Publications (2)6.29 Total impact
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ABSTRACT: The objective of this study was to assess clinical effects and logistical feasibility of acupuncture given during labor and delivery in a U.S. hospital setting. A case-control pilot study was conducted with 45 parturients receiving acupuncture during labor and delivery alongside standard care. Primary outcome endpoints were incidence of cesarean section, amount of parenteral opioids used, use of epidural anesthesia, and duration of labor. Secondary endpoints included patient satisfaction and nursing staff acceptance as assessed by postpartum questionnaire, maximum flow rate of oxytocin, incidence of instrumental delivery, Apgar score, and incidence of adverse event. Forty-five (45) patients receiving acupuncture were compared to 127 historical controls matched for maternal age, gestational age, parity, and use of oxytocin (augmentation and induction were matched separately). Acupuncture patients underwent significantly fewer cesarean sections (7% versus 20%, p = 0.004). No significant differences were noted in other clinical endpoints. Seventy-eight percent (78%) of nurses reported a subjective perception of improvement in patients' comfort with acupuncture, while 83% reported that the acupuncturists' presence never interfered with their work. Eighty-seven percent (87%) of patients reported that acupuncture had helped them. Acupuncture during labor and delivery is well tolerated by patients and medical staff. It should be further evaluated for its promise in potentially reducing the incidence of cesarean section.
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ABSTRACT: The purpose of this study was to evaluate the ability to screen for structural fetal anomalies during the nuchal translucency (NT) ultrasound examination, without performing a complete anatomic fetal scan, by using the sagittal views of the fetus. In a prospective study, we evaluated all the suspected structural findings observed during the NT examinations performed in our Division of Maternal-Fetal Medicine in 2004-2005. The purpose of the examination was to screen for fetal chromosome abnormalities by using the fetal NT measurements. However, the sonographers were instructed to pay attention to any abnormality observed while obtaining the sagittal views of the fetus. Other views were not to be obtained and fetal anatomy scan was performed only if a structural fetal anomaly was suspected when viewing the fetus in sagittal planes. When a structural fetal anomaly was suspected, a fetal anatomy scan was performed, and then a diagnosis was established at 14-16 weeks' gestation or later. We performed 1723 NT examinations during the study period. The sonographers suspected structural fetal anomalies in 22 cases (1.3%), most of them performed between 11.2 and 13 weeks' gestation. Further evaluation of these cases diagnosed 9 fetuses (0.52%) with structural anomalies including: acrania, holoprosencephaly, Dandy-Walker syndrome, cerebellar agenesis, prune belly syndrome, 2 cases of omphalocele, and 2 cases of cleft lip. The NT was abnormal (greater than 3 mm) in only 1 case (omphalocele). None of the additional 8 cases diagnosed with structural anomalies had a positive maternal serum screening result for trisomy 21. Eight of these 9 fetal structural anomalies were sonographically confirmed at 14-16 weeks' gestation and the remaining 1 was confirmed at 20 weeks' gestation. An additional 13 noncardiac structural anomalies were detected in the study group during routine fetal anatomy scan performed at 14-16 or at 18-24 weeks' gestation. Four of these 9 fetal cardiac defects (44%) were diagnosed by an early fetal echocardiography performed for an increased fetal NT. In addition to chromosomal anomalies and congenital cardiac defects, the NT examination can provide an opportunity to screen for structural fetal anomalies when viewing within the sagittal planes of the fetus. The NT examination can be used as a screening test for those who require an early fetal anatomy scan without performing an additional early anatomy scan to all patients.
Society for Maternal-Fetal MedicineBrooklyn, New York, United States