Medical Termination Research Articles

Interruptions médicales de grossesse pour indications maternelles : analyse rétrospective en Normandie Occidentale (2010–2019)

IntroductionTermination of pregnancy for maternal reasons (MTOP) are authorized in France without limit of term when “the continuation of the pregnancy puts in serious danger the health of the woman”. The literature on the subject is rare and we wanted to make an inventory in our region. MethodsRetrospective observational study between 2010 and 2019 at the multidisciplinary center for prenatal diagnosis in Western Normandy. ResultsThirty-one cases of MTOP were included (2.5% of all TOP). At the CHU de Caen, they represented one in 1200 births. Twenty-three percent of MTOP had a psychosocial or psychiatric indication (average term=22 SA) and 29% an obstetric indication due to severe preeclampsia (23 SA). Finally, 48% were linked to a non-obstetric somatic disorder including 46% pre-existing pathologies (average term=11 SA), most often cardiological or nephrological and 54% diagnosed during pregnancy (17 SA) dominated by neoplasias. They were more often (68%) performed in the second trimester. Vaginal births were more frequent (74% against 26% of endouterine aspirations). ConclusionStrict medical contraindications to pregnancy are exceptional. Recourse to the medical termination of pregnancy within the framework of a preexisting pathology must remain rare, by systematizing of the preconception consultation.

S0847 Pregnancy Outcomes in the Tofacitinib Ulcerative Colitis OCTAVE Studies: An Update as of February 2020

INTRODUCTION: Pregnant women with UC have a higher risk of adverse pregnancy outcomes compared with age-matched controls [1]. Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of UC. In rats and rabbits, tofacitinib exhibits teratogenic effects at 146 and 13 times, respectively, the human dose of 5 mg twice daily. There are no adequately sized, well-controlled studies of tofacitinib in pregnant women. METHODS: We report updated pregnancy outcomes [2] from 3 randomized, placebo-controlled studies (OCTAVE Induction 1&2: NCT01465763, NCT01458951; OCTAVE Sustain: NCT01458574) and an ongoing, open-label, long-term extension study (OCTAVE Open: NCT01470612) of tofacitinib in patients (pts) with moderately to severely active UC [3,4]. Pregnancy outcomes following maternal or paternal exposure to tofacitinib were identified from Pfizer’s internal safety database up to Feb 11, 2020, and categorized as healthy newborn, medical termination, fetal death, congenital malformation, spontaneous abortion, or lost to follow-up. Trial protocols required females of childbearing potential to use highly effective contraception, and included regular urine β-hCG testing. The study drug was discontinued in pts who became pregnant. RESULTS: The UC OCTAVE trials included 1,139 unique pts (including placebo), of whom 296 were females of childbearing age. A total of 34 pregnancies with exposure to tofacitinib were reported. Of these, 15 were cases of maternal exposure, all during the 1st trimester: 9 (60.0%) healthy newborns, 2 (13.3%) medical terminations, 2 (13.3%) spontaneous abortions, and 2 (13.3%) cases lost to follow-up. There were 19 cases of paternal exposure: 15 (78.9%) healthy newborns, 2 (10.5%) spontaneous abortions, and 2 (10.5%) cases lost to follow-up. There were no cases of fetal death or congenital malformation. CONCLUSION: The majority of known outcomes for both maternal and paternal cases were healthy newborns. Although there are limited data and follow-up available, this analysis was consistent with a previous analysis in pts with UC [2], as well as an analysis in pts with rheumatoid arthritis and psoriasis [5]. Tofacitinib should not be used during pregnancy unless clearly necessary.Table 1

P33 Menstrual regulation: Incidence, methods, and sources of this understudied reproductive practice in three countries

Objectives: Evidence suggests that many women view early medical terminations or actions taken to bring back a late period early in a suspected pregnancy as distinct from induced abortion. This study seeks to measure the rate of menstrual regulation and assess differences in sources, methods, and safety compared to a more traditional measure of abortion.

Medical Induction for Mid trimester Abortion: A Hospital-based Descriptive Cross-sectional Study.

Second trimester abortion is known as termination of pregnancy from 13- 28 weeks of gestation which can be further divided into early second trimester as 13-22 weeks and late as 23-28 weeks. In our study we have limited up to early second trimester. We intend to see the success rate of combination of mifepristone and misoprostol for medical induction, median time required for expulsion, complication and need of dilation and evacuation in some cases. This study also aims to give a review of current literature in mid trimester abortion with respect to efficacy, complication and also to provide evidencebase recommendation for safe regimens for mid trimester pregnancy termination. This was hospital-based descriptive cross-sectional study conducted among 40 pregnant women at second trimester admitted for termination of pregnancy in Kathmandu medical collage teaching hospital for the period of six month. Ethical approval was taken from the Institutional Review Committee of Kathmandu Medical College (Ref: 2207202002). Convenient sampling was done. All the pregnant women who need to terminate their pregnancy at second trimester (13-22 weeks) were admitted at Kathmandu Medical College Teaching hospital for termination of pregnancy were included in the study. Among the 40 women, who had termination of pregnancy at second trimester 37 (92.5%) had successful medical termination whereas 3 (7.5%) needed dilatation and evacuation. The combination of Mifepristone and Misoprostol have excellent result for termination of pregnancy if appropriately used after evaluating the patient with minimal complications.

A Model for Predicting Unsafe Induced Abortion among Women in India

Background: Unsafe abortion is one of the major cause of maternal morbidity and mortality. Approximately 15.6 million abortions take place every year in India of which a significant proportion is unsafe. Objective: To explore risk factors associated with unsafe induced abortion. Method: National Family Health Survey-IV data have 82,369 women aged between 15-49 years who responded about their aborted /miscarriage/stillbirth is used. Out of these total women, 8,878 were induced aborted and found eligible. Result: Of the total induced aborted, 30.6% of women are unsafe induced abortion. Women age between 35-49 years are 53% more likely to have unsafe induced abortion than age between 15-19 years. Women living in rural areas have 26% less likely to unsafe abortion than women living in urban areas. Women who have knowledge about the fertile period are 35% less likely to have unsafe abortion than no correct knowledge. Unsafe induced abortion is found increasing as education and wealth index are increasing. Conclusion: Unsafe induced abortion is a large contributor to maternal morbidity and mortality. Awareness of contraceptives use, Medical Termination of Pregnancy (MTP) and Comprehensive Abortion Care (CAC) service should be increased through media exposure

UNILATERAL LOWER LIMB PHOCOMELIA DURING THE COVID-19 PANDEMIC: ETHICAL DILEMMA FROM AN OBSTETRICIAN’S PERSPECTIVE

Isolated unilateral phocomelia is a rare congenital disorder. Historically, the most famous association with consumption of thalidomide in first trimester of pregnancy resulted in babies born with limbs resembling flippers of a seal. Genetic inheritance in the form of autosomal recessive manner is also postulated. It can be sporadic, familial or syndromic.
 On account of the deadly COVID-19 pandemic, suspension of non-emergency services including OPDs in majority of the hospitals led to diversion of resources for combatting emergency medical care. This temporary pause and containment was detrimental to non-COVID patients. We present a rare case of unilateral phocomelia where lockdown due to COVID-19 pandemic has resulted in denial of medical termination of pregnancy (MTP).

GEBELİĞİN TIBBİ TERMİNASYONU: HEMŞİRELİK DESTEK PROGRAMI ÖRNEĞİ

Özellikle viabilite sınırını aşmış gebelerde yapılan fetosit işlemi anne için yıpratıcı bir durumdur. Kayıp aile için sadece bir bebeğin kaybı ile sınırlı kalmaz geleceğe yönelik ümitsizlik ve hayal kırıklığına da neden olur. Her ebeveynin yas süreci birbirinden farklıda olsa da bu süreçte sosyal desteğe ve destekleyici hemşirelik bakımına ihtiyaç duyar. Tıbbi terminasyon süreci kadının anksiyeteyle, bilgi eksikliğine bağlı korkuyla ve tıbbi terminasyon kararı aşamasındaki zorlukla baş etmesine ve uyum sağlamasına yönelik pek çok zorluğu içerir. Buna ek olarak kadının doğum süreci ve sonrasında da karşılanması gereken fiziksel (ağrı, kanama, bulantı, kusma vb.) ve ruhsal (anksiyete, korku, yas vb.) bakım gereksinimi vardır. Kayıp yaşayan ailenin bakım gereksinimlerinin belirlenmesi ve bakımın sağlanması profesyonel bir ekip tarafından yapılmalıdır. Hemşire bu ekip içerisinde bakım verici rolüne ek olarak multidisipliner veya interdisipliner sağlık ekip üyeleriyle işbirliği yapar ve koordinatör rolü üstlenir. Bu derleme gebeliğin tıbbi terminasyon sürecini, tıbbi terminasyon sürecindeki hemşirelik yaklaşımını tanımlamak ve “Roy’un Adaptasyon Modeli”nin kullanımını, bir örnek ile açıklayarak, hemşirelik modellerinin kullanılmasının gerekliliğine dikkat çekmek ve kullanımının yaygınlaştırılmasını sağlamak amacıyla yazılmıştır.

Over-Representation of Recessive Osteogenesis Imperfecta in Asian Indian Children.

Several genes are implicated in the etiology of early onset osteogenesis imperfecta (OI). The various genes causing severe OI include WNT1 , SERPINF1 , P3H1 , CREB3L1 , and CRTAP , although glycine substitutions in COL1A1chains have also been predicted to cause perinatal lethal OI . Patients with early onset OI present decreased mobility, recurrent rib fractures, bony deformities, and chest infections that lead to an early death. We reported our experience in children with OI in Asian Indian families, which includes two patients with SERPINF1 pathogenic variants; and another two patients with severe OI and antenatal fractures caused by pathogenic variants in the CRTAP gene, identified by next generation sequencing (NGS). For one affected fetus, medical termination of pregnancy was done. The other baby was started on zoledronate therapy just after birth and is now 3 years old. Prenatal diagnosis was subsequently done on chorionic villus sample in the latter family.

Pregnancy rates and outcomes in early axial spondyloarthritis: An analysis of the DESIR cohort.

Only scarce data is available regarding pregnancy outcomes in early axSpA, particularly little is known about the impact of disease activity. The objective is to identify (a) the factors associated with the occurrence of a clinical pregnancy during follow-up and (b) the risk factors for an unfavorable pregnancy outcome (e.g. miscarriage, medical termination or pre-term delivery) in an early axSpA population. Observational prospective French cohort (DESIR) with 6 years of follow-up including 381 TNFi-naïve women with early axSpA. Factors associated with a clinical pregnancy occurring over follow-up and risk factors for an unfavorable pregnancy outcome were estimated by multivariable multilevel models (i.e. Frailty Shared Models and Mixed Models). During follow-up, 124 pregnancies occurred. Patients who got pregnant during follow-up were more likely to have discontinued their TNFi treatment in the 6 months preceding the pregnancy (HR=2.0 [95% CI 1.1-3.3], P=0.01) and to have an increased CRP at the previous visit (HR=1.7 [95% CI 1.2-2.5], P=0.01). Full-term delivery was by far the most frequent pregnancy outcome (75% of all pregnancies), and only NSAID use in the 6 months prior to the outcome was associated with an unfavorable outcome (OR=2.5 [95% CI 1.1-5.0], P=0.02). No association was found between TNFi use and an unfavorable pregnancy outcome. Full-term delivery was the most frequent pregnancy outcome. NSAID use within 6 months of outcome, but not TNFi use, was associated with an unfavorable pregnancy outcome in this early axSpA cohort.

Efficacy of mifepristone – Prostaglandin analogue combination in medical termination of pregnancy up to and beyond 7 weeks of amenorrhea: The RYMMa study.

ObjectiveTo assess, in real-life conditions, the success rate of the protocol mifepristone 600 mg / prostaglandin analogue (PG) in women requesting medical termination of pregnancy (MToP) either up to or beyond 7 weeks of amenorrhea (WA). Study designThe study was performed between 2015 and 2016. This was a non-interventional prospective, multicentre, longitudinal study conducted in France, among a sample of public and/or private centres dealing with MToP. Characteristics of women, term of Mtop, modality of PG used were reported. The primary outcome was success of MToP, defined as complete abortion without surgical procedure. ResultsA total of 893 pregnant women with less than the legal term of 14 WA were included in this study: 490 (54.9 %) ≤7 WA and 403 (45.1 %) >7 WA comprising 29 > 9 WA. The mean age of women was 28.1 ± 6.8 years and the one of pregnancy was 7.0 WA ± 1.3 WA. The most frequently used PG combined to mifepristone 600 mg was misoprostol 400 μg (57.0 % ≤7 WA and 35.1 % >7 WA) or 800 μg per os (oral or oral transmucosal) (27.5 % ≤7 WA and 40.1 % >7 WA). Vaginal misoprostol (6.4 %, N = 48) and gemeprost (5.2 %, N = 39) were less used. In women ≤7 WA (N = 422) and women >7 WA (N = 354) for whom result of the MToP was collected, success rates were 94.5 % (95 %CI 91.9 %–96.5 %) and 92.4 % (95 %CI 89.1 %–94.9 %), respectively (p = 0.219). In multivariate regression analysis, three factors were significantly associated with a higher risk of MToP failure: increased number of previous pregnancies (OR = 1.233; 95 %CI 1.086–1.401 for one pregnancy), increased number of previous surgical ToPs (OR = 1.563; 95 %CI 1.036–2.359 for one ToP) and increased interval between mifepristone and PG intake (OR = 1.061; 95 %CI 1.012–1.112 for one hour). Term of pregnancy (OR = 1.497; 95 %CI 0.833–2.690 for ≤7 WA vs >7WA), administration route (OR = 1.553; 95 %CI 0.488–4.936 for oral vs oral transmucosal; and OR = 1.216; 95 %CI 0.625–2.366 for vaginal vs oral transmucosal), and dose of misoprostol (OR = 1.000; 95 %CI 0.999–1.001), were not associated with the risk of failure. Overall, tolerance was good. ConclusionThis study showed, in real-life settings, a high rate of success for MToP using mifepristone 600 mg, independent of the pregnancy term and the therapeutic protocol used. MToP was safe and well tolerated however only a small number of women beyond 9 WA have been included.

The Spine Journal Outstanding Paper Awards Presentations Outstanding Paper: Basic Science Uncovering molecular targets for regenerative therapy in degenerative disc disease: do small leucine-rich proteoglycans hold the key?

BACKGROUND CONTEXT Small leucine-rich proteoglycans (SLRPs) play an essential role in extracellular matrix (ECM) organization and function. Recently, dysregulation of SLRPs has been implicated in degenerative disc disease (DDD). An in-depth analysis using high-throughput proteomic sequencing might provide valuable information on their implications in health and disease. PURPOSE To utilize proteomics for analyzing the expression of SLRPs in fetal, healthy adult, and degenerated discs, to identify possible molecular targets to halt or reverse the degenerative process. STUDY DESIGN Experimental analysis. METHODS Proteomic signatures of 8 magnetic resonance imaging (MRI) normal lumbar discs (ND) [harvested from brain dead alive organ donors] were compared to 8 fetal disc samples (FD) [harvested from fetal spines devoid of congenital anomalies following spontaneous or medical termination of pregnancy] and 8 degenerate discs (DD) [collected from patients undergoing fusion surgery]. The various functional pathways along with the differential expression of SLRPs and the associated changes in collagens, large proteoglycans (LLRPs), matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) have been analyzed further using bioinformatics. This project was self-funded by the Ganga Orthopedic Research and Education Foundation. RESULTS ESI-LC-MS/MS analysis revealed a total of 1,029 proteins in FD, 1,785 proteins in ND, and 1,775 proteins in DD. Fetal disc proteins were engaged mainly in ribosomal pathways (indicating active proliferation and regenerative potential). The healthy adult discs (ND) primarily participated in ECM maintenance and basic metabolic pathways, whereas the unique proteins of DD group were involved in inflammatory (complement and coagulation cascades, systemic lupus erythematosus and leukocyte transendothelial migration) pathways and infective (Staphylococcus aureus infection, prion diseases, amoebiasis, pertussis, and Legionellosis) channels which favor the recent concepts of inflammaging and subclinical infection as causes of DDD. Analysis of SLRPs revealed the upregulation of biglycan in FDs and downregulation of lumican, decorin, prolargin, and chondroadherin in the DD group. The universal decrease in the abundance of SLRPs in the DD group was associated with an increase in MMPs and a reduction in TIMPs, collagen and LLRP content. CONCLUSIONS Our study documents the influence of SLRPs in the maintenance of disc health and also the need for future research in using them for disc regeneration. CLINICAL SIGNIFICANCE The various SLRPs that we identified are all known to have a beneficial influence on ECM integrity and a negative effect on the degenerative process at different stages in the evolution of degeneration. Biglycan, which is abundantly present in a fetus, may be suitable for regenerative therapy, and the other SLRPs like lumican, prolargin, decorin, and chondroadherin may serve the same purpose and/or as biomarkers. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Medical termination of unplanned pregnancy

Medical termination of unplanned pregnancy

Original Research Paper_Knowledge, Attitudes and Practice of Medical Termination of Pregnancy amongst doctors in Shillong , Northeast India

Original Research Paper_Knowledge, Attitudes and Practice of Medical Termination of Pregnancy amongst doctors in Shillong , Northeast India

Contraception and MTP in COVID Times

In this pandemic of COVID-19, women's health is disproportionately affected due to reduced access to contraceptive and safe abortion services. It has led to increased incidence of unsafe abortions, unwanted pregnancy, and quack practices. With the help of government services and policymakers, all these services should be made easily approachable to women. Basic guidelines of COVID precaution should be clearly explained to women and adolescent girls, safe contraception methods and their access should be known to patients. Telemedicine can play a huge role in covering all these aspects of women's health. Psychological counseling by doctors and health service providers reduces fear and anxiety regarding their health issues. Contraception can reduce the need for termination of pregnancy, resulting in the reduced risk of women and girls facing unsafe abortions. Recently, the United Nations Fund for Population Activities (UNFPA) data reveal that if lockdown continues for another 6 months, 47 million women in low- and middle-income countries may not be able to access contraception and that 7 million unintended pregnancies are expected to occur globally. Hence, contraception and medical termination of pregnancy services also have to be taken as prime importance among all the other gynec services to avoid upcoming population explosion.

Mid Trimester Termination of Pregnancy : Role of Combined Mifepristone and Misoprostol

Background: Mid trimester abortions constitute 10%-15% of all induced abortionsworld wide. Over the last decade this increase is due to better prenatal screening. Itcan be done by surgical and medical methods. Medical methods such as Misoprostolis widely used for mid trimester abortion. Mifepristone has antiprogesteroneproperty,so addition of Mifepristone with Misoprostol can increase its effectiveness.To assess the safety, effectiveness and acceptibility of combined Mifepristone andMisoprostol for mid trimester medical termination of pregnancy (Between 13-24weeks of gestation).
 Materials and methods: This experimental study was conducted among 40 healthywomen who presented for mid trimester termination of pregnancy between 13-24weeks with missed abortion, gross congenital anomalies with or without previoushistory of one caesarian section. The study was conducted from March October2018 at Chattogram Maa-O-Shishu Hospital Medical College, Chattogram,Bangladesh. Each woman received a single dose of tablet Mifepristone 200mg. After24 hours, 200 mcg vaginal Misoprostol was administered which was repeated at 6hourly interval for maximum of 5 doses (1000 mcg) in 24 hours. Success was takenas complete expulsion of fetus and placenta within 24 hours of first dose ofMisoprostol. Primary and secondary outcomes were measured. Statistical analysiswas done using SPSS version 23.
 Results: Success rate of complete abortion was 97.5%. Mean Induction AbortionInterval was11.59 hours (SD± 3.34). Mean dose of Misoprostol was 1.85 (SD± 0.77)or 370 mcg. Over all safety of the study was satisfactory with only 1 patientexperienced fever and 1 had nausea .There was no major complication.
 Conclusion: The Mifepristone/Misoprostol regimen is a highly effective as well assafe option for mid trimester medical termination of pregnancy with a shortinduction abortion interval and it can also be used in scarred uterus with closesupervision.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 63-67

Load balancing strategy for medical big data based on low delay cloud network

Since the cloud servers are far away from the medical detection terminal and user terminal, the communication overhead such as the delay caused by data transmission is large. At the same time, a large number of medical terminals and user terminals access the cloud servers, which makes the cloud servers overloaded, the overall robustness of the network is poor, and the network is prone to failure, which may lead to the work efficiency of doctors cannot be guaranteed, and the waiting time of patients will also increase. To solve the above problems, according to the characteristics of dynamic resource allocation in the medical big data environment, a new cloud network architecture is proposed. To solve the resource scheduling problem, a chaotic algorithm is introduced into the artificial firefly algorithm, and a load balancing optimisation strategy based on a chaotic firefly algorithm is proposed. The simulation results show that the convergence rate of the proposed algorithm is accelerated by adding chaos factor, to avoid the algorithm falling into the local optimal solution. Compared with other load balancing algorithms, the proposed algorithm is more suitable for solving the resource scheduling problem of large-scale tasks in cloud-fog networks.

Unexplained repeated pregnancy loss and T helper cells

ObjectiveTo know the prevalence of immunology as a cause of unexplained repeated pregnancy loss (RPL) by comparing T helper cell 1(Th1) and T helper cell 2 (Th2) in the decidua of women with RPL, at the time of miscarriage with the decidua of women, at the time of induced abortion. Study designcase control study SettingAcademic medical centre Subjects36 Women requiring surgical evacuation, with history of previous one or more spontaneous abortions enrolled as cases. 37 patients undergoing surgically induced termination of pregnancy taken as control.Inclusion criteria- women who presented to the hospital with signs of abortion requiring surgical evacuation, with history of previous one or more spontaneous abortion.Exclusion criteria- women who had taken progesterone for present pregnancy, prior to this miscarriage. Also women who had clinical evidence of autoimmune disease, who were critically ill and who had biohazard exposures like HIV, HCV, HBsAg. InterventionThe decidual tissue obtained was subjected to histopathology and immunohistochemistry staining for Th1 and Th2 cells. Statistical analysisData entered in MS EXCEL spreadsheet and analysis done using Statistical Package for Social Sciences (SPSS) version 21.0. ResultsThe Th1 cells were found to be positive in 25 % women in cases and 29.73 % women in controls group whereas Th2 cells were positive in 16.67 % women in cases and 8.11 % in control group. Both Th1 and Th2 cells were seen in 16.44 % of total women. (p- 0.678) ConclusionNo statistically significant difference in Th1 and Th2 cells in the decidua of patients undergoing recurrent abortion when compared to women undergoing medical termination of pregnancy. Therefore, routine screening for immunological factors and cytokine testing is not recommended. Patients of RPL should not be offered immune treatment routinely.

Analysis of Ultrasonographic Misdiagnosis of Cephalothoracopagus Janiceps Conjoined Twins: A Case Report

Background and Objective: Conjoined twins (CTs) are rare complications of monozygotic twinning. Cephalothoracopagus is the rarest subtype of CTs and occurs once in every 58 sets of conjoined twins or once in every three million births. Here we present such a case and analyze the possible reasons for ultrasonographic misdiagnosis and recommend solutions to avoid it.Case Report: In this article, we have reported a case of Cephalothoracopagus Janiceps twining. The ultrasonographic diagnosis was missed at 7 and 12 weeks scans. Increased thickness of nuchal translucency and absent nasal bone was observed alongside with suspected gastroschisis. The patient was referred for further evaluation at 13-14 weeks of pregnancy. Unexpectedly, two alive fetuses were reported fused in the head, thorax, and abdomen. Because of the poor prognosis, counseling was provided for parents and elective medical pregnancy termination was carried out. We have analyzed the possible reasons for ultrasonographic misdiagnosis.Conclusion: Without applying a standardized scanning of the entire uterus both in a longitudinal and transverse approach in early pregnancy, cephalothoracopagus twining may be misdiagnosed with a singleton pregnancy. A high level of concerns may raise for conjoined cephalothoracopagus twinning in case of finding a single fetal pole with an irregular body outline and a disproportionally large head in the presence of two separate fetal hearts in early pregnancy. Two fused heads with two brains and two sets of lower and upper extremities do confirm the diagnosis.

The effectiveness of a simple antimicrobial stewardship intervention in general practice in Australia: a pilot study

BackgroundInappropriate and excessive antimicrobial prescribing can lead to antimicrobial resistance. Antimicrobial Stewardship (AMS) principles are not well established in general practice in Australia despite the relatively high rate of community antimicrobial prescribing. Few interventions have been implemented that have resulted in a significant reduction or improvement in antimicrobial prescribing by General Practitioners (GPs). This study was therefore conducted to assess the impact of a novel GP educational intervention on the appropriateness of antimicrobial prescriptions as well as GP compliance with antimicrobial prescription guidelines.MethodsIn 2018, a simple GP educational intervention was rolled out in a large clinic with the aim of improving antimicrobial prescribing. It included face-to-face education sessions with GPs on AMS principles, antimicrobial resistance, current prescribing guidelines and microbiological testing. An antibiotic appropriateness audit on prescribing practice before and after the educational intervention was conducted. Data were summarised using percentages and compared across time points using Chi-squared tests and Poisson regression (results reported as risk ratios (RR) with 95% confidence intervals (CI)).ResultsData from 376 and 369 prescriptions in July 2016 and July 2018, respectively, were extracted. There were significant improvements in appropriate antimicrobial selection (73.9% vs 92.8%, RR = 1.26; 95% CI = 1.18–1.34), appropriate duration (53.1% vs 87.7%, RR = 1.65; 95% CI = 1.49–1.83) and compliance with guidelines (42.2% vs 58.5%, RR = 1.39, 95% CI = 1.19–1.61) post- intervention. Documentation of antimicrobial duration directions, patient follow-up as well as patient weight significantly increased after the intervention (p < 0.001). There was significant reduction in; prescriptions without a listed indication for antimicrobial therapy, prescriptions without appropriate accompanying microbiological tests and the provision of unnecessary repeat prescriptions (p < 0.001). Inappropriate antimicrobial prescriptions observed pre-intervention for medical termination of pregnancy ceased post-intervention.ConclusionsAuditing GP antimicrobial prescriptions identified prescribing practices inconsistent with Australian guidelines. However, implementation of a simple education program led to significantly improved antimicrobial prescribing by GPs. These findings indicate the important role of AMS and continued antimicrobial education within general practice.

Feasibility of a fetal anatomy 3D atlas by computer-assisted anatomic dissection

ObjectiveTo assess the feasibility of 3D modelisation of fetal anatomy by using the Computer-assisted anatomic dissection (CAAD) based on immunolabeled histologic slices and MRI slices with a specific 3D software. Study designFor pelvis and lower limbs, subjects came from legal abortion, medical pregnancy termination, or late miscarriage. Specimens were fixed in 10 % formalin, then embedded in paraffin wax and serially sectioned. The histological slices were stained using HES and Masson Trichrome. Protein S-100 and D2−40 markers were used for immuno-labelling. Serial transverse sections were digitalized and manually aligned. Fetal brain slices were obtained from in utero or post-mortem MRI. ResultsCAAD was performed on 10 fetuses: pelvis was modelised with 3 fetuses of 13, 15 and 24 W G, lower limbs with 2 fetuses of 14 and 15 W G and brain with 5 fetuses aged between 19 and 37 W G. Fetal pelvis innervation was analysed after immunolabelling and nerves appeared proportionally bigger than in adults with the same topography. Lower limbs analysis revealed that nerve development was guided by vascular development: the sciatic nerve along the big axial vein, the saphen nerve along the big saphen vein and the sural nerve along the small saphen vein. Fetal brain study allowed to describe the gyration process and the lateral ventricle development. ConclusionCAAD technique provides an accurate 3D reconstruction of fetal anatomy for lower limbs and pelvis but has to be improved for brain model since midline structures were not amendable for analysis. These results need to be confirmed with larger series of specimens at different stages of development.