case studies & continued learning

Hi all
It was such a pleasure and inspiration to meet you all over the weekend seminars …. Hopefully this is just a starting point for the use of obstetric acupuncture becoming a routine care offered to women
There was a depression study that was referenced in your notes but missing off the power point - (this was the one that found that by treating anxiety and depression during pregnancy there was a protection offered to these women from developing post natal depression)
The reference is
Manber R, Schnyer R, Allen J, Rush A, Blasey C. (2004)Acupuncture: a promising treatment for depression during pregnancy. Journal of Affective Disorders 83. 89-95

Look forward to hearing your comments and questions so that we can keep learning from each other ….
Debra

Hi Lorne
Interesting …..
I have never seen a woman with this diagnosis
Did she mean that it was a bilateral notch in the uterine artery?
This is a Doppler measurement thought to be associated with intrauterine growth restriction, pregnancy induced hypertension, and poor perinatal outcomes.
But it all depends when it was detected as it may disappear by 24 weeks
I thought the following might be relevant as it sounds as if she had the MSAFP screen followed by the Doppler ?

THE RELATIONSHIP BETWEEN MATERNAL SERUM α- FETOPROTEIN AND UTERINE ARTERY DOPPLER FINDINGS AT 20-24 WEEKS’ GESTATION FOR PREDICTION OF PREECLAMPSIA AND INTRAUTERINE GROWTH RETARDATION
Seyfettin Uludağ, Rıza Madazlı, Ali Benian, Vildan Ocak, Selçuk Erez
Sub-department of Perinatology, Department of Obstetrics and Gynecology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
Keywords: IUGR, Preeclampsia, MSAFP, Diastolic notch
________________________________________
Objective: To estimate the relationship between maternal serum α- fetoprotein (MSAFP) levels and uterine artery Doppler findings at 20th week of pregnancy for prediction of preeclampsia and intrauterine growth retardation (IUGR).
Methods: Eighty pregnant women were followed as a study group prospectively. MSAFP levels at the 15-18th week of gestation and bilateral uterine artery Doppler findings at the 20th week of gestation were obtained.
Results: Bilateral early diastolic notch of the uterine artery was detected in 17 cases (21, 75%) at the 20th week of gestation. In 9 of them early diastolic notch was persistent at the 24th week while in 8 cases, it had disappeared. Uterine artery diastolic notch was found to be a significant predictive factor for preeclampsia, as well as for IUGR (p< 0.001, OR: 69.74; p<0.02, OR: 10.11, respectively). MSAFP levels of 17 cases that showed early diastolic notch in uterine artery Doppler were significantly higher than in the notch negative cases (p<0.05). The levels of MSAFP in 9 cases which demonstrated the persistence of diastolic notch, were significantly higher than the 8 cases where the notch had disappeared, at the 24th week of gestation (p<0.05).
Conclusion: Our findings suggest that abnormal uterine artery Doppler findings at 20th week of gestation correlate with elevated MSAFP levels, and bilateral diastolic notch in uterine artery at 20 weeks’ gestation together with elevated MSAFP, is associated with poor obstetric outcome.

As the foetal growth is slowing (is this in one or both twins?) this is obviously not a positive sign - treatment could look at trying to nourish the babies through nourishing the mother – if you felt a TCM diagnosis supported this - using moxa on points such as ST 36 and BL 23 ( 5 to ten minutes each point for ten days )
Or if you felt there was any heat / liver qi stagnation through aiming to treat preventing the occurrence of preeclampsia - through points such as LIV 3, ST 36 and LI 11
The good news is that the placenta previa isn’t a problem until she reaches at least 32 weeks gestation as this will usually have moved out of the way by then
I am working with the midwives this weekend – including one who works in a high risk clinic, will ask to see if I can find anything else …

Debra

Hi Everyone
Thought you all might find these comments from a midwife about her use of moxa interesting – as mentioned in the seminar this is routine practice here, as elsewhere - has anyone approached your association about this?

Over the last 6 months I have had three women with Breech presentations confirmed on Scan at 35 weeks gestation. Good foetal growth in all cases. With no hypertension, increased liquor volume, diabetes or known foetal abnormality.
I taught all three clients how to apply Moxa (using smokeless sticks) to BL-67 showing them the illustration from the acupressure booklet, and giving them a copy of the instructions on the safe use of Moxa. I instructed all to continue Moxa for 10 days even if baby turned.

Amber was a primigravida who employed Moxa for 7 days prior to presenting for ECV at 37 weeks, On that day the baby was found to be in oblique position and was easily turned to cephalic presentation by the obstetrician and stayed cephalic until delivery.

Beth was a multigravid patient who had a previous Caesarean section and again I started Moxa at about 36 weeks. When presented fro ECV at 37 weeks baby was transverse and easily turned to Cephalic presentation. I was not present at ECV as busy elsewhere and unfortunately she was advised by my colleague to stop moxa at that point. I did not find out about this until several days later. Baby reverted to transverse and an emergency Caesarean ensued after rupture of membranes and a baby in transverse position.

Cathy was an interesting case. Early scan at 7 weeks showed a bicornuate uterus with baby in right horn. Scan at 20 weeks failed to re demonstrate a bicornuate uterus. At 34+ weeks she complained of reduced movements and a scan showed a baby in the breech position. All other measurements normal. I decided to offer her Moxa despite Bicornuate uterus and arranged for an ECV at 37 weeks. I fully discussed with the obstetrician her scan reports and comments re bicornuacity of uterus and he opted for an attempt at 36 weeks.
On presenting for ECV baby was in oblique position and ECV was successful. Moxa continued for 5 more days. Spontaneous labour at term with normal delivery of 3.8kg baby.

Margaret Hadley

d betts
http://acupuncture.rhizome.net.nz