Disproportionate Intrauterine Growth Intervention Trial At Term: DIGITAT

Contains fulltext : 65628.pdf ( ) (Open Access)BACKGROUND: Around 80% of intrauterine growth restricted (IUGR) infants are born at term. They have an increase in perinatal mortality and morbidity including behavioral problems, minor developmental delay and spastic cerebral palsy. Management is controversial, in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance. We propose a randomised trial to compare effectiveness, costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term. METHODS/DESIGN: The proposed trial is a multi-centre randomised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36+0 and 41+0 weeks. After informed consent women will be randomly allocated to either induction of labour or expectant management with maternal and fetal monitoring. Randomisation will be web-based. The primary outcome measure will be a composite neonatal morbidity and mortality. Secondary outcomes will be severe maternal morbidity, maternal quality of life and costs. Moreover, we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry (Child Behavioral Check List-CBCL and Ages and Stages Questionnaire-ASQ). Analysis will be by intention to treat. Quality of life analysis and a preference study will also be performed in the same study population. Health technology assessment with an economic analysis is part of this so called Digitat trial (Disproportionate Intrauterine Growth Intervention Trial At Term). The study aims to include 325 patients per arm. DISCUSSION: This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality, costs and maternal quality of life aspects. This will be the first randomised trial for IUGR at term. TRIAL REGISTRATION: Dutch Trial Register and ISRCTN-Register: ISRCTN10363217

Evaluation of spent coffee obtained from the most common coffeemakers as a source of hydrophilic bioactive compounds

The main hydrophilic antioxidant compounds (3-, 4-, and 5-monocaffeoylquinic and 3,4-, 3,5-, and 4,5-dicaffeoylquinic acids, caffeine, and browned compounds, including melanoidins) and the antioxidant capacity (Folin-Ciocalteu, ABTS, DPPH, Fremy's salt, and TEMPO) were evaluated in Arabica and Robusta spent coffee obtained from the preparation of coffee brews with the most common coffeemakers (filter, espresso, plunger, and mocha). All spent coffee grounds, with the exception of those from the mocha coffeemaker, had relevant amounts of total caffeoylquinic acids (6.22-13.24 mg/g of spent coffee), mainly dicaffeoylquinic acids (3.31-5.79 mg/g of spent coffee), which were 4-7-fold higher than in their respective coffee brews. Caffeine ranged from 3.59 to 8.09 mg/g of spent coffee. The antioxidant capacities of the aqueous spent coffee extracts were 46.0-102.3% (filter), 59.2-85.6% (espresso), and <42% (plunger) in comparison to their respective coffee brews. This study obtained spent coffee extracts with antioxidant properties that can be used as a good source of hydrophilic bioactive compounds

Effects of hypoxemic events on breathing, body movements, and heart-rate variation - a study in growth-retarded human fetuses

In 14 growth-retarded human fetuses, breathing and body movements were studied before, during, and after late heart rate decelerations. Heart rate variation was measured before and after the decelerations. Breathing and body movements were significantly reduced during and after the deceleration. Heart rate variation was reduced after the decelerative episode. Since late heart rate decelerations are presumably signs of acute fetal hypoxemia, there is evidence that these reductions are caused by hypoxemia. The results suggest, furthermore, that just as in fetal sheep, these changes might be mediated by a change in brain activity state

Fetal behavior at 30 to 32 weeks of gestation

Coordinated behavior states with concomitant variation in cyclic patterns of heart rate and of eye and gross body movements are present in the near term fetus. As in the newborn infant, there is conflicting evidence concerning their relationship at earlier gestational ages. In the present study 120-min recordings were made of fetal heart rate, eye, and gross body movements in 11 healthy nulliparous women who were 30 to 32 wk pregnant. From the presented data it is concluded that at this gestational age heart rate variation and eye and gross body movements are not independent variables and that coordination among the cyclic patterns of these variables starts well before 36 wk

Maternal temperature during labour

OBJECTIVE: The aim of this study was to describe the variation of normal maternal temperature during labour. Design A prospective cohort study. SETTING: Two hospitals in Amsterdam, the Netherlands. POPULATION: All women with a live singleton pregnancy and a gestational age of 36 weeks or more admitted to the delivery ward from June 2000 to January 2002. METHODS: Maternal temperature was measured rectally every 2-3 hours from admission until the beginning of second stage, and 1-hour postpartum. Normal labour (n = 843) was defined as gestational age > or =37 weeks, spontaneous onset of labour, rupture of membranes 0.05) but increased thereafter. CONCLUSIONS: At the beginning of labour, temperature was 37.1 degrees C. Temperature increased slowly during labour and was 37.4 degrees C (2SD 1.2) after 22 hours. The upper 2SD limit for normal temperature did not follow a circadian pattern and time of day is not relevant for the classification of normal versus elevated temperatur

Een spontane leverbloeding tijdens de zwangerschap: een zeldzame, levensbedreigende situatie

Three pregnant women, of whom 2 were 33 and 1 was 35 years of age, were seen; 2 of them had upper abdominal pain and 1had oedema. All had proteinuria and liver enzyme abnormalities, and pre-eclampsia or the HELLP syndrome was suspected. They were consequently admitted and at first treated with antihypertensive agents. One patient underwent a Caesarean section and the baby had a good start. Afterwards, however, the patient developed shock. A CT-scan revealed a hepatic rupture, for which repeated surgical packing of the liver was carried out. The postoperative course was complicated. A second patient developed shock and the foetus died. Here the CT-scan revealed a liver haematoma. At surgery the next day, removal of the foetus was followed by heavy uterine bleeding. The patient again developed shock and the uterus was resected. A haematoma that was seen in the liver was treated expectatively. The postoperative course was not complicated. In a third patient, abdominal echography revealed bleeding from the liver. Simultaneous Caesarean section and surgical exploration of the liver took place, with packing of the liver. The child had Apgar scores of 4, 7 and 9. After re-laparotomy because of persistent bleeding from the liver the patient recovered. Spontaneous liver haemorrhage and hepatic rupture during pregnancy is a rare condition associated with significant maternal and perinatal mortality. The majority of cases occur during pregnancies complicated by pre-eclampsia or the HELLP syndrome. The presenting symptoms are non-specific. A high index of suspicion is important and early evaluation with imaging is necessary to improve the prognosis of both mother and chil