Breast self-examination in Greek midwives and midwifery students.

The aim of this study is to assess breast self-examination (BSE) practice in a representative sample of Greek midwives and midwifery students. Breast self-examination (BSE) is infrequent in healthcare professionals, including physicians and nurses. All midwives (n=245) and graduating midwifery students (n=165) who attended a congress of midwives were eligible to participate in the study, and a self-administered, anonymous questionnaire was developed to assess BSE practice. Midwives performed BSE more frequently than students (p<0.001). In addition, 27.0% of students performed BSE less frequently than every year whereas the midwives' rate is 14.0% (p<0.001). The proportion of subjects searching for specific signs of breast cancer during BSE and the BSE technique did not differ between midwives and students. In midwifery students, higher perceived knowledge of breast cancer-related issues was associated with more frequent BSE. Only a minority of Greek midwives and midwifery students practice BSE every month, and therefore implications for nursing management in BSE education should be included in midwifery school curricula to ensure increased BSE frequency, improved BSE accuracy and the promotion of BSE teaching to patients.

Serum relaxin and cervical length for prediction of spontaneous preterm birth in second-trimester symptomatic women.

OBJECTIVE: To investigate whether serum relaxin level is associated with preterm birth in symptomatic women, either as a standalone test or in the context of a combined model of serum relaxin and cervical length (CL). METHODS: This was a case-control study of women with a singleton pregnancy who presented between 24 + 0 and 26 + 6 weeks' gestation with threatened preterm labor and intact membranes. CL, full blood count, C-reactive protein level and maternal demographics were recorded at presentation, and blood samples were taken for relaxin measurement. Parameters were compared between women who delivered preterm (before 37 weeks) (n = 46) and those delivering at term (n = 66). Logistic regression with receiver-operating characteristics (ROC) curve analysis was used to assess significant predictors for birth before 37 and before 34 weeks. RESULTS: Women delivering before 37 weeks had higher mean serum relaxin levels and lower mean CL than those delivering at term (P < 0.0001). Relaxin alone had 63% (95% CI, 49-75%) sensitivity for birth before 37 weeks and 61% (95% CI, 47-74%) for birth before 34 weeks, at a 10% false-positive rate (FPR). Serum relaxin levels did not correlate with CL; a combined model of the two predictors had an area under the ROC curve of 0.895 (95%CI, 0.835-0.954) for the prediction of birth before 37 weeks and 0.869 (95% CI, 0.802-0.937) for birth before 34 weeks (n = 44). Serum relaxin > 1010 pg/mL had 58% sensitivity for prediction of preterm birth in women with a CL > 15 mm, at a 10% FPR. CONCLUSIONS: High serum relaxin level is associated with an increased risk of preterm birth in second-trimester symptomatic women with intact membranes. A combination of serum relaxin and CL increases predictive accuracy for preterm birth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

The role of gasless laparoscopy in differential diagnosis of acute abdomen.

BACKGROUND: The diagnosis of acute abdomen in the emergency setting, still remains a challenging problem. In these cases timely diagnosis and management is of great importance, while the anesthetic risk is high. The combination of the risk of an open laparotomy and the relative high likelihood of negative findings when performed, creates the need for a better approach. The alternative actually exists since 1911 when Eruheim made the first gasless laparoscopy. The aim of this study is to put back into the spotlight, gasless laparoscopy in the differential diagnosis of acute abdomen and to underline the advantages of this simple, cheap and very useful technique, especially in patients that require prompt diagnosis and have relative or absolute contraindications to general anesthesia or pneumoperitoneum. METHODS: This study included 49 patients that were managed with gasless laparoscopy for the diagnosis of acute abdomen, from 2011 to 2013. Two techniques were used: the mechanical lift of the anterior abdominal wall and the LapVision device. RESULTS: From the 49 patients included in the study, 41 were diagnosed with gasless laparoscopy while in eight the results were uncertain or there wasn't any pathology involved. With both techniques used, sample of the intraperitoneal fluid or biopsy could be obtained. CONCLUSION: The gasless technique for laparoscopy is an extremely useful mean of diagnosis in emergency conditions, or for patients with contraindications to undergo laparoscopy by pneumoperitoneum. Requiring only local or regional anesthesia, this technique could easily find application in diagnosis and treatment, while avoiding unnecessary laparotomies. Hippokratia 2015, 19 (1): 69-72.