Rationalisation of the caesarean section rate in a tertiary referral hospital using the Robson classification.

The aim of this study was to implement the Robson Ten Groups Classification System (RTGCS) to identify the main contributors to the caesarean section (CS) rate and to evaluate whether the introduction of a plan of obstetrical interventions reduced this rate. An observational retrospective cross-sectional study was conducted during two time periods at Alicante University General Hospital. In the pre-implementation period (2009-2012), RTGCS was applied to identify the main groups contributing to the overall CS rate. In the post-implementation period (2013-2017), RTGCS was applied again to identify changing trends in CS rates. In all, 11,034 deliveries during the pre-intervention period and 11,453 during the post-intervention period were analysed. The overall CS rate was 23.9% and 20.9%, respectively. There were no changes in perinatal outcomes. In the post-intervention period, there was a significant decrease of the CS rate in the groups of targeted interventions 1, 2, 3, 4, 5, and 8B.Impact statementWhat is already known on this subject? High CS rates are becoming a public health problem because of risks, costs, excessive medicalisation, and abuse of resources. RTGCS provides a framework for auditing and analysing CS rates.What do the results of this study add? RTGCS can identify the groups that have the greatest impact on the CS rate and monitor changes in it consequent to policy changes.What are the implications of these findings for clinical practice? The introduction of a strategic plan with evidence-based clinical interventions may have a greater effect on the CS rate than other features justifying the increase in the incidence of CS.

Effect of the Use of Purified Grape Pomace as a Fining Agent on the Volatile Composition of Monastrell Wines.

(1) Background: The lack of viable alternatives for the industrial exploitation of grape pomace is one of the reasons why it is considered a serious environmental pollutant. However, as a byproduct, it could be used as a fining agent, since previous studies have shown that it is able to eliminate undesirable substances in wine. However, the little information available does not describe its effect on wine aroma. (2) Methods: Purified grape pomace extracts were used for fining a red wine and their effect on the volatile compounds of the wine was assessed, comparing the results with those obtained with different commercial fining agents. (3) Results: The results showed how purified grape pomace decreased the total volatile content of a wine to a similar extent as other fining products, such as yeast extracts or gelatin. Among the different families of volatile compounds analyzed, only total esters and terpenes differed from the levels recorded for a control wine, being slightly lower. No statistical differences were found for the rest of the volatile compounds (alcohols, carbonyl, lactones, and acids) compared with the levels measured in control wine. (4) Conclusions: The results suggest that purified grape pomace could be used as a non-allergenic wine fining agent.

Performance of purified grape pomace as a fining agent to reduce the levels of some contaminants from wine.

The quality of red wine depends on the absence of compounds which may affect its safety and/or stability such as ochratoxin A, biogenic amines and some metals and trace compounds. The presence of ochratoxin A in musts and wines is due to fungal contamination of the grapes and has been classified as a possible human carcinogen. Biogenic amines are formed by the microbiological decarboxylation of the corresponding amino acid precursors during the fermentation or ageing and storage, and, at high concentrations, they may induce adverse reactions in sensitive people. Trace elements may have both a nutritional and a toxic effect on health, but also can cause turbidity and stability problems. Their presence is affected mainly by natural factors such as soil mineral content and direct contact with tank surfaces and metallic tubing during winemaking. One of the best options to remove these compounds when present in excess in wine is fining. However, some fining agents commonly used may themselves present problems related with their allergenic properties or with their propensity to increase the protein content, which can cause turbidity problems. In an attempt to avoid such these problems, purified grape pomace was tested as a fining alternative since it has been seen to have a high capacity to reduce the astringency, turbidity and also the ochratoxin A content. The main aim of this work, therefore, was to study if this material can limit the presence of ochratoxin A, biogenic amines and metals and some trace elements in a Monastrell red wine, thus increasing the value and safety of this product.

Technological Implications of Modifying the Extent of Cell Wall-Proanthocyanidin Interactions Using Enzymes.

The transference and reactivity of proanthocyanidins is an important issue that affects the technological processing of some fruits, such as grapes and apples. These processes are affected by proanthocyanidins bound to cell wall polysaccharides, which are present in high concentrations during the processing of the fruits. Therefore, the effective extraction of proanthocyanidins from fruits to their juices or derived products will depend on the ability to manage these associations, and, in this respect, enzymes that degrade these polysaccharides could play an important role. The main objective of this work was to test the role of pure hydrolytic enzymes (polygalacturonase and cellulose) and a commercial enzyme containing these two activities on the extent of proanthocyanidin-cell wall interactions. The results showed that the modification promoted by enzymes reduced the amount of proanthocyanidins adsorbed to cell walls since they contributed to the degradation and release of the cell wall polysaccharides, which diffused into the model solution. Some of these released polysaccharides also presented some reactivity towards the proanthocyanidins present in a model solution.