Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial.

OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes. DESIGN: Randomised controlled multicentre open-label trial. SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011. POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section. METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days). MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events. RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups. CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

Difference in plasma bilirubin concentration between monozygotic and dizygotic newborn twins.

AIM: To investigate whether inherited factors, other than those already known, influence the bilirubin concentration in neonates of northern European descent, by comparison of monozygotic and dizygotic twins with respect to differences in the plasma bilirubin concentrations between the twins. METHODS: 77 healthy pairs of twins of the same gender with a gestational age > or = 250 d and of northern European descent were included. Fourth postnatal day blood sampling was done. A multiple linear regression analysis was carried out with the difference in serum bilirubin concentration between the twins as the independent factor, and zygosity, gender, gestational age, postnatal age, maternal smoking, ABO blood-type incompatibility, and the differences between the twins in blood haemoglobin concentration, formula feeding and weight loss as dependent factors. RESULTS: 27 pairs of twins were monozygotic and 50 pairs dizygotic. The analysis showed that the difference in serum bilirubin concentration between the twins was dependent on whether the twins were monozygotic or dizygotic, i.e. the estimated difference in serum bilirubin concentration between the monozygotic twins was 17.8 micromol l(-1) [SE 6.6 micromol l(-1), p = 0.02, 95% confidence interval (95% CI) 3.4, 32.3 micromol l(-1)] less than the difference between the dizygotic twins, adjusted for the above-mentioned potential confounders. The difference in serum bilirubin concentration between the twins was positively correlated to the difference in weight loss (%) between the twins (adjusted estimate 5.2 micromol l(-1), SE 2.1 micromol l(-1) , p = 0.01, 95% CI 1.2, 9.3 micromol l(-1)). CONCLUSION: In a population of northern European descent, other genetic factors than gender and ABO blood type were significant for the plasma bilirubin concentration in healthy infants.

[Polyglyconate or polyglycolic acid suture in patients with suspected impaired wound healing]. / Polyglykonat- eller polyglykolsyresutur hos patienter med forventet haemmet sårheling.

A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard to development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7% of patients with polyglyconate sutures and in 16% of those with polyglycolic acid sutures (p = 0.04). Monofilament polyglyconate suture does not reduce the incidence of fascial disruption and incisional hernia after laparotomy in patients with suspected impaired wound healing but the incidence of wound infection may be reduced compared with that of multifilament polyglycolic acid suture.

Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing.

A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P = 0.04). Monofilament polyglyconate suture does not reduce the incidence of fascial disruption and incisional hernia after laparotomy in patients with suspected impaired wound healing but the incidence of wound infection may be reduced compared with that of multifilament polyglycolic acid suture.

The superiority of rectal thermometry to oral thermometry with regard to accuracy.

Electronic oral thermometry is performed routinely in most medical centres. From the studies available on this subject it seems difficult to find any documentation for this practice. We have conducted clinically controlled studies in which the accuracy of electronic oral thermometry (CRAFTEMP and TERUMO WCT) and that of electronic rectal thermometry (TERUMO WCT) were tested. Rectal glass mercury thermometry was used as a reference method. Two studies were designed. In study 1, 184 patients (72 women, 112 men), median age 70 (18-95) years were investigated. In study 2, 91 patients (41 women, 50 men), median age 59 (18-96) years were investigated. Electronic oral thermometry was found unacceptably inaccurate under daily routine conditions. Electronic rectal thermometry was found to be accurate. Calculations of mean temperature difference between reference measurements and test measurements (mean +/- SD) were found to be: routine oral CRAFTEMP at 0.70 +/- 0.50 degrees C, optimum oral TERUMO WCT at 0.75 +/- 0.74 degrees C, routine rectal TERUMO WCT at 0.08 +/- 0.26 degrees C and optimum rectal TERUMO WCT at 0.02 +/- 0.17. In the screening procedure for fever oral thermometry showed low sensitivity (routine CTAFTEMP 0.47 and optimum TERUMO WCT 0.59) whereas rectal thermometry showed high sensitivity (routine TERUMO WCT 0.74 and optimum TERUMO WCT 0.91). It was concluded that rectal thermometry must be preferred to oral thermometry for daily routine measurements.

[Only rectal temperature measurements are suitable for routine temperature measurement]. / Kun rektale målinger er egnede til rutinemaessig temperaturmåling.

A new rapid electronic thermometer (V.C.T. TERUMO) has been introduced to Danish hospitals. Oral and rectal V.C.T. measurements were compared with rectal measurements with mercury thermometers. In addition, rectal V.C.T. measurements in the wards were compared with rectal measurements with mercury thermometers. A total of 91 patients participated in the investigation. The average differences between the electronic rectal and oral compared with recordings by mercury thermometers were found to be 0.02 degree C and 0.75 degree C, respectively, under optimal conditions for measurement while the corresponding scatters of difference in temperature were 0.17 degree C and 0.74 degree C, respectively. The average difference between rectal temperature measurements with mercury thermometers and rectal V.C.T. measurements carried out during daily routine circumstances was 0.08 degree C while the scatter of the difference in temperature was 0.26 degree C. It is concluded that rectal V.C.T. measurements are just as suitable as rectal measurements with mercury thermometers and employment of rectal V.C.T. thermometer measurements is recommended in the daily hospital routine. Employment of oral and axillary measurements is discussed and not recommended.

[Prostatic hypertrophy: natural history. Subjective and objective changes during a 6-month period]. / Hypertrophia prostatae: "Naturhistorie". Subjektive og objektive aendringer i en 6 måneders periode.

Out of 30 patients, referred consecutively, with symptomatic and urodynamic signs of benign hypertrophy of the prostate, 22 were observed for six months as regards symptom scoring, urine flow measurements, serum creatinine and culture from the urine. After the period of observation, 1/3 of the patients no longer wanted operation on account of subjective improvement. The symptom scoring in this group was significantly lower (p less than 0.01) than in the group which was subsequently submitted to operation, on the other hand, no difference in urine flow was demonstrated. No statistically significant alteration in symptom scoring or urine flow was observed during the period of observation but both parameters showed fluctuations. The variations in flow were no greater than in men with normal micturition. None of the patients developed acute retention or involvement of upper urinary tracts during the period of observation. This investigation speaks for a more observing attitude towards treatment of benign hypertrophy of the prostate. In cases where no absolute indications for operative treatment are present (episodes of retention of urine or involvement of the upper urinary tracts), the patient's subjective symptoms constitute an important factor in the indications for operation.

Tubulo-villous adenoma of the female genital tract: a case report and review of literature.

A case is presented of tubulo-villous adenoma in the vagina of a 43-year-old woman. The possible origin of this rare condition is discussed and the need for careful follow-up is emphasized.

[Urinary flow measurement at home prior to examination for intravesical obstruction]. / Urinflowmåling i hjemmet inden undersøgelse for infravesikal obstruktion.

Fifty patients referred with the diagnosis of prostatic hypertrophy were sent written instructions for simple home flow measurement. Forty-one patients came to outpatient interview and carried out uroflowmeterflow, home flow as water cystometry supplemented by simultaneous pressure-flow examination. Thirty-one patients achieved conclusive flows. No significant differences were observed between home flow (mean 6.7 ml/second, range 2.2-21.8 ml/second) and uroflowmeterflow (mean 5.9 ml/second, range 1.8-14.7 ml/second) assessed by Pratt's test (p greater than 0.05). The positive predictive values were 88% and 85%, respectively. The conclusion of this investigation is that simple home flow measurement is a useful parameter in the prehospital assessment of patients with suspected infravesical obstruction.

Prognostic value of semen analyses in infertility evaluation (male fertility/life-table analysis).

The aim of the present study was to evaluate which of the various parameters of semen analysis that are most significantly related to the obtainment of pregnancy. A follow up questionnaire was sent to 1953 couples, who had been examined for infertility, and 1,480 (76%) replied. We focused on 713 of these couples, in whom the female partner had a normal fertility set-up (potentially fertile). This study suggests that sperm vitality and sperm concentration bear the most significant relation to pregnancy. Evaluation of a couple's fertility potential by means of the life-table method shows a gradual increase in the pregnancy rate of all couples, irrespective of semen quality, during a observation period of 10 years. The pregnancy rate after 5 years was 14% in a group with reduced semen quality and 44% in a group with normal semen quality.

Familial occurrence of diminished pancreatic amylase in serum--a "silent" Amy-2 allelic variant?

We describe a family of 32 subjects, including two healthy siblings without detectable pancreatic amylase in serum and five healthy relatives (one of them a sister) exhibiting subnormal pancreatic amylase activities. Comparisons of immunoreactive amylase concentrations with the corresponding amylase activities may justify the assumption of a "silent" Amy-2 allelic variant.