynecology, Policlinico Campus Bio-Medico, Rome, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy -
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Policlinico Campus Bio-Medico, Rome, Italy
| | - Rita Rossi
- Department of Obstetrics and Gynecology, Massa Carrara General Hospital, Massa Carrara, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Caterina DE Luca
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Denise Rinaldo
- Department of Obstetrics and Gynecology, Bolognini General Hospital, Seriate, Bergamo, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
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4
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Thompson JMD, Wilson J, Bradford BF, Li M, Cronin RS, Gordon A, Raynes-Greenow CH, Stacey T, Cullling VM, Askie LM, O'Brien LM, Mitchell EA, McCowan LME, Heazell AEP. A better understanding of the association between maternal perception of foetal movements and late stillbirth-findings from an individual participant data meta-analysis. BMC Med 2021; 19:267. [PMID: 34775977 PMCID: PMC8591897 DOI: 10.1186/s12916-021-02140-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late stillbirth continues to affect 3-4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at the greatest odds of stillbirth in relation to the maternal report of foetal movements in late pregnancy (≥ 28 weeks' gestation). METHODS This is an individual participant data meta-analysis of all identified case-control studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the UK and an internet-based study based out of the USA. There were a total of 851 late stillbirths, and 2257 controls with ongoing pregnancies. RESULTS Increasing strength of foetal movements was the most commonly reported (> 60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted odds ratio (aOR) = 0.20, 95% CI 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last 2 weeks had increased odds of late stillbirth (aOR = 2.33, 95% CI 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28-36 weeks' gestation). Foetal hiccups (aOR = 0.45, 95% CI 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67, 95% CI 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86, 95% CI 2.01 to 4.07), which was higher in women at term. CONCLUSIONS Reduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks' gestation, whereas a single episode of vigorous movement is associated with stillbirth at term.
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Affiliation(s)
- John M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand. .,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jessica Wilson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand.,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Billie F Bradford
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand.,School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Minglan Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | | | - Tomasina Stacey
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, UK
| | - Vicki M Cullling
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Lisa M Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Louise M O'Brien
- Departments of Neurology Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA.,Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Alexander E P Heazell
- Division of Developmental Biology & Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, England, UK
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Delay U, Nawarathne T, Dissanayake S, Gunarathne S, Withanage T, Godaliyadda R, Rathnayake C, Ekanayake P, Wijayakulasooriya J. Novel non-invasive in-house fabricated wearable system with a hybrid algorithm for fetal movement recognition. PLoS One 2021; 16:e0254560. [PMID: 34255780 PMCID: PMC8277045 DOI: 10.1371/journal.pone.0254560] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Fetal movement count monitoring is one of the most commonly used methods of assessing fetal well-being. While few methods are available to monitor fetal movements, they consist of several adverse qualities such as unreliability as well as the inability to be conducted in a non-clinical setting. Therefore, this research was conducted to design a complete system that will enable pregnant mothers to monitor fetal movement at home. This system consists of a non-invasive, non-transmitting sensor unit that can be fabricated at a low cost. An accelerometer was utilized as the primary sensor and a micro-controller based circuit was implemented. Clinical testing was conducted utilizing this sensor unit. Two phases of clinical testing procedures were done and during the first phase readings from 120 mothers were taken while during the second phase readings from 15 mothers were taken. Validation was done by conducting an abdominal ultrasound scan which was utilized as the ground truth during the second phase of the clinical testing procedure. A clinical survey was also conducted in parallel with clinical testings in order to improve the sensor unit as well as to improve the final system. Four different signal processing algorithms were implemented on the data set and the performance of each was compared with each other. Out of the four algorithms three algorithms were able to obtain a true positive rate around 85%. However, the best algorithm was selected on the basis of minimizing the false positive rate. Consequently, the most feasible as well as the best performing algorithm was determined and it was utilized in the final system. This algorithm have a true positive rate of 86% and a false positive rate of 7% Furthermore, a mobile application was also developed to be used with the sensor unit by pregnant mothers. Finally, a complete end to end method to monitor fetal movement in a non-clinical setting was presented by the proposed system.
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Affiliation(s)
- Upekha Delay
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thoshara Nawarathne
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sajan Dissanayake
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Samitha Gunarathne
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thanushi Withanage
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Roshan Godaliyadda
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chathura Rathnayake
- Department of Obstetrics and Gynacology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Parakrama Ekanayake
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Janaka Wijayakulasooriya
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, Sri Lanka
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6
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Koshida S, Ono T, Tsuji S, Murakami T, Arima H, Takahashi K. Fetal movement frequency and the effect of associated perinatal factors: Multicenter study. Women Birth 2018; 32:127-130. [PMID: 31007206 DOI: 10.1016/j.wombi.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Decreased fetal movements are associated with adverse perinatal outcomes, including stillbirth. Delayed maternal visits to a health care provider after perceiving decreased fetal movements are frequently observed in stillbirths. Informing pregnant women of the normal range of fetal movement frequency is essential in their earlier visits in order to prevent stillbirth. AIM To investigate the fetal movement frequency in late pregnancy and the effects of associated perinatal factors. METHODS This prospective multicenter study was conducted in 20 obstetric facilities in our region of Japan. A total of 2337 pregnant women were asked to record the time it took to perceive 10 fetal movements by the modified 'count to 10' method every day from 34weeks of gestation until delivery. FINDINGS The 90th percentile of the time for the maternal perception of 10 fetal movements was 18-29min, with a gradually increasing trend toward the end of pregnancy. The numbers of both pregnant women giving birth after 39weeks' gestation and infants with a birth weight exceeding 3000g were significantly higher in mothers who took ≥30min to count 10 fetal movements than in those who took <30min. CONCLUSION The maternal perception time of fetal movements shows a gradually increasing trend within 30min for 10 fetal movements by the modified 'count to 10' method. Informing pregnant women of the normal range of the fetal movement count time will help improve the maternal recognition of decreased fetal movements, which might prevent fetal death in late pregnancy.
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Affiliation(s)
- Shigeki Koshida
- Perinatal Center, Shiga University of Medical Science, Japan.
| | - Tetsuo Ono
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine & Public Health, Fukuoka University, Japan
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7
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Fetal optimization during maternal sepsis: relevance and response of the obstetric anesthesiologist. Curr Opin Anaesthesiol 2014; 27:259-66. [PMID: 24709666 DOI: 10.1097/aco.0000000000000077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In many labor and delivery units, the obstetric anesthesiologist is often responsible for managing and stabilizing the acutely septic parturient. The management of maternal sepsis has been summarized previously; this study will focus on the implications of maternal sepsis on the fetus, and ways to optimize fetal outcomes. RECENT FINDINGS Although the complex pathophysiology of sepsis is being better understood, the incidence of maternal severe sepsis and deaths continues to increase. The differential sensitivities of systemic and uterine vasculature to catecholamines during pregnancy and the role of fetal inflammatory responses have recently been further elucidated. Additional investigations on methods of fetal monitoring are needed to assist in early identification of the compromised fetus. Despite decades of research, management of a septic parturient and her fetus, including the most appropriate resuscitation fluids, vasopressors and hemodynamic monitoring systems to maximize maternal and fetal outcomes, remain controversial. SUMMARY In the setting of maternal sepsis, fetal optimization is frequently best accomplished by meeting maternal hemodynamic, oxygenization, and infection treatment goals. Understanding the circulatory and pathophysiologic changes that occur within the uteroplacental unit and fetus is essential to identifying and resolving potential conflicts between maternal and fetal management goals.
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Christensen FC, Olson K, Rayburn WF. Cross-over trial comparing maternal acceptance of two fetal movement charts. J Matern Fetal Neonatal Med 2009; 14:118-22. [PMID: 14629093 DOI: 10.1080/jmf.14.2.118.122] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare two daily fetal movement charting techniques to determine which chart was preferred by patients and which promoted more patient adherence. METHODS This randomized trial included patients with singleton gestations between 28 and 34 weeks' gestation, with intact membranes and not in labor. Consenting women were given a Hollister chart and a 'count to 10' chart in a cross-over manner over two consecutive 1-week periods. Each patient answered a questionnaire establishing which chart was preferred. All returned charts were evaluated for patient adherence. Data were analyzed using either the Yates-corrected chi2 test or Fisher's exact test when appropriate. RESULTS Forty patients agreed to participate, and 31 completed and returned both charts. The 'count to 10' chart was clearly preferred over the Hollister chart (29 vs. 2; p = 0.002) because of the shorter recording period (median 23 min vs. 1 h; p < 0.01). The proportion of patients who fully completed the 'count to 10' chart during the week was significantly higher than the proportion completing the Hollister chart (68% vs. 26%; p < 0.001). CONCLUSION The 'count to 10' fetal movement chart was clearly preferred and promoted a higher level of adherence.
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Affiliation(s)
- F C Christensen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, New Mexico 87131, USA
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10
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Singh G, Sidhu K. Daily Fetal Movement Count Chart : Reducing Perinatal Mortality in Low Risk Pregnancy. Med J Armed Forces India 2008; 64:212-3. [PMID: 27408147 DOI: 10.1016/s0377-1237(08)80094-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 08/09/2007] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND A reduction or cessation of fetal movements (FMs) is frequently reported by pregnant women resulting in anxiety and concern. Formal counting of FMs by the pregnant woman could possibly identify the fetuses at risk. METHODS A prospective study was carried out over 500 booked cases after introducing daily fetal movement count (DFMC) Chart in the ninth month of pregnancy. Prior ultrasound (USG) was done in all cases. DFMC chart was used to record number of fetal movements perceived by patient for one hour after food (breakfast, lunch, dinner). Fetal movements were considered satisfactory if the count was three or more on each occasion. RESULT During the study period, no fetus was lost after introduction of DFMC chart in the 250 cases that were given DFMC chart and delivered in our hospital (Nil perinatal mortality). This was compared with 250 booked cases that were not given DFMC chart but had normal ultrasound done after completion of eight months of pregnancy and followed up. Five intrauterine deaths occurred in the ninth month in control group (2% perinatal mortality). In the DFMC chart group, 15 patients were admitted with decreased fetal movements. Out of these, 12 were discharged after monitoring for three days and three cases were delivered. CONCLUSION DFMC chart in ninth month of pregnancy helps in identifying at risk fetus in low risk pregnancies in absence of any other adverse factors necessitating early delivery.
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Affiliation(s)
- G Singh
- Classified Specialist (Obstetrics & Gynaecology), Amritsar Cantt, 143001
| | - K Sidhu
- GD Matron, Military Hospital, Amritsar Cantt, 143001
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11
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Kuwata T, Matsubara S, Ohkusa T, Ohkuchi A, Izumi A, Watanabe T, Suzuki M. Establishing a reference value for the frequency of fetal movements using modified ‘count to 10’ method. J Obstet Gynaecol Res 2008; 34:318-23. [PMID: 18588609 DOI: 10.1111/j.1447-0756.2008.00791.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan
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12
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Olesen AG, Svare JA. Decreased fetal movements: background, assessment, and clinical management. Acta Obstet Gynecol Scand 2004; 83:818-26. [PMID: 15315592 DOI: 10.1111/j.0001-6349.2004.00603.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A reduction or cessation of fetal movements (FMs) is frequently reported by pregnant women and causes concern and anxiety. However, the clinical significance of a history of reduced FMs remains unclear, and the assessment and management of these pregnancies is controversial. This article is a review of the literature on decreased FMs found in medline and the cochrane library using the search phrases: decreased FMs, perinatal outcome, FM monitoring, and fetal assessment. Formal counting of FMs by the pregnant woman could possibly identify the fetuses, which are at risk of compromise, thus allowing for appropriate action. However, the benefit of this intervention has not been definitely proven. Cardiotocography, umbilical/uterine artery Doppler velocimetry, and ultrasonography have been used for antepartum fetal assessment in pregnancies with decreased FMs, but the evidence of a clinical benefit is limited. The effects of fetal assessment with vibroacoustic stimulation and biophysical profile are unknown and should be further evaluated. Present recommendations on the management of pregnancies with decreased FMs are based on limited and inconsistent scientific evidence. There is a need for further well-designed studies in order to provide evidence-based guidelines in the future.
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Affiliation(s)
- Anette G Olesen
- Department of Obstetrics and Gynecology, Glostrup University Hospital, Copenhagen, Denmark.
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13
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Armour K. Antepartum maternal-fetal assessment. Using surveillance to improve maternal and fetal outcomes. ACTA ACUST UNITED AC 2004; 8:232-40. [PMID: 15305597 DOI: 10.1177/1091592304267576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kim Armour
- Central DuPage Hospital, Winfield, IL, USA
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14
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Lam G, Moise K. Antenatal Surveillance in Preeclampsia and Chronic Hypertension. Hypertens Pregnancy 2002. [DOI: 10.1201/b14088-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
A large number of molecular, cellular, and epidemiologic factors have been implicated in the regulation of bone development. A major unsolved problem is how to integrate these disparate findings into a concept that explains the development of bone as an organ. Often events on the organ level are simply presented as the cumulative effect of all factors that individually are known to influence bone development. In such a cumulative model it must be assumed that each bone cell carries the construction plan of the entire skeletal anatomy in its genes. This scenario is implausible, because it would require an astronomical amount of positional information. We therefore propose a functional model of bone development, which is based on Frost's mechanostat theory. In this model the genome only provides positional information for the basic outline of the skeleton as a cartilaginous template. Thereafter, bone cell action is coordinated by the mechanical requirements of the bone. When mechanical challenges exceed an acceptable level (the mechanostat set point), bone tissue is added at the location where it is mechanically necessary. The main mechanical challenges during growth result from increases in bone length and in muscle force. Hormones, nutrition, and environmental factors exert an effect on bone either directly by modifying the mechanostat system or indirectly by influencing longitudinal bone growth or muscle force. Predictions based on this model are in accordance with observations on prenatal, early postnatal, and pubertal bone development. We propose that future studies on bone development should address topics that can be derived from the mechanostat model.
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Affiliation(s)
- F Rauch
- Children's Hospital, University of Cologne, 50924 Cologne, Germany.
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