Primigravidas are at Increased Risk for Mental Health Disorders Earlier Than and Beyond the 6-Week...
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JOURNAL REVIEWS Sharon Bond, CNM, APRN-BC FETAL OXYGEN SATURATION VIA PULSE OXIMETRY IS NOT ASSOCIATED WITH IMPROVED OUTCOMES OR DECREASED RATES OF CESAREAN DELIVERY Bloom SL, Spong CY, Thom E, Varner MW, Rouse DJ, Weininger S, et al. Fetal pulse oximetry and cesarean delivery. N Engl J Med 2006;355:2195–202. Reviewed by: Sharon Bond, CNM, APRN-BC. Fetal pulse oximetry is a recent adjunctive technology; it is used with electronic fetal monitoring and is intended to enhance the understanding of fetal status in the presence of non-reassuring fetal heart rate patterns. Its use was conditionally approved by the U. S. Food and Drug Administration (FDA) in 2000. A sensor is inserted through the dilated cervix and placed against the skin on the fetal face in laboring women with ruptured mem- branes. A reading then gives a measurement of fetal oxygen saturation. In a previous randomized trial, this knowledge was shown to influence the management of women with non-reassuring fetal heart rate patterns and significantly reduce the incidence of cesarean section. In this same trial, however, the rate of cesareans for women having a diagnosis of labor dystocia doubled. Conse- quently, additional studies were undertaken by the FDA to explain these unexpected findings. This second randomized trial was organized and car- ried out by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network in 14 university-based centers between 2002 and 2005. Didactic and hands-on training sessions pre- pared all physicians and nurses participating in the trial. After screening and consent, 5341 nulliparous women having non-reassuring fetal heart rate patterns were randomly assigned to “open” or “masked” fetal pulse oximetry. Though its status was continuously recorded and monitored by research nurses, values in the “masked” group were not known to physicians, and in both groups labor was managed by physicians according to their discretion. No significant differences were found between the two study groups in cesarean section rates, forceps use, vacuum-assisted births, or dystocia. In a subgroup of women noted to have non-reassuring fetal heart rate patterns before randomization, no differences in rates of cesarean delivery were found. The sensor was removed from women (n 238 open group, n 267 in masked group) for reasons including patient or physician request and technical problems. An unexpected finding was that nuchal cords were subsequently identified among women who had a prolonged deceleration during sensor insertion (n 54), a rate more than twice what was expected. Trapping of the sensor or inadvertent manipulation of the fetal head or nuchal cord during insertion was considered most likely responsible for these prolonged decelera- tions. Authors found that low levels of fetal oxygen satura- tion were common among women with both normal and abnormal fetal heart rate patterns and thus the signifi- cance of low oxygen saturation detected on the fetal cheek in labor remains uncertain. At this time, knowl- edge of fetal oxygen saturation appears to have no effect on cesarean rates and shows no benefit when used as an adjunct to fetal heart rate monitoring. The knowledge of fetal oxygen saturation does not appear to improve the condition of newborns. The authors concluded by com- paring fetal pulse oximetry to electronic fetal monitoring. Both represent examples of technology widely applied in practice before its benefits have been thoroughly re- searched. PRIMIGRAVIDAS ARE AT INCREASED RISK FOR MENTAL HEALTH DISORDERS EARLIER THAN AND BEYOND THE 6-WEEK POSTPARTUM CHECK-UP Munk-Olsen T, Munk Laursen T, Bøcker Pedersen C, Mors O, Mortensen PB. New parents and mental disorders: A population- based register study. JAMA 2006;296:2582–9. Wisner K, Chambers C, Sit D. Postpartum depression: A major public health problem. JAMA 2006;296:2616 – 8. Reviewed by: Sharon Bond, CNM, APRN-BC. Postpartum “blues” lasts 1 to 2 weeks and affects 50% of new mothers, while postpartum depression (PPD) is more extreme, affecting 10% to 15% of new mothers, and it may last several weeks, months, or longer. A combination of hormonal shifts after birth and sleep deprivation, coupled with the physical and emotional demands of caring for a newborn, are a few of the physiologic and psychosocial factors at work in the development of PPD. In some women, true depression can develop when the “blues” linger or turn increasingly severe. The objectives of this study were to evaluate the risk of postpartum mental health disorders among new mothers and fathers for 1 year after the birth of their first child and to compare these risks with similar individuals who are not parents. The country of Denmark has a highly centralized and computerized record system which allowed researchers to access an extensive database to study 630,373 women and 547,431 men in the year following the birth of their first child (the study used data collected between 1995– 2005). Munk-Olsen et al. designed their study by merg- ing information from two health registries (a civil service registry and a psychiatric central register). They looked at hospitalizations and outpatient contacts for several 310 Volume 52, No. 3, May/June 2007 © 2007 by the American College of Nurse-Midwives 1526-9523/07/$32.00 Issued by Elsevier Inc.
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Transcript of Primigravidas are at Increased Risk for Mental Health Disorders Earlier Than and Beyond the 6-Week...
JOURNAL REVIEWS Sharon Bond, CNM, APRN-BC
FETAL OXYGEN SATURATION VIA PULSE OXIMETRY IS NOTASSOCIATED WITH IMPROVED OUTCOMES OR DECREASEDRATES OF CESAREAN DELIVERYBloom SL, Spong CY, Thom E, Varner MW, Rouse DJ, Weininger S,et al. Fetal pulse oximetry and cesarean delivery. N Engl J Med2006;355:2195–202.
Reviewed by: Sharon Bond, CNM, APRN-BC.
Fetal pulse oximetry is a recent adjunctive technology; itis used with electronic fetal monitoring and is intended toenhance the understanding of fetal status in the presenceof non-reassuring fetal heart rate patterns. Its use wasconditionally approved by the U. S. Food and DrugAdministration (FDA) in 2000. A sensor is insertedthrough the dilated cervix and placed against the skin onthe fetal face in laboring women with ruptured mem-branes. A reading then gives a measurement of fetaloxygen saturation. In a previous randomized trial, thisknowledge was shown to influence the management ofwomen with non-reassuring fetal heart rate patterns andsignificantly reduce the incidence of cesarean section. Inthis same trial, however, the rate of cesareans for womenhaving a diagnosis of labor dystocia doubled. Conse-quently, additional studies were undertaken by the FDAto explain these unexpected findings.
This second randomized trial was organized and car-ried out by the National Institute of Child Health andHuman Development Maternal-Fetal Medicine UnitsNetwork in 14 university-based centers between 2002and 2005. Didactic and hands-on training sessions pre-pared all physicians and nurses participating in the trial.After screening and consent, 5341 nulliparous womenhaving non-reassuring fetal heart rate patterns wererandomly assigned to “open” or “masked” fetal pulseoximetry. Though its status was continuously recordedand monitored by research nurses, values in the“masked” group were not known to physicians, and inboth groups labor was managed by physicians accordingto their discretion.
No significant differences were found between the twostudy groups in cesarean section rates, forceps use,vacuum-assisted births, or dystocia. In a subgroup ofwomen noted to have non-reassuring fetal heart ratepatterns before randomization, no differences in rates ofcesarean delivery were found. The sensor was removedfrom women (n � 238 open group, n � 267 in maskedgroup) for reasons including patient or physician requestand technical problems. An unexpected finding was thatnuchal cords were subsequently identified among womenwho had a prolonged deceleration during sensor insertion(n � 54), a rate more than twice what was expected.Trapping of the sensor or inadvertent manipulation of the
fetal head or nuchal cord during insertion was consideredmost likely responsible for these prolonged decelera-tions.
Authors found that low levels of fetal oxygen satura-tion were common among women with both normal andabnormal fetal heart rate patterns and thus the signifi-cance of low oxygen saturation detected on the fetalcheek in labor remains uncertain. At this time, knowl-edge of fetal oxygen saturation appears to have no effecton cesarean rates and shows no benefit when used as anadjunct to fetal heart rate monitoring. The knowledge offetal oxygen saturation does not appear to improve thecondition of newborns. The authors concluded by com-paring fetal pulse oximetry to electronic fetal monitoring.Both represent examples of technology widely applied inpractice before its benefits have been thoroughly re-searched.
PRIMIGRAVIDAS ARE AT INCREASED RISK FOR MENTALHEALTH DISORDERS EARLIER THAN AND BEYOND THE6-WEEK POSTPARTUM CHECK-UP
Munk-Olsen T, Munk Laursen T, Bøcker Pedersen C, Mors O,Mortensen PB. New parents and mental disorders: A population-based register study. JAMA 2006;296:2582–9.Wisner K, Chambers C, Sit D. Postpartum depression: A majorpublic health problem. JAMA 2006;296:2616 – 8.
Reviewed by: Sharon Bond, CNM, APRN-BC.
Postpartum “blues” lasts 1 to 2 weeks and affects 50% ofnew mothers, while postpartum depression (PPD) ismore extreme, affecting 10% to 15% of new mothers,and it may last several weeks, months, or longer. Acombination of hormonal shifts after birth and sleepdeprivation, coupled with the physical and emotionaldemands of caring for a newborn, are a few of thephysiologic and psychosocial factors at work in thedevelopment of PPD. In some women, true depressioncan develop when the “blues” linger or turn increasinglysevere. The objectives of this study were to evaluate therisk of postpartum mental health disorders among newmothers and fathers for 1 year after the birth of their firstchild and to compare these risks with similar individualswho are not parents.
The country of Denmark has a highly centralized andcomputerized record system which allowed researchersto access an extensive database to study 630,373 womenand 547,431 men in the year following the birth of theirfirst child (the study used data collected between 1995–2005). Munk-Olsen et al. designed their study by merg-ing information from two health registries (a civil serviceregistry and a psychiatric central register). They lookedat hospitalizations and outpatient contacts for several
310 Volume 52, No. 3, May/June 2007
© 2007 by the American College of Nurse-Midwives 1526-9523/07/$32.00Issued by Elsevier Inc.
