Obstetrics

BANFF, ALTA. — An attempted external cephalic version and subsequent delivery costs more than a planned cesarean section for a term breech pregnancy, but it is still cost effective, based on national success rates for the maneuver, Jonathan Tan said at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

“ECV [external cephalic version] is cost effective when compared to scheduled cesarean for breech delivery if the probability of ECV success is above 46%,” said Mr. Tan, a medical student at State University of New York at Stony Brook.

“The 58% national average for ECV success in the United States puts us right in the range of cost-effectiveness, but it is still important to note that ECV costs more than a planned cesarean delivery,” Mr. Tan said.

A scheduled cesarean delivery costs around $7,200 while an ECV costs about $1,200 with an additional cost of $5,000 for a vaginal delivery, he said. However, not all ECV attempts are successful, and not all successes result in a vaginal delivery; “there are other indications for cesarean section,” he said.

In his analysis using a computer-based decision model, Mr. Tan used rates from the literature for successful ECV, spontaneous reversion, and probability of unanticipated emergency cesarean to calculate an incremental cost-effectiveness ratio of $31,600 per quality-adjusted life year gained for conducting a trial of ECV.

Although the American College of Obstetricians and Gynecologists currently recommends that all women near term with breech presentations should be offered a trial of ECV (ACOG Practice Bulletin Number 13, 2000), “in many hospitals in the United States, cesarean section is the exclusive method of management,” he said.

BANFF, ALTA. — An attempted external cephalic version and subsequent delivery costs more than a planned cesarean section for a term breech pregnancy, but it is still cost effective, based on national success rates for the maneuver, Jonathan Tan said at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

“ECV [external cephalic version] is cost effective when compared to scheduled cesarean for breech delivery if the probability of ECV success is above 46%,” said Mr. Tan, a medical student at State University of New York at Stony Brook.

“The 58% national average for ECV success in the United States puts us right in the range of cost-effectiveness, but it is still important to note that ECV costs more than a planned cesarean delivery,” Mr. Tan said.

A scheduled cesarean delivery costs around $7,200 while an ECV costs about $1,200 with an additional cost of $5,000 for a vaginal delivery, he said. However, not all ECV attempts are successful, and not all successes result in a vaginal delivery; “there are other indications for cesarean section,” he said.

In his analysis using a computer-based decision model, Mr. Tan used rates from the literature for successful ECV, spontaneous reversion, and probability of unanticipated emergency cesarean to calculate an incremental cost-effectiveness ratio of $31,600 per quality-adjusted life year gained for conducting a trial of ECV.

Although the American College of Obstetricians and Gynecologists currently recommends that all women near term with breech presentations should be offered a trial of ECV (ACOG Practice Bulletin Number 13, 2000), “in many hospitals in the United States, cesarean section is the exclusive method of management,” he said.

BANFF, ALTA. — An attempted external cephalic version and subsequent delivery costs more than a planned cesarean section for a term breech pregnancy, but it is still cost effective, based on national success rates for the maneuver, Jonathan Tan said at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

“ECV [external cephalic version] is cost effective when compared to scheduled cesarean for breech delivery if the probability of ECV success is above 46%,” said Mr. Tan, a medical student at State University of New York at Stony Brook.

“The 58% national average for ECV success in the United States puts us right in the range of cost-effectiveness, but it is still important to note that ECV costs more than a planned cesarean delivery,” Mr. Tan said.

A scheduled cesarean delivery costs around $7,200 while an ECV costs about $1,200 with an additional cost of $5,000 for a vaginal delivery, he said. However, not all ECV attempts are successful, and not all successes result in a vaginal delivery; “there are other indications for cesarean section,” he said.

In his analysis using a computer-based decision model, Mr. Tan used rates from the literature for successful ECV, spontaneous reversion, and probability of unanticipated emergency cesarean to calculate an incremental cost-effectiveness ratio of $31,600 per quality-adjusted life year gained for conducting a trial of ECV.

Although the American College of Obstetricians and Gynecologists currently recommends that all women near term with breech presentations should be offered a trial of ECV (ACOG Practice Bulletin Number 13, 2000), “in many hospitals in the United States, cesarean section is the exclusive method of management,” he said.

SANTIAGO, CHILE — Risk factors affecting a person's vulnerability to posttraumatic stress disorder (PTSD) include factors associated with personal experiences as well as genetic or heritable factors, Rachel Yehuda, Ph.D., said at an international congress sponsored by the World Federation of Societies of Biological Psychiatry.

Trauma can cause symptoms in offspring even though the trauma is experienced vicariously, Dr. Yehuda said. Vulnerability to stress can be biologically transmitted, either through genetic susceptibility or possibly by epigenetic transmission.

Low cortisol levels are associated with PTSD. As might be expected, cortisol levels have been shown to be low in high-risk PTSD subjects immediately after trauma, or in those who actually develop PTSD at follow-up, Dr. Yehuda said. In studies involving adult children of Holocaust survivors, for example, Dr. Yehuda and her colleagues have shown that cortisol levels were significantly lower in the offspring of Holocaust survivors who had PTSD, compared with those whose parents did not have PTSD.

Follow-up studies have shown that maternal, not paternal, PTSD is relevant to cortisol effects in the offspring, said Dr. Yehuda, professor of psychiatry at the Mount Sinai School of Medicine and the James J. Peters VA Medical Center, both in New York.

In a study of women who were pregnant during the Sept. 11, 2001, terrorist attacks in New York City, Dr. Yehuda and her colleagues found that the infants of mothers with PTSD had lower cortisol levels than did infants of those without PTSD (J. Clin. Endocrinol. Metab. 2005;90:4115–8).

Normally, the sympathetic arousal associated with the acute stress decreases over time, and the individual can recall the traumatic event without experiencing physiologic responses. In some people, though, recovery does not take place, and PTSD occurs—sometimes months or even years after the traumatic event.

Early experiences influence the subjective interpretation of events. A person's response to trauma may resemble those of his parents, Dr. Yehuda said. Parents transmit perspectives about the world to their offspring. As a result, parents who suffer from PTSD may have deficits in parenting, and children can “learn” symptoms of stress from their parents.

Subjective interpretation of an event largely determines whether that event is traumatic to a person. What the subject thinks about the event—including why it happened and what could have been done differently—affects the response to trauma. A subject who blames herself for rape, or a subject who feels that an event occurred as punishment from God, may be more likely to experience PTSD than will someone who regards his involvement in the traumatic event as a matter of chance.

PTSD has been recognized as a diagnosis since the publication of the DSM-III. “In the beginning when PTSD was first established, the idea really was to have a diagnostic entity that would explain long-term response to a traumatic event, and the discussions were about what kind of event would give [rise to] PTSD,” Dr. Yehuda said. What has become clear is that most people who are exposed to trauma do not develop this disorder, she noted; “PTSD does occur frequently, but it is more likely not to occur, no matter what traumatic event we are talking about.”

Consequently, the focus has switched from a definition of which traumatic events lead to PTSD to a definition of why some people are more vulnerable, or less resistant, than others to the long-term effects of trauma. Risk factors that affect vulnerability to PTSD include posttraumatic factors, such as retraumatization and lack of social support. Event characteristics, such as injury or intense emotional responses associated with the traumatic event, are pretraumatic factors that can increase the likelihood of PTSD.

In an effort to identify those with greater vulnerability to PTSD, Dr. Yehuda's research has focused on characterizing pretraumatic factors that may contribute to a person's reaction of intense distress.

Unresolved issues in the field of PTSD research include whether there are distinct biologic correlates of different risk factors for PTSD and whether a biologic “final common pathway” exists representing PTSD, Dr. Yehuda said.

SANTIAGO, CHILE — Risk factors affecting a person's vulnerability to posttraumatic stress disorder (PTSD) include factors associated with personal experiences as well as genetic or heritable factors, Rachel Yehuda, Ph.D., said at an international congress sponsored by the World Federation of Societies of Biological Psychiatry.

Trauma can cause symptoms in offspring even though the trauma is experienced vicariously, Dr. Yehuda said. Vulnerability to stress can be biologically transmitted, either through genetic susceptibility or possibly by epigenetic transmission.

Low cortisol levels are associated with PTSD. As might be expected, cortisol levels have been shown to be low in high-risk PTSD subjects immediately after trauma, or in those who actually develop PTSD at follow-up, Dr. Yehuda said. In studies involving adult children of Holocaust survivors, for example, Dr. Yehuda and her colleagues have shown that cortisol levels were significantly lower in the offspring of Holocaust survivors who had PTSD, compared with those whose parents did not have PTSD.

Follow-up studies have shown that maternal, not paternal, PTSD is relevant to cortisol effects in the offspring, said Dr. Yehuda, professor of psychiatry at the Mount Sinai School of Medicine and the James J. Peters VA Medical Center, both in New York.

In a study of women who were pregnant during the Sept. 11, 2001, terrorist attacks in New York City, Dr. Yehuda and her colleagues found that the infants of mothers with PTSD had lower cortisol levels than did infants of those without PTSD (J. Clin. Endocrinol. Metab. 2005;90:4115–8).

Normally, the sympathetic arousal associated with the acute stress decreases over time, and the individual can recall the traumatic event without experiencing physiologic responses. In some people, though, recovery does not take place, and PTSD occurs—sometimes months or even years after the traumatic event.

Early experiences influence the subjective interpretation of events. A person's response to trauma may resemble those of his parents, Dr. Yehuda said. Parents transmit perspectives about the world to their offspring. As a result, parents who suffer from PTSD may have deficits in parenting, and children can “learn” symptoms of stress from their parents.

Subjective interpretation of an event largely determines whether that event is traumatic to a person. What the subject thinks about the event—including why it happened and what could have been done differently—affects the response to trauma. A subject who blames herself for rape, or a subject who feels that an event occurred as punishment from God, may be more likely to experience PTSD than will someone who regards his involvement in the traumatic event as a matter of chance.

PTSD has been recognized as a diagnosis since the publication of the DSM-III. “In the beginning when PTSD was first established, the idea really was to have a diagnostic entity that would explain long-term response to a traumatic event, and the discussions were about what kind of event would give [rise to] PTSD,” Dr. Yehuda said. What has become clear is that most people who are exposed to trauma do not develop this disorder, she noted; “PTSD does occur frequently, but it is more likely not to occur, no matter what traumatic event we are talking about.”

Consequently, the focus has switched from a definition of which traumatic events lead to PTSD to a definition of why some people are more vulnerable, or less resistant, than others to the long-term effects of trauma. Risk factors that affect vulnerability to PTSD include posttraumatic factors, such as retraumatization and lack of social support. Event characteristics, such as injury or intense emotional responses associated with the traumatic event, are pretraumatic factors that can increase the likelihood of PTSD.

In an effort to identify those with greater vulnerability to PTSD, Dr. Yehuda's research has focused on characterizing pretraumatic factors that may contribute to a person's reaction of intense distress.

Unresolved issues in the field of PTSD research include whether there are distinct biologic correlates of different risk factors for PTSD and whether a biologic “final common pathway” exists representing PTSD, Dr. Yehuda said.

SANTIAGO, CHILE — Risk factors affecting a person's vulnerability to posttraumatic stress disorder (PTSD) include factors associated with personal experiences as well as genetic or heritable factors, Rachel Yehuda, Ph.D., said at an international congress sponsored by the World Federation of Societies of Biological Psychiatry.

Trauma can cause symptoms in offspring even though the trauma is experienced vicariously, Dr. Yehuda said. Vulnerability to stress can be biologically transmitted, either through genetic susceptibility or possibly by epigenetic transmission.

Low cortisol levels are associated with PTSD. As might be expected, cortisol levels have been shown to be low in high-risk PTSD subjects immediately after trauma, or in those who actually develop PTSD at follow-up, Dr. Yehuda said. In studies involving adult children of Holocaust survivors, for example, Dr. Yehuda and her colleagues have shown that cortisol levels were significantly lower in the offspring of Holocaust survivors who had PTSD, compared with those whose parents did not have PTSD.

Follow-up studies have shown that maternal, not paternal, PTSD is relevant to cortisol effects in the offspring, said Dr. Yehuda, professor of psychiatry at the Mount Sinai School of Medicine and the James J. Peters VA Medical Center, both in New York.

In a study of women who were pregnant during the Sept. 11, 2001, terrorist attacks in New York City, Dr. Yehuda and her colleagues found that the infants of mothers with PTSD had lower cortisol levels than did infants of those without PTSD (J. Clin. Endocrinol. Metab. 2005;90:4115–8).

Normally, the sympathetic arousal associated with the acute stress decreases over time, and the individual can recall the traumatic event without experiencing physiologic responses. In some people, though, recovery does not take place, and PTSD occurs—sometimes months or even years after the traumatic event.

Early experiences influence the subjective interpretation of events. A person's response to trauma may resemble those of his parents, Dr. Yehuda said. Parents transmit perspectives about the world to their offspring. As a result, parents who suffer from PTSD may have deficits in parenting, and children can “learn” symptoms of stress from their parents.

Subjective interpretation of an event largely determines whether that event is traumatic to a person. What the subject thinks about the event—including why it happened and what could have been done differently—affects the response to trauma. A subject who blames herself for rape, or a subject who feels that an event occurred as punishment from God, may be more likely to experience PTSD than will someone who regards his involvement in the traumatic event as a matter of chance.

PTSD has been recognized as a diagnosis since the publication of the DSM-III. “In the beginning when PTSD was first established, the idea really was to have a diagnostic entity that would explain long-term response to a traumatic event, and the discussions were about what kind of event would give [rise to] PTSD,” Dr. Yehuda said. What has become clear is that most people who are exposed to trauma do not develop this disorder, she noted; “PTSD does occur frequently, but it is more likely not to occur, no matter what traumatic event we are talking about.”

Consequently, the focus has switched from a definition of which traumatic events lead to PTSD to a definition of why some people are more vulnerable, or less resistant, than others to the long-term effects of trauma. Risk factors that affect vulnerability to PTSD include posttraumatic factors, such as retraumatization and lack of social support. Event characteristics, such as injury or intense emotional responses associated with the traumatic event, are pretraumatic factors that can increase the likelihood of PTSD.

In an effort to identify those with greater vulnerability to PTSD, Dr. Yehuda's research has focused on characterizing pretraumatic factors that may contribute to a person's reaction of intense distress.

Unresolved issues in the field of PTSD research include whether there are distinct biologic correlates of different risk factors for PTSD and whether a biologic “final common pathway” exists representing PTSD, Dr. Yehuda said.

TORONTO — Triple antiretroviral therapy during pregnancy was effective for preventing vertical transmission of HIV to newborns, and was not associated with an increased risk of prematurity, significant growth abnormalities, or malformations in a retrospective cohort of 206 mother-infant pairs, Dr. Sophie Alloul reported in a poster at the annual meeting of the Pediatric Academic Societies.

Nucleoside and nucleotide analogue reverse transcriptase inhibitors were used in 205 (99.5%) mothers, protease inhibitors in 177 (86%), nonnucleoside reverse transcriptase inhibitors in 40 (19%), and zidovudine during labor in 202 (98%). Nelfinavir (Viracept) was the most commonly used protease inhibitor. Most women were treated for a median of 20 weeks before delivery. Among newborns, 97% received a 6-week regimen of zidovudine, lamivudine, and nelfinavir from birth.

The transmission rate in the cohort was 0.5%, with only one infant contracting HIV during the study period of 1997–2005, said Dr. Alloul and her colleagues at Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal.

The average gestational age was 38 weeks, and there was one stillbirth. The prevalence of prematurity was 8.5%, and premature infants' median weight was 2,257 g.

Term neonates had a median birth weight of 3,200 g, and 10.3% were small for gestational age (SGA), with a mean weight of 2,208 g. In all, 29 (14%) infants presented with minor malformations.

When compared with a control group of 91 newborns from noninfected, nontreated mothers, the prevalences of prematurity, SGA, and malformations were not significantly different, the authors said.

Centers for Disease Control and Prevention growth parameters—including weight, length, and head circumference—were all within normal range during the first 2 years of life for infants born to treated mothers.

The findings are reassuring, inasmuch as recent data suggest that the use of protease inhibitors is correlated with an increased rate of prematurity in newborns, Dr. Alloul said in an interview.

Triple therapy is now standard of care at CHU Sainte-Justine for all HIV-infected mothers and their offspring, she said.

TORONTO — Triple antiretroviral therapy during pregnancy was effective for preventing vertical transmission of HIV to newborns, and was not associated with an increased risk of prematurity, significant growth abnormalities, or malformations in a retrospective cohort of 206 mother-infant pairs, Dr. Sophie Alloul reported in a poster at the annual meeting of the Pediatric Academic Societies.

Nucleoside and nucleotide analogue reverse transcriptase inhibitors were used in 205 (99.5%) mothers, protease inhibitors in 177 (86%), nonnucleoside reverse transcriptase inhibitors in 40 (19%), and zidovudine during labor in 202 (98%). Nelfinavir (Viracept) was the most commonly used protease inhibitor. Most women were treated for a median of 20 weeks before delivery. Among newborns, 97% received a 6-week regimen of zidovudine, lamivudine, and nelfinavir from birth.

The transmission rate in the cohort was 0.5%, with only one infant contracting HIV during the study period of 1997–2005, said Dr. Alloul and her colleagues at Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal.

The average gestational age was 38 weeks, and there was one stillbirth. The prevalence of prematurity was 8.5%, and premature infants' median weight was 2,257 g.

Term neonates had a median birth weight of 3,200 g, and 10.3% were small for gestational age (SGA), with a mean weight of 2,208 g. In all, 29 (14%) infants presented with minor malformations.

When compared with a control group of 91 newborns from noninfected, nontreated mothers, the prevalences of prematurity, SGA, and malformations were not significantly different, the authors said.

Centers for Disease Control and Prevention growth parameters—including weight, length, and head circumference—were all within normal range during the first 2 years of life for infants born to treated mothers.

The findings are reassuring, inasmuch as recent data suggest that the use of protease inhibitors is correlated with an increased rate of prematurity in newborns, Dr. Alloul said in an interview.

Triple therapy is now standard of care at CHU Sainte-Justine for all HIV-infected mothers and their offspring, she said.

TORONTO — Triple antiretroviral therapy during pregnancy was effective for preventing vertical transmission of HIV to newborns, and was not associated with an increased risk of prematurity, significant growth abnormalities, or malformations in a retrospective cohort of 206 mother-infant pairs, Dr. Sophie Alloul reported in a poster at the annual meeting of the Pediatric Academic Societies.

Nucleoside and nucleotide analogue reverse transcriptase inhibitors were used in 205 (99.5%) mothers, protease inhibitors in 177 (86%), nonnucleoside reverse transcriptase inhibitors in 40 (19%), and zidovudine during labor in 202 (98%). Nelfinavir (Viracept) was the most commonly used protease inhibitor. Most women were treated for a median of 20 weeks before delivery. Among newborns, 97% received a 6-week regimen of zidovudine, lamivudine, and nelfinavir from birth.

The transmission rate in the cohort was 0.5%, with only one infant contracting HIV during the study period of 1997–2005, said Dr. Alloul and her colleagues at Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal.

The average gestational age was 38 weeks, and there was one stillbirth. The prevalence of prematurity was 8.5%, and premature infants' median weight was 2,257 g.

Term neonates had a median birth weight of 3,200 g, and 10.3% were small for gestational age (SGA), with a mean weight of 2,208 g. In all, 29 (14%) infants presented with minor malformations.

When compared with a control group of 91 newborns from noninfected, nontreated mothers, the prevalences of prematurity, SGA, and malformations were not significantly different, the authors said.

Centers for Disease Control and Prevention growth parameters—including weight, length, and head circumference—were all within normal range during the first 2 years of life for infants born to treated mothers.

The findings are reassuring, inasmuch as recent data suggest that the use of protease inhibitors is correlated with an increased rate of prematurity in newborns, Dr. Alloul said in an interview.

Triple therapy is now standard of care at CHU Sainte-Justine for all HIV-infected mothers and their offspring, she said.

MIAMI — Women with problematic substance use during pregnancy prefer integrated treatment over separate obstetric and substance-use care, according to a presentation at the annual conference of the American Society of Addiction Medicine.

The investigators found that women attending one of two integrated programs reported feeling less stigmatization about their substance abuse. They also liked the care they received from consistent providers.

In contrast, those who received isolated substance abuse treatment at a traditional center and obstetric care at a general hospital were less satisfied. Those women reported harsh and punitive treatment from hospital staff that made them feel marginalized, Dr. Lisa G. Lefebvre said during an interview at a poster session.

“Because our program is fairly new … we wanted to get an idea of what women thought,” said Dr. Lefebvre, an addiction medicine consultant with the department of family and community medicine, University of Toronto. Patients tour the maternity ward in advance, and everyone on the staff is trained to be sensitive to their substance use “The women like this [integrated] model,” she said. “They have one doctor who treats pregnancy and everything you'd do for addiction.”

In 2005, researchers used focus groups in Toronto to assess satisfaction among women attending one of two integrated programs—the Toronto Center for Substance Use in Pregnancy or the Herzl Family Practice Centre. Transcripts of these sessions were coded for recurring themes.

The researchers compared the subjects' satisfaction with that of women recruited from the obstetrics department at a general hospital in 1995. Women in the latter group also attended a community substance use treatment center—the Centre for Addiction and Mental Health's addictions program in Toronto.

Women who attended separate programs were less likely to report a good birth experience or to know their obstetrician at delivery. “They had great addiction care but missed obstetric appointments,” Dr. Lefebvre said. Is it possible that the stigma of substance use was worse in 1995? “Even in 2005, when they ended up in another facility, they felt stigma.”

Clinicians in the integrated program encouraged the pregnant women to report themselves to child protection services. Surprisingly, many patients used the services as a resource, Dr. Lefebvre commented.

MIAMI — Women with problematic substance use during pregnancy prefer integrated treatment over separate obstetric and substance-use care, according to a presentation at the annual conference of the American Society of Addiction Medicine.

The investigators found that women attending one of two integrated programs reported feeling less stigmatization about their substance abuse. They also liked the care they received from consistent providers.

In contrast, those who received isolated substance abuse treatment at a traditional center and obstetric care at a general hospital were less satisfied. Those women reported harsh and punitive treatment from hospital staff that made them feel marginalized, Dr. Lisa G. Lefebvre said during an interview at a poster session.

“Because our program is fairly new … we wanted to get an idea of what women thought,” said Dr. Lefebvre, an addiction medicine consultant with the department of family and community medicine, University of Toronto. Patients tour the maternity ward in advance, and everyone on the staff is trained to be sensitive to their substance use “The women like this [integrated] model,” she said. “They have one doctor who treats pregnancy and everything you'd do for addiction.”

In 2005, researchers used focus groups in Toronto to assess satisfaction among women attending one of two integrated programs—the Toronto Center for Substance Use in Pregnancy or the Herzl Family Practice Centre. Transcripts of these sessions were coded for recurring themes.

The researchers compared the subjects' satisfaction with that of women recruited from the obstetrics department at a general hospital in 1995. Women in the latter group also attended a community substance use treatment center—the Centre for Addiction and Mental Health's addictions program in Toronto.

Women who attended separate programs were less likely to report a good birth experience or to know their obstetrician at delivery. “They had great addiction care but missed obstetric appointments,” Dr. Lefebvre said. Is it possible that the stigma of substance use was worse in 1995? “Even in 2005, when they ended up in another facility, they felt stigma.”

Clinicians in the integrated program encouraged the pregnant women to report themselves to child protection services. Surprisingly, many patients used the services as a resource, Dr. Lefebvre commented.

MIAMI — Women with problematic substance use during pregnancy prefer integrated treatment over separate obstetric and substance-use care, according to a presentation at the annual conference of the American Society of Addiction Medicine.

The investigators found that women attending one of two integrated programs reported feeling less stigmatization about their substance abuse. They also liked the care they received from consistent providers.

In contrast, those who received isolated substance abuse treatment at a traditional center and obstetric care at a general hospital were less satisfied. Those women reported harsh and punitive treatment from hospital staff that made them feel marginalized, Dr. Lisa G. Lefebvre said during an interview at a poster session.

“Because our program is fairly new … we wanted to get an idea of what women thought,” said Dr. Lefebvre, an addiction medicine consultant with the department of family and community medicine, University of Toronto. Patients tour the maternity ward in advance, and everyone on the staff is trained to be sensitive to their substance use “The women like this [integrated] model,” she said. “They have one doctor who treats pregnancy and everything you'd do for addiction.”

In 2005, researchers used focus groups in Toronto to assess satisfaction among women attending one of two integrated programs—the Toronto Center for Substance Use in Pregnancy or the Herzl Family Practice Centre. Transcripts of these sessions were coded for recurring themes.

The researchers compared the subjects' satisfaction with that of women recruited from the obstetrics department at a general hospital in 1995. Women in the latter group also attended a community substance use treatment center—the Centre for Addiction and Mental Health's addictions program in Toronto.

Women who attended separate programs were less likely to report a good birth experience or to know their obstetrician at delivery. “They had great addiction care but missed obstetric appointments,” Dr. Lefebvre said. Is it possible that the stigma of substance use was worse in 1995? “Even in 2005, when they ended up in another facility, they felt stigma.”

Clinicians in the integrated program encouraged the pregnant women to report themselves to child protection services. Surprisingly, many patients used the services as a resource, Dr. Lefebvre commented.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

NEW YORK — What physicians and researchers know for sure about physical activity during pregnancy hasn't changed much since the early 1900s, James M. Pivarnik, Ph.D., said at the annual meeting of the Diabetes in Pregnancy Study Group of North America.

Recommendations from the Handbook for Prospective Mothers, published in 1913, advised pregnant women that the amount of exercise needed cannot be precisely stated, walking is the best kind of exercise, and all kinds of violent exertion should be avoided. Although today's recommendations have been more thoroughly researched, they don't provide women with many more definitive answers, said Dr. Pivarnik, director of the Center for Physical Activity and Health at Michigan State University, East Lansing.

But professional medical societies are generally becoming less conservative in their recommendations about exercise for pregnant women. For example, the American College of Obstetricians and Gynecologists has revised its recommendations three times in the last 2 decades and has moved away from strict limits on physical activity.

In 1985, ACOG released its first exercise guidelines for pregnant women, which included time limits for exercise and recommended that a woman's heart rate not exceed 140 beats per minute. However, even these early guidelines included the disclaimer that physically fit pregnant woman may tolerate a more strenuous program.

“There was actually the dispensation way back then but a lot of people just didn't follow that,” Dr. Pivarnik said.

In 1994, ACOG issued updated guidelines that were less cautious and emphasized the benefits of mild to moderate exercise at least 3 days a week. “There was more stress on the health benefits, rather than the fear,” he said.

The most recent ACOG guidelines on exercise in pregnancy were issued in 2002 and address activity among recreational and competitive athletes. Specifically, the guidelines recommend that athletes with uncomplicated pregnancies can remain active during pregnancy and should modify their routines as medically indicated. However, since information on strenuous exercise is limited, these women require close medical supervision.

And most pregnant women without medical or obstetric complications can aim to engage in 30 minutes or more of moderate exercise a day, according to the guidelines.

Guidelines issued in Canada in 2003 by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology take an even more aggressive approach. The joint 2003 guidelines recommend that all women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises during pregnancy.

But some physicians and nurse-midwives who deal with obstetrics are not up to date on the guidelines and still recommend more conservative approaches, such as not exceeding a heart rate of 140 beats per minute, Dr. Pivarnik said. “There's no evidence that that's the way it should be done,” he said.

NEW YORK — What physicians and researchers know for sure about physical activity during pregnancy hasn't changed much since the early 1900s, James M. Pivarnik, Ph.D., said at the annual meeting of the Diabetes in Pregnancy Study Group of North America.

Recommendations from the Handbook for Prospective Mothers, published in 1913, advised pregnant women that the amount of exercise needed cannot be precisely stated, walking is the best kind of exercise, and all kinds of violent exertion should be avoided. Although today's recommendations have been more thoroughly researched, they don't provide women with many more definitive answers, said Dr. Pivarnik, director of the Center for Physical Activity and Health at Michigan State University, East Lansing.

But professional medical societies are generally becoming less conservative in their recommendations about exercise for pregnant women. For example, the American College of Obstetricians and Gynecologists has revised its recommendations three times in the last 2 decades and has moved away from strict limits on physical activity.

In 1985, ACOG released its first exercise guidelines for pregnant women, which included time limits for exercise and recommended that a woman's heart rate not exceed 140 beats per minute. However, even these early guidelines included the disclaimer that physically fit pregnant woman may tolerate a more strenuous program.

“There was actually the dispensation way back then but a lot of people just didn't follow that,” Dr. Pivarnik said.

In 1994, ACOG issued updated guidelines that were less cautious and emphasized the benefits of mild to moderate exercise at least 3 days a week. “There was more stress on the health benefits, rather than the fear,” he said.

The most recent ACOG guidelines on exercise in pregnancy were issued in 2002 and address activity among recreational and competitive athletes. Specifically, the guidelines recommend that athletes with uncomplicated pregnancies can remain active during pregnancy and should modify their routines as medically indicated. However, since information on strenuous exercise is limited, these women require close medical supervision.

And most pregnant women without medical or obstetric complications can aim to engage in 30 minutes or more of moderate exercise a day, according to the guidelines.

Guidelines issued in Canada in 2003 by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology take an even more aggressive approach. The joint 2003 guidelines recommend that all women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises during pregnancy.

But some physicians and nurse-midwives who deal with obstetrics are not up to date on the guidelines and still recommend more conservative approaches, such as not exceeding a heart rate of 140 beats per minute, Dr. Pivarnik said. “There's no evidence that that's the way it should be done,” he said.

NEW YORK — What physicians and researchers know for sure about physical activity during pregnancy hasn't changed much since the early 1900s, James M. Pivarnik, Ph.D., said at the annual meeting of the Diabetes in Pregnancy Study Group of North America.

Recommendations from the Handbook for Prospective Mothers, published in 1913, advised pregnant women that the amount of exercise needed cannot be precisely stated, walking is the best kind of exercise, and all kinds of violent exertion should be avoided. Although today's recommendations have been more thoroughly researched, they don't provide women with many more definitive answers, said Dr. Pivarnik, director of the Center for Physical Activity and Health at Michigan State University, East Lansing.

But professional medical societies are generally becoming less conservative in their recommendations about exercise for pregnant women. For example, the American College of Obstetricians and Gynecologists has revised its recommendations three times in the last 2 decades and has moved away from strict limits on physical activity.

In 1985, ACOG released its first exercise guidelines for pregnant women, which included time limits for exercise and recommended that a woman's heart rate not exceed 140 beats per minute. However, even these early guidelines included the disclaimer that physically fit pregnant woman may tolerate a more strenuous program.

“There was actually the dispensation way back then but a lot of people just didn't follow that,” Dr. Pivarnik said.

In 1994, ACOG issued updated guidelines that were less cautious and emphasized the benefits of mild to moderate exercise at least 3 days a week. “There was more stress on the health benefits, rather than the fear,” he said.

The most recent ACOG guidelines on exercise in pregnancy were issued in 2002 and address activity among recreational and competitive athletes. Specifically, the guidelines recommend that athletes with uncomplicated pregnancies can remain active during pregnancy and should modify their routines as medically indicated. However, since information on strenuous exercise is limited, these women require close medical supervision.

And most pregnant women without medical or obstetric complications can aim to engage in 30 minutes or more of moderate exercise a day, according to the guidelines.

Guidelines issued in Canada in 2003 by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology take an even more aggressive approach. The joint 2003 guidelines recommend that all women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises during pregnancy.

But some physicians and nurse-midwives who deal with obstetrics are not up to date on the guidelines and still recommend more conservative approaches, such as not exceeding a heart rate of 140 beats per minute, Dr. Pivarnik said. “There's no evidence that that's the way it should be done,” he said.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years, the authors said. “We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases.” They also noted the importance of these findings for the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years, the authors said. “We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases.” They also noted the importance of these findings for the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years, the authors said. “We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases.” They also noted the importance of these findings for the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

BANFF, ALTA. — Compared with extraabdominal uterine repair after cesarean section, the intraabdominal technique is associated with significantly less nausea and should be considered as the primary method for uterine repair, according to Dr. Jeanette Lager of the University of North Carolina at Chapel Hill.

“Uterine exteriorization is advantageous when exposure is difficult and many surgeons believe it is easier and more efficient,” said Dr. Lager, who presented her findings at the annual meeting of the Society of Obstetric Anesthesia and Perinatology. Opposition to uterine exteriorization centers on concerns about hemodynamic instability, possible trauma to the uterine structures, and the potential for increased nausea, she said.

In her double-blinded, randomized trial, Dr. Lager found no difference between the two techniques in hemodynamic stability and estimated blood loss, although the intraabdominal technique was associated with a slightly longer operative time. “However, the difference was 7 minutes from skin [incision] to skin [closure] and 1 minute for uterine closure, so one could argue whether this is actually clinically significant,” she commented.

In terms of nausea, measured on a visual analog scale (VAS) ranging from 0 to 10, with 0 representing no nausea, mean nausea scores were considerably less in the 35 patients randomized to intraabdominal repair (2.3), compared with the 36 who received external repairs (4.6), she said. In addition, the rate of moderate to severe nausea was significantly lower in the intraabdominal group (35% vs. 67%). The intraabdominal group also used fewer antiemetics (18% vs. 23%) although this was not statistically significant, and VAS pain scores also showed a nonsignificant trend favoring the intraabdominal group, Dr. Lager said.

“Nausea is one of the most common concerns during cesarean delivery, second only to pain, and can interfere with uterine repair” if the patient is retching, she said, noting that according to an informal review at her hospital, 40% of women are pretreated or require treatment for nausea intraoperatively.

BANFF, ALTA. — Compared with extraabdominal uterine repair after cesarean section, the intraabdominal technique is associated with significantly less nausea and should be considered as the primary method for uterine repair, according to Dr. Jeanette Lager of the University of North Carolina at Chapel Hill.

“Uterine exteriorization is advantageous when exposure is difficult and many surgeons believe it is easier and more efficient,” said Dr. Lager, who presented her findings at the annual meeting of the Society of Obstetric Anesthesia and Perinatology. Opposition to uterine exteriorization centers on concerns about hemodynamic instability, possible trauma to the uterine structures, and the potential for increased nausea, she said.

In her double-blinded, randomized trial, Dr. Lager found no difference between the two techniques in hemodynamic stability and estimated blood loss, although the intraabdominal technique was associated with a slightly longer operative time. “However, the difference was 7 minutes from skin [incision] to skin [closure] and 1 minute for uterine closure, so one could argue whether this is actually clinically significant,” she commented.

In terms of nausea, measured on a visual analog scale (VAS) ranging from 0 to 10, with 0 representing no nausea, mean nausea scores were considerably less in the 35 patients randomized to intraabdominal repair (2.3), compared with the 36 who received external repairs (4.6), she said. In addition, the rate of moderate to severe nausea was significantly lower in the intraabdominal group (35% vs. 67%). The intraabdominal group also used fewer antiemetics (18% vs. 23%) although this was not statistically significant, and VAS pain scores also showed a nonsignificant trend favoring the intraabdominal group, Dr. Lager said.

“Nausea is one of the most common concerns during cesarean delivery, second only to pain, and can interfere with uterine repair” if the patient is retching, she said, noting that according to an informal review at her hospital, 40% of women are pretreated or require treatment for nausea intraoperatively.

BANFF, ALTA. — Compared with extraabdominal uterine repair after cesarean section, the intraabdominal technique is associated with significantly less nausea and should be considered as the primary method for uterine repair, according to Dr. Jeanette Lager of the University of North Carolina at Chapel Hill.

“Uterine exteriorization is advantageous when exposure is difficult and many surgeons believe it is easier and more efficient,” said Dr. Lager, who presented her findings at the annual meeting of the Society of Obstetric Anesthesia and Perinatology. Opposition to uterine exteriorization centers on concerns about hemodynamic instability, possible trauma to the uterine structures, and the potential for increased nausea, she said.

In her double-blinded, randomized trial, Dr. Lager found no difference between the two techniques in hemodynamic stability and estimated blood loss, although the intraabdominal technique was associated with a slightly longer operative time. “However, the difference was 7 minutes from skin [incision] to skin [closure] and 1 minute for uterine closure, so one could argue whether this is actually clinically significant,” she commented.

In terms of nausea, measured on a visual analog scale (VAS) ranging from 0 to 10, with 0 representing no nausea, mean nausea scores were considerably less in the 35 patients randomized to intraabdominal repair (2.3), compared with the 36 who received external repairs (4.6), she said. In addition, the rate of moderate to severe nausea was significantly lower in the intraabdominal group (35% vs. 67%). The intraabdominal group also used fewer antiemetics (18% vs. 23%) although this was not statistically significant, and VAS pain scores also showed a nonsignificant trend favoring the intraabdominal group, Dr. Lager said.

“Nausea is one of the most common concerns during cesarean delivery, second only to pain, and can interfere with uterine repair” if the patient is retching, she said, noting that according to an informal review at her hospital, 40% of women are pretreated or require treatment for nausea intraoperatively.

BANFF, ALTA. — Most obstetric anesthesia malpractice claims for maternal death or brain damage stem from block-related cardiac arrest, primarily caused by inadvertant and unrecognized intrathecal injections, according to an analysis of data from the American Society of Anesthesiologists Closed Claims Project over the last decade.

Careful spinal/epidural placement, both test and incremental dosing, and meticulous management of regional anesthetics would not only reduce this risk but also might reduce claims for more minor injuries, “which are still a very major part of litigation,” said Jo Davies of the department of anesthesiology at the University of Washington Medical Center in Seattle.

The study, which she presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, analyzed a total of 255 claims associated with obstetric regional anesthesia. “The database contains information on closed anesthesia malpractice claims from 35 insurance companies, which cover about 60% of all anesthesiologists in the United States,” she explained.

Out of the 255 claims, the study focused on those associated with maternal death (21), brain damage (15), emotional distress (26), and pain during delivery/surgery (21). The rest of the claims focused on nerve damage, headache, and backache, she said. “As one might expect, payments were most frequently made for the severe and permanent injuries of maternal death and brain damage—with a much lower rate of payment for minor injuries.”

Overall, in more than 50% of cases, anesthetic management met the standard of care, she said. However, care was found to be substandard in more than 60% of brain damage cases.

Claims for emotional distress and for pain during delivery/surgery sometimes overlapped, with patients suing for both. Inadequate block was the only contributing factor in claims for pain during surgery or delivery, with 95% resulting from cesarean rather than vaginal deliveries, she said. But inadequate block also accounted for 31% of emotional distress claims.

“Although some women vehemently refused conversion to general anesthesia and still sued, what is more disturbing are those cases where conversion to general anesthesia was either delayed or never happened—and one case where there was no verification of adequate analgesia prior to incision,” she said.

Other factors that caused emotional distress were high block causing respiratory distress and conversion to general anesthesia (15%), accidental dural puncture (15%), and unprofessional behavior (8%).

Among emotional distress claims, care was adequate in 75% of cases and payment was made in only 25%.

However, among the claims for pain, care was questionable or inadequate in nearly half because of delayed conversion or failure to convert to general anesthesia, and payment was made in 71% of these claims.

Professional conduct, the provision of realistic expectations, and education regarding the risks associated with obstetric anesthesia “may minimize the number of patients unhappy with their obstetric experience using malpractice litigation as a means of emotional vindication,” noted Ms. Davies.

BANFF, ALTA. — Most obstetric anesthesia malpractice claims for maternal death or brain damage stem from block-related cardiac arrest, primarily caused by inadvertant and unrecognized intrathecal injections, according to an analysis of data from the American Society of Anesthesiologists Closed Claims Project over the last decade.

Careful spinal/epidural placement, both test and incremental dosing, and meticulous management of regional anesthetics would not only reduce this risk but also might reduce claims for more minor injuries, “which are still a very major part of litigation,” said Jo Davies of the department of anesthesiology at the University of Washington Medical Center in Seattle.

The study, which she presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, analyzed a total of 255 claims associated with obstetric regional anesthesia. “The database contains information on closed anesthesia malpractice claims from 35 insurance companies, which cover about 60% of all anesthesiologists in the United States,” she explained.

Out of the 255 claims, the study focused on those associated with maternal death (21), brain damage (15), emotional distress (26), and pain during delivery/surgery (21). The rest of the claims focused on nerve damage, headache, and backache, she said. “As one might expect, payments were most frequently made for the severe and permanent injuries of maternal death and brain damage—with a much lower rate of payment for minor injuries.”

Overall, in more than 50% of cases, anesthetic management met the standard of care, she said. However, care was found to be substandard in more than 60% of brain damage cases.

Claims for emotional distress and for pain during delivery/surgery sometimes overlapped, with patients suing for both. Inadequate block was the only contributing factor in claims for pain during surgery or delivery, with 95% resulting from cesarean rather than vaginal deliveries, she said. But inadequate block also accounted for 31% of emotional distress claims.

“Although some women vehemently refused conversion to general anesthesia and still sued, what is more disturbing are those cases where conversion to general anesthesia was either delayed or never happened—and one case where there was no verification of adequate analgesia prior to incision,” she said.

Other factors that caused emotional distress were high block causing respiratory distress and conversion to general anesthesia (15%), accidental dural puncture (15%), and unprofessional behavior (8%).

Among emotional distress claims, care was adequate in 75% of cases and payment was made in only 25%.

However, among the claims for pain, care was questionable or inadequate in nearly half because of delayed conversion or failure to convert to general anesthesia, and payment was made in 71% of these claims.

Professional conduct, the provision of realistic expectations, and education regarding the risks associated with obstetric anesthesia “may minimize the number of patients unhappy with their obstetric experience using malpractice litigation as a means of emotional vindication,” noted Ms. Davies.

BANFF, ALTA. — Most obstetric anesthesia malpractice claims for maternal death or brain damage stem from block-related cardiac arrest, primarily caused by inadvertant and unrecognized intrathecal injections, according to an analysis of data from the American Society of Anesthesiologists Closed Claims Project over the last decade.

Careful spinal/epidural placement, both test and incremental dosing, and meticulous management of regional anesthetics would not only reduce this risk but also might reduce claims for more minor injuries, “which are still a very major part of litigation,” said Jo Davies of the department of anesthesiology at the University of Washington Medical Center in Seattle.

The study, which she presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, analyzed a total of 255 claims associated with obstetric regional anesthesia. “The database contains information on closed anesthesia malpractice claims from 35 insurance companies, which cover about 60% of all anesthesiologists in the United States,” she explained.

Out of the 255 claims, the study focused on those associated with maternal death (21), brain damage (15), emotional distress (26), and pain during delivery/surgery (21). The rest of the claims focused on nerve damage, headache, and backache, she said. “As one might expect, payments were most frequently made for the severe and permanent injuries of maternal death and brain damage—with a much lower rate of payment for minor injuries.”

Overall, in more than 50% of cases, anesthetic management met the standard of care, she said. However, care was found to be substandard in more than 60% of brain damage cases.

Claims for emotional distress and for pain during delivery/surgery sometimes overlapped, with patients suing for both. Inadequate block was the only contributing factor in claims for pain during surgery or delivery, with 95% resulting from cesarean rather than vaginal deliveries, she said. But inadequate block also accounted for 31% of emotional distress claims.

“Although some women vehemently refused conversion to general anesthesia and still sued, what is more disturbing are those cases where conversion to general anesthesia was either delayed or never happened—and one case where there was no verification of adequate analgesia prior to incision,” she said.

Other factors that caused emotional distress were high block causing respiratory distress and conversion to general anesthesia (15%), accidental dural puncture (15%), and unprofessional behavior (8%).

Among emotional distress claims, care was adequate in 75% of cases and payment was made in only 25%.

However, among the claims for pain, care was questionable or inadequate in nearly half because of delayed conversion or failure to convert to general anesthesia, and payment was made in 71% of these claims.

Professional conduct, the provision of realistic expectations, and education regarding the risks associated with obstetric anesthesia “may minimize the number of patients unhappy with their obstetric experience using malpractice litigation as a means of emotional vindication,” noted Ms. Davies.

BANFF, ALTA. — Ultralight doses of epidural analgesia given either as a continuous infusion or as patient-controlled boluses appear to result in comparable pain and Apgar scores as well as medication usage, according to the preliminary results of an ongoing study.

“Our numbers are very small right now, but as soon as we get more I am sure we will see a statistical difference between the two in terms of patient satisfaction,” predicted Dr. Maya Suresh, chief of obstetric anesthesiology at Baylor College of Medicine, Houston. “I think patient-controlled epidural analgesia [PCEA] is advantageous to the patient because she is in control of her own pain. And, if you are not called frequently to intervene or to trouble-shoot that also adds to the provider's satisfaction,” she said in an interview.

The study, presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, is the first to compare outcomes using an ultralight epidural solution of 0.0625% bupivacaine plus 2 mcg/mL fentanyl. Fifteen nulliparous parturients requesting epidural were randomized to the continuous-infusion epidural analgesia (CIEA) arm and received the solution at a dose of 14 L/hr. Another 15 women were randomized to PCEA and received an 8-mL/hr background infusion of the same solution with the option for 5-mL boluses on demand at a 5-minute lockout interval, and an hourly limit of 26 mL, reported Dr. LaToya Mason from the same institution, who presented the study.

There was no statistically significant difference between the groups in umbilical artery pH scores, Apgar scores, or pain scores, said Dr. Mason. All patients had spontaneous vaginal deliveries except for four who had cesareans (two in each group).

BANFF, ALTA. — Ultralight doses of epidural analgesia given either as a continuous infusion or as patient-controlled boluses appear to result in comparable pain and Apgar scores as well as medication usage, according to the preliminary results of an ongoing study.

“Our numbers are very small right now, but as soon as we get more I am sure we will see a statistical difference between the two in terms of patient satisfaction,” predicted Dr. Maya Suresh, chief of obstetric anesthesiology at Baylor College of Medicine, Houston. “I think patient-controlled epidural analgesia [PCEA] is advantageous to the patient because she is in control of her own pain. And, if you are not called frequently to intervene or to trouble-shoot that also adds to the provider's satisfaction,” she said in an interview.

The study, presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, is the first to compare outcomes using an ultralight epidural solution of 0.0625% bupivacaine plus 2 mcg/mL fentanyl. Fifteen nulliparous parturients requesting epidural were randomized to the continuous-infusion epidural analgesia (CIEA) arm and received the solution at a dose of 14 L/hr. Another 15 women were randomized to PCEA and received an 8-mL/hr background infusion of the same solution with the option for 5-mL boluses on demand at a 5-minute lockout interval, and an hourly limit of 26 mL, reported Dr. LaToya Mason from the same institution, who presented the study.

There was no statistically significant difference between the groups in umbilical artery pH scores, Apgar scores, or pain scores, said Dr. Mason. All patients had spontaneous vaginal deliveries except for four who had cesareans (two in each group).

BANFF, ALTA. — Ultralight doses of epidural analgesia given either as a continuous infusion or as patient-controlled boluses appear to result in comparable pain and Apgar scores as well as medication usage, according to the preliminary results of an ongoing study.

“Our numbers are very small right now, but as soon as we get more I am sure we will see a statistical difference between the two in terms of patient satisfaction,” predicted Dr. Maya Suresh, chief of obstetric anesthesiology at Baylor College of Medicine, Houston. “I think patient-controlled epidural analgesia [PCEA] is advantageous to the patient because she is in control of her own pain. And, if you are not called frequently to intervene or to trouble-shoot that also adds to the provider's satisfaction,” she said in an interview.

The study, presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, is the first to compare outcomes using an ultralight epidural solution of 0.0625% bupivacaine plus 2 mcg/mL fentanyl. Fifteen nulliparous parturients requesting epidural were randomized to the continuous-infusion epidural analgesia (CIEA) arm and received the solution at a dose of 14 L/hr. Another 15 women were randomized to PCEA and received an 8-mL/hr background infusion of the same solution with the option for 5-mL boluses on demand at a 5-minute lockout interval, and an hourly limit of 26 mL, reported Dr. LaToya Mason from the same institution, who presented the study.

There was no statistically significant difference between the groups in umbilical artery pH scores, Apgar scores, or pain scores, said Dr. Mason. All patients had spontaneous vaginal deliveries except for four who had cesareans (two in each group).