The NICOM device is simple to use, operator independent, and provides clear and consistent monitoring signals. The output identified distinct hemodymamic profiles that are consistent with the findings of more invasive existing methods.

Purpose The epidural electrical stimulation test (EEST) is a highly specific and sensitive test for confirming placement of the epidural catheter in the epidural space. The purpose of this study was to investigate if the EEST could predict the spread and consumption of local anesthetic solutions during labour epidural analgesia. Methods This observational study was conducted in labouring parturients requesting epidural analgesia. The EEST was performed after the epidural catheter placement (T0) and repeated five minutes after a test dose with 2% lidocaine 3 mL (T1). The minimum current required to elicit the motor response at each time point was recorded.A loading dose of 0.125% bupivacaine 10 mL and fentanyl 50 lg was administered and followed by patient-controlled epidural analgesia with 0.0625% bupivacaine and fentanyl 2 lgÁmL -1 (baseline infusion 10 mLÁhr -1 , bolus dose 5 mL, lockout interval ten minutes, maximum dose 20 mLÁhr -1 ). The primary outcome was the correlation between the current required to elicit motor responses at T0 and T1 and the consumption of bupivacaine in the first two hours of epidural administration. The secondary outcomes included the muscle contraction patterns determined by the EEST and the incidence of failed, inadequate, or asymmetric blocks. Results The study was conducted in 102 parturients. The mean electric current required to elicit muscle response was 4.43 mA (range 1-10 mA) at T0, 5.97 mA (range 1-14 mA) at T1, and the mean D (T1-T0) current was 1.54 mA (range 0-8 mA). There was no correlation between either the mean baseline current required or the D (T1-T0) current and the total bupivacaine consumption at two hours. The incidence of inadequate blocks at two hours was 18%; however, none of the catheters required replacement. Unilateral left (34%) or right (31%) leg contraction was the most frequent pattern elicited by the EEST. Conclusions The EEST shows a wide range of electrical current requirements and elicits a variety of muscle twitch patterns on the lower limbs. Although it confirms the epidural placement of the catheter, the EEST cannot be used to predict the spread or consumption of the local anesthetic solution during labour epidural analgesia. RésuméObjectif Le test de stimulation e´lectrique pe´ridurale (TSEP) est un test extreˆmement spe´cifique et sensible qui

A specific and sensitive radioimmunoassay for human pregnancy-associated plasma protein A (PAPP-A) is described. This assay utilized tracer repurified by affinity chromatography on heparin-Sepharose. The most sensitive assay developed had a detection limit of 5 microliters PAPP-A in serum, and this protein could not be detected in sera from non-pregnant subjects. During pregnancy, mean circulating levels rose from 0.6 mg/l at 6 weeks gestation to 110 mg/l at term, and PAPP-A was detected in 44 of 101 umbilical blood samples. The use of the anticoagulants EDTA and acid citrate dextrose resulted in significantly different results in the plasma compared to the corresponding serum sample. PAPP-A was also measured in amniotic fluid.

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