The midwife factor in obstetric procedures and neonatal outcome

Aims. In the face of major tendency towards midwiferyled-care it was our purpose to investigate the extent of the influence of the midwife on the rates of obstetric procedures and perinatal outcome. Methods. 5384 consecutive deliveries at the Department of Obstetrics and Gynecology. University of Graz, were enrolled in the study. The following data were collected: mode of delivery, pH of umbilical artery, Apgar score. Firstly, data were investigated for interindividual differences and, secondly, for relationship with age of the midwife as a measure of experience. Results. Interindividual differences were significant for episiotomy rates (minimum: 31.6%; maximum 76.9%; p<0.001), forceps rates (minimum: 1.7%; maximum 11.1%;p=0.002) and pH of umbilical arteries (minimum: 7.21:maxinium: 7.28 p=0.001) but not for cesarean section rates and Apgar scores. Linear regression analysis was significant between age of midwives and pH of umbilical arteries (p<0.001: r=0.055) and for one-minute Apgar score (p=0.009; r=0.050) but not for episiotomy rates, cesarean section rates, forceps rates and five-minutes Apgar score. Conclusions. There are large interindividual differences in obstetric intervention rates which cannot be explained by the midwives' age. Provision of health care should be primarily determined by need and not by the personal characteristics of the health care provider, thus interindividual differences should be reduced and more often taken into account when analyzing any kind of data

Doppler sonography of the uterine and the cubital arteries in normal pregnancies, preeclampsia and intrauterine growth restriction: evidence for a systemic vessel involvement

Aims: The decrease in uterine resistance during normal pregnancy is known to be related to invading trophoblast cells which derive from placental tissue. Uterine and peripheral resistance is elevated in preeclampsia. The aim of the present study was to prospectively examine uterine and peripheral resistance in pregnancies complicated by preeclampsia (PE), fetal intrauterine growth restriction (IUGR) and pregnancy induced hypertension (PIH). Methods: Sixty-seven women with normal pregnancies, 17 with PE, 12 with IUGR underwent Doppler sonographic investigation of the uterine and the cubital arteries. The Pulsatility Index (PI) was calculated for each vessel. Statistical analysis was performed and a P-value < 0.05 was considered significant. Results: Patients with preeclampsia and IUGR showed a significant higher resistance at the placental (mean PI 1.267 and 1.063), nonplacental (mean PI 1.631 and 1.124) and cubital artery (mean PI 3,777 and 3.995) compared to the normal pregnancy group (mean PI 0.678; 0.859 and 2.95 respectively). Mean birth weight in the PE group was 1409 g, in the IUGR group 1649 g and 3419 g in the normal pregnancy group. Conclusions: Pregnancies with IUGR are associated with elevated peripheral resistance in the maternal arterial system as seen in pregnancies with preeclampsia. Our findings encourage to further investigate the maternal vascular system in high risk pregnancies

More Please: Food and the Infinity of Desires

This dissertation might best be described as a discussion and analysis of the tendency towards excess at the heart of modern American culture. In studying excess, the philosophy of Arthur Schopenhauer—whose writings on the limitless desire of the will had such a profound influence on the writers and thinkers at the end of the 19th and beginning of the 20th century— is linked to Emile Durkheim’s theory, which informs much of this study. Durkheim’s conception of anomie is examined using a combination of etymology and hermeneutics culminating in the understanding of anomie as derangement, or, as rules that are lack of rules. To illustrate this tendency in a concrete way, food is employed as a vehicle for discussion. I outline and critique the various definitions of food, and offer my own definition of food as something that sustains life, but does so through the utilization of the collective constituent elements (vitamins, minerals, calories) that naturally occur within a material substance. Defining food holistically and in terms of nature allows me to also identify unnatural foods by employing Durkheim’s concept of derangement. I trace the origins of excessive willing in modern American culture back to the Protestant religious doctrines of predestination and the calling, arguing that tendency towards worldly asceticism has been removed—replaced by an insatiable desire to consume more—and resulting in the formation of what I am calling the consumption industry. Recontexualizing Mestrovic’s postemotional theory, I contend that the food industry in particular, and the consumption industry in general, rely on prepacked ideas as well as prepacked emotions to sell their foods in modern American society. This includes the consumption industry’s research on human biology and neurology—which has led to the production of deranged foods that actually induce hunger in consumers. Finally, the rise of monopoly capitalism is examined in light of Eros’ unitive power—highlighted through a comparison of Plato, Freud, and Durkheim— leading to the conclusion that the modern spirit of capitalism is postemotional Eros – a drive towards greater unity, divided against itself, fueled by recycled emotions and inflamed desires

Decreasing resistance in the maternal uterine and peripheral arterial system is apparently unrelated to plasma and urinary levels of nitrite/nitrate and cyclic-guanosinmonophosohate during the course of normal pregnancies

Aims: The aim of the presented study was to clarify the relationship between the pulsatility index of the uterine arteries and the maternal cubital artery and peripheral concentrations of the metabolites of nitric oxide (NO) and its second messenger cyclic guanosinmonophophate (cGMP) during the normal course of pregnancy and postpartum. Methods: 49 uncomplicated pregnancies were investigated every 46 weeks until delivery, 29 of them were additionally investigated postpartum. Paralleling each Doppler sonografic investigation maternal blood and urine samples were taken. The measurements of nitrite/ nitrate and cGMP were performed with a colorimetric and radio immuno assay. We demonstrate a significant decrease of the PI of the uterine arteries and of the cubital artery with inverse correlation to advancing gestational age. Results: The concentrations of nitrite/nitrate and cGMP remain stable during gestation and do not correlate to the PI of the uterine and cubital artery. Postpartum a reincrease in the uterine and peripheral resistance can be shown. The concentrations of urinary cGMP and nitrite/ nitrate as well as plasma cGMP remain unchanged, whereas plasma nitrite/nitrate decreases postpartum. Conclusions: The status of NO biosyntheses in normal pregnancy remains controversial. We hypothesize further systemically acting mediators which contribute to the decreasing vascular resistance