scholarly journals Short-Term Effects of Dexamethasone versus Betamethasone on Ultrasonic Measures of Fetal Well-Being: Cohort from a Blinded, Randomized Trial

2021 ◽  
pp. 1-15
Author(s):  
Amanda Henry ◽  
Aditi Mahajan ◽  
Caroline A. Crowther ◽  
Anne Lainchbury ◽  
Lynne Roberts ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Randomized Trial ◽  
Umbilical Artery ◽  
Well Being ◽  
Ductus Venosus ◽  
Short Term ◽  
Fetal Ultrasound ◽  
Corticosteroid Administration ◽  
Uterine Artery Doppler ◽  
Biophysical Profile

<b><i>Introduction:</i></b> Maternal corticosteroid administration for anticipated preterm birth is common; however, the corticosteroid effect on fetal ultrasound and cardiotocograph (CTG) remains contested. This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect. <b><i>Methods:</i></b> Substudy of blinded randomized trial of dexamethasone versus betamethasone (given &#x3c;34 weeks). Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid. <b><i>Results:</i></b> Of 47 fetuses (39 singleton; 4 dichorionic, diamniotic twins; and 4 monochorionic, diamniotic twins) in the February 2012–2013 period, 24 received dexamethasone and 23 betamethasone at average gestation 29.8 ± 2.9 weeks. Thirteen pregnancies (30%) had pre-corticosteroid fetal concerns (estimated weight &#x3c;10th centile and/or abnormal UA/MCA Doppler). Few significant differences were seen post-corticosteroid: DV pulsatility index and right MPI initially decreased 15–20%, and average BPP decreased slightly on days 1–2. There were no major differential effects of dexamethasone versus betamethasone. <b><i>Discussion/Conclusion:</i></b> No substantive post-corticosteroid effects were seen for most ultrasound/CTG measures in fetuses with heightened preterm birth risk but predominantly normal pre-corticosteroid measures. Clinically, this suggests avoiding overreliance on individual measures for delivery decisions post-corticosteroid; equally, multiple/marked ultrasound changes suggest true pathology and not corticosteroid effect.

scholarly journals Successful amnioinfusion for severe fetal growth restriction with umbilical cord complications: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Daisuke Katsura ◽  
Yuichiro Takahashi ◽  
Shigenori Iwagaki ◽  
Rika Chiaki ◽  
Kazuhiko Asai ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Umbilical Cord ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Cord Compression ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Fetal Ultrasound ◽  
Fetal Doppler

Abstract Background There is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications. Case presentation We encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions. Conclusions Amnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography.

Intraindividual Variability and Stability of Affect and Well-Being

GeroPsych ◽  
2013 ◽  
Vol 26 (3) ◽  
pp. 185-199 ◽  
Author(s):  
Christina Röcke ◽  
Annette Brose
Keyword(s):  
Age Differences ◽  
Well Being ◽  
Subjective Well Being ◽  
Emotional Experiences ◽  
Short Term ◽  
Regulatory Processes ◽  
Functional Implications ◽  
Methodological Approaches ◽  
Underlying Processes

Whereas subjective well-being remains relatively stable across adulthood, emotional experiences show remarkable short-term variability, with younger and older adults differing in both amount and correlates. Repeatedly assessed affect data captures both the dynamics and stability as well as stabilization that may indicate emotion-regulatory processes. The article reviews (1) research approaches to intraindividual affect variability, (2) functional implications of affect variability, and (3) age differences in affect variability. Based on this review, we discuss how the broader literature on emotional aging can be better integrated with theories and concepts of intraindividual affect variability by using appropriate methodological approaches. Finally, we show how a better understanding of affect variability and its underlying processes could contribute to the long-term stabilization of well-being in old age.

Positive Emotions

2009 ◽  
pp. 12-24 ◽  
Author(s):  
Michael A. Cohn ◽  
Barbara L. Fredrickson
Keyword(s):  
Positive Emotions ◽  
Well Being ◽  
Life Outcomes ◽  
Short Term ◽  
Future Success ◽  
Broaden And Build Theory ◽  
Mental And Physical Health ◽  
Very High ◽  
Future Growth

Positive emotions include pleasant or desirable situational responses, ranging from interest and contentment to love and joy, but are distinct from pleasurable sensation and undifferentiated positive affect. These emotions are markers of people's overall well-being or happiness, but they also enhance future growth and success. This has been demonstrated in work, school, relationships, mental and physical health, and longevity. The broaden-and-build theory of positive emotions suggests that all positive emotions lead to broadened repertoires of thoughts and actions and that broadening helps build resources that contribute to future success. Unlike negative emotions, which are adapted to provide a rapid response to a focal threat, positive emotions occur in safe or controllable situations and lead more diffusely to seeking new resources or consolidating gains. These resources outlast the temporary emotional state and contribute to later success and survival. This chapter discusses the nature of positive emotions both as evolutionary adaptations to build resources and as appraisals of a situation as desirable or rich in resources. We discuss the methodological challenges of evoking positive emotions for study both in the lab and in the field and issues in observing both short-term (“broaden”) and long-term (“build”) effects. We then review the evidence that positive emotions broaden perception, attention, motivation, reasoning, and social cognition and ways in which these may be linked to positive emotions' effects on important life outcomes. We also discuss and contextualize evidence that positive emotions may be detrimental at very high levels or in certain situations. We close by discussing ways in which positive emotions theory can be harnessed by both basic and applied positive psychology research.

scholarly journals Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study

2021 ◽  
Author(s):  
E. Sutton ◽  
◽  
J. A. Lane ◽  
M. Davis ◽  
E. I. Walsh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Qualitative Interviews ◽  
Well Being ◽  
Localized Prostate Cancer ◽  
Short Term ◽  
Age Related ◽  
Qualitative Interview Study ◽  
Long Term Treatment

Abstract Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT.

scholarly journals Doppler ultrasound in pregnancy – quality requirements of DEGUM and clinical application (part 2)

2021 ◽  
Author(s):  
Renaldo Faber ◽  
Kai-Sven Heling ◽  
Horst Steiner ◽  
Ulrich Gembruch
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Umbilical Artery ◽  
Prophylactic Treatment ◽  
Doppler Sonography ◽  
First Trimester ◽  
Ductus Venosus ◽  
Fetal Diagnosis

AbstractThis second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. It also has significant implications for the diagnosis and surveillance of growth-restricted fetuses in the second and third trimesters through Doppler-sonographic analysis of umbilical artery, middle cerebral artery and ductus venosus. Here, especially the hemodynamics of the ductus venosus provides a critical criterium for birth management of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination of maximum blood flow velocity of the middle cerebral artery is a central parameter in fetal diagnosis of anemia which has been significantly improved by this analysis. However, it is important to note that the mentioned improvements can only be achieved through highest methodological quality. Importantly, all these analyses are also applied to twins and higher order multiples. Here, for the differential diagnosis of specific complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has become indispensable. To conclude, the successful application of Doppler sonography requires both exact methodology and precise pathophysiological interpretation of the data.

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