Outreach obstetrics training in Western Australia improves neonatal outcome and decreases caesarean sections

The objective of this study was to determine the effect of a multi-professional outreach obstetric training programme on perinatal and neonatal outcomes. This was a retrospective comparison of 5-min low Apgar scores, stillbirth, perinatal death and moderate/severe hypoxic ischaemic encephalopathy rates in 127,753 infants born in Western Australia before and after the introduction of training in rural and remote areas. Following the introduction of the training programme, there was a highly significant (p0.003) decrease in the rate of infants born with low 5-min Apgar scores (from 20.4 to 15.4/1,000 live births). While the changes in the other three outcomes were not significant, all three demonstrated a trend for improvement in the intervention area. This is the second study of an educational intervention in obstetrics to demonstrate improvement in neonatal outcome and the first to be associated with a decrease in caesarean sections

Effectiveness of vaginal breech birth training strategies: an integrative review of the literature

Background: The safety of vaginal breech birth depends on the skill of the attendant. The objective of this review was to identify, synthesise and report the findings of evaluated breech birth training strategies. Methods: A systematic search of the following on-line databases: Medline, CINAHL Plus, PsychINFO, EBM Reviews/Cochrane Library, EMBASE, Maternity and Infant Care, and Pubmed, using a structured search strategy. Studies were included in the review if they evaluated the efficacy of a breech birth training programme or particular strategies, including obstetric emergency training evaluations that reported differentiated outcomes for breech. Out of 1040 original citings, 303 full-text articles were assessed for eligibility, and 17 methodologically diverse studies met the inclusion criteria. A data collection form was used to extract relevant information. Data were synthesised using an evaluation levels framework, including reaction, learning (subjective and objective assessment) and behavioural change. Results: No evaluations included clinical outcome data. Improvements in selfassessed skill and confidence were not associated with improvements in objective assessments or behavioural change. Inclusion of breech birth as part of an obstetric emergencies training package without support in practice was negatively associated with subsequent attendance at vaginal breech births. Conclusions: Due to the heterogeneity of the studies available, and the lack of evidence concerning neonatal or maternal outcomes, no conclusive practice recommendations can be made. However, the studies reviewed suggest that vaginal breech birth training may be enhanced by reflection, repetition and experienced clinical support in practice. Further evaluation studies should prioritise clinical outcome data

The impact of tubal ectopic pregnancy in Papua New Guinea - a retrospective case review

BACKGROUND: Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. METHODS: We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. RESULTS: A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. CONCLUSIONS: Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion

Induction of labour for trial of vaginal birth after Caesarean section in a remote district hospital

In a retrospective review of 79 women with 1 or more previous Caesarean section, 33 (41.8%) women agreed to a trial of vaginal birth. Twenty nine women had labour induced and 26 (89.7%) of them had a successful vaginal delivery. Four women laboured spontaneously and 1 of them needed an emergency Caesarean section for failure to progress. The overall vaginal delivery rate for women selected to undergo a trial of vaginal birth after Caesarean was 87.9%. The overall emergency Caesarean section rate was 4 of 33 (12.1%). During the study period the Caesarean section rate for the hospital fell from 32.2% to 11%. This study suggests that induction of labour in women with a previous Caesarean section is very successful in achieving vaginal delivery and has a role to play in remote and rural hospitals

CO2 refrigeration system heat recovery and thermal storage modelling for space heating provision in supermarkets: An integrated approach

[EN] The large amount of recoverable heat from CO2 refrigeration systems has led UK food retailers to examine the prospect of using refrigeration integrated heating and cooling systems to provide both the space heating and cooling to food cabinets in supermarkets. This study assesses the performance of a refrigeration integrated heating and cooling system installation with thermal storage in a UK supermarket. This is achieved by developing a thermal storage model and integrating it into a pre-existing CO2 booster refrigeration model. Five scenarios involving different configurations and operation strategies are assessed to understand the techo-economic implications. The results indicate that the integrated heating and cooling system with thermal storage has the potential to reduce energy consumption by 17¿18% and GHG emissions by 12¿13% compared to conventional systems using a gas boiler for space heating. These reductions are achieved despite a marginal increase of 2¿3% in annual operating costs. The maximum amount of heat that can be stored and utilised is constrained by the refrigeration system compressor capacity. These findings suggest that refrigeration integrated heating and cooling systems with thermal storage are a viable heating and cooling strategy that can significantly reduce the environmental footprint of supermarket space heating provision and under the adequate circumstances can forsake the use of conventional fossil-fuel (natural gas) boiler systems in food-retail buildings.This research was supported by funds provided via the Imperial-Sainsbury s Supermarkets Ltd. partnership. This work also was supported by the UK Engineering and Physical Sciences Research Council (EPSRC) [grant number EP/P004709/1]. Emilio J. Sarabia gratefully acknowledges financial support from Universitat Politècnica de València Fellowship. Data supporting this publication can be obtained on request from [email protected], G.; Sarabia Escrivà, EJ.; Acha, S.; Shah, N.; Markides, C. (2020). CO2 refrigeration system heat recovery and thermal storage modelling for space heating provision in supermarkets: An integrated approach. Applied Energy. 264:1-17. https://doi.org/10.1016/j.apenergy.2020.114722S11726