A higher diastolic blood pressure and a lower Qp/Qs ratio were associated with a more stable and efficient circulation in patients with a right ventricular to pulmonary artery conduit. More intensive ventilatory support was necessary during the first postoperative days. We did not note any adverse effects of the ventriculotomy on ventricular performance.

It has long been recognized that maternal subjective experience of childbirth is an important outcome of obstetric care. A number of questionnaires have been developed to investigate the maternal experience in childbirth. Most studies using such questionnaires have focused on maternal experience with labor and vaginal birth, with less attention given to the maternal experience for cesarean without labor.This cohort study compared maternal satisfaction with the birth experience among the following 2 groups of women: primiparous women planning primary cesarean (n ϭ 44) and a comparison group of women planning vaginal birth (n ϭ 160). A visual analog scale and a patient questionnaire evaluated the maternal subjective experience of childbirth postpartum and at 8 weeks after birth. Each woman rated her satisfaction with her childbirth experience with respect to fulfillment, distress, and difficulty.More than 80% of women in both groups completed the postpartum questionnaire, with no difference in follow-up between groups. At 8 weeks postpartum, women planning cesarean birth had higher satisfaction ratings (P ϭ 0.023), higher scores for fulfillment (P ϭ 0.017), lower scores for distress (P ϭ 0.010), and lower scores for difficulty compared with those planning virginal birth. The least favorable scores were found among women who delivered by unplanned cesarean (n ϭ 48). Women with planned cesarean reported a more favorable birth experience compared with those planning vaginal birth; much of the reduced satisfaction among women planning vaginal birth was attributed to unplanned cesarean.These findings suggest that efforts in the United States to reduce the rate of unplanned cesarean births are likely to have the greatest positive impact on maternal satisfaction with childbirth. OBSTETRICSVolume 66, Number 9 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe relationship between the timing of epidural anesthesia during labor with delivery and outcome of labor is controversial. A systematic review published in 2007 found a similar rate for cesarean delivery and instrumental vaginal delivery for early epidural analgesia and control group. These results have been questioned, however, because of the use of a broad definition of the early group (before 4-5 cm dilatation) and an incomparable control group.The primary aim of this report was to review recent literature on the effect of the timing of epidural analgesia on the rate of cesarean or instrumental vaginal deliveries in nulliparous women at a gestational age of at least 36 weeks. A search in electronic databases (Pubmed, EMBASE, and the Cochrane Library) was performed until 2010 for randomized controlled trials and prospective and retrospective cohort studies evaluating the effects of early epidural analgesia defined as cervical dilatation Յ3 cm (including combined-spinal epidural) and late-phase epidural analgesia (at least 4 cm) on the mode of delivery in nulliparous term women. The main outcome measure was the rate of cesarean deliveries or instrumental vaginal deliveri...

Objective Valvuloplasty of the fetal aortic valve has the potential to prevent progression of critical aortic stenosis (AS) to hypoplastic left heart syndrome (HLHS

No abstract

ObjectiveTo assess the immediate effects of fetal pulmonary valvuloplasty on right ventricular (RV) size and function as well as in‐utero RV growth and postnatal outcome.MethodsPatients with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS) who underwent fetal pulmonary valvuloplasty at our center between October 2000 and July 2017 were included. Echocardiographic data obtained before and after the procedure were analyzed retrospectively (median interval after intervention, 1 (range, 1–3) days) for ventricular and valvular dimensions and ratios, RV filling time (duration of tricuspid valve (TV) inflow/cardiac cycle length), TV velocity time integral (TV‐VTI) × heart rate (HR) and tricuspid regurgitation (TR) velocity. Longitudinal data were collected from only those fetuses followed up in our center. Outcome was assessed using the scoring system as described by Roman et al. for non‐biventricular outcome.ResultsThirty‐five pulmonary valvuloplasties were performed in our institution on 23 fetuses with PAIVS (n = 15) or CPS (n = 8). Median gestational age at intervention was 28 + 4 (range, 23 + 6 to 32 + 1) weeks. No fetal death occurred. Immediately after successful intervention, RV/left ventricular length (RV/LV) ratio (P ≤ 0.0001), TV/mitral valve annular diameter (TV/MV) ratio (P ≤ 0.001), RV filling time (P ≤ 0.00001) and TV‐VTI × HR (P ≤ 0.001) increased significantly and TR velocity (P ≤ 0.001) decreased significantly. In fetuses followed longitudinally to delivery (n = 5), RV/LV and TV/MV ratios improved further or remained constant until birth. Fetuses with unsuccessful intervention (n = 2) became univentricular, all others had either a biventricular (n = 15), one‐and‐a‐half ventricular (n = 3) or still undetermined (n = 3) outcome. Five of nine fetuses with a predicted non‐biventricular outcome, in which the procedure was successful, became biventricular, while two of nine had an undetermined circulation.ConclusionIn selected fetuses with PAIVS or CPS, in‐utero pulmonary valvuloplasty led immediately to larger RV caused by reduced afterload and increased filling, thus improving the likelihood of biventricular outcome even in fetuses with a predicted non‐biventricular circulation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.