Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study

Objective: To determine whether twins born second are at increased risk of perinatal death because of complications during labour and delivery. Design: Retrospective cohort study. Setting: Scotland, 1992 and 1997. Participants: All twin births at or after 24 weeks' gestation, excluding twin pairs in which either twin died before labour or delivery or died during or after labour and delivery because of congenital abnormality, non-immune hydrops, or twin to twin transfusion syndrome. Main outcome measure: Delivery related perinatal deaths (deaths during labour or the neonatal period). Results: Overall, delivery related perinatal deaths were recorded for 23 first twins only and 23 second twins only of 1438 twin pairs born before 36 weeks (preterm) by means other than planned caesarean section (P>0.99). No deaths of first twins and nine deaths of second twins (P=0.004) were recorded among the 2436 twin pairs born at or after 36 weeks (term). Discordance between first and second twins differed significantly in preterm and term births (P=0.007). Seven of nine deaths of second twins at term were due to anoxia during the birth (2.9 (95% confidence interval 1.2 to 5.9) per 1000); five of these deaths were associated with mechanical problems with the second delivery following vaginal delivery of the first twin. No deaths were recorded among 454 second twins delivered at term by planned caesarean section. Conclusions: Second twins born at term are at higher risk than first twins of death due to complications of delivery. Previous studies may not have shown an increased risk because of inadequate categorisation of deaths, lack of statistical power, inappropriate analyses, and pooling of data about preterm births and term births

Predicting cesarean section and uterine rupture among women attempting vaginal birth after prior cesarean section

<p><b>Background:</b> There is currently no validated method for antepartum prediction of the risk of failed vaginal birth after cesarean section and no information on the relationship between the risk of emergency cesarean delivery and the risk of uterine rupture.</p> <p><b>Methods and Findings:</b> We linked a national maternity hospital discharge database and a national registry of perinatal deaths. We studied 23,286 women with one prior cesarean delivery who attempted vaginal birth at or after 40-wk gestation. The population was randomly split into model development and validation groups. The factors associated with emergency cesarean section were maternal age (adjusted odds ratio [OR] = 1.22 per 5-y increase, 95% confidence interval [CI]: 1.16 to 1.28), maternal height (adjusted OR = 0.75 per 5-cm increase, 95% CI: 0.73 to 0.78), male fetus (adjusted OR = 1.18, 95% CI: 1.08 to 1.29), no previous vaginal birth (adjusted OR = 5.08, 95% CI: 4.52 to 5.72), prostaglandin induction of labor (adjusted OR = 1.42, 95% CI: 1.26 to 1.60), and birth at 41-wk (adjusted OR = 1.30, 95% CI: 1.18 to 1.42) or 42-wk (adjusted OR = 1.38, 95% CI: 1.17 to 1.62) gestation compared with 40-wk. In the validation group, 36% of the women had a low predicted risk of caesarean section (<20%) and 16.5% of women had a high predicted risk (>40%); 10.9% and 47.7% of these women, respectively, actually had deliveries by caesarean section. The predicted risk of caesarean section was also associated with the risk of all uterine rupture (OR for a 5% increase in predicted risk = 1.22, 95% CI: 1.14 to 1.31) and uterine rupture associated with perinatal death (OR for a 5% increase in predicted risk = 1.32, 95% CI: 1.02 to 1.73). The observed incidence of uterine rupture was 2.0 per 1,000 among women at low risk of cesarean section and 9.1 per 1,000 among those at high risk (relative risk = 4.5, 95% CI: 2.6 to 8.1). We present the model in a simple-to-use format.</p> <p><b>Conclusions:</b> We present, to our knowledge, the first validated model for antepartum prediction of the risk of failed vaginal birth after prior cesarean section. Women at increased risk of emergency caesarean section are also at increased risk of uterine rupture, including catastrophic rupture leading to perinatal death.</p&gt

Red Giants in the Small Magellanic Cloud. I. Disk and Tidal Stream Kinematics

We present results from an extensive spectroscopic survey of field stars in the Small Magellanic Cloud (SMC). 3037 sources, predominantly first-ascent red giants, spread across roughly 37.5 sq. deg, are analysed. The line of sight velocity field is dominated by the projection of the orbital motion of the SMC around the LMC/Milky Way. The residuals are inconsistent with both a non-rotating spheroid and a nearly face on disk system. The current sample and previous stellar and HI kinematics can be reconciled by rotating disk models with line of nodes position angle, theta, ~ 120-130 deg., moderate inclination (i ~ 25-70 deg.), and rotation curves rising at 20-40 km/s/kpc. The metal-poor stars exhibit a lower velocity gradient and higher velocity dispersion than the metal-rich stars. If our interpretation of the velocity patterns as bulk rotation is appropriate, then some revision to simulations of the SMC orbit is required since these are generally tuned to the SMC disk line-of-nodes lying in a NE-SW direction. Residuals show strong spatial structure indicative of non-circular motions that increase in importance with increasing distance from the SMC centre. Kinematic substructure in the north-west part of our survey area is associated with the tidal tail or Counter-Bridge predicted by simulations. Lower line-of-sight velocities towards the Wing and the larger velocities just beyond the SW end of the SMC Bar are probably associated with stellar components of the Magellanic Bridge and Counter-Bridge, respectively. Our results reinforce the notion that the intermediate-age stellar population of the SMC is subject to substantial stripping by external forces.Comment: To appear in MNRA

Red Giants in the Small Magellanic Cloud. II. Metallicity Gradient and Age-Metallicity Relation

We present results from the largest CaII triplet line metallicity study of Small Magellanic Cloud (SMC) field red giant stars to date, involving 3037 objects spread across approximately 37.5 sq. deg., centred on this galaxy. We find a median metallicity of [Fe/H]=-0.99+/-0.01, with clear evidence for an abundance gradient of -0.075+/-0.011 dex / deg. over the inner 5 deg. We interpret the abundance gradient to be the result of an increasing fraction of young stars with decreasing galacto-centric radius, coupled with a uniform global age-metallicity relation. We also demonstrate that the age-metallicity relation for an intermediate age population located 10kpc in front of the NE of the Cloud is indistinguishable from that of the main body of the galaxy, supporting a prior conjecture that this is a stellar analogue of the Magellanic Bridge. The metal poor and metal rich quartiles of our RGB star sample (with complementary optical photometry from the Magellanic Clouds Photometric Survey) are predominantly older and younger than approximately 6Gyr, respectively. Consequently, we draw a link between a kinematical signature, tentatively associated by us with a disk-like structure, and the upsurges in stellar genesis imprinted on the star formation history of the central regions of the SMC. We conclude that the increase in the star formation rate around 5-6Gyr ago was most likely triggered by an interaction between the SMC and LMC.Comment: To appear in MNRA

Enhanced MHD transport in astrophysical accretion flows: turbulence, winds and jets

Astrophysical accretion is arguably the most prevalent physical process in the Universe; it occurs during the birth and death of individual stars and plays a pivotal role in the evolution of entire galaxies. Accretion onto a black hole, in particular, is also the most efficient mechanism known in nature, converting up to 40% of accreting rest mass energy into spectacular forms such as high-energy (X-ray and gamma-ray) emission and relativistic jets. Whilst magnetic fields are thought to be ultimately responsible for these phenomena, our understanding of the microphysics of MHD turbulence in accretion flows as well as large-scale MHD outflows remains far from complete. We present a new theoretical model for astrophysical disk accretion which considers enhanced vertical transport of momentum and energy by MHD winds and jets, as well as transport resulting from MHD turbulence. We also describe new global, 3D simulations that we are currently developing to investigate the extent to which non-ideal MHD effects may explain how small-scale, turbulent fields (generated by the magnetorotational instability -- MRI) might evolve into large-scale, ordered fields that produce a magnetized corona and/or jets where the highest energy phenomena necessarily originate.Comment: 8 pages, 2 figures. Minor revision, published version: Proc 14th International Congress on Plasma Physics, Fukuoka, Japan, Sep 200

Evolved solar systems in Praesepe

"Copyright 2011 American Institute of Physics. This article may be downloaded for personal use only. Any other use requires prior permission of the author and the American Institute of Physics." Original paper can be found at: http://scitation.aip.org/"We have obtained near-IR photometry for the 11 Praesepe white dwarfs, to search for an excess indicative of a dusty debris disk. All the white dwarfs are in the DAZ temperature regime, however we find no indications of a disk around any white dwarf. We have, however determined that the radial velocity variable white dwarf WD0837+185 could have an unresolved T8 dwarf companion that would not be seen as a near-IR excess.Final Accepted Versio