Often it is very easy to differentiate between
syncope and seizure. In syncope, the patient suddenly feels
giddy and faints, and may fall down and sweat. Usually, the
BP falls and pulse rate is slow. Often the recovery is rapid.
In case of seizure, the attack of unconsciousness lasts longer.
There are often tonic or clonic type of movements of the limbs
(the patient may also pass urine during the attack). Recovery
is slow and may take 5-10 minutes or more. If the family physician
can collect blood for Prolactin levels within 15-20 minutes
of the episode, and blood for CPK 3 hours after the episode,
the differential diagnosis becomes very easy.
In an attack of syncope, both these tests are normal. However,
in an epileptic seizure, the readings of both these tests are
high.
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NarrowED
retinal arterioles predict development of hypertension
Labouring in water may reduce the need for augmentation
and other forms of obstetric intervention in women with
dystocia, and be an option when progress in the first
phase of labour is slower than expected. Cluett and
colleagues randomised 99 nulliparous women with dystocia
to immersion in water in a birth pool or to standard
augmentation (amniotomy and intravenous oxytocin). Women
labouring in water had a lower rate of epidural analgesia,
and fewer required augmentation. There was no difference
in the rate of operative delivery, but more neonates
in the water group were admitted to a neonatal unit
for reasons apparently unrelated to water labouring.
The authors believe that this strategy may increase
satisfaction, reduce pain, and optimise use of resources.
BMJ,
2004; 328 : 314.
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