Outcome of Induction of Labour in Nulliparous Women Following Replacement of Cervidil with Prostin

This study at the Logan Hospital, Australia, compared the outcome of induction of labour (IOL) in nulliparous women following replacement of Cervidil with Prostin. Eighty-two nulliparous women were identified for this retrospective cohort study over a period of three months on either side of the changed practice. Forty-four women received Prostin and 38 received Cervidil. Baseline characteristics were similar amongst the groups including maternal age, mean gestational age, and modified Bishop's score at the commencement of IOL. The incidence of amniotomy, oxytocin augmentation of labour, and rate of epidural use did not differ significantly between the groups. The mean time to delivery (vaginally or abdominally) showed a significant difference, with women receiving Prostin delivering earlier than those having Cervidil (P = 0.018). Women receiving Prostin were more likely to have assisted vaginal delivery compared to the Cervidil group (P = 0.04)

Hyperscanning during Psychotherapy for Test Anxiety Reveals Evidence for Inter-Brain Plasticity as Mechanisms of Change

Objective There is a growing consensus that interpersonal processes are key to understanding psychotherapy. However, neuroscientific inquiries of therapeutic processes have been limited to (offline) assessments of patients outside of treatment sessions. The current study examines, for the first time, online interpersonal neurological processes between patients and therapists during sessions. Recent research proposes that inter-brain synchrony is a biomarker of interpersonal interaction quality. We hypothesized that over the course of therapy inter-brain synchrony between patients and therapists would gradually increase, and that that this increase – i.e., inter-brain plasticity - would be associated with therapeutic change. Method 8 participants enlisted in a 6-session treatment for test anxiety (N = 8 patients). During three of the sessions, therapist and patient brain activity was measured using functional near-infrared spectroscopy (fNIRS), focusing on the inferior-frontal gyrus (IFG). Patient-therapist inter-brain synchrony was calculated using wave transform coherence; perceived session quality, test anxiety symptoms, and therapeutic alliance were assessed using baseline, session-by-session and follow-up questionnaires. Results Inter-brain synchrony in the IFG was associated with reduced symptoms, improved wellbeing and perceived session quality, but not with a stronger therapeutic alliance. Importantly, inter-brain synchrony significantly improved over the course of treatment, suggesting that inter-brain plasticity has occurred. Conclusion While these findings require replication, they demonstrate that fNIRS imaging during psychotherapy is a promising research method, that inter-brain synchrony has potential as an indicator of effective therapy sessions and that inter-brain plasticity might be a biological mechanism underlying therapeutic change

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery