Search

The increased circulatory and metabolic demands of pregnancy lead to a variety of adaptive responses in many regional vascular beds. The concomitant development of anemia could modify these adaptive processes. The purpose of our studies was to quantify the regional vascular responses to chronic anemia in pregnant sheep and to compare those responses to those occurring with acute anemia. We measured regional blood flows and O2 deliveries and calculated vascular resistances in 10 near-term pregnant sheep, five of which were made anemic (hematocrit = 14%) for 6 days by isovolemic hemodilution with fresh plasma. The remaining five sheep served as controls (hematocrit = 28%). As a result of 6 days of anemia, almost all regional beds (except for the small intestines, colon, and spleen) had increases in blood flow, which helped maintain tissue O2 deliveries at or near normal levels. Tissues with increased flow accounted for 88% of cardiac output, in contrast to what has been reported for acute anemia of comparable severity, where tissues receiving increased flow accounted for only 9% of cardiac output. Our data indicate that regional vascular responses to chronic anemia differ from those to acute anemia during pregnancy. The global increase in perfusion with chronic anemia plays an important role in counteracting the potential adverse effects of the anemic state on both mother and fetus.

The purpose of this reprospective study was to determine the cost of antenatal testing in an ambulatory setting for the most common indications for testing. A cost analysis based on abnormal test results leading to intervention to deliver was done for the various high risk indications. The population consisted of 467 high risk patients who were divided into five categories based on the indications for testing: Postdate pregnancy, risk for Uteroplacental Insufficiency, Diabetes, Twins, and Other. The cost to detect one patient with an abnormal test for a marker utilizing fetal heart rate, breathing movement, body movement, and tone was $13,536. For the marker oligohydramnios, the cost was $2,707. Significant differences in cost were noted among each of the five groups within the study population. Future studies of antenatal fetal surveillance should consider the cost of testing and attempt to direct a specific patient to the most appropriate test to enhance utilization of resources.