Uterocervical angle measurement improves prediction of preterm birth in twin gestation

Objective An obtuse uterocervical angle (UCA) has been associated with increased risk of preterm birth in singleton gestations. Our objective was to compare the performance of UCA to cervical length (CL) as sonographic predictors of spontaneous preterm birth (sPTB) in patients with twin gestation. Study Design We conducted a retrospective cohort study of twin gestations at a single academic center from May 2008-2016 who received a transvaginal ultrasound for the evaluation of the cervix between 16 0/7 - 22 6/7 weeks. An investigator blinded to clinical outcomes reviewed images of cervical morphology and measured UCA and CL parameters. Data on obstetrical outcomes was extracted from the medical record. The primary outcome was prediction of preterm birth <28 weeks and <32 weeks by UCA and CL. Receiver operator characteristic (ROC) curves and binary logistic regression were used for statistical analysis. Statistical significance was defined as p <0.05. Results Among 259 women with twin gestation, the mean gestational age at birth was 34.83 +/- 3.48 weeks, and 44.7% (n=116) delivered prior to 36 weeks. ROC curves demonstrated optimal prediction of sPTB prior to 32 weeks at a UCA > 110o (80% sensitivity, 82% specificity) vs. CL 114o (80% sensitivity, 84% specificity) vs. CL 110o conferred an OR 15.7 (95% CI 7.2-34.4) for delivery prior to 32 weeks, and UCA > 114o an OR 24.3 (95% CI 6.7-88.5) for delivery prior to 28 weeks. In comparison, CL<25mm had an OR 5.2 (95% CI 2.2-12.2) and OR 6.0 (95% CI 2.0-18.1) prior to 32 and 28 weeks respectively. Conclusion Uterocervical angles >110o performed better than the traditional cervical length threshold (25mm) for the prediction of sPTB in a cohort of twin gestations. Measurement of the UCA during the mid-trimester may improve identification of twin gestations at risk for sPTB

Principles of Anti-infective Dosing in Pregnancy

AbstractPurposeAnti-infectives are among the most commonly prescribed medications in pregnancy. However, detailed information on the pharmacokinetics and pharmacodynamics of these medications in pregnancy is limited, leading to uncertainty among clinicians regarding the tolerability and efficacy of treatments. The purposes of this review were to highlight key physiologic changes during pregnancy that influence drug behavior, and to discuss areas of active research related to anti-infective drugs in pregnancy.MethodsA review of literature in PubMed was performed for topics related to physiologic changes of pregnancy, postcesarean surgical site infections, vaccines in pregnancy, and intrauterine infections. The literature was reviewed and pertinent sources were utilized for this article.FindingsPhysiologic changes during pregnancy may impact drug disposition and efficacy. Cefazolin regimens are the current prophylactic treatment of choice for postcesarean surgical site infections. Vaccines are provided in pregnancy for both maternal and neonatal benefit. Broad-spectrum antibiotics continue to be used as first-line therapy for intrauterine infections.ImplicationsContinued efforts to broaden the knowledge base on anti-infective drug behavior in pregnancy will result in increased therapeutic options for this population

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Contextualising Apartheid at the End of Empire: Repression, ‘Development’ and the Bantustans

This article examines the global dynamics of late colonialism and how these informed South African apartheid. More specifically, it locates the programmes of mass relocation and bantustan ‘self-government’ that characterised apartheid after 1959 in relation to three key dimensions. Firstly, the article explores the global circulation of idioms of ‘development’ and trusteeship in the first half of the twentieth century and its significance in shaping segregationist policy; secondly, it situates bantustan ‘selfgovernment’ in relation to the history of decolonisation and the partitions and federations that emerged as late colonial solutions; and, thirdly, it locates the tightening of rural village planning in the bantustans after 1960 in relation to the elaboration of anti-colonial liberation struggles, repressive southern African settler politics and the Cold War. It argues that, far from developing policies that were at odds with the global ‘wind of change’, South African apartheid during the 1960s and 1970s reflected much that was characteristic about late colonial strategy

Lidcombe Program: Development and validation of reflective questions

The Lidcombe Program of early stuttering intervention is an evidence-based behavioural treatment originally developed for children younger than 6 years. Problem-solving is inherent during Lidcombe Program treatment. Therefore a number of reflective questions were devised to assist speech-language pathologists (SLPs) to detect clinical procedures that vary from those recommended in the Lidcombe Program Treatment Guide and to employ suitable strategies. A two-stage validation process of the reflective questions was conducted. First, questions were developed and then revised with input from the members of the international Lidcombe Program Trainers Consortium. Then feedback on their clinical usefulness was obtained from public health SLPs. The outcomes of each stage of validation are reported and implications for speech-language pathologists delivering the Lidcombe Program discussed

Challenges and strategies for speech-language pathologists using the lidcombe program for early stuttering

© 2018 American Speech-Language-Hearing Association. Purpose: The Lidcombe program is a treatment for preschool-age children who stutter. Studies indicate that its implementation is not always straightforward. In this study, challenges that parents and speech-language pathologists (SLPs) encounter when implementing the Lidcombe program were identified, and strategies to address them were sought. Method: In Part 1, Lidcombe program treatment challenges were determined from 4 sources. In Part 2, 7 SLPs with 15 to 23 years of Lidcombe program experience were interviewed to develop strategies to respond to the identified treatment challenges. Result: A template of the themes and a report with possible strategies are the outcomes of this study. A total of 124 themes were identified, mostly related to the implementation of Lidcombe program procedures. Strategies to deal with these challenges were formulated. Conclusions: This study provides treatment challenges that parents or SLPs may encounter during the Lidcombe program. It also provides strategies that SLPs can suggest to address them. An added contribution of the findings is that SLPs in the clinic can now anticipate the sort of treatment challenges that parents may face. A summary of the findings will be made available on the Australian Stuttering Research Centre website and through the Lidcombe Program Trainers Consortium