Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

OBJECTIVE: We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34+0 weeks of gestation. DESIGN: Population-based prospective cohort study. SETTING: Ten public hospitals in the Austrian province of Styria. SAMPLE: A total of 87 065 neonates delivered in the period 2004-2015. METHODS: Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority. MAIN OUTCOME MEASURES: Neonatal composite adverse and severely adverse outcome measures. RESULTS: The odds ratio for severely adverse events during the night-time (22:01-07:29 hours) compared with the daytime (07:30-15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13-1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500-1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events. CONCLUSIONS: Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period. TWEETABLE ABSTRACT: Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.

[Foetal scalp blood sampling: impact on the incidence of Caesarean section and assisted vaginal deliveries for non-reassuring foetal heart rate and its use according to gestational age]. / Reduktion der operativen Entbindungsrate durch den Einsatz von Mikroblutuntersuchungen bei auffälligem CTG unter Berücksichtigung des Gestationsalters.

BACKGROUND: Interpretation of a suspicious, non-reassuring or pathological foetal heart rate tracing does not provide any direct information about foetal oxygen saturation, blood gas status or the extent of changes in pH. Without foetal scalp blood sampling, such tracings often necessitate rapid intervention to deliver the baby by Caesarean section or assisted vaginal delivery. The aim of this study was to show the impact of foetal blood sampling on reducing the number of Caesarean sections and assisted vaginal deliveries in a clinical setting in such cases. MATERIALS AND METHODS: A retrospective study of the mode of delivery in 669 women where foetal scalp blood sampling had been performed for suspicious or pathological foetal heart rate monitoring, in the period 2008-2009 was undertaken. The gestational age of the foetus was also investigated. RESULTS: Because one or more results of foetal scalp pH were within the normal range an operative delivery could be avoided in 6.4% of the study population, in spite of the non-reassuring foetal heart rate monitoring. Foetal blood sampling was performed more frequently in post-term pregnancies. CONCLUSIONS: Foetal blood analysis still is an effective tool to reduce unnecessary operative deliveries and should be regularly included in intrapartum monitoring. The risk of foetal complications is low compared with the reduction in the rate of Caesarean sections and assisted vaginal deliveries. Obstetricians are evidently becoming more willing to carry out foetal scalp blood sampling with rising gestational age.

[Cervical cancer in pregnancy--practical recommendations]. / Zervixkarzinom während der Schwangerschaft--Empfehlungen für die Praxis.

Five-year survival did not differ between 20 pregnant women and 541 patients with invasive cervical cancer treated with radical surgery at the Department of Obstetrics and Gynecology of the University of Graz. Therapeutic recommendations are given. In stage Ib to IIb disease, surgery is recommended postpartum following the induction of fetal lung maturity if fertility should be preserved and if the cancer is diagnosed after the 20th week of pregnancy. The same is recommended in stage Ia independent of the duration of gestation. In advanced disease (stage IIIb to IVb) definite therapy should be applied immediately after diagnosis. If cervical intraepithelial neoplasia grade III is suspected, colposcopy, cytology and biopsy are mandatory. Definite therapy should be performed 6 weeks postpartum.

Concomitant endometrial hyperplasia in patients with endometrial carcinoma.

OBJECTIVES: The aim of this study was to compare the histopathologic features and prognosis of patients with endometrial carcinoma with and without concomitant hyperplasia. METHODS: Histologic slides of the surgical specimens of 214 consecutive patients who underwent surgery as primary treatment for endometrial carcinoma from 1985 through 1991 were reviewed. RESULTS: Ninety-two of the 214 patients (43%) with endometrial carcinoma had concomitant endometrial hyperplasia. Patients with endometrial carcinoma with hyperplasia were significantly younger than those without hyperplasia (mean age 62 +/- 10 vs 65 +/- 9 years, P < 0.05). Carcinomas associated with hyperplasia were better differentiated and of lower surgical stage. By univariate analysis the frequency of recurrence was significantly lower (4% vs 17%, P < 0.004) and the estimated 5-year survival rate significantly higher (96% vs 85%, P < 0.01) in patients with endometrial carcinoma with concomitant hyperplasia. However, in multivariate analysis the presence of endometrial hyperplasia was not an independent prognostic factor and the 5-year survival rates of patients with or without hyperplasia did not differ significantly in any surgical stage. CONCLUSION: The presence or absence of concomitant endometrial hyperplasia is strongly correlated with the surgical stage of endometrial carcinoma.

[Large cell acanthoma (author's transl)]. / Large Cell Acanthoma.

The large cell acanthoma of Pinkus (1970) is a variety of actinic keratosis. It is characterized by extraordinary large cells with polyploidy. Out of 1027 actinic keratoses and 3241 seborrhoic keratoses, 4 cases of LCA could be found at the Department of Dermatology of the University of Cologne.

[Escherichia coli R live vaccine Suicolplex "Dessau"]. / Escherichia-coli-R-Lebendimpfstoff Suicolplex "Dessau".

Immunisation of pregnant sows prior to parturition has long proved to be a good method to forestall coli dysentery in piglets before weaning. Inactivated vaccines of the pathogenetically important E. coli serogroups with and without adjuvant so far were primarily used at international level. A vaccine of that kind has become available in the GDR more than eight years ago. Its name is Coliporc "Dessau". A live vaccine has been developed from two R-mutants at the authors' institute. The effectiveness of that live vaccine on laboratory animals and in field experiments is reported in this paper together with possibilities of differential diagnosis to distinguish wild strains from the mutants. The live vaccine was commercially registered under the name of Suicolpex "Dessau", in spring 1976.

[Requirements of live vaccines for use in veterinary medicine]. / Anforderungen an Lebendimpfstoffe für den Einsatz in der Veterinärmedizin.

The potential advantages offered by live vaccines, as compared to inactivated vaccines, are described, with reference being made to experience so far obtained from the use of live vaccines in livestock farming. The favourable properties of live vaccines seem to promise more widespread use in the future. Certain demands have to be made on live vaccines against the background of production processes in livestock farming. These are described in greater detail. Demands, finally, are derived from the above aspects regarding immunobiological action.

[Suisaloral "Dessau"--a Salmonella cholerae suis live vaccine for oral, parenteral and combined applications]. / Suissaloral "Dessau"--ein Salmonella-cholerae-suis-Lebendimpfstoff zur oralen, parenteralen und kombinierten Anwendung.

An account is given of all immune preparations which had been available by summer 1976 and their uses in public disease control, with reference being made to the epizootiological role and detrimental effects of Salmonella cholerae suis (S. c.-s.). The need for using live Salmonella strains to test their immunogenic properties is derived from a thorough assessment of inactivated S.-c.-s.-vaccine, Salmoporc "Dessau", which had been used in the past. Salmonellae are pathogens of zoo-anthroponoses by their very nature, and the point is made that, therefore, comprehensive attention should be given to all aspects relating to genetic stability and identity of potential live vaccines. An S.-c.-s.-R-strain is described as the point of departure from which to develop a doubly attenuated strain, the basis of Salmonella cholerae suis live vaccine Suisaloral "Dessau". The live vaccine proper is characterised on the basis of results obtained from bacteriologico-serological, clinical, and epizootiological laboratory tests as well as preclinical and clinical tests applied to the animals (field testing). Suisaloral "Dessau" is the first Salmonella live vaccine on the basis of a non-reproduction-limited mutant with two independent genetic markers, and it is suitable for both oral and parenteral application. The vaccine also is widely applicable for combination with other live vaccines.

[Epizootiology of Salmonella typhimurium infection in chickens]. / Epizootiologie der Salmonella-typhimurium-Infektion beim Huhn.

The incidence of S. typhimurium infections among fowl increased in thr region of Potsdam in general, and on various big farms in particular, 1976 and over the first half of 1977. The outbreaks included subclinical infections and clinically manifest diseases which caused remarkable loss of broilers from the affected stocks (up to 15.92 per cent). Parent stocks contaminated with S. typhimurium were to be the sources of infection in all cases. A total of 1,220 Salmonella strains were isolated from fowl and its environment, with 1,151 of them being S. typhimurium (2.98 per cent of all samples tested). The following amounts of S. typhimurium strains were isolated from different types of samples which had been collected from infected broiler stocks: 8.10 per cent from dead broilers, 5.86 per cent from dead broiler parents, 2.11 per cent from pulp linings of transport cages for day-old chicks, 1.23 per cent from litter, 1.0 per cent from hatching material (eggs or dead and jammed embryos, and 0.12 per cent from swabs used in hygiene supervision). No Salmonellae were isolated from feedstuff. The transmission of S. typhimurium, therefore, is though to have taken the route via the hatching egg and via congenitally infected chicks traded between breeders and propagation farms. The control and prophylaxis of S. typhimurium infections, therefore, should be based primarily on action in the centralised breeding stocks. Specific steps of such action are proposed. Fifty-three strains were biochemically and lysotypically analysed, with the following types being determined: ut/Ph 30 BT b, ut/Ph 30 BT c, n.c. 1/72/n.c. BT b, 2 n.c. BT a, and 1A/6 BT a. The first two types covered 84.9 per cent of all strains isolated from the fowl. All lysotype ut/Ph 30 strains isolated from fowl fell under the copenhagen variant which had rarely been isolated from man in the past. These results are likely to support the demand for a joint control programme for enteritis Salmonellae, with particular emphasis on S. typhimurium, for implementation in human and veterinary medicine.

[High spinal anaesthesia following intrathoracic intercostal nerve block. Report of a case (author's transl)]. / Hohe Spinalanaesthesie nach intrathorakal angelegter Interkostalnervenblockade

In a 59-year-old female, anaesthetized with halothane, nitrous oxide/oxygen, intercostal nerve blocks were performed after right lateral thoracotomy. Before closure of the chest four segments were blocked each with 3 ml 0.5% bupivacain (Marcain, Carbostesin) without adrenaline. Three minutes after the last injection, the blood pressure, heart rate, and central venous pressure fell. The postoperative neurological status showed a high spinal anaesthesia. The patient was able to be extubated 90' after the last block and there were no further complications. The possible mechanism of producing spinal anaesthesia after peripheral nerve blocks and the necessary precautions to avoid this complication are discussed.