Is it time to ban oxytocin for poor labour progress?

Oxytocin causes myometrial contractions and prostaglandin release. It is commonly used as an intervention for women in established labour with slow progress. However recent large randomised trials of oxytocin for this indication have shown no difference in caesarean section rates associated with its use. This may be due to inadequate doses of oxytocin and small randomised studies have suggested high dose oxytocin may indeed reduce caesarean delivery. The results of a high quality large randomised trial of high versus low dose oxytocin for women with slow progress are keenly awaited. There is no evidence to support the concept of turning the oxytocin off once contractions have been established, although this certainly merits further investigation. Recent evidence of contemporary labour patterns indicate that our whole concept of slow progress in labour is fundamentally flawed

Comment on "Two-photon decay of the sigma meson"

We comment on a recent paper by Giacosa, Gutsche, and Lyobovitskij, in which it is argued that a quarkonium interpretation of the $\sigma$ meson should give rise to a much smaller two-photon decay width than commonly assumed. The reason for this claimed discrepancy is a term in the transition amplitude, necessary for gauge invariance, which allegedly is often omitted in the literature, including the work of the present authors. Here we show their claims to be incorrect by demonstrating, in the context of the Quark-Level Linear $\sigma$ Model, that the recently extracted experimental value $\Gamma_{\sigma\to2\gamma}=(4.1\pm0.3)$ keV is compatible with a $q\bar{q}$ assignment for the $\sigma$, provided that meson loops are taken into account as well.Comment: RevTeX, 4 pages, Comment on Phys. Rev. D 77 (2008) 034007 [0710.3403 [hep-ph]

Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis

BACKGROUND: Fetal macrosomia is associated with an increased risk of adverse maternal and neonatal outcomes. OBJECTIVES: To compare the accuracy of antenatal two-dimensional (2D) ultrasound, three-dimensional (3D) ultrasound, and magnetic resonance imaging (MRI) in predicting fetal macrosomia at birth. SEARCH STRATEGY: Medline (1966-2013), Embase, the Cochrane Library and Web of Knowledge. SELECTION CRITERIA: Cohort or diagnostic accuracy studies of women with a singleton pregnancy, who had third-trimester imaging to predict macrosomia (>4000 g, >4500 g or >90th or >95th centile). DATA COLLECTION AND ANALYSIS: Two reviewers screened studies, performed data extraction and assessed methodological quality. The bivariate model was used to obtain summary sensitivities, specificities and likelihood ratios. MAIN RESULTS: Fifty-eight studies (34 367 pregnant women) were included. Most were poorly reported. Only one study assessed 3D ultrasound volumetry. For predicting birthweight >4000 g or >90th centile, the summary sensitivity for 2D ultrasound (Hadlock) estimated fetal weight (EFW) >90th centile or >4000 g (29 studies) was 0.56 (95% CI 0.49-0.61), 2D ultrasound abdominal circumference (AC) >35 cm (four studies) was 0.80 (95% confidence interval [95% CI] 0.69-0.87) and MRI EFW (three studies) was 0.93 (95% CI 0.76-0.98). The summary specificities were 0.92 (95% CI 0.90-0.94), 0.86 (95% CI 0.74-0.93) and 0.95 (95% CI 0.92-0.97), respectively. CONCLUSION: There is insufficient evidence to conclude that MRI EFW is more sensitive than 2D ultrasound AC (which is more sensitive than 2D EFW); although it was more specific. Further primary research is required before recommending MRI EFW for use in clinical practice

Towards Meson Spectroscopy Instead of Bump Hunting

Mesonic resonances are generally observed in data as narrow, moderately broad, or wide peaks in scattering or production processes. In the eyes of nearly all experimentalists, any suchlike bump is a true resonance as soon as its statistical significance exceeds certain minimal values. However, this simple point of view ignores possible effects from competing hadronic channels and the opening of the corresponding thresholds. On the other hand, most theoretical hadron-model builders consider mesons merely bound states of a quark and an antiquark, or of more exotic combinations sometimes involving valence gluons as well. Also the latter description is much too naive, since considerable mass shifts or even the dynamical generation of extra states due to unquenching are equally ignored. In the present paper, a largely empirical yet very successful approach to meson spectroscopy is revisited, in which all the above phenomena can be accounted for non-perturbatively, with concrete examples of some enigmatic mesonic states described in detail. First, the X(4260) charmonium enhancement is argued to be a non-resonant structure resulting from depletion effects due to competing channels and resonances. Then, the X(3872) charmonium-like meson is described as a unitarised $J^{PC}=1^{++}$ $c\bar{c}$ state. Also, the unusual pattern of masses and widths of the open-charm axial-vector mesons $D_1(2420)$, $D_1(2430)$, $D_{s1}(2536)$, and $D_{s1}(2460)$ is shown to follow from highly non-perturbative coupled-channel and mixing effects. Finally, first indications of a very light scalar boson are presented, on the basis of published BABAR data.Comment: Invited seminar given by G. Rupp at the International School of Nuclear Physics, 33rd course: "From Quarks and Gluons to Hadrons and Nuclei", Erice, Sicily, Italy, 16 - 24 September 2011; 7 pages, 5 figures (9 plots), style of Progress in Particle and Nuclear Physic

Relating multichannel scattering and production amplitudes in a microscopic OZI-based model

Relations between scattering and production amplitudes are studied in a microscopic multichannel model for meson-meson scattering, with coupling to confined quark-antiquark channels. Overlapping resonances and a proper threshold behaviour are treated exactly in the model. Under the spectator assumption, it is found that the two-particle production amplitude shares a common denominator with the elastic scattering amplitude, besides a numerator consisting of a linear combination of all elastic and some inelastic matrix elements. The coefficients in these linear combinations are shown to be generally complex. Finally, the standard operator expressions relating production and scattering amplitudes, viz. A=T/V and Im(A)=T*A, are fulfilled, while in the small-coupling limit the usual isobar model is recovered.Comment: 16 pages, 3 figures, plain LaTeX

Induction of labour versus expectant management for nulliparous women over 35 years of age: a multi-centre prospective, randomised controlled trial.

BACKGROUND: British women are increasingly delaying childbirth. The proportion giving birth over the age of 35 rose from 12% in 1996 to 20% in 2006. Women over this age are at a higher risk of perinatal death, and antepartum stillbirth accounts for 61% of all such deaths. Women over 40 years old have a similar stillbirth risk at 39 weeks as women who are between 25 and 29 years old have at 41 weeks.Many obstetricians respond to this by suggesting labour induction at term to forestall some of the risk. In a national survey of obstetricians 37% already induce women aged 40-44 years. A substantial minority of parents support such a policy, but others do not on the grounds that it might increase the risk of Caesarean section. However trials of induction in other high-risk scenarios have not shown any increase in Caesarean sections, rather the reverse. If induction for women over 35 did not increase Caesareans, or even reduced them, it would plausibly improve perinatal outcome and be an acceptable intervention. We therefore plan to perform a trial to test the effect of such an induction policy on Caesarean section rates.This trial is funded by the NHS Research for Patient Benefit (RfPB) Programme. DESIGN: The 35/39 trial is a multi-centre, prospective, randomised controlled trial. It is being run in twenty UK centres and we aim to recruit 630 nulliparous women (315 per group) aged over 35 years of age, over two years. Women will be randomly allocated to one of two groups: Induction of labour between 39⁰/⁷ and 39⁶/⁷ weeks gestation. Expectant management i.e. awaiting spontaneous onset of labour unless a situation develops necessitating either induction of labour or Caesarean Section.The primary purpose of this trial is to establish what effect a policy of induction of labour at 39 weeks for nulliparous women of advanced maternal age has on the rate of Caesarean section deliveries. The secondary aim is to act as a pilot study for a trial to answer the question, does induction of labour in this group of women improve perinatal outcomes? Randomisation will occur at 36⁰/⁷-39⁶/⁷ weeks gestation via a computerised randomisation programme at the Clinical Trials Unit, University of Nottingham. There will be no blinding to treatment allocation. DISCUSSION: The 35/39 trial is powered to detect an effect of induction of labour on the risk of caesarean section, it is underpowered to determine whether it improves perinatal outcome. The current study will also act as a pilot for a larger study to address this question. TRIAL REGISTRATION: ISRCTN11517275.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Comment on Intrinsic and dynamically generated scalar meson states

The scalar-meson assignments of Shakin and Wang in a generalized Nambu--Jona-Lasinio model are contradicted by recent experimental information. Also the strict distinction made by these authors between ``intrinsic'' and ``dynamically generated'' states is contested, as well as a number of other statements.Comment: 7 pages, (v2 cosmetics, v3 corrections in one reference), to be published in Phys.Rev.