Coping with cancer: A prospective psycho-social analysis of cancer patients and their non-medical caregivers (cg) – A goim study

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Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised controlled Trial (START).

BACKGROUND: Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress. METHODS: This study will be a single-centre, parallel-group, randomised controlled trial, conducted over 3 years. The primary hypothesis will be that the proportion of women with an emergency caesarean section on ST analysis will not equal that for women on cardiotocography monitoring alone. Participants will be recruited at the Women's and Children's Hospital, a high-risk specialty facility with approximately 5000 deliveries per annum. A total of 1818 women will be randomised to the treatment or conventional arm with an allocation ratio of 1:1, stratified by parity. The primary outcome is emergency caesarean section (yes/no). Statistical analysis will follow standard methods for randomised trials and will be performed on an intention-to-treat basis. Secondary maternal and neonatal outcomes will also be analysed. Additional study outcomes include psychosocial outcomes, patient preferences and cost-effectiveness. DISCUSSION: Approximately 20% of Australian babies are delivered by emergency caesarean section. This will be the first Australian trial to examine ST analysis of the fetal electrocardiogram as an adjunct to cardiotocography as a potential method for reducing this proportion. The trial will be among the first to comprehensively examine ST analysis, taking into account the impact on psychosocial well-being as well as cost-effectiveness. This research will provide Australian evidence for clinical practice and guideline development as well as for policy-makers and consumers to make informed, evidence-based choices about care in labour. TRIAL REGISTRATION: ANZCTR, ACTRN1261800006268 . Registered on 19 January 2018

Risk Factors Associated with Adverse Fetal Outcomes in Pregnancies Affected by Coronavirus Disease 2019 (COVID-19): A Secondary Analysis of the WAPM study on COVID-19

To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6\ub19.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible

Comparison of vegetation sampling methods in a Michigan sedge meadow.

http://deepblue.lib.umich.edu/bitstream/2027.42/53910/1/2345.pdfDescription of 2345.pdf : Access restricted to on-site users at the U-M Biological Station

The Effects of Labor Induction on the Progress of Childbirth

peer reviewedLabour induction has become a common practice. Given the significant number of induced deliveries carried out each year, it is important to know the consequences of this induction policy. The effects of labour induction on the childbirth are still the subject of considerable controversy. The increase of the caesarean and instrumental extraction rates has already been emphasized in previous studies. This article is based on an analysis of 10,045 deliveries carried out in the CHR Obstetrical Clinic of La Citadelle, between 1991 and 1997. The conclusions are instructive. Thus a departmental policy of setting an induction level of 35% will allocate 2/3 of the workload between 8:00 AM and 8:00 PM during the week, with a preponderance on Friday. The Caesarean rate is not increased but peridurals and recourse to instrumental extraction are more frequent

Procédures thérapeutiques invasives chez les jumeaux monochorioniques: réalité clinique et questions en suspens.

Monochorionic twin pregnancies (MC) are associated with a higher risk of complications than their bichorionic equivalents. When two fetuses share the same placenta, the two fetal circulations are closely bound by omnipresent vascular anastomoses. The determination of the chorionicity is essential for an adequate management of these particular pregnancies. The twin-to-twin transfusion syndrome (TTTS) is one of the. possible complications and must be considered as an obstetrical emergency. Severe growth restriction of one twin occurs in 11% of MC pregnancies. Before the limit of viability, in some of the cases, selective foeticide using particular methods are mandatory to preserve the wellbeing of the healthy twin. The invasive procedures carried out at the time these complications occur proved their effectiveness, under the condition of being applied by experienced experts. Laser coagulation, TTTS gold standard treatment, is associated with a fetal survival rate equal or higher than 75%. Among MC twins, selective foeticide with bipolar cord coagulation allows an intact survival rate of the other twin in more than 75 to 80% of the cases

L'allaitement maternel: de la physiologie a la pratique.

Exclusive breastfeeding is recommended up to 6 months of age, and may be continued in combination with a more diversified diet until 2 years of age. It represents the ideal natural diet for the newborn. The current change of maternity care policy and the adherence to the Baby Friendly Hospital Initiative (BFHI) project, have been associated with a significant improvement of patient information. This positive aspect combined with the effect of perinatal education were major contributors for breastfeeding promotion. This article presents the physiology of breastfeeding and its practical aspects, useful for the family doctor. The doctor plays a central role both in the information, which might influence the choice of breastfeeding, and also in the support of the mother or her baby. The duration of breastfeeding represents the new goal to be emphasized. Lactating mothers should be encouraged to consult competent caregivers, including the family doctor in case of breastfeeding difficulties.English AbstractJournal ArticleReviewSCOPUS: ar.jinfo:eu-repo/semantics/publishe