The influence of MRI-based pelvimetric measurements in mother's choice of delivery in fetal breech position.

INTRODUCTION: At term, about 3-4% of all singleton pregnancies present as breech. MRI-based pelvimetry is a valuable tool to support selection of adequate candidates for a trial-of-labor in women expecting term breech babies. Shared decision-making is playing an increasingly important role in obstetrics. Since the divergent existing knowledge of breech term delivery needs to be discussed with the pregnant woman, we examined the influence of MRI results on the shared decision-making process in women with term breech presentation. METHODS: Between 08/2021 and 12/2022, anamnestic and clinical parameters were collected from singleton pregnancies expecting term breech babies resulting in birth at the Hanover Medical School. After information, written consent and inclusion, clinical parameters, the course of birth and the maternal and fetal outcome were collected retrospectively. 32 women participated in a postpartum questionnaire study on inquiry. The subsequent acquisition of information and the arguments in the decision-making process were determined. In addition, the sense of security and self-determination was asked both before and during birth. RESULTS: 50% of the respondents had not decided for a mode of delivery before having MRI pelvimetry. After imaging and information, about the own pelvic dimensions and predictors for a successful vaginal birth, 80% of this subgroup decided to give birth vaginally. Over 40% of the collective descripted that they made a decision based on the result of MRI pelvimetry. None of the women felt to be insecure after having talked about the MRI results. The elective cesarean section group and the group of those who delivered vaginally were approximately equally highly satisfied with their feeling of self-determination of the birth mode. Overall, the study population had a very positive birth experience. The group of women who had delivered by elective cesarean showed a wider range in their assessment and appeared to perceive the experience more negative than the group of women who had a vaginal birth or emergency cesarean. Fetal and maternal outcomes did not differ between the groups. DISCUSSION: MRT pelvimetry measurements can be used as a predictor for a successful vaginal breech delivery. The additional information obtained from the MRI measurements can be used in the shared decision-making process to decide more easily on the mode of delivery while improving women's awareness and safety. A balanced education on rare and frequently adverse events of vaginal delivery and cesarean section and patient expectations about labor processes must be taken into account.

Investigation of potential metal emissions from galvanic anodes in offshore wind farms into North Sea sediments.

To evaluate potential metal emissions from offshore wind farms (OWFs), 215 surface sediment samples from different German North Sea OWFs taken between 2016 and 2022 were analyzed for their mass fractions of metals and their isotopic composition of Sr. For the first time, this study provides large-scale elemental data from OWFs of the previously proposed galvanic anode tracers Cd, Pb, Zn, Ga and In. Results show that mass fractions of the legacy pollutants Cd, Pb and Zn were mostly within the known variability of North Sea sediments. At the current stage the analyzed Ga and In mass fractions as well as Ga/In ratios do not point towards an accumulation in sediments caused by galvanic anodes used in OWFs. However, further investigations are advisable to evaluate long-term effects over the expected lifetime of OWFs, especially with regard to the current intensification of offshore wind energy development.

Occurrence and Temporal Variation of Technology-Critical Elements in North Sea Sediments-A Determination of Preliminary Reference Values.

As interest in the investigation of possible sources and environmental sinks of technology-critical elements (TCEs) continues to grow, the demand for reliable background level information of these elements in environmental matrices increases. In this study, a time series of ten years of sediment samples from two different regions of the German North Sea were analyzed for their mass fractions of Ga, Ge, Nb, In, REEs, and Ta (grain size fraction < 20 µm). Possible regional differences were investigated in order to determine preliminary reference values for these regions. Throughout the investigated time period, only minor variations in the mass fractions were observed and both regions did not show significant differences. Calculated local enrichment factors ranging from 0.6 to 2.3 for all TCEs indicate no or little pollution in the investigated areas. Consequently, reference values were calculated using two different approaches (Median + 2 median absolute deviation (M2MAD) and Tukey inner fence (TIF)). Both approaches resulted in consistent threshold values for the respective regions ranging from 158 µg kg-1 for In to 114 mg kg-1 for Ce. As none of the threshold values exceed the observed natural variation of TCEs in marine and freshwater sediments, they may be considered baseline values of the German Bight for future studies.