RE: [ozmidwifery] Low liquor was Trial of scar
Title: Message Thanks... -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Melissa SingerSent: Tuesday, 11 July 2006 1:11 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] Low liquor was Trial of scar I didn't think Lisa was dismissive of Gloria, and I thought she made a valid and well stated point, which has encouraged debate, discussion and further thought. Thanks Lisa - Original Message - From: Stephen Felicity To: ozmidwifery@acegraphics.com.au Sent: Tuesday, July 11, 2006 10:12 AM Subject: Re: [ozmidwifery] Low liquor was Trial of scar Lisa, "such a broad unsupported statement could lead a woman to believe that the current management of her pregnancy is incorrect because she read on this list of very experienced midwives and doulas that decreased liqour was only due to imminent labour." Well, since women aren't morons, and pregnancy is not really an issue of "management" but rather CARE and SUPPORT, I don't think we need to fear that a woman reading research, evidence and opinion and making her own decisionswill trulybe endangered by "a little bit of knowledge" - if she is able to enjoy true control of her own pregnancy and birth and receive true care and support. Besides which I personally find no flaw in Janet's reasoning and statement; it's accurate. And this is a consumer list as much as it is a Midwife and Doula list. "Mary I was not 'dismissing" the opinions of Gloria Lemay, and I am aware of her background." Gloria Lemay's wisdom, experience and evidence based knowledge is not "the opinion of an American Doula" (I don't know of many women with more claim to the title of MIDWIFE than Gloria!) - besides which, I'm intrigued as to why an American Doula's contributions would hold little weight anyway? If you ARE in fact aware of her background (as well as the fact that she can see and post on this list), I would have thought you would have at leastphrased your dismissal more respectfully. I also feel sad that wisdom, intuition, instinct and common senseare rejected and that Midwives will disregard the hard won wisdom of their own (Gloria made some colossal personal sacrifices in honour of TRULY being with woman and providing REAL support and care). Where is our respect for our real crones and our birthing women's innate wisdom? And I wouldn't "shoot an opinion from an Obstetrician down in flames" if that opinion was accurate, fair, woman-centered, evidence-based,and reasonable.
[ozmidwifery] Low liquor was Trial of scar
Title: Message Felicity I have deliberatley left replying until today so as not to reply in haste or anger and to try and understand where you are coming from Firstly I agree with you that women are not morons; but the reality for many of us is that the women we work with are not always willing to do extensive research into a form of care that is presented to them, and for some research may just involve logging onto the internet and reading statements such as Janets, I still believe that such a statment is too broad could prove problematic in such a situation. You are lucky if you work with women who read research and make informed descisons because for many of us, our realities are unfortuantely different and despite all the empowering in the worldsome choose not to be like this. And I disagree with the accuracy of Janets statement, as I am unable to find any literature that states that low liquor means labour is imminent. And for some women, decreased liqour volume, when present with other variables is indicative of an increased risk to the well being of her baby. In hindsight I probably could have worded my post better- my dismissiveness related to the fact that I was presented with an opinion based paper as evidence for Janets statement, and yes opinion counts, but as a health professional I am also required to provide women with eveidence based information. No disrespect was directed at anyone. Yes I still believe that alittle knowledge can be dangerous.A perfect example is the woman whohas a normal healthyfetus and decreased liqour .is told by the doc that she must have IOL because there is a risk to the baby...she asks no further questions...presents for IOL which fails and she goes to CS, and has a PPH.. is this not acase of alittle info being dangerous...am sure midwives have countless such examples! And in regards to birthing womans innate wisdom well, again this is not always the case unfortunately; as a woman presenting weekly from 32K, with various aches and pains, in the hope that someone will suggest IOL because she is tired of being pregnant is not being particulary wise. Not all woman have the wisdom or the intuiton when it comes to their pregnancies and their bodies that you speak of. In such a public forum I think we need to take into account all the women who birth babies in this country...including those who are experiencing less than normal pregnancies, and those too who choose not to inform themselves adequately, or those who leave the choices up to others. Lisa PS my apologies if I offended anyone for my use of the word 'management'I obviously require further tuition in the art of political correctedness. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Stephen FelicitySent: Tuesday, 11 July 2006 12:12 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] Low liquor was Trial of scar Lisa, "such a broad unsupported statement could lead a woman to believe that the current management of her pregnancy is incorrect because she read on this list of very experienced midwives and doulas that decreased liqour was only due to imminent labour." Well, since women aren't morons, and pregnancy is not really an issue of "management" but rather CARE and SUPPORT, I don't think we need to fear that a woman reading research, evidence and opinion and making her own decisionswill trulybe endangered by "a little bit of knowledge" - if she is able to enjoy true control of her own pregnancy and birth and receive true care and support. Besides which I personally find no flaw in Janet's reasoning and statement; it's accurate. And this is a consumer list as much as it is a Midwife and Doula list. "Mary I was not 'dismissing" the opinions of Gloria Lemay, and I am aware of her background." Gloria Lemay's wisdom, experience and evidence based knowledge is not "the opinion of an American Doula" (I don't know of many women with more claim to the title of MIDWIFE than Gloria!) - besides which, I'm intrigued as to why an American Doula's contributions would hold little weight anyway? If you ARE in fact aware of her background (as well as the fact that she can see and post on this list), I would have thought you would have at leastphrased your dismissal more respectfully. I also feel sad that wisdom, intuition, instinct and common senseare rejected and that Midwives will disregard the hard won wisdom of their own (Gloria made some colossal personal sacrifices in honour of TRULY being with woman and providing REAL support and care). Where is our respect for our real crones and our birthing women's innate wisdom? And I wouldn't "shoot an opinion from an Obstetrician down in flames" if that opinion was accurate, fair, woman-centered, evidence-based,and
: [ozmidwifery] Low liquor was Trial of scar
Felicity I have deliberatley left replying until today so as not to reply in haste or anger and to try and understand where you are coming from Firstly I agree with you that women are not morons; but the reality for many of us is that the women we work with are not always willing to do extensive research into a form of care that is presented to them, and for some research may just involve logging onto the internet and reading statements such as Janets, I still believe that such a statment is too broad could prove problematic in such a situation. You are lucky if you work with women who read research and make informed descisons because for many of us, our realities are unfortuantely different and despite all the empowering in the world some choose not to be like this. And I disagree with the accuracy of Janets statement, as I am unable to find any literature that states that low liquor means labour is imminent. And for some women, decreased liqour volume, when present with other variables is indicative of an increased risk to the well being of her baby. In hindsight I probably could have worded my post better- my dismissiveness related to the fact that I was presented with an opinion based paper as evidence for Janets statement, and yes opinion counts, but as a health professional I am also required to provide women with eveidence based information. No disrespect was directed at anyone. Yes I still believe that alittle knowledge can be dangerous. A perfect example is the woman who has a normal healthy fetus and decreased liqour .is told by the doc that she must have IOL because there is a risk to the baby...she asks no further questions...presents for IOL which fails and she goes to CS, and has a PPH.. is this not a case of alittle info being dangerous... am sure midwives have countless such examples! And in regards to birthing womans innate wisdom well, again this is not always the case unfortunately; as a woman presenting weekly from 32K, with various aches and pains, in the hope that someone will suggest IOL because she is tired of being pregnant is not being particulary wise. Not all woman have the wisdom or the intuiton when it comes to their pregnancies and their bodies that you speak of. In such a public forum I think we need to take into account all the women who birth babies in this country...including those who are experiencing less than normal pregnancies, and those too who choose not to inform themselves adequately, or those who leave the choices up to others. Lisa PS my apologies if I offended anyone for my use of the word 'management'I obviously require further tuition in the art of political correctedness. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Stephen Felicity Sent: Tuesday, 11 July 2006 12:12 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Low liquor was Trial of scar Lisa, such a broad unsupported statement could lead a woman to believe that the current management of her pregnancy is incorrect because she read on this list of very experienced midwives and doulas that decreased liqour was only due to imminent labour. Well, since women aren't morons, and pregnancy is not really an issue of management but rather CARE and SUPPORT, I don't think we need to fear that a woman reading research, evidence and opinion and making her own decisions will truly be endangered by a little bit of knowledge - if she is able to enjoy true control of her own pregnancy and birth and receive true care and support. Besides which I personally find no flaw in Janet's reasoning and statement; it's accurate. And this is a consumer list as much as it is a Midwife and Doula list. Mary I was not 'dismissing the opinions of Gloria Lemay, and I am aware of her background. Gloria Lemay's wisdom, experience and evidence based knowledge is not the opinion of an American Doula (I don't know of many women with more claim to the title of MIDWIFE than Gloria!) - besides which, I'm intrigued as to why an American Doula's contributions would hold little weight anyway? If you ARE in fact aware of her background (as well as the fact that she can see and post on this list), I would have thought you would have at least phrased your dismissal more respectfully. I also feel sad that wisdom, intuition, instinct and common sense are rejected and that Midwives will disregard the hard won wisdom of their own (Gloria made some colossal personal sacrifices in honour of TRULY being with woman and providing REAL support and care). Where is our respect for our real crones and our birthing women's innate wisdom? And I wouldn't shoot an opinion from an Obstetrician down in flames if that opinion was accurate, fair, woman-centered, evidence-based, and reasonable. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Today's West Australian
At last - something positive about birth in the media!! In todays Health and Medicine section of the west was 3 page cover on where and why women choose to birth. Mums ranged from: 1 unplanned C/S for preterm breech, 1 planned c/s for placenta praevia, 1 planned c/s who changed her mind after talking to a midwife and had a '2 hour natural labour and birth', 1 VBAC, 1 Birth Centre birth and 1 planned homebirth!!! They also recommended talking to a GP or midwife (note - NOT an obstetrician! in fact the "O" word barely gets a mention but "midwife' gets plenty) and checking out all the hosps, birth centre and community midwifery program (i.e. shop around) plus some good reading, and informing yourself/ asking questions/changing your mind and knowing that you can make these choices. Women need to get more of this- more balanced views on birth and understand that they have choices - it quite cheered me up today! Sue
Re: [ozmidwifery] Pinky on TV tomorrow x 2!!!
Hi Kelly - Kerri Anne is on Tomorrow ( prerecord yesterday) -Thursday 13th between 10.30 and 11am Also - nine am with david and Kim tomorrow am - I think thats before ten - Pinky - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Tuesday, July 11, 2006 7:57 PM Subject: RE: [ozmidwifery] Pinky on TV tomorrow x 2!!! Tomorrow on TODAY: Sleeping like a baby? Does your baby or toddler have trouble sleeping? Be watching tomorrow at 8.10am when we speak with parenting expert Pinky McKay about this common problem. If you'd like to ask Pinky a question - email us at [EMAIL PROTECTED] Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Kelly @ BellyBellySent: Tuesday, 11 July 2006 5:53 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Pinky on TV tomorrow x 2!!! Hello all! Please tune into the Today Show (8.10am AEST) and Kerri-Anne (bet. 10.30-11am AEST) tomorrow, the 11th July. Pinky will be on and she needs our support!!! Dont forget to write in, AFTER the show hehehe to let them know we loved her being on and would like to see more. Go Pinky! (who sounds like she is having a gorgeous time in Sydney!!!) Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
[ozmidwifery] The weekend australian
There was an article in the careers section of last weekends Australian, that was an interesting read on c/section. The photo that went with it has me perplexed though.It appears to show a bub being born by caesarean, still in the abdomen but with an ET tube and sats monitor. It is lovely and pink and has a cord that doesn't appear to have been clamped. anyone have any ideas? Cath
Re: [ozmidwifery] Pinky on TV tomorrow x 2!!!
Thanks for your reply on the Today show, Pinky ;)I thought you came across really well, and hopefully made people think twice about co-sleeping, especially.9am with David and Kim, what's that show? Or is that the name of the show? I don't think we get that here in WA if it is the name.Good luck!JoOn 12/07/2006, at 7:19 PM, Pinky McKay wrote:Hi Kelly - Kerri Anne is on Tomorrow ( prerecord yesterday) -Thursday 13th between 10.30 and 11am Also - nine am with david and Kim tomorrow am - I think thats before ten - Pinky- Original Message -From: Kelly @ BellyBellyTo: ozmidwifery@acegraphics.com.auSent: Tuesday, July 11, 2006 7:57 PMSubject: RE: [ozmidwifery] Pinky on TV tomorrow x 2!!!Tomorrow on TODAY: Sleeping like a baby? Does your baby or toddler have trouble sleeping? Be watching tomorrow at 8.10am when we speak with parenting expert Pinky McKay about this common problem. If you'd like to ask Pinky a question - email us at [EMAIL PROTECTED] Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-supportFrom: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Kelly @ BellyBellySent: Tuesday, 11 July 2006 5:53 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Pinky on TV tomorrow x 2!!! Hello all! Please tune into the Today Show (8.10am AEST) and Kerri-Anne (bet. 10.30-11am AEST) tomorrow, the 11th July. Pinky will be on and she needs our support!!! Don’t forget to write in, AFTER the show hehehe to let them know we loved her being on and would like to see more. Go Pinky! (who sounds like she is having a gorgeous time in Sydney!!!)Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
[ozmidwifery] Interesting article
Antiviral reduces vertical herpes transmission Source:Obstetrics Gynecology 2006; 108: 141-7 Measuring the efficacy of valacyclovir suppression in late pregnancy for reducing herpes recurrence and the need for cesarean delivery. Treating pregnant women who have a history of genital herpes with the antiviral valacyclovir lowers the risk that they will need a cesarean to protect the infant from infection, a randomized controlled trial suggests. Women with active genital herpes or prodromal symptoms at the time of labor are currently recommended to have a cesarean. However, 70 percent of cases of neonatal infection occur in infants born to women who asymptomatically shed the virus near delivery. In the current study, Jeanne Sheffield (University of Texas Southwestern Medical Center, Dallas, USA) and colleagues assessed the prophylactic efficacy of valacyclovir, a prodrug of acyclovir, one of the most commonly used antiviral drugs. In all, 170 women were treated with valacyclovir from 36 weeks' gestation and 168 were given placebo. At delivery, 13 percent of the women in the placebo group had a herpes recurrence warranting cesarean delivery, compared with just 4 percent of those given prophylaxis. I think this will help immensely in giving doctors stronger evidence in using this treatment, Sheffield commented. Besides reducing the number of herpes outbreaks at birth, we also dropped the numbers of women without symptoms who were shedding the virus into the birth canal, she explained. Posted: 12 July 2006
[ozmidwifery] MCHN problems
Thank goodness she is going to do something about this it was one of the Moderators on my site that this happened to: I took Rosie down yesterday just to get her weighed - (9kg BTW! 90th percentile, and my smallest bubba at this age ). Anyway she was going through the book and checking off all of the questions relating to a 6month old when it came to solids So I tell her that Rosie isn't really into them, so we are just trying little bits to get her used to textures and flavours. This nurse was a nutter - this is what she told me... So goes off saying that at 6months she should be having a few meals a day then puts her hands up to her head and says Hmmm just thinking...no I don't think we'll introduce formula at this point WT Formula??? I am breastfeeding with NO supply problems, and no problems other than being worn out and she is thinking formula??? Then says that she is surprised that I am able to breastfeed because she is my third baby and the quality of my milk wouldn't be so good. Then...and this is the corker...says that I should deny Imogen breast because a baby will eat when it gets hungry. I may have to put up with screaming for a while until she realises that she won't be getting a breast feed, but when she's that hungry she'll eat solid food...OMG OMG OMG And I should give water instead of BM. She also started talking developmental delay because Imogen is too lazy to get up and move! She is ONLY 6 MONTHS!!! Thank God I am confident in my mothering enough to ignore all of her crap! This is the same nurse that told me that when Imogen was 4months old that she should start solid food because being 8kgs, she is ready. Anyway my point to this massive post is that, is it any wonder that people introduce solid food at 3months, or cut down milk feeds for solids I fear for the new mothers that don't have the confidence in themselves to do what is right. Not once did she mention that milk is to be the primary food until 12months, or that solid food is just complimentary until then. This health professional is giving out dodgy advice and people will believe her because of her position as a CHN. I will be writing to the chemist and complaining about the advice given, because she is going against all WHO recommendations and I am sure she has made more than one mother feel like crap because of her stupid ideas. Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
[ozmidwifery] Today Tonight asking for feedback
There is a section on the Today Tonight website asking for feedback about the rising rates of caesarian births. It's down the bottom right hand corner. http://seven.com.au/todaytonight Get writing. I didn't see the program. Has anyone got a transcript? I have written a letter anyway putting my two cents worth in. Helen
[ozmidwifery] article FYI
Circumcision Could Cut HIV Infection Male Circumcision Would Prevent Millions of AIDS Deaths in Africa By Daniel DeNoon WebMD Medical News Reviewed By Louise Chang, MD on Tuesday, July 11, 2006 July 11, 2006 -- Male circumcision , if widely adopted in Africa, would prevent 3 million deaths over 20 years. It would work as well as a moderately effective AIDS vaccine. The prediction comes from an international team of researchers including Brian G. Williams, PhD, of the World Health Organization. They report their findings in the July issue of the public-access, online journal PLoS Medicine. Male circumcision could avert 2 million new HIV infections and 300,000 deaths over the next 10 years in sub-Saharan Africa, Williams and colleagues write. In the 10 years after that, it could avert a further 3.7 million new infections and 2.7 million deaths. About a fourth of the impact would be in South Africa, which is particularly hard-hit by the AIDS pandemic. These estimates are based on a 2005 clinical trial that found male circumcision reduces female-to-male spread of HIV -- the AIDS virus -- by 60%. This would be the same effect as an AIDS vaccine that was 37% effective in protecting both men and women against HIV infection. Preventing HIV infection of men would slow HIV spread to women. But Williams and colleagues note that women need protection of their own -- a safe, HIV-killing agent that could be applied directly to the vagina prior to sex. And while it's important to find ways to cut the spread of HIV, it's even more important to get effective treatments to people already infected with the virus that causes AIDS. The need to keep HIV-positive people alive through the provision of [AIDS drugs] remains the most immediate priority, Williams and colleagues write. SOURCE: Williams, B.G. PLoS Medicine, July 2006; vol: 3 pp e262. © 2006 WebMD Inc. All rights reserved Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Pinky on TV tomorrow x 2!!!
The show is called Nine am and david and Kim are teh presenters. Its teh same time as Bert used to be on - smae time as Kerri Anne - but being in WA - the channel ten show I was on Live earlier - about 10 am and Kerri- anne just after 10.30 - it was prerecorded. Hopefully lots of mums can relax -= was one of the email questions on Today from you? The media response has been phenomenal -I have already been asked back on several of them. Pinky www.pinky-mychild - Original Message - From: Jo Watson To: ozmidwifery@acegraphics.com.au Sent: Wednesday, July 12, 2006 10:09 PM Subject: Re: [ozmidwifery] Pinky on TV tomorrow x 2!!! Thanks for your reply on the Today show, Pinky ;) I thought you came across really well, and hopefully made people think twice about co-sleeping, especially. 9am with David and Kim, what's that show? Or is that the name of the show? I don't think we get that here in WA if it is the name. Good luck! Jo On 12/07/2006, at 7:19 PM, Pinky McKay wrote: Hi Kelly - Kerri Anne is on Tomorrow ( prerecord yesterday) -Thursday 13th between 10.30 and 11am Also - nine am with david and Kim tomorrow am - I think thats before ten - Pinky - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Tuesday, July 11, 2006 7:57 PM Subject: RE: [ozmidwifery] Pinky on TV tomorrow x 2!!! Tomorrow on TODAY: Sleeping like a baby? Does your baby or toddler have trouble sleeping? Be watching tomorrow at 8.10am when we speak with parenting expert Pinky McKay about this common problem. If you'd like to ask Pinky a question - email us at [EMAIL PROTECTED] Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Kelly @ BellyBellySent: Tuesday, 11 July 2006 5:53 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Pinky on TV tomorrow x 2!!! Hello all! Please tune into the Today Show (8.10am AEST) and Kerri-Anne (bet. 10.30-11am AEST) tomorrow, the 11th July. Pinky will be on and she needs our support!!! Don’t forget to write in, AFTER the show hehehe to let them know we loved her being on and would like to see more. Go Pinky! (who sounds like she is having a gorgeous time in Sydney!!!) Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
Re: [ozmidwifery] Pinky on TV tomorrow x 2!!!
Yup the first email she read out to you on the Today show was mine :)I hope to catch your other appearances - as I think you are very well spoken, don't seem to get flustered with questions, and have a lot of great ideas :)Thanks,JoOn 13/07/2006, at 9:09 AM, Pinky McKay wrote:The show is called Nine am and david and Kim are teh presenters. Its teh same time as Bert used to be on - smae time as Kerri Anne - but being in WA - the channel ten show I was on Live earlier - about 10 am and Kerri- anne just after 10.30 - it was prerecorded. Hopefully lots of mums can relax -= was one of the email questions on Today from you? The media response has been phenomenal -I have already been asked back on several of them. Pinkywww.pinky-mychild- Original Message -From: Jo WatsonTo: ozmidwifery@acegraphics.com.auSent: Wednesday, July 12, 2006 10:09 PMSubject: Re: [ozmidwifery] Pinky on TV tomorrow x 2!!!Thanks for your reply on the Today show, Pinky ;)I thought you came across really well, and hopefully made people think twice about co-sleeping, especially.9am with David and Kim, what's that show? Or is that the name of the show? I don't think we get that here in WA if it is the name.Good luck!JoOn 12/07/2006, at 7:19 PM, Pinky McKay wrote:Hi Kelly - Kerri Anne is on Tomorrow ( prerecord yesterday) -Thursday 13th between 10.30 and 11am Also - nine am with david and Kim tomorrow am - I think thats before ten - Pinky- Original Message -From: Kelly @ BellyBellyTo: ozmidwifery@acegraphics.com.auSent: Tuesday, July 11, 2006 7:57 PMSubject: RE: [ozmidwifery] Pinky on TV tomorrow x 2!!!Tomorrow on TODAY: Sleeping like a baby? Does your baby or toddler have trouble sleeping? Be watching tomorrow at 8.10am when we speak with parenting expert Pinky McKay about this common problem. If you'd like to ask Pinky a question - email us at [EMAIL PROTECTED]Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-supportFrom: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Kelly @ BellyBellySent: Tuesday, 11 July 2006 5:53 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Pinky on TV tomorrow x 2!!!Hello all!Please tune into the Today Show (8.10am AEST) and Kerri-Anne (bet. 10.30-11am AEST) tomorrow, the 11th July. Pinky will be on and she needs our support!!! Don’t forget to write in, AFTER the show hehehe to let them know we loved her being on and would like to see more. Go Pinky! (who sounds like she is having a gorgeous time in Sydney!!!)Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
Re: [ozmidwifery] MCHN problems
can I ask why is a letter being written to the chemist? Was this a MCHN or a nurse in a different role. I live in the country and MCHN are in a child health centre office. - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Thursday, July 13, 2006 8:22 AM Subject: [ozmidwifery] MCHN problems Thank goodness she is going to do something about this it was one of the Moderators on my site that this happened to: I took Rosie down yesterday just to get her weighed - (9kg BTW! 90th percentile, and my smallest bubba at this age ). Anyway she was going through the book and checking off all of the questions relating to a 6month old when it came to solids So I tell her that Rosie isn't really into them, so we are just trying little bits to get her used to textures and flavours. This nurse was a nutter - this is what she told me...So goes off saying that at 6months she should be having a few meals a day then puts her hands up to her head and says "Hmmm just thinking...no I don't think we'll introduce formula at this point" WT Formula??? I am breastfeeding with NO supply problems, and no problems other than being worn out and she is thinking formula???Then says that she is surprised that I am able to breastfeed because she is my third baby and the quality of my milk wouldn't be so good.Then...and this is the corker...says that I should deny Imogen breast because a baby will eat when it gets hungry. I may have to put up with screaming for a while until she realises that she won't be getting a breast feed, but when she's that hungry she'll eat solid food...OMG OMG OMG And I should give water instead of BM.She also started talking developmental delay because Imogen is too lazy to get up and move! She is ONLY 6 MONTHS!!! Thank God I am confident in my mothering enough to ignore all of her crap!This is the same nurse that told me that when Imogen was 4months old that she should start solid food because being 8kgs, she is ready.Anyway my point to this massive post is that, is it any wonder that people introduce solid food at 3months, or cut down milk feeds for solids I fear for the new mothers that don't have the confidence in themselves to do what is right. Not once did she mention that milk is to be the primary food until 12months, or that solid food is just complimentary until then. This health professional is giving out dodgy advice and people will believe her because of her position as a CHN.I will be writing to the chemist and complaining about the advice given, because she is going against all WHO recommendations and I am sure she has made more than one mother feel like crap because of her stupid ideas. Best Regards,Kelly ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
RE: [ozmidwifery] MCHN problems
Sometimes here I notice MCHNs go to chemists for weighing etc must be some arrangement with the chemist / council?. I have directed her to write to the MCH co-ordinator though. Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of cath nolan Sent: Thursday, 13 July 2006 11:53 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] MCHN problems can I ask why is a letter being written to the chemist? Was this a MCHN or a nurse in a different role. I live in the country and MCHN are in a child health centre office. - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Thursday, July 13, 2006 8:22 AM Subject: [ozmidwifery] MCHN problems Thank goodness she is going to do something about this it was one of the Moderators on my site that this happened to: I took Rosie down yesterday just to get her weighed - (9kg BTW! 90th percentile, and my smallest bubba at this age ). Anyway she was going through the book and checking off all of the questions relating to a 6month old when it came to solids So I tell her that Rosie isn't really into them, so we are just trying little bits to get her used to textures and flavours. This nurse was a nutter - this is what she told me... So goes off saying that at 6months she should be having a few meals a day then puts her hands up to her head and says Hmmm just thinking...no I don't think we'll introduce formula at this point WT Formula??? I am breastfeeding with NO supply problems, and no problems other than being worn out and she is thinking formula??? Then says that she is surprised that I am able to breastfeed because she is my third baby and the quality of my milk wouldn't be so good. Then...and this is the corker...says that I should deny Imogen breast because a baby will eat when it gets hungry. I may have to put up with screaming for a while until she realises that she won't be getting a breast feed, but when she's that hungry she'll eat solid food...OMG OMG OMG And I should give water instead of BM. She also started talking developmental delay because Imogen is too lazy to get up and move! She is ONLY 6 MONTHS!!! Thank God I am confident in my mothering enough to ignore all of her crap! This is the same nurse that told me that when Imogen was 4months old that she should start solid food because being 8kgs, she is ready. Anyway my point to this massive post is that, is it any wonder that people introduce solid food at 3months, or cut down milk feeds for solids I fear for the new mothers that don't have the confidence in themselves to do what is right. Not once did she mention that milk is to be the primary food until 12months, or that solid food is just complimentary until then. This health professional is giving out dodgy advice and people will believe her because of her position as a CHN. I will be writing to the chemist and complaining about the advice given, because she is going against all WHO recommendations and I am sure she has made more than one mother feel like crap because of her stupid ideas. Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
[ozmidwifery] Maternal hydration liquor volume
Ovid Technologies, Inc. Email Service -- Results: AWHONN Lifelines Copyright (C) 1999 by the Association of Women's Health, Obstetric and Neonatal Nurses Volume 3(6), December/January 1999/2000, pp 20-24 Focus on Fluids: Examining Maternal Hydration and Amniotic Fluid Volume [Features] Calhoun, Simone RNC, BSN Simone Calhoun, RNC, BSN, is a perinatal nurse clinician, at St. Francis Hospital and Medical Center in Manchester, CT. -- Outline Factors Affecting Amniotic Fluid Volume Conditions Associated with Oligohydramnios Mechanics of Amniotic Fluid Balance Evaluating Amniotic Fluid Volume Nursing Implications References Graphics Figure 1 Figure 2 Figure 3 Case Study Rebecca is a 33-year-old gravida 3, para 1011, health care professional at 31.5 weeks' gestation currently being treated with 2.5 mg terbutaline and being checked every 4 hours for signs of preterm labor. She has had an upper respiratory infection with severe nasal congestion for which she had taken Chlor-trimetron (4 mg) twice overnight. A nonstress test (NST) was nonreactive. Fetal heart rate baseline was 150 beats/minute, with an average LTV and no decelerations. One contraction was noted in 40 minutes. Biophysical profile score was 6/10 (-2 NST, -2 amniotic fluid volume [AFV]), with no cord-free pocket of 2 x 2 cm in two dimensions. Amniotic fluid index (AFI) was 2.4 cm. Placenta was posterior and fundal (grade 1). A sonogram 1 week earlier showed fetal growth in the 50th percentile and an AFI of 14.6 cm. After discussion with maternal-fetal medicine personnel, who suggested a possible need for delivery because of severe oligohydramnios, the AFI was reevaluated and 6 hours later was found to be 7.8 cm. The patient stated that she had been drinking copious amounts of fluid since the initial AFI. The patient continued pregnancy with a twice-weekly NST and amniotic fluid evaluation. The AFI remained in the 8- to 9-cm range. Terbutaline was discontinued at 37 weeks. The patient spontaneously delivered a 6-pound, 9-ounce healthy boy with Apgar scores of 8 and 9 at 37 weeks, 3 days. Mother and infant were discharged after 48 hours. Factors Affecting Amniotic Fluid Volume Historically, oligohydramnios in the absence of rupture of membranes has been considered to be a sign of chronic suboptimal placental function that leads to decreased fetal urine output. Acute decreases in AFV because of inadequate maternal hydration or medication effects aren't widely reported. This begs two questions: * Assuming no technical errors, was the rapidly improved amniotic fluid observed in this case patient due to the effect of oral hydration? * Could lack of maternal hydration adversely affect AFV? Studies support the notion that maternal fluid volume may play an important role in maintaining AFV. Sherer et al. (1990) reported a case of severe oligohydramnios in a woman who presented with severe dehydration because of gastroenteritis. After the patient was hydrated with 6,500 ml intravenous crystalloid fluid and was no longer hypovolemic, a rapid reaccumulation of AFV to normal status was observed. Also, Kilpatrick and Safford (1993) found that fluid restriction decreased the AFI by 8 percent. Kilpatrick and Safford also showed that maternal oral hydration with 2 liters of water over a 2-hour period increased the AFI in pregnancies with normal AFV by 16 percent. Previously, Kilpatrick et al. (1991) had shown that maternal oral hydration with 2 liters of fluids over 2 hours increased the AFI by 31 percent in women with decreased AFV. In contrast, Flack et al. (1995) and Kerr (1996) found that oral hydration increased the AFI in women with oligohydramnios, but did not significantly increase AFI in women with normal amounts of amniotic fluid. Flack et al. (1995) found that the increased AFI was not attributable to increased fetal urine production but instead was probably attributable to improved uteroplacental perfusion caused by maternal plasma volume expansion. Flack et al.'s research also suggests that there may be fluid passage from the maternal intravascular compartment into the amniotic fluid compartment. Although demonstrated in animal studies, this hasn't been evaluated in humans. Animal studies have found significant flows of amniotic fluid through the transmembranous pathway between the fetal vessels on the chorionic plate and the amniotic cavity (Flack et al., 1995). Flack et al. also suggested that AFV volume may be increased by intramembranous net water transfer between mother and fetus across the chorionic plate, fetal skin, and the surface of the umbilical cord. Kilpatrick and Safford (1993) noted a significant increase in umbilical artery mean velocity after maternal hydration and theorized that hydration may work to increase the AFI by improving placental blood flow or by bulk transfer of water across the placenta. Conditions Associated with
RE: [ozmidwifery] Low liquor was Trial of scar
Title: Message Mary here is a quick summary of what I found all pretty standard stuff.have full text papers if anyone is interested in any of the points...some of interest forwarded to the list.. isolated oligohydramnios at term in relation to no other fetal or maternal health issue is not an indication for IOL...although may require further monitoring oligohydramnios diagnosed prior to third trimester has poor outcomes- live birth rate in one small study of only 1 in 15 measurement of liqour volume is done in different ways and alone is a poor predictor of problems but is probably quite useful when combined with other tests such as dopplers to monitor high risk pregnancies oligohydramnios is common in IUGR and in such cases warrants further ongoing assessment of fetal wellbing fetal growth restriction is the most common cause of stillbirth and one study suggests probably plays a large role in those IUFDs which are reported as unexplained overall oligohydramnios probably is related to an an increase in fetal intolerability of labour and an increase in CS for fetal distress; and a increase in the incidence of low apgarat 5 minutes;no study has shown at relationship between oligohydramnios and neonatal acidosis maternal oral hydration has been shown to improve liqour volume within hours and probably has a lasting effect Regards Lisa -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Tuesday, 11 July 2006 6:24 PMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] Low liquor was Trial of scar have done my own lit r/v and answered my own questions!! Regards Lisa Lisa, would you share this with us? I am very interested in the subject. Thanks. MM
[ozmidwifery] AFI perienatal outcomes
Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis [General Obstetrics And Gynecology: Obstetrics] Chauhan, Suneet P. MDa; Sanderson, Maureen PhDb; Hendrix, Nancy W. MDa; Magann, Everett F. MDc; Devoe, Lawrence D. MDd Spartanburg and Columbia, South Carolina, Jackson, Mississippi, and Augusta, Georgia From the Spartanburg Regional Medical Center,a the Department of Epidemiology and Biostatistics, University of South Carolina,b the Department of Obstetrics and Gynecology, University of Mississippi,c and the Department of Obstetrics and Gynecology, Medical College of Georgia.d Received for publication October 2, 1998; revised January 19, 1999; accepted July 29, 1999. Reprint requests: Suneet P. Chauhan, MD, Division of Maternal-Fetal Medicine, Regional Women's Health Care, 853 North Church St, Suite 403, Spartanburg, SC 29303. Abstract OBJECTIVE: Our purpose was to perform a meta-analysis of studies on the risks of cesarean delivery for fetal distress, 5-minute Apgar score 7, and umbilical arterial pH 7.00 in patients with antepartum or intrapartum amniotic fluid index 5.0 or 5.0 cm. STUDY DESIGN: Using a MEDLINE search, we reviewed all studies published between 1987 and 1997 that correlated antepartum or intrapartum amniotic fluid index with adverse peripartum outcomes. The inclusion criteria were studies in English that associated at least one of the selected adverse outcomes with an amniotic fluid index of =5.0 cm versus 5.0 cm. Contingency tables were constructed for each study, and relative risks and standard errors of their logs were calculated. Fixed-effects pooled relative risks were calculated for groups of studies that were homogeneous, whereas random-effects pooled relative risks were calculated for significantly heterogeneous groups of studies. RESULTS: Eighteen reports describing 10,551 patients met our inclusion criteria. An antepartum amniotic fluid index of =5.0 cm, in comparison with 5.0 cm, is associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 2.2; 95% confidence interval, 1.5-3.4) and an Apgar score of 7 at 5 minutes (pooled relative risk, 5.2; 95% confidence interval, 2.4-11.3). An intrapartum amniotic fluid index of =5.0 cm is also associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 1.7; 95% confidence interval, 1.1-2.6) and an Apgar score 7 at 5 minutes (pooled relative risk, 1.8; 95% confidence interval, 1.2-2.7). A poor correlation between the amniotic fluid index and neonatal acidosis was noted in the only study that examined this end point. More than 23,000 patients are necessary to demonstrate that the incidence of umbilical arterial pH 7.00 is 1.5 times higher among those with oligohydramnios in labor than among those with adequate amniotic fluid index ([alpha] = 0.05; [beta] = 0.2) CONCLUSIONS: An antepartum or intrapartum amniotic fluid index of =5.0 cm is associated with a significantly increased risk of cesarean delivery for fetal distress and a low Apgar score at 5 minutes. There are few reports linking amniotic fluid index and neonatal acidosis, the only objective assessment of fetal well-being. A multicenter study with sufficient power should be undertaken to demonstrate that a low amniotic fluid index is associated with an umbilical arterial pH 7.00. Ultrasonographic assessment of amniotic fluid is used frequently to identify fetuses at risk of having adverse outcomes as suggested by the finding of abnormal fluid volumes. Hydramnios is associated with anomalies or aneuploidy,1 whereas oligohydramnios is linked with pulmonary hypoplasia, postural deformity, fetal distress, and perinatal morbidity and death.2 In 1987 Phelan et al 3 described the amniotic fluid index (AFI) as the summation of the largest vertical pocket in 4 quadrants. This technique of assessing amniotic fluid volume has become increasingly popular in obstetric practice. A MEDLINE search for reports published from 1987 to 1997 includes 125 publications with AFI as the subject. A recent Technical Bulletin on obstetric ultrasonography from The American College of Obstetricians and Gynecologists 4 states that AFI is a more accurate and reproducible method of determining abnormalities in amniotic fluid volume than are other techniques. An AFI =5.0 cm, consistent with most ultrasonographic criteria for oligohydramnios, has been used as an indication for delivery of infants at or near term. This practice has been suggested by Rutherford et al 5 and by Sarno et al,6 who noted a significantly higher risk of cesarean delivery for fetal distress and low Apgar scores for those parturients with an AFI =5.0 cm than for those with an AFI 5.0 cm. Since these initial publications, other investigators have not consistently confirmed the association of adverse peripartum outcomes with an AFI
[ozmidwifery] Clinical assessment of amniotic fluid
Ovid Technologies, Inc. Email Service -- Results: Clinical Obstetrics and Gynecology (C) Lippincott-Raven Publishers Volume 40(2), June 1997, pp 303-313 Clinical Assessment of Amniotic Fluid [Articles] MOORE, THOMAS R. MD Department of Reproductive Medicine, University of California San Diego Correspondence: Thomas R. Moore, MD, Mail Code 8433, 200 West Arbor Drive, San Diego, CA 92118. -- Outline Abstract Clinical Value of Amniotic Fluid Volume Assessment PREDICTION OF POOR PERINATAL OUTCOME DETECTION OF FETAL ANOMALIES IDENTIFICATION OF INTRAUTERINE GROWTH RESTRICTION AND PLACENTAL INSUFFICIENCY Factors Influencing Amniotic Fluid Volume AMNIOTIC FLUID PRODUCTION AMNIOTIC FLUID REMOVAL Gestational Age Influences on Amniotic Fluid Volume Techniques of Estimating Amniotic Fluid Volume INTERSERVER AND INTRAOBSERVER RELIABILITY TECHNICAL ASPECTS OF PERFORMING THE AMNIOTIC FLUID INDEX Indications for and Frequency of Amniotic Fluid Volume Assessment Summary References Graphics Fig. 1 Table 1 Table 2 Fig. 2 Table 3 Fig. 3 Abstract Appreciation of the importance of amniotic fluid volume as an indicator of fetal status is a relatively recent development.1 Before 1975, discussions of amniotic fluid volume in the obstetric literature were limited to observations of the quantity of fluid released after rupture of membranes. The occurrence of thick meconium and fetal distress in post dates pregnancy, for example, was attributed vaguely to placental insufficiency. More recently, progressive improvements in ultrasonographic imaging have taken the technology of fetal and amniotic fluid assessment from the stage of subjective impression to the present state in which relatively sophisticated judgments of fetal condition can be based on reproducible measurements. In present practice, semiquantitative amniotic fluid volume assessment during routine ultrasound (US) examination and antepartum testing has become the standard of care. However, the complicated relationships imposed by the placenta and complexly folded fetus within an irregularly ovoid uterus have impeded the development of a precise method of calculating amniotic fluid volume ultrasonographically. And although both subjective and semiquantitative methods of estimating amniotic volume are in use, the best technique remains controversial. In this article, the author reviews the relative precision of the various volume estimation techniques and clinical situations in which amniotic fluid volume assessment is helpful. -- Clinical Value of Amniotic Fluid Volume Assessment PREDICTION OF POOR PERINATAL OUTCOME Recognizing abnormal amniotic fluid volume before delivery may alert the clinician to situations of potentially high perinatal risk. Chamberlain et al.2 observed a perinatal mortality rate of 4.12/1,000 in pregnancies with polyhydramnios compared with a rate of 1.97/1,000 when the amniotic fluid was normal. The perinatal mortality rate was increased 13-fold more than normal when amniotic fluid volume was sonographically marginal, and increased 47-fold (187.5/1,000) if severe oligohydramnios was present. Pregnancies complicated by extremes of amniotic fluid volume also experience increased maternal and neonatal morbidity. During labor, polyhydramnios is associated with abnormal fetal lie, operative delivery, and abruptio placentae.3 Preterm delivery occurred in 11.1% in patients with polyhydramnios studied by Varma et al.4 compared with 6.7% in controls with normal fluid. Fetal distress, low Apgar scores, macrosomia, and intensive care nursery admission were significantly more frequent in the polyhydramnios group. With oligohydramnios, meconium, fetal heart rate abnormalities, and depressed Apgar scores are more frequent: neonatal (31.2%) and fetal (25.0%) acidosis rates were doubled compared with controls;5 fetal distress requiring operative intervention was tripled (64%) with oligohydramnios compared with 21% of normals (P = .005).6 Crowley et al.7 reported meconium staining in 29% and an emergency cesarean section rate of 11% with oligohydramnios in post-date patients but only 2% in normals. Maternal complications of oligohydramnios include increased incidence of hypertension (22.1%), second trimester bleeding (4.1%), and abruptio placentae (4.2%).8 DETECTION OF FETAL ANOMALIES Recognition of abnormal amniotic fluid volume may provide clues to congenital anomalies, which might otherwise be overlooked. The finding of polyhydramnios may lead to detection of fetal gastrointestinal obstruction (esophageal atresia, or thoracic masses compressing the esophagus such as diaphragmatic hernia).4 Cardiac, intracranial, spinal, and ventral wall anomalies have also been reported with excessive amniotic fluid.9 Oligohydramnios is
[ozmidwifery] Isolalated oligohydramnios at Term
January 2005 · Vol. 54, No. 1 Isolated oligohydramnios at term: Is induction indicated? Lawrence Leeman, MD, MPH University of New Mexico, Albuquerque, NM David Almond, MD, MS Community Health Clinic Ole, Napa, Calif Practice recommendations Isolated term oligohydramnios, as defined by an amniotic fluid index (AFI) of less than 5 cm, has not been shown to be associated with poor maternal or fetal outcomes. Management may be individualized based on factors such as parity, cervical ripeness, and patient preference (SOR: B). Maternal hydration with oral water has been shown to increase AFI in a few hours, likely due to improved uteroplacental perfusion. This is a reasonable alternative to immediate labor induction in women with isolated term oligohydramnios (SOR: B). An isolated finding of a so-called border-line AFI (58 cm) is not an indication for labor induction (SOR: B). Family physicians providing maternity care often face a scenario in which an otherwise low-risk, term patient is incidentally noted to have a low amniotic fluid index (AFI). Common reasons for obtaining an AFI in a woman with a low-risk pregnancy include evaluation of decreased fetal movement, spontaneous variable decelerations during monitoring to evaluate for labor, or an ultrasound evaluation for fundal height measurements discordant with gestational age. How should isolated oligohydramniosan AFI 5 cmbe interpreted, and should immediate induction be recommended for such patients? Oligohydramnios occurs in about 1% to 5% of pregnancies at term.1,2 Because adverse outcomes occur in high-risk pregnancies complicated by low amniotic fluid volume, oligohydramnios commonly prompts labor induction.1,3,4 At one university center, oligohydramnios is now the leading indication for labor induction.5 Many centers may even induce labor when the AFI is between 5 cm and 8 cm, the so-called borderline AFI.3 Labor induction increases the use of cesarean delivery, particularly for the primiparous woman with an unripe cervix.6 Recent studies questioning the safety of labor induction in women who have had a cesarean may increase the number of elective repeat cesarean procedures when delivery is believed indicated for oligohydramnios.7 (See Underlying causes of oligohydramnios.) Underlying causes of oligohydramnios By the second trimester, amniotic fluid is being produced primarily through fetal urine production and is primarily resorbed through fetal swallowing. Significant amounts of amniotic fluid are also produced and resorbed by the fetal lung and directly resorbed from the amniotic cavity by the placenta.8,9 Amniotic fluid volume is affected by the status of maternal hydration and maternal plasma osmolality.10-13 Acute oligohydramnios may occur from ruptured membranes, usually diagnosed by clinical signs and vaginal fluid with altered pH and a ferning pattern on microscopic exam. Chronic oligohydramnios arises from prerenal, renal, and postrenal causes. The latter 2 groups reflect fetal kidney and urogenital abnormalities, which directly decrease fetal amniotic fluid production. Uteroplacental insufficiency is the most common cause of prerenal oligohydramnios, and the decreased amniotic fluid is a direct result of decreased fetal renal perfusion.14 Uteroplacental insufficiency may result in intrauterine growth restriction as the fetus shunts blood away from the growing torso and limbs and to vital organs such as the brain. Preeclampsia and postdate pregnancies both involve pathologic changes in the placenta that may result in uteroplacental insufficiency and oligohydramnios. Oligohydramnios is difficult to assess True oligohydramnios can be difficult to confirm due to the questionable accuracy of amniotic fluid measurement by ultrasound. There is controversy, for example, about whether (and how) to include pockets of amniotic fluid containing umbilical cord.15 The AFI was introduced in 19872 to replace the 2 cm pocket technique of fluid assessment, and studies continue to question to what extent the AFI reflects actual amniotic fluid volume. AFI measurements may vary with the amount of pressure applied to the abdomen and with fetal position or movement.16 Serial measurements taken by the same ultrasound operator have been shown to differ from the true volume by 1 cm, or 10.8%; serial measurements taken by multiple operators have differed by as much as 2 cm, or 15.4%.17,18 OReilly-Green compared the diagnosis of oligohydramnios in 449 post-term patients with actual amniotic fluid volume measured at rupture of membranes.19 They found a positive predictive value of 50% for oligohydramnios at an AFI of 5 cm as the lower limit of normal. A study of 144 third trimester patients using the dye-dilution technique found that, to achieve 95% confidence for ruling out oligohydramnios, a cutoff AFI of 30 cm would need to be used, a value consistent with polyhydramnios.20 What is the association between
FW: [ozmidwifery] AFI perienatal outcomes
The rest of this reference is: 1999 December181(6): pp1473-1478; Amer J Of Obs Gyn. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis [General Obstetrics And Gynecology: Obstetrics] Chauhan, Suneet P. MDa; Sanderson, Maureen PhDb; Hendrix, Nancy W. MDa; Magann, Everett F. MDc; Devoe, Lawrence D. MDd Spartanburg and Columbia, South Carolina, Jackson, Mississippi, and Augusta, Georgia From the Spartanburg Regional Medical Center,a the Department of Epidemiology and Biostatistics, University of South Carolina,b the Department of Obstetrics and Gynecology, University of Mississippi,c and the Department of Obstetrics and Gynecology, Medical College of Georgia.d Received for publication October 2, 1998; revised January 19, 1999; accepted July 29, 1999. Reprint requests: Suneet P. Chauhan, MD, Division of Maternal-Fetal Medicine, Regional Women's Health Care, 853 North Church St, Suite 403, Spartanburg, SC 29303. Abstract OBJECTIVE: Our purpose was to perform a meta-analysis of studies on the risks of cesarean delivery for fetal distress, 5-minute Apgar score 7, and umbilical arterial pH 7.00 in patients with antepartum or intrapartum amniotic fluid index 5.0 or 5.0 cm. STUDY DESIGN: Using a MEDLINE search, we reviewed all studies published between 1987 and 1997 that correlated antepartum or intrapartum amniotic fluid index with adverse peripartum outcomes. The inclusion criteria were studies in English that associated at least one of the selected adverse outcomes with an amniotic fluid index of =5.0 cm versus 5.0 cm. Contingency tables were constructed for each study, and relative risks and standard errors of their logs were calculated. Fixed-effects pooled relative risks were calculated for groups of studies that were homogeneous, whereas random-effects pooled relative risks were calculated for significantly heterogeneous groups of studies. RESULTS: Eighteen reports describing 10,551 patients met our inclusion criteria. An antepartum amniotic fluid index of =5.0 cm, in comparison with 5.0 cm, is associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 2.2; 95% confidence interval, 1.5-3.4) and an Apgar score of 7 at 5 minutes (pooled relative risk, 5.2; 95% confidence interval, 2.4-11.3). An intrapartum amniotic fluid index of =5.0 cm is also associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 1.7; 95% confidence interval, 1.1-2.6) and an Apgar score 7 at 5 minutes (pooled relative risk, 1.8; 95% confidence interval, 1.2-2.7). A poor correlation between the amniotic fluid index and neonatal acidosis was noted in the only study that examined this end point. More than 23,000 patients are necessary to demonstrate that the incidence of umbilical arterial pH 7.00 is 1.5 times higher among those with oligohydramnios in labor than among those with adequate amniotic fluid index ([alpha] = 0.05; [beta] = 0.2) CONCLUSIONS: An antepartum or intrapartum amniotic fluid index of =5.0 cm is associated with a significantly increased risk of cesarean delivery for fetal distress and a low Apgar score at 5 minutes. There are few reports linking amniotic fluid index and neonatal acidosis, the only objective assessment of fetal well-being. A multicenter study with sufficient power should be undertaken to demonstrate that a low amniotic fluid index is associated with an umbilical arterial pH 7.00. Ultrasonographic assessment of amniotic fluid is used frequently to identify fetuses at risk of having adverse outcomes as suggested by the finding of abnormal fluid volumes. Hydramnios is associated with anomalies or aneuploidy,1 whereas oligohydramnios is linked with pulmonary hypoplasia, postural deformity, fetal distress, and perinatal morbidity and death.2 In 1987 Phelan et al 3 described the amniotic fluid index (AFI) as the summation of the largest vertical pocket in 4 quadrants. This technique of assessing amniotic fluid volume has become increasingly popular in obstetric practice. A MEDLINE search for reports published from 1987 to 1997 includes 125 publications with AFI as the subject. A recent Technical Bulletin on obstetric ultrasonography from The American College of Obstetricians and Gynecologists 4 states that AFI is a more accurate and reproducible method of determining abnormalities in amniotic fluid volume than are other techniques. An AFI =5.0 cm, consistent with most ultrasonographic criteria for oligohydramnios, has been used as an indication for delivery of infants at or near term. This practice has been suggested by Rutherford et al 5 and by Sarno et al,6 who noted a significantly higher risk of cesarean delivery for fetal distress and low Apgar scores for those parturients with an AFI =5.0 cm than for those with an AFI 5.0 cm. Since these initial publications, other investigators
