Home uterine activity monitoring in a rural setting

Article Abstract:

Since preterm labor is a major cause of preterm birth, preterm prevention programs focus on identifying patients at risk for early delivery. When preterm labor is diagnosed early, effective management strategies can be instituted early before delivery becomes inevitable. A home monitoring device (tocodynamometer) measures patterns of uterine contractions with a good deal of accuracy even before signs and symptoms of labor are perceived by the patient. The monitor records and transmits uterine activity via the telephone to perinatal nurses. When home monitoring of high-risk patients is used in conjunction with daily nursing contact, the diagnosis of preterm labor is greatly improved. It would seem that this system would be particularly useful for high-risk patients residing in rural areas that do not have specialized facilities close by. Decisions to transfer patients to high-risk high-cost centers or to treat them in hospitals less equipped for preterm complications are difficult to make. To see if this home monitoring system can benefit patients residing in a rural area, 25 women at risk for preterm delivery were studied. The home monitoring system reduced patient anxiety by allowing them to remain in their community close to their families. Physicians felt confident that they could manage these high-risk patients effectively because the monitors detected labor early enough to allow for transport to high-risk centers. In addition, daily contact with the facility receiving the monitored transmissions allowed the health care provider to conference daily with perinatal specialists in high-risk centers who could help make treatment decisions. Therefore, home monitoring devices that measure uterine activity daily can be a useful in managing patients at risk for early delivery who live in rural areas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Premature labor, Premature birth, Rural health services

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Administration of heparin by subcutaneous infusion with a programmable pump

Article Abstract:

A potentially serious complication of pregnancy is deep venous thrombosis (a clot in a deep vein). The clot can dislodge and move to the lungs (pulmonary embolism), which is associated with a mortality of 15 percent. The risk of pulmonary embolism is substantially reduced by the administration of anticoagulant (anticlotting) drugs. However, the most commonly used such drug for ambulatory patients is warfarin, known to be associated with birth defects if given during pregnancy. Another anticoagulant, sodium heparin, needs to be injected several times each day, and patients may fail to comply with such a regimen. To evaluate the effectiveness of continuous administration of heparin using a programmable pump implanted under the skin (subcutaneously), a retrospective study was carried out with 16 patients. Eight used the pump and another eight had intermittent subcutaneous injections of heparin. Treatment started when the women were at approximately 27 weeks gestation. All subjects had histories of deep venous thrombosis or emboli before pregnancy. The continuous infusion group used more heparin per day than the injection group and had longer mean partial thromboplastin times (a measure of clotting). This indicates a smoother, more therapeutic delivery of heparin was provided with the infusion method. Two complications (bruising and infection at the injection site) occurred in the subcutaneous infusion group; no complications were noted in the continuous infusion group. These results are more favorable than those reported by other studies and may reflect the type of equipment used. Use of the heparin infusion pump in pregnancy seems safe and effective, and should be explored further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Pulmonary embolism, Dosage and administration, Pregnancy, Complications of, Pregnancy complications, Heparin, Drug infusion pumps

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Similar abstracts:

• Abstracts: Home uterine activity monitoring is associated with a reduction in preterm birth. Uterine activity compared with symptomatology in the detection of preterm labor
• Abstracts: Uterine activity and symptoms as predictors of preterm labor
• Abstracts: The contribution of symptomatology and/or uterine activity to the incidence of unscheduled visits. Characteristics of uterine activity in gestations less than 20 weeks

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