Health implications resulting from the timing of elective cesarean delivery

<p>Abstract</p> <p>Background</p> <p>The literature is nearly unanimous in recommending elective cesarean delivery at 39 weeks of gestation because of the lower rates of neonatal respiratory complications compared to 38 weeks. However, elective cesarean delivery at 39 weeks or more may have maternal and other fetal consequences compared to delivery at 38 weeks, which are not always addressed in these studies.</p> <p>Discussion</p> <p>Between 38 and 39 weeks of gestation, approximately 10% - 14% of women go into spontaneous labor; meaning that a considerable number of women scheduled for an elective cesarean delivery at 39 weeks will deliver earlier in an unscheduled, frequently emergency, cesarean delivery. The incidence of maternal morbidity and mortality is higher among women undergoing non-elective cesarean deliveries than among those undergoing elective ones. Complications may be greater among women after numerous repeat cesarean deliveries and among older women. Other than reducing the frequency of non-elective cesarean deliveries, bringing forward the timing of elective cesarean delivery to 38 weeks, may occasionally prevent intrauterine fetal demise which has been shown to increase with increasing gestational age and to avoid other fetal consequences related to the emergency delivery. All these considerations need to be weighed against the medical and the economic impact of the increase in neonatal morbidity resulting from births at 38 weeks compared to 39 weeks.</p> <p>Summary</p> <p>Until prospective randomized trials are conducted, we are unlikely to be able to precisely answer all risk:benefit questions as to the best timing of scheduled elective cesarean delivery. Older women, and women with numerous prior cesarean deliveries, are of particular concern. It is reasonable to inform the pregnant women of the risk of each of the above options and to respect her autonomy and decision-making.</p

Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta

Placenta accreta is a severe pregnancy complication and is currently the most common indication for peripartum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Main risk factor for placenta accreta is a previous cesarean delivery particularly when accompanied with a coexisting placenta previa. Antenatal diagnosis seems to be a key factor in optimizing maternal outcome. Diagnosis can be achieved by ultrasound in the majority of cases. Women with placenta accreta are usually delivered by a cesarean section. In order to avoid an emergency cesarean and to minimize complications of prematurity it is acceptable to schedule cesarean at 34 to 35 weeks. A multidisciplinary team approach and delivery at a center with adequate resources, including those for massive transfusion are both essential to reduce neonatal and maternal morbidity and mortality. The optimal management after delivery of the neonate is vague since randomized controlled trials and large cohort studies are lacking. Cesarean hysterectomy is probably the preferable treatment. In carefully selected cases, when fertility is desired, conservative management may be considered with caution. The current review discusses the epidemiology, predisposing factors, pathogenesis, diagnostic methods, clinical implications and management options of this condition

The impact of non-significant variable decelerations appearing in the latent phase on delivery mode: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Variable decelerations are the most frequent fetal heart rate changes that are related to labor. The objective of the study was to estimate the impact of non-significant variable decelerations (NSV) appearing during the latent phase of labor on delivery mode and neonatal outcome.</p> <p>Methods</p> <p>Women at term, who were in the latent phase of labor and had a singleton pregnancy, were prospectively included. Women were divided into three groups. All had a fetal heart rate tracing with normal baseline and variability. The study group was composed of women who had in addition NSV, Category II, according to the National Institute of Child Health and Human Development categorization system. Women who had Category I tracings composed the control group. Women who had non-repetitive severe variables (SV) composed a second control group (Category II-SV). Main outcome compared was mode of delivery. Secondary outcome was cord pH. One-way analysis of variance was used to compare the continuous demographic and clinical variables of the three groups. Backwards stepwise logistic regression using significant univariables was performed to determine which predicted operative delivery. P < 0.05 was considered significant.</p> <p>Results</p> <p>Of 1005 women who delivered during the study period 186 had Category II- NSV tracings (study group), 76 had Category II-SV and 251 had Category I tracings. Mode of delivery and indications for operative delivery were similar between women in Category II-NSV compared to Category I. In addition mean cord pH did not differ between the two groups. Conversely, women in Category II-SV, had a higher rate of cesarean or vacuum deliveries compared to the other groups (p = 0.0001). Beside, they had a significantly higher number of neonates born with cord pH between 7.0 to 7.1 (p = 0.03).</p> <p>Conclusions</p> <p>Non-significant variable decelerations in early stages of labor are probably a non-ominous sign for neonatal outcome and have no impact on delivery mode.</p

Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>A prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities. We aimed to compare between oxytocin augmentation, amniotomy and a combination of both on the duration of labor among women with a prolonged latent phase.</p> <p>Methods</p> <p>Women with a singleton fetus in cephalic presentation who have a prolonged latent phase, were randomly allocated to amniotomy (group 1), oxytocin (group 2) or both (group 3). A group of women who progressed spontaneously without intervention composed the control group (group 4). The primary outcome was the duration of time from initiation of augmentation until delivery.</p> <p>Results</p> <p>A total of 213 women were consented and randomized to group 1 (70 women), group 2 (72 women) and group 3 (71 women). Group 4 was composed from additional 70 women. A mean reduction of 120 minutes in labor duration was observed among group 3 compared to group 1 (p = 0.08) and 180 minutes compared to group 2 and 4 (p = 0.001). Women in group 3 had a shorter length of time from augmentation until the beginning of the active phase and a shorter first stage of labor than group 1 (p = 0.03), group 2 (p = 0.001) and group 4 (p = 0.001). Satisfaction was greater among group 3 and 4. Mode of delivery and neonatal outcome were comparable between the groups.</p> <p>Conclusion</p> <p>Labor augmentation by combined amniotomy and oxytocin among women with a prolonged latent phase at term seems superior compared to either of them alone.</p

Microwave sensor for liquid mixture identification based on composite right left hand-zero-order resonator for sensitivity improvement

This work aims to present an improved version of the liquid mixture identification sensor, the proposed sensor is tested experimentaly on mixture of water ethanol, the identification of liquid is based on the measurement of frequency displacement, and comparison with reference values of water ethanol. This device is based on metamaterial structure which is a CRLH (composite right left hand) resonator with ZOR (Zero Order Resonator). The CRLH in addition to its property of miniaturization effect, when combined with ZOR, the resonant frequency of various volume fraction are extended, which make the sensitivity higher. The high sensitivity of the sensor is obtained by an optimum choice of the CRLH components. The geometrical size of the sensor is 20 mm by 11 mm. It was printed on a RT/Duroid 5880 substrate with a very short testing surface area of 4 mm by 8 mm, the liquid is placed on the top side of the sensor, exactly on the CRLH structure. Three prototypes of sensors operating from 1 GHz to 3 GHz are proposed, designed and simulated using the commercial software HFSS (high-frequency structural simulator). The main advantages of this work is first miaturization effect, second high sensitivity and finaly a wide range of liquid can be tested with this sensor. To prove the working principle, ethanol with different volume fractions was adopted as a liquid under test, the obtained results present very good agreement with the literature and suggested that it is a miniaturised and high sensitive candidate (better than 1.38%) for liquid mixture identification

Vitamin B12 deficiency in diabetic patients treated with metformin: A narrative review

Metformin is the most prescribed oral hypoglycemic drug and is considered by many health practitioners as the first-line treatment for non-insulin-dependent diabetes mellitus (T2DM). It is used either as a monotherapy or adjuvant to other anti-hyperglycemic agents. Most of its side effects are usually mild and self-limiting. However, several studies have shown an association between the use of metformin and low vitamin B12 levels in diabetic patients. The current review aimed to provide a literature review of the current published reports on the association, the possible mechanisms, and the related individualized risk factors that might lead to this incidence. The most accepted mechanism of the effect of metformin on vitamin B12 level is related to the absorption process where metformin antagonism of the calcium cation and interference with the calcium-dependent IF-vitamin B12 complex binding to the ileal cubilin receptor. In addition, many risk factors have been associated with the impact of metformin on vitamin B12 levels in diabetic patients such as dose and duration where longer durations showed a greater prevalence of developing vitamin B12 deficiency. Male patients showed lower levels of vitamin B12 compared to females. Black race showed a lower prevalence of vitamin B12 deficiency in metformin-treated patients. Moreover, chronic diseases including T2DM, hyperlipidemia, coronary artery disease, polycystic ovary disease (PCOD), obesity, and metformin therapy were significantly associated with increased risk of vitamin B12 deficiency. Graphical abstract: Metformin impacts vitamin B12 by (A) inhibiting calcium-dependent IF-B12 binding. (B) Prolonged use raises deficiency risk. (C) Males have lower B12 levels than females. (D) Black individuals show lower deficiency rates. (E) Conditions like T2DM, hyperlipidemia, coronary artery disease, PCOD, obesity, and metformin use heighten deficiency risk. (Figure presented.).Open Access funding provided by the Qatar National Library

Cognitive performance following stroke, transient ischaemic attack, myocardial infarction, and hospitalisation:an individual participant data meta-analysis of six randomised controlled trials

BACKGROUND: Survivors of stroke are often concerned about cognitive problems, and information on the risk of cognitive problems often comes from small studies. We aimed to estimate years of cognitive ageing associated with stroke compared with transient ischaemic attack, myocardial infarction, and other hospitalisations in a large population.METHODS: Using data from six randomised controlled trials (ORIGIN, ONTARGET, TRANSCEND, COMPASS, HOPE-3, and NAVIGATE ESUS), we completed an individual participant data meta-analysis using data requested from the Public Health Research Institute to estimate the association of stroke (by type and severity), transient ischaemic attack, myocardial infarction, and other hospitalisations with cognitive performance measured at the end of each trial. We included participants in any of these randomised controlled trials with a cognitive assessment at baseline and at least one other timepoint. Cognitive performance was measured with the Mini-Mental State Examination or the Montreal Cognitive Assessment, transformed into Z scores. We estimated Z score differences in end of trial cognitive performance between people with and without events and calculated corresponding years of cognitive ageing in these trials, and additionally calculated using a population representative cohort-the Cognitive Function and Ageing Study.FINDINGS: In 64 106 participants from 55 countries, compared with no event, stroke was associated with 18 years of cognitive ageing (1487 strokes included in the model, 95% CI 10 to 28; p&lt;0·0001) and transient ischaemic attack with 3 years (660 transient ischaemic attacks included in the model, 0 to 6; p=0·021). Myocardial infarction (p=0·60) and other hospitalisations (p=0·26) were not associated with cognitive ageing. The mean difference in SD compared with people without an event was -0·84 (95% CI -0·91 to -0·76; p&lt;0·0001) for disabling stroke, and -0·12 (-0·19 to -0·05; p=0·0012) for non-disabling stroke. Haemorrhagic stroke was associated with worse cognition (-0·75, -0·95 to -0·55; p&lt;0·0001) than ischaemic stroke (-0·42, -0·48 to -0·36; p &lt;0·0001).INTERPRETATION: Stroke has a substantial effect on cognition. The effects of transient ischaemic attack were small, whereas myocardial infarction and hospitalisation had a neutral effect. Prevention of stroke could lead to a reduction in cognitive ageing in those at greatest risk.FUNDING: Population Health Research Institute and Chief Scientist Office of Scotland.</p

A review on material analysis of food safety based on fluorescence spectrum combined with artificial neural network technology

Aiming at the problem that it is difficult to achieve rapid and accurate detection of pesticide residues, the artificial neural network method is used to separate the mixed fluorescence spectra in the measurement of acetamiprid pesticide residues, and a fluorescence spectrum that can quickly detect the pesticide residues of acetamiprid on solid surfaces is designed. According to the back-propagation algorithm, the three-layer artificial neural network principle is used to detect the acetamiprid residue in the mixed system of acetamiprid and filter paper with severely overlapping fluorescence spectra. In the range of 340nm~400nm, using the fluorescence intensity values ​​at 20 characteristic wavelengths as the characteristic network parameters, after network training and testing, the recovery rates of acetamiprid concentrations of 40mg/kg and 90mg/kg are 102% and 97%, respectively. The relative standard deviations of the determination results were 1.4% and 1.9%, respectively. The experimental results show that the BP neural network-assisted fluorescence spectroscopy method for the determination of acetamiprid pesticide residues on filter paper has the characteristics of fast network training, short detection period, and high measurement accuracy