Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study

Objectives: Cesarean section is a lifesaving procedure with short and long-term consequences. Growing rates of cesarean sections worldwide arise problems for subsequent birth. The aim of this study was to compare safety of vaginal birth after two cesarean sections with repeat third cesarean section to help healthcare providers and patients make well informed decisions about mode of subsequent delivery.  Material and methods: This was a retrospective cohort study conducted in a tertiary reference hospital. Database of all deliveries (2010–2017) after two previous cesarean sections was created from electronic and paper medical records. Preterm deliveries, abnormal karyotype and neonates with congenital anomalies were excluded from the study. The final analysis included 412 cases for maternal outcome analysis and 406 cases for neonatal outcome analysis.  Results: Trial of labor after two cesareans in comparison to repeat cesarean section increases the risk of hemorrhage (OR: 10.84) and unfavorable composite maternal outcome (OR: 2.58). Failed trial of labor increases this risk of hemorrhage (OR: 15.27) and unfavorable composite maternal outcome (OR: 4.59) even further. There were no significant differences in neonatal outcomes. 22 out of 35 trials of labor ended in successful delivery giving a success rate of 62.85%. 5 of 7 labor inductions ended in repeat cesarean section giving 28.6% success rate. There were no maternal deaths and emergency hysterectomies. Conclusions: Trial of labor, especially failed trial of labor, is associated with an increased risk of perinatal complications

The Clinical Utility of Dual-Energy Computed Tomography in the Diagnosis of Gout—A Cross-Sectional Study

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806–0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878–0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924–0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout