As nitrogen entering coastal waters continues to be an issue, much attention has been generated to identify potential options that may help alleviate this stressor to estuaries, including the ...propagation of bivalves to remove excess nitrogen. Oysters (Crassostrea virginica) and quahogs (Mercenaria mercenaria) from numerous Cape Cod, MA, (USA) sources were analyzed for nitrogen content stored in tissues that would represent a net removal of nitrogen from a water body if harvested. Results showed local oysters average 0.69% nitrogen by total dry weight (mean 0.28gN/animal) and quahogs average 0.67% nitrogen by total dry weight (mean 0.22gN/animal); however, these values did vary by season and to a lesser extent by location or grow-out method. The differences in nitrogen content were largely related to the mass of shell or soft tissue. Nitrogen isotope data indicate shellfish from certain water bodies in the region are incorporating significant amounts of nitrogen from anthropogenic sources.
•Oyster and quahog nitrogen content values are reported from a variety of sources.•Nitrogen content in oysters is affected by grow-out methodology.•Season of harvest affects bivalve nitrogen bioextraction potential.•Δ15N suggests potential for wastewater related bioextraction in certain regions.
Aim
To evaluate the cardiotocography (CTG) features observed in suspected intrapartum chorioamnionitis in term fetuses according to the recently suggested criteria for the pathophysiological ...interpretation of the fetal heart rate and their correlation with perinatal outcomes.
Methods
Retrospective analysis of nonconsecutive CTG traces. ‘CTG chorioamnionitis’ was diagnosed either based on a persistent rise in the baseline for the given gestation or on a persistent increase in the baseline fetal heart rate during labor >10% without preceding CTG signs of hypoxia and in the absence of maternal pyrexia. Perinatal outcomes were compared among cases with no sign of chorioamnionitis, in those with only CTG features suspicious for chorioamnionitis and in those who developed clinical chorioamnionitis.
Results
Two thousand one hundred and five CTG traces were analyzed. Of these, 356 fulfilled the criteria for “CTG chorioamnionitis”. Higher rates of Apgar <7 at 1 and 5 min (21.6% vs 9.0% and 9.8% vs 2.0%, respectively, P < 0.01 for both) and lower umbilical artery pH (7.14 ± 0.11 vs 7.19 ± 0.11, P < 0.01) and an over fivefold higher rate of neonatal intensive care unit admission (16.6% vs 2.9%, P < 0.01) were noted in the ‘CTG chorioamnionitis’ group. Differences in the incidence of abnormal CTG patterns were noted between cases who eventually had clinical evidence of chorioamnionitis (89/356) and those showing CTG features suspicious for chorioamnionitis in the absence of clinical evidence of chorioamnionitis (267/356).
Conclusion
Intrapartum CTG features of suspected chorioamnionitis are associated with adverse perinatal outcomes.
To determine the perinatal outcomes in fetuses with baseline fetal heart rate changes with preceding decelerations on the cardiotocography (CTG) trace, and to interpret CTG traces from the aspect of ...fetal physiology.
A retrospective analysis of 500 consecutive CTG traces was carried out. The presence of repetitive variable and late decelerations followed by the changes in the baseline including baseline tachycardia and abnormal baseline variability were determined. Perinatal outcomes including Apgar scores and umbilical arterial pH at birth, NNU admission, and meconium-stained amniotic fluid were analyzed. We interpreted the changes in CTG based on fetal physiology.
When repetitive variable and late decelerations were present without tachycardia (n = 81), none of the fetuses had an Apgar score <7 at 5 minutes or an umbilical cord pH <7. After the onset of fetal tachycardia (n = 262), fetuses showed decreased Apgar scores and umbilical arterial pH(p < .01), however, there was no significant difference in the rate of abnormal 5 min Apgar score, abnormal PH and NNU admission, if the baseline variability remained normal. However, if the baseline variability was abnormal (n = 44), (either increased or reduced) after tachycardia, there was a statistically significant increase in poor perinatal outcomes. Fetuses with abnormal versus normal variability had lower Apgar scores ≤7 at 5 min (29.6 versus 0.9%, p = .000); umbilical cord arterial pH <7 at birth (29.5 versus 0%, p = .000); increased admission to the NNU (27.3 versus 3.7%, p = .000) and increased incidence of meconium-stained amniotic fluid (38.6 versus 22.5%, p = .024). These serial changes in CTG could be interpreted and predicted by the application of fetal physiology.
There were significant differences in perinatal outcomes when fetuses were exposed to evolving intrapartum hypoxic stress culminating in an abnormal baseline fetal heart rate variability, which was preceded by repetitive decelerations, followed by an increase in the baseline heart rate. However, despite ongoing decelerations, if the baseline variability remained normal, none of the fetuses had a pH of <7. Therefore, the knowledge of fetal physiological response to evolving hypoxic stress can be reliably used to determine fetal compensation.
Introduction: Instrumental vaginal delivery (IVD) helps expedite delivery during second stage of labour so as to avoid a second stage caesarean section. However, due to mechanical effects on the ...fetal head, vacuum and forceps may cause cardiotocograph (CTG) abnormalities due to vigal stimulation as well as increased intracranial pressure.
Objective: To determine the features observed on the CTG during IVD in term pregnancy and correlate them to perinatal outcomes.
Methods: A retrospective analysis of 445 cases who had vacuum deliveries (227) and forceps deliveries (218) at St. George's University Hospitals NHS Foundation Trust during a 12-month period was performed. CTG features were analysed at 10 minutes prior to and immediately after applications of the chosen instrument till delivery. Specific abnormalities were correlated to Apgar score and umbilical blood pH.
Results: Specific CTG abnormalities after applications of vacuum and forceps were: tachycardia (99 (43.61%) versus 88 (40.37%)), increased baseline fetal heart rate (FHR) 14 (6.17%) versus 4 (1.83%) p = .0204, baro-receptor-mediated "variable" deceleration (101 (44.49%) versus 85 (38.99%)), chemoreceptor-mediated "late" deceleration (62 (27.31%) versus 76 (34.86%)), prolonged deceleration (32 (14.10%) versus 24 (11.01%)), saltatory pattern 35 (15.42%) versus 76 (34.86%) p < .0001, and reduced baseline variability (10 (4.41%) versus 7 (3.21%)). There were no significant differences in the mean Apgar Scores at 1 and 5 minutes between ventouse and forceps delivery (8 and 9, respectively) or the umbilical blood pH (both >7.20).
Conclusions: After application of instruments, 90% of CTG traces showed abnormal features. Tachycardia, baro- and chemoreceptor-mediated decelerations, and saltatory patterns were the most common abnormalities. Increased baseline FHR during vacuum as compared to forceps delivery was possibly secondary to pain/pressure and resultant sympathetic overactivity. The saltatory pattern was more common in forceps deliveries, possibly secondary to increased intracranial pressure and resultant autonomic instability. Despite these CTG abnormalities, the perinatal outcomes were good.
Electronic foetal monitoring using cardiotocography is aimed at the timely recognition and management of foetal hypoxia. The primary objective of this study was to examine whether a relationship ...exists between the types of foetal hypoxia (acute, subacute, evolving, chronic), as identified on cardiotocography and the nature of hypoxic ischaemic encephalopathy, as observed on MRI scans after birth. We conducted a retrospective study of 16 babies born (out of 52,187 births) at St George's Hospital in London during 2006-2017 with a postnatal diagnosis of HIE. Of the 16 babies, only 11 had both MRI scans and CTG traces available. Of those, 9 showed evidence of intrapartum hypoxia on CTG, but only 6 demonstrated evidence of HIE on MRI. Those with acute hypoxia showed abnormalities in the basal ganglia and thalami. A gradually evolving hypoxia or subacute hypoxia was associated with lesions in myelination and cerebral cortex.
Impact Statement
What is already known on this subject? It has been reported that inter-observer agreement for CTG interpretation is low (30%) when pattern recognition based guidelines are used (Rhöse et al.
2014
; Reif et al.
2016
), even amongst 'experts' (Hruban et al.
2015
). Furthermore, it has been shown that CTG traces do not reliably predict neonatal encephalopathy (Spencer et al.
1997
).
What do the results of this study add? Our study indicates that if 'types of intrapartum hypoxia' are used for interpretation, then inter-observer agreement increases to 81%, from the reported 30% when traces are classified into 'normal, suspicious and pathological' using guidelines based on 'pattern recognition'. Furthermore, our study shows a good correlation between the type of intrapartum hypoxia observed on CTG trace and the nature of injury observed on the MRI.
What are the implications of these findings for clinical practise and/or further research? Improving inter-observer agreement of CTGs with the use of pattern recognition in combination with the good correlation to MRI scan findings ultimately leads to better management and post-natal outcomes. This is evidenced by the fact that after the introduction of physiology-based CTG interpretation and mandatory competency testing on CTG interpretation for all staff in 2010, St. George's Maternity Unit has half the nationally reported rate of cerebral palsy.
To describe feasibility, adherence, acceptability, and outcomes of a cognitive-behavioral-based physical therapy (CBPT-ACLR) intervention for improving postoperative recovery after anterior cruciate ...ligament reconstruction (ACLR).
Pilot study.
Academic medical center.
Eight patients (mean age SD = 20.1 2.6 years, 6 females) participated in a 7-session telephone-based CBPT-ACLR intervention beginning preoperatively and lasting 8 weeks after surgery.
At 6 months, patients completed Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life (QOL) subscales, International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), and Knee Self-Efficacy Scale (K-SES), return to sport (Subjective Patient Outcome for Return to Sports), and satisfaction. Minimal clinically important difference (MCID) was used for meaningful change.
Seven (88%) patients completed all sessions. Seven (88%) patients exceeded MCID on the TSK, 6 (75%) on the PCS, 5 (63%) on the KOOS sports/recreation subscale, 4 (50%) on the IKDC, and 3 (38%) on the KOOS QOL subscale. Three (38%) patients returned to their same sport at the same level of effort and performance. All patients were satisfied with their recovery.
A CBPT-ACLR program is feasible and acceptable for addressing psychological risk factors after ACLR.
•Limited evidence exists on psychologically-informed rehabilitation after anterior cruciate ligament reconstruction (ACLR).•A cognitive-behavioral based physical therapy (CBPT-ACLR) intervention may be a beneficial approach for return to sport.•The CBPT-ACLR intervention is feasible to implement prior to and after ACLR.•The CBPT-ACLR intervention is acceptable to patients based on adherence and positive feedback on intervention components.
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