Delivery Rate Research Articles

Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever.

Meconium-stained amniotic fluid (MSAF) often signifies colonization of the amniotic sac by microorganisms. This study investigated additional adverse obstetric outcomes associated with MSAF in deliveries complicated by maternal intrapartum fever (IF). This retrospective study included all singleton pregnancies from 2014 to 2020, with intrapartum maternal fever ≥ 38°C during a trial of labor. In accordance with departmental protocol, all patients received intravenous antibiotic therapy consisting of ampicillin and gentamicin in the absence of allergies to these medications. Subsequent antibiotic therapy was adjusted based on the culture results. Antibiotic treatment was discontinued postpartum after 48h without fever. Swab cultures were obtained immediately postpartum from both the maternal and fetal sides of the placenta. Maternal and fetal outcomes, along with positive placental cultures, were compared between participants with MSAF&IF and those with clear amniotic fluid &IF (control group). In comparison to the control group (n = 1089), the MSAF&IF group (n = 264) exhibited significantly higher rates of cesarean delivery (CD) (p = 0.001), CD due to non-reassuring fetal heart rate (p = 0.001), and cord pH ≤ 7.1 (p = 0.004). Positive swab cultures from the placental maternal and fetal sides were more prevalent among the MSAF&IF group (23.1% vs. 17.6%, p = 0.041 and 29.2% vs. 22.9%, p = 0.032, respectively). Placental cultures yielding gastrointestinal pathogens and extended spectrum beta-lactamase were notably more common in the MSAF&IF group compared to controls (p = 0.023). However, there was no significant difference between groups regarding the rate of group B streptococcus positive placental cultures. Women experiencing IF and MSAF during labor face an elevated risk of CD compared to those with IF alone. The presence of MSAF heightens the risk of positive placental cultures, particularly with gastrointestinal and extended spectrum beta-lactamase pathogens.

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery

IntroductionBoth twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery. MethodsWe conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n=8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage. ResultsAmong the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p=0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group. ConclusionIn women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

Prospective Observational Study Of The Outcome Of Pregnancies With Sonologically Detected Nuchal Cord At Term

Background: Nuchal cord refers to the condition where the umbilical cord wraps around the fetal neck, potentially leading to complications during pregnancy and delivery. The prevalence of nuchal cords at delivery ranges between 6% and 37%, with possible adverse outcomes including fetal asphyxia, hypoxia, and in severe cases, stillbirth. The current study aims to evaluate the impact of nuchal cord detection via ultrasound in fullterm pregnancies and assess its prognostic significance concerning perinatal outcomes. Materials and Methods: This prospective observational study involved a cohort of pregnant women at term (37- 42 weeks of gestation) with sonologically detected nuchal cords. Ultrasound evaluations were conducted to determine the presence and characteristics of nuchal cords, including the number of loops and tightness. The outcomes measured included the mode of delivery, fetal distress, Apgar scores, and neonatal complications such as hypoxic-ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS). Statistical analysis was performed to assess the correlation between nuchal cord characteristics and perinatal outcomes. Results: The study found that the presence of nuchal cords was associated with an increased rate of cesarean deliveries and a higher incidence of fetal distress during labor. However, the degree of tightness and the number of loops significantly influenced the severity of outcomes. Neonates with tightly looped nuchal cords showed a higher incidence of low Apgar scores and required more intensive neonatal care. The study also observed a slight increase in the occurrence of neonatal complications, including MAS and HIE, among those with multiple nuchal cord loops. Conclusion: The detection of nuchal cords at term via ultrasound is a valuable tool in predicting potential delivery complications. While many nuchal cords do not adversely affect perinatal outcomes, those with multiple loops or tight cords pose a higher risk of complications. This study emphasizes the importance of careful monitoring and tailored management strategies for pregnancies complicated by nuchal cords to optimize maternal and fetal outcomes.

MCLORA: Maritime ad-hoc communication system based on LORA

Maritime communication plays a crucial role in fields such as ocean resource exploration and marine environmental monitoring. Existing maritime communication methods either face challenges in equipment deployment or are limited by high power requirements, making sustained operation difficult. The emergence of LoRa presents an opportunity in this regard, with its characteristics of low power consumption and long communication range, meeting the demands for long-term maritime communication. However, LoRa’s underlying implementation is not open-source, and LoRaWAN itself adopts a star topology, limiting communication between nodes. Therefore, we have devised a communication packet header working at the application layer to enable peer-to-peer communication between nodes. Our on-campus field tests have shown that our system can achieve node-to-node communication, networking functionalities, with a packet delivery rate more than 94%, and max data transmission rate can achieve 1027 bps. In the sea test, the communication rate of our node remained basically around 1035 bps due to the absence of objects blocking the line of sight, and packet delivery rate was more than 96%.The byte error rates of all experiments were less than 0.5%.

Hybrid vehicular access protocol and message prioritization for real-time safety messaging

Real-time safety services rely on the exchange of messages to enhance the operations of connected and automated vehicles (CAVs). These safety messages convey vital information about traffic conditions, enabling drivers to take necessary measures to prevent accidents. The timely and reliable delivery of these messages is essential, necessitating efficient channel access. Vehicular Deterministic Access (VDA) is employed as a channel access scheme with distinct priorities and stringent timing guidelines, particularly for urgent safety warnings. In this paper, we propose a hybrid approach that combines VDA and Carrier Sense Multiple Access with Collision Avoidance (CSMA/CA) protocols, along with a message prioritization algorithm, to ensure efficient and reliable communication of safety messages in vehicular networks. Our approach leverages the strengths of both VDA and CSMA/CA to avoid message collisions; VDA is more efficient under high traffic loads, while CSMA/CA is better suited for low traffic loads. Additionally, the incorporation of the message prioritization algorithm ensures strict deadline guarantees for high-priority messages, such as Decentralized Environmental Notification Messages (DENMs). We evaluate our proposed solution using the Artery simulation framework. Our results show over a 93% delivery rate for DENM exchanges while maintaining low collision probability across various traffic loads. This research provides practical guidance for the development of efficient and reliable communication systems for CAVs. It also offers a detailed analysis of the trade-offs among different access protocols and message prioritization strategies in vehicular networks.

Generation, expansion, gene delivery, and single-cell profiling in rhesus macaque plasma B cells.

A key step in developing engineered B cells for therapeutic purposes is evaluation in immunocompetent, large-animal models. Therefore, we developed methods to purify, expand, and differentiate non-human primate (NHP; rhesus macaque) B cells. After 7days in culture, B cells expanded 10-fold, differentiated into a plasma cell phenotype (CD38, CD138), and secreted immunoglobulin G. Using single-cell sequencing and flow cytometry, we verified the presence of plasma cell genes in differentiated NHP B cells and unearthed less-recognized markers, such as CD59 and CD79A. In contrast with human cells, we found that the immune checkpoint molecule CD274 (PD-L1) and major histocompatibility complex (MHC) class I molecules were upregulated in NHP plasma cells in the transcriptional data. Lastly, we established the conditions for efficient transduction of NHP B cells with adeno-associated virus (AAV) vectors, achieving a delivery rate of approximately 60%. We envision that this work will accelerate proof-of-concept studies using engineered B cells in NHPs.

Cohen vs Pfannenstiel cesarean skin incision for body mass index ≥35 kg/m2: a randomized controlled trial

Background: Maternal obesity is recognized as a significant risk factor for adverse pregnancy outcomes, including increased cesarean delivery rates and heightened surgical complications. It is unclear if the Cohen or Pfannenstiel skin incisions at cesarean delivery are associated with different outcomes. Objective: To evaluate the impact of either Cohen or Pfannenstiel cesarean skin incision type on maternal morbidity. Study Design: Pregnant individuals with a BMI of ≥35 kg/m2, carrying either singleton or multiple gestations, were consented prenatally and in labor. Eligible participants who underwent a cesarean delivery between 24 and 41 weeks of gestation were randomized to either Pfannenstiel or Cohen skin incisions at Thomas Jefferson University Hospital from October 2016 to March 2020. The study aimed to recruit 284 participants based on a sample size calculation assuming a 50% reduction in wound complications with Cohen versus Pfannenstiel incisions (80% power, α=0.05), but recruitment was terminated early after 72 participants were randomized. The primary outcome was a composite maternal morbidity within six weeks, which consisted of the following: wound infection, hematoma, seroma, separation of skin ≥1 cm, readmission for wound complications, endometritis, and postpartum hemorrhage. Statistical analyses included bivariate tests, t-tests, and non-parametric analyses. Results: Of 331 pregnant individuals consented prenatally and in labor, 72 eventually underwent cesarean delivery and were randomized, 34 to Cohen and 38 to Pfannenstiel skin incisions. The mean BMI was >42 kg/m2, about two thirds of the patients had a pannus, 56% were Black, 47% had diabetes, and 56% hypertensive disorders. The primary outcome of composite maternal morbidity occurred in 47.1% in the Cohen and 36.8% in the Pfannenstiel groups (RR 1.24, 95% CI 0.71-2.08), and was also similar regardless of the presence of a pannus, or by degree of obesity. Surgical site infection, hematoma, seroma, wound separation/dehiscence, endometritis, and postpartum hemorrhage were each similar between Cohen and Pfannenstiel participants. Neonatal outcomes were also similar between the Cohen and Pfannenstiel groups, except that the Cohen group was found to have statistically significant lower Apgar score at 5 minutes and higher need for respiratory support compared to the Pfannenstiel group, possibly related to the trend for a longer time from skin incision to delivery. Physicians were found to be significantly less satisfied with the Cohen compared to the Pfannenstiel incision. Conclusion: In pregnant patients with BMI of ≥35 kg/m2, obstetrical providers can chose from either a Cohen or an Pfannenstiel skin incision, as they are associated in general with similar outcomes, except for lower Apgar scores and lower physician satisfaction associated with the Cohen incision. The findings of this study are limited by its early cessation for logistical reasons, leading to an underpowered analysis. It is crucial to acknowledge that these results must be interpreted cautiously due to the reduced sample size and the circumstances surrounding the study's termination. These data can inform future trial design and implementation as well as fuel individual patient level meta-analyses on this topic.

A new aerosol delivery approach for enhanced long-term respiratory care in resource-poor settings

Continuous aerosol therapy is safe, superior, and the mainstay in the therapy of patients with severe asthma, cystic fibrosis, chronic obstructive pulmonary disease (COPD), and coronavirus disease (COVID-19). However, continuous nebulization has been perceived as highly expensive and labor-intensive, which often requires specialized medical equipment. Moreover, it is difficult to maintain consistent aerosol output and particle size delivery over an extended period without operator intervention. This work proposes a simple and reliable continuous nebulization method using a conventional gas jet nebulizer and intravenous (IV) bottle/bag. The present work reports detailed experimental studies on a gas jet nebulizer with Particle image velocimetry (PIV), Particle/droplet Imaging Analysis (PDIA), and Mie scattering techniques to demonstrate the feasibility of the proposed technique. The preliminary investigation shows that the proposed method provides continuous liquid output delivery without external supervision. The liquid delivery rate and mass median diameter (MMD) of the nebulizer mainly depend on the gas flow rate and suction height. The MMD of the primary generated droplets is reported to vary between 100 and 230 μm for a ± 10 cm suction height and 500–1000 mlph nebulization gas flow rate. Most importantly, the nebulizer spray angle, stability, droplet size distribution, and the axial and radial velocities of the droplets are marginally affected by the suction height. Therefore, the proposed system is a versatile, safe, and cost-effective method of continuous nebulization therapy, especially in resource-poor countries or contagious disease outbreak situations.

Impact of Different Packaging Configurations on A Topical Cream Product

PurposeThe objective of this study was to investigate whether different dispensing processes can alter the physicochemical and structural (Q3) attributes of a topical cream product, and potentially alter its performance.MethodsAcyclovir cream, 5% (Zovirax®) is sold in the UK and other countries in a tube and a pump packaging configurations. The structural attributes of the cream dispensed from each packaging configuration were analyzed by optical microscopy, confocal Raman microscopy and cryo-scanning electron microscopy. Rheological behavior of the products was also evaluated. Product performance (rate and extent of skin delivery) was assessed by in vitro permeation tests (IVPT) using heat-separated human epidermis mounted in static vertical (Franz-type) diffusion cells.ResultsDifferences in Q3 attributes and IVPT profiles were observed with creams dispensed from the two packaging configurations, even though the product inside each packaging appeared to be the same in Q3 attributes. Visible globules were recognized in the sample dispensed from the pump, identified as dimethicone globules by confocal Raman microscopy. Differences in rheological behaviour could be attributed to these globules as products not dispensed through the pump, demonstrated a similar rheological behaviour. Further, IVPT confirmed a reduced rate and extent to delivery across human epidermis from the product dispensed through a pump.ConclusionsDifferent methods of dispensing topical semisolid products can result in metamorphosis and Q3 changes that may have the potential to alter the bioavailability of an active ingredient. These findings have potential implications for product developers and regulators, related to the manufacturing and comparative testing of reference standard and prospective generic products dispensed from different packaging configurations.

Effect Of Cerclage Suture Type On Pregnancy And Newborn Results: Mersylene Suture Versus Prolene Suture

Purpose: The aim of this study is to compare pregnancy and neonatal outcomes according to the type of the suture material used in the transvaginal cerclage operation. Materials and Methods: Patients who underwent transvaginal cervical cerclage due to cervical insufficiency in a tertiary health center between 2020 and 2024 were evaluated retrospectively. Demographic data regarding cerclage indications (ultrasound-based, prophylactic or physical examination-based), number of weeks of gestation in cerclage, cerclage suture type (prolene, mersilen), gestational week at cerclage insertion and delivery, routes of delivery were recorded. In addition, birth weight, 1st and 5th minute APGAR scores, and neonatal intensive care unit (NICU) requirements were recorded as neonatal parameters. Patients were divided into two groups according to cerclage suture type (mersilene or prolene) and maternal, newborn and pregnancy outcomes were compared between these groups. Results: Comparison of the groups in terms of age, gravidity, parity, number of miscarriages and BMI revealed significantly higher mean gravidity in group 1 compared to group 2 (P0.05). No difference was determined with regard to gestational week at cerclage application, cervical length, cervical dilatation just before cerclage insertion, gestational age at cerclage removal and delivery and birth weight (p>0.05). Groups were comparable in terms of subgroups established according to their numbr number of previous deliveries (p>0.05). Groups were comparable in terms of indications for cerclage insertion (p>0.05). Cesarean delivery rate was 40 % in group 1 while it was 43.6 % in groups 2, no statistical difference was determined in terms of rate of cesarean delivery (p>0.05). Similar number of newborns needed NICU admission between the two groups following delivery (17.5% versus 17.9 %p>0.05). Mean APGAR scores at 1st (6.8 versus 7.4) and 5 th (7.8 versus 8.3) min were comparable between the groups (p>0.05) Conclusion: Although mersilen stitch is commonly preferred, data analysis revealed similar results with prolene stitch in terms of maternal and neonatal outcomes.

Clinical and statistical analysis of the course of preterm birth based on the materials of communal enterprise «Regional Perinatal Center of the Rivne Regional Council» in 2013–2023 years

One of the priority tasks of modern medical science and practice is the preservation of reproductive health and the gene pool of the nation. It is especially difficult to perform this task during the russian war in Ukraine, which has been going on for more than ten years. According to sociologists, the outcomes of a low birth rate for the country will be catastrophic precisely because of the war.One of the reasons for the decline in the quality of health in the future is the increase in the specific weight of premature births, the frequency of which, according to the World Health Organization, has increased in Ukraine already after six months of full-scale war.The objective: to conduct an analysis of the course of premature births in the conditions of war based on the materials of the communal enterprise (CE) “Regional Perinatal Center of the Rivne Regional Council” for 2013–2023.Materials and methods. A retrospective clinical and statistical analysis of 2,742 histories of pregnancy and childbirth of women who were in labor between 22/0–36/6 weeks of gestation in obstetric departments of the communal enterprise “Regional Perinatal Center of the Rivne Regional Council” in 2013–2023 was carried out.Results. According to CE “Regional Perinatal Center of the Rivne Regional Council”, a progressive decrease in the total number of births by 41.9% was observed in the Rivne Region from 2013 to 2023. At the same time, in the general population of women giving birth, the specific rate of premature births did not have a tendency to increase.In the structure of preterm births, early and late preterm births prevailed. The specific gravity of very early preterm births, which are the most unfavorable for perinatal outcomes, did not have a sustained upward trend. At the same time, the frequency of too early premature births among residents of districts and territorial communities of the Rivne region has significantly increased (2013 – 19 (79.2%) cases, 2023 – 17 (100.0%) cases; p<0.05).Every second premature birth occurred within the first day of hospitalization of a pregnant woman, while the specific rate of such too early premature births increased by 3.4 times during the analyzed period, which significantly worsens the chances of survival of newborns and is the reason for their high perinatal morbidity.The number of premature births in pregnant women with multiple pregnancies remains stable. Every third preterm birth took place on the background of early premature rupture of the fetal membranes, while a significant increase in the frequency of this complication was found in women who gave birth at 22/0–27/6 weeks of pregnancy.Traditionally, the specific rate (55.7–57.5%) of surgical delivery by caesarean section of pregnant women and mothers with premature births remains high, which contributed to a reliable reduction of the perinatal mortality rate of premature babies by 13.7% due to the reduction of antenatal losses. Indicators of early neonatal death were formed at the expense of newborns from too early and early premature births in the same ratio.Conclusions. According to thedata of CE “Regional Perinatal Center of the Rivne Regional Council”, there was a progressive decrease in the birth rate in the Rivne Region with a simultaneous stabilization of the number of premature births. The widespread use of a holistic approach during the medical care of pregnant women and the introduction of modern methods of care for premature newborns ensured a significant decrease in the rate of perinatal death of premature infants due to the reduction of antenatal losses.

PREGNANCY OUTCOME IN PERIPARTUM CARDIOMYOPATHY

Background:Peripartum cardiomyopathy(PPCM) is characterized by the onset of heart failure due to left ventricular systolic dysfunction in late pregnancy or shortly after delivery. The incidence of PPCM varies widely globally, with reports ranging from 1 in 100-15000 pregnancies This study aims to evaluate the incidence, clinical characteristics, and outcomes of PPCM in a cohort of women at Basaweshwara General and Teaching Hospital, Kalaburgi. Methods:A retrospective observational study was conducted over one year (January 1 to December 31, 2023). Inclusion criteria were based on NHLBI standards for diagnosing PPCM, while patients with preexisting cardiac conditions, liver disorders, and malignancies were excluded. Data were collected from hospital records, focusing on demographics, clinical presentations,echocardiographic findings, complications, and outcomes. Statistical analysis was performed using SPSS version22. Results:Among 2,200 deliveries, 12 cases of PPCM were identified, yielding an incidence of 0.55%. The mean age of affected women was 26.33 years, with 66% being primigravida. A significant proportion (58.33%) presented with hypertensive disorders.Maternal outcomes included a 25% mortality rate and high rates of cesarean delivery (83.33%).Neonatal outcomes were concerning, with 58.33% of infants requiring NICU admission and 16.66% experiencing intrauterine death. Conclusion:PPCM poses substantial risks to maternal and fetal health, particularly in younger and first-time mothers. Identifying women with risk factors such as hypertensive disorders and anemia is crucial for optimizing care and improving outcomes. Enhanced monitoring and intervention strategies are necessary to address the complexities of PPCM in pregnancy.

Maternal and Neonatal Consequences of Early Augmentation of Labor Among Women With Spontaneous Onset of Labor: A National Population-Based Study.

While some labor interventions are essential in preventing maternal and neonatal morbidity, there is little evidence to support systematic early augmentation of labor (EAL). Our objective was to assess the association between EAL and cesarean delivery rate, postpartum hemorrhage and adverse neonatal outcomes. Population-based study using data from the 2016 French Perinatal Survey. Women with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. "EAL" was defined by artificial rupture of the membranes (AROM) and/or oxytocin within 1 h of admission and/or duration between interventions of less than 1 h. Women without EAL were women without labor augmentation or without EAL. The primary endpoint, cesarean delivery and the secondary endpoints were compared between women with and without EAL using univariate analysis. A multivariable logistic regression was adjusted on the suspected confounders and a propensity score approach was then performed. Among the 7196 women included, 1524 (21.2%) had EAL. Cesarean delivery rates were significantly higher in the EAL group compared with the no EAL group, 8.40% versus 6.15% (p < 0.01). EAL was associated with cesarean delivery in the multivariable analysis aOR 1.45 95% CI [1.15-1.82] and in the cohort matched on the propensity score, OR 1.56 [1.17-2.07]. EAL was not associated with severe postpartum hemorrhage, low 5-min Apgar score, low neonatal cord pH or transfer to NICU. EAL is frequent, involving one in five spontaneous laboring women in France. This practice is associated with an increased cesarean delivery risk.

Impact of SARS-CoV-2 infection on neonates born to mothers with positive COVID-19 tests. Retrospective cohort study

Background and objectives. COVID-19 infection in pregnant women has an important impact on perinatal and neonatal outcomes. In the small group with critically ill mothers, the complications in the neonates are influenced more by the mother’s state of health than by the disease caused by the SARS-CoV-2 infection. The authors aimed to evaluate the impact of neonatal positive results on SARS-CoV-2 testing. Materials and methods. The retrospective cohort study included all newborns with positive results on SARS-CoV-2 PRC testing admitted to IMSP Mother and Child Institute Kishinev, Republic of Moldova, between 2020 and 2021. Analyzed data were extracted from the maternal and neonatal medical charts, focusing on gestational age, gender, birthweight, Apgar score, type of delivery, respiratory support, radiography findings, and the number of days spent in the NICU. Results. In the present study, of the total number of patients (47), only 7 neonates had a positive COVID-19 test. Two premature infants with a positive test did not suffer from respiratory distress, while the other five needed nasal CPAP (one term infant and four premature infants of 32, 33, and 34 weeks gestational age). There was a high prematurity rate (89.36%) and a high C-section delivery rate (74.4%). Conclusions. In conclusion, the results of our study have shown the direct impact of maternal COVID-19 infection on neonates, irrespective of whether the SARS-CoV-2 test was positive or negative.

How oxygenation shapes immune responses: emerging roles for physioxia and pathological hypoxia.

Most eukaryotes require oxygen for their survival and, with increasing multicellular complexity, oxygen availability and delivery rates vary across the tissues of complex organisms. In humans, healthy tissues have markedly different oxygen gradients, ranging from the hypoxic environment of the bone marrow (where our haematopoietic stem cells reside) to the lungs and their alveoli, which are among the most oxygenated areas of the body. Immune cells are therefore required to adapt to varying oxygen availability as they move from the bone marrow to peripheral organs to mediate their effector functions. These changing oxygen gradients are exaggerated during inflammation, where oxygenation is often depleted owing to alterations in tissue perfusion and increased cellular activity. As such, it is important to consider the effects of oxygenation on shaping the immune response during tissue homeostasis and disease conditions. In this Review, we address the relevance of both physiological oxygenation (physioxia) and disease-associated hypoxia (where cellular oxygen demand outstrips supply) for immune cell functions, discussing the relevance of hypoxia for immune responses in the settings of tissue homeostasis, inflammation, infection, cancer and disease immunotherapy.

Red blood cell transfusion in a tertiary Haitian hospital’s emergency department: patient characteristics and availability challenges

BackgroundRed blood cell (RBC) transfusions are essential for many patients admitted to emergency departments (ED). However, accessibility to red cell transfusions is often limited, especially in low-income countries such as Haiti. This article aims to determine the proportion of patients requiring emergency transfusion, transfused patients’ characteristics, as well as the response rate and timeliness of blood product delivery for requests made.MethodsA retrospective study was conducted among all patients with RBC transfusion indications from January to June 2022 at the ED of Mirebalais Teaching Hospital. The parameters studied included transfusion indications, pre-transfusion hemoglobin levels, and delay from prescription to transfusion.ResultsDuring the study period, 3993 patients received treatment in the ED. The proportion of patients requiring RBCs was 7.69%, including 145 males and 117 females, with a median age of 43 [30–56] years. Only 21.7% of these patients received a transfusion. The average pre-transfusion hemoglobin level was 4.75 ± 1.68 g/dL. The most common transfusion’s indications were infection/sepsis (36.74%), trauma (23.48%), and cancer (21.57%). The median time delay from prescription to transfusion was 2.37 [0.97–4.93] days. The study identified significant associations between RBC transfusion probability and patient factors like hemoglobin levels, patient disposition, urgency of RBC request, and length of stay.ConclusionRBC transfusion requests are frequent in the ED of Mirebalais Teaching Hospital, with a relatively high transfusion delay. Further studies on the relevance of RBC requests and ways to reduce delay from prescription to transfusion would be beneficial to improve this situation.

Results of the RE-DINO multicenter randomized trial on the repeated use of vaginal dinoprostone (Propess®) for labor induction in patients at term

BackgroundLabor is induced in over 25% of women in France. Prostaglandins, especially intravaginal dinoprostone (Propess®), are widely used to initiate cervical ripening. If labor does not start within 24 hours, there is uncertainty about whether to administer a second dinoprostone pessary or to use oxytocin to induce labor in order to achieve a vaginal delivery. ObjectivesOur principal objective was to determine whether placement of a second Propess®, followed by oxytocin (Syntocinon®) if necessary, in pregnant women for whom the first Propess® failed to induce cervical ripening increases the vaginal delivery rate compared to direct oxytocin injection. The vaginal delivery rate was therefore the primary outcome. The secondary outcomes were the cervical ripening failure rate and maternal and fetal morbidity and mortality. Study DesignRE-DINO is a prospective, open-label, multicenter, randomized superiority trial with 2 parallel arms running in 7 French hospitals. Patients at > 37 weeks of gestation who had unfavorable cervical conditions (Bishop score < 6) 24 hours after placement of the first Propess® (vaginal patch featuring progressive continuous diffusion of 10 mg dinoprostone), with fetuses in cephalic presentation, were included. Results160 pregnant women were randomized, 80 patients in each group, from December 2016 through April 2022. Baseline characteristics such as age, BMI, maternal age at induction and Bishop score at induction were similar between both groups. Vaginal delivery occurred in 76.3% of cases in the 2nd Propess® group and 73.8% of cases in the Syntocinon® group (RR=1.03 [0.86; 1.24], p=.715). Although the cesarean section rate was similar in each group, there were significantly more cesarean sections for arrest of dilatation (52.6% vs 19%; p=.0262) in the Propess® group and a larger, borderline-significant difference in patients having operative vaginal delivery (24.6% vs 11.9%; p=.07) for abnormal fetal heart rate (80% vs 29%; p=.05). There was significantly more failure of cervical ripening in the Propess® group (57.1% vs 19%; RR=2.59 ; 95% CI [1.64; 4.11]; p<.0001) and the interval between study treatment and delivery was also significantly longer (28.1h vs 9,7h; p<.0001). There was a higher incidence of postpartum hemorrhage in the Propess® group, although this was not significant (11.3% vs 5% ; p=,15), but also more newborns with acidosis (39.3% vs 27.9% ; p=.18) or severe acidosis (8,6% vs 3.4% ; p=.27), more meconium fluid (11.3% vs 6.3% ; p=.26) and transferred to intensive care (5% vs 2.5% ; p=.68). ConclusionOur data showed no superiority of a second dinoprostone pessary over oxytocin in patients not responding to initial prostaglandins E2 maturation for labor induction. Repeated use of Propess® is not useful for induction of labor.

Uterine Leiomyomas and Reproduction.

There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ.

Understanding resurgence and other emergent activity with the laws of allocation, induction, and covariance.

Resurgence is defined as an increase in a previously extinguished target response (B1) resulting from the worsening of conditions for a more recently reinforced alternative response (B2). Worsening includes extinction or reductions in rate, amount, and immediacy of delivery of food or some other phylogenetically important event (PIE). In the first part of the article, we apply the laws of allocation, induction, and covariance to understand not only resurgence of operant activity previously covarying with the PIE (B1) but also a constellation of ontogenetic and phylogenetic activities both related to the PIE (B0) and unrelated to the PIE (BN). In the second part, we discuss how induction might be incorporated into and provide alternative processes within an existing matching-based framework, resurgence as choice (RaC). We begin to identify how this range of activities could depend on changes in the relative competitive weight (V) of all available activities (B1, B2, B0, BN) in addition to only those receiving explicit training (B1, B2). Future empirical and theoretical research is needed within this framework to provide a more complete understanding of resurgence and behavior more generally.

An analytical model to predict the mass loading of air cleaners in typical indoor environments and to estimate the service interval from standardized filter loading tests

For indoor air cleaners, especially those using electret filters, it is known that the clean air delivery rate (CADR) can strongly decrease over time due to loading of the filters with particles. Standardized tests like in GB/T 18801 are used to determine the mass of test aerosol particles leading to a reduction of the initial CADR by 50 % (cumulative clean mass), but this method does not allow to draw conclusions on when this reduction is reached in a typical indoor environment. However, a good estimate would help manufactures to give reasonable recommendations in which intervals a service of the air cleaner becomes necessary. Therefore, we developed an analytical model including the most relevant parameters of a typical indoor environment and assumed different courses for the time-dependent decay of the CADR. We show that consistent estimates for the service interval can be derived, which do only slightly depend on the exact choice of the model. However, we partially find pronounced differences between scenarios dominated by either indoor or outdoor sources. We compare the new model to the model of GB/T 18801 and show that the standard overestimates the service interval for a given set of parameters by about 30 %. We finally propose a method for estimating the service interval from only one loading and one discharging step and give perspectives for further applications of the model.