Delivery Success Rate Research Articles

Nonmonotonic Effects of Chronic Low-Dose Di(2-ethylhexyl) Phthalate on Gonadal Weight and Reproductive.

ABSTRACTEndocrine disruptors have been concerned in toxicology but now challenged as physiological point especially concerned with exposing dose and period. In this study the low-dose chronic administration of di(2-ethylhexyl) phthaltae (DEHP) during reproductive period was examined to evaluate the possible roles. Adult male and female CD-1 mice were exposed to DEHP with drinking water containing 133 1g/L and 1,330 /g/L DEHP in water according to OECD 433 guide line and sacrificed just after weaning. The weights of uterus and ovary were decreased by drinking of 1,330 /g/L DEHP water. There was not adverse effects on either accumulated mating rate and mating rate depend on estrus stage, pregnancy duration, and sex ration at birth. However, the accumulated rate of successful delivery and litter size were significantly high at 1,330 dg/L DEHP water. The number of epididymal sperm was significantly increased by drinking of 1,330 g/L DEHP water. In addition, the number of follicles (primary, secondary, tertiary) were more many than control at 1,330 /g/L DEHP water drunk mother. Though further studies are needed to identify what are the mechanism of DEHP in folliculogenesis and spermatogenesis. From this study we firstly report the effect of low-dose chronic administration of DEHP with drinking could change the ovarian follicle population size and spermatogenesis rate. Put together, those finding is different from previous high-dose effects and suggest the physiological role of DEHP in gonads and uterus.

A single-center experience with 12 consecutive cases of pregnancy among patients with membranous ventricular septal aneurysm

BackgroundMembranous ventricular septal aneurysm (MVSA) is a rare cardiac anomaly that can occur as an isolated entity or being associated with other cardiac malformations. Complications of MVSA include thromboembolism, arrhythmia, rupture, bacterial endocarditis, right ventricular outflow tract obstruction, and atrioventricular valve diseases.The success rate of pregnancy and delivery in patients with MVSA has not been reported in the literature. This study was to assess the clinical implications of this condition from our center’s experience.MethodsThis was a retrospective study for consecutive 12 pregnancies in women with MVSA, who delivered at a tertiary care center in west China between May 2008 and March 2015.ResultsAll patients with MVSA delivered via caesarian section. One patient with severe pulmonary arterial hypertension expired from pulmonary infection and heart failure after delivery. One patient terminated pregnancy in the second trimester- necessitated by cardiogenic shock. The other mothers had varying degrees of cardiac morbidity, but survived. Ten of thirteen newborns survived. Congenital heart disease and small-for-gestational-age (SGA) of newborn occurred in two cases (one twin and one single gestation). Two of these babies expired.ConclusionsMaternal and neonatal risk appeared associated with heart functional classifications, pulmonary hypertension and histories of cardiac events such as serious cardiac arrhythmia. Accurate diagnosis and care by a multidisciplinary team is recommended for pregnant woman with MVSA.

585: Trial of labor after cesarean (TOLAC) in women with Premature rapture of membranes

Reducing the rate of cesarean section by increase in the rate of TOLAC is important to address since repeat cesarean section is associated with increased maternal morbidity and mortality. There is limited data regarding risks and benefits of TOLAC after premature rapture of membranes (PROM). We investigated the success rate of TOLAC after PROM between those receiving conservative management and those receiving labor induction. This was a retrospective cohort study conducted in a single tertiary care center between 01/2011-03/2017. All women with singleton pregnancy and a previous cesarean section who presented with PROM after 34 0/7 weeks of gestation and underwent TOLAC were included. To minimize labor induction, women were offered conservative management until spontaneous labor commenced. Labor induction was performed if spontaneous onset of labor did not take place within 48 hours or if there were signs of maternal or fetal distress. Operative complications were defined as: laceration of the uterus, bladder injury, urethral injury, bowel injury or hysterectomy. Postpartum complications were defined as: fever, endometritis, need for blood transfusion and wound complications. Outcomes and rate of successful vaginal delivery after induction of labor were compared to spontaneous onset of labor using univariable and multivariable analysis. Among 830 women who met the inclusion criteria, 723 (87.1%) had a spontaneous delivery and 107 (12.9%) had an induction of labor. The rate of successful TOLAC was similar between the groups (75.7% vs 81.6%, respectively, P=0.22). However, induction of labor was associated with an increased risk of uterine rupture (1.87% vs 0.96%, P <0.001), operative complications (30.76% vs 12.03%, P<0.001) and composite maternal postpartum complications (21.4% vs 12.1%, respectively, P= 0.014) compared to spontaneous vaginal delivery. There was no difference in neonatal outcome between the groups. In women attempting TOLAC who present with PROM and fail to progress spontaneously into active labor, Induction of labor is associated with high successful vaginal delivery rate. However, the risk for uterine rupture and operative and maternal complications is significantly increased compared to spontaneous delivery.

Abruptio Placentae 116 Cases: Role of PGE1 in Cervical Ripening and Induction of Labor, January 2006-August 2006

OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is of utmost urgency, since the complications are related to the abruption delivery interval. Before the introduction of prostaglandins for labor induction, it was a routine practice to do amniotomy and use oxytocin drip to accelerate labor when vaginal delivery was contemplated. We present 116 cases of placental abruption, including the severe cases, managed in the year 2006 during a period of 8 months, at Modern Government Maternity Hospital, which was the biggest maternity hospital in the combined state of Andhra Pradesh, and is the biggest in the state of Telangana, attached to Osmania Medical College. The role of prostaglandin E1 (PGE1), for cervical ripening and labor induction/augmentation has been analyzed in this observational study. A variety of variables including age, parity, gestational age, severity of abruption and maternal and fetal status, associated preeclampsia, Bishop score, availability of blood and blood products, associated complications, all factors influence the management adopted. MATERIAL METHODS: The response to PGE1 induction has been studied in terms of efficacy, the total number of doses of vaginal PGE1 in relation to parity, induction delivery interval, successful vaginal delivery rate, the indications for caesarean delivery, perinatal outcome and complications. A decision was made for either abdominal delivery or vaginal delivery on a case to case basis. A routine amniotomy was performed when the cervical os was open, both for confirmation of diagnosis and to release intra uterine pressure, and also it would help in the acceleration of labor. When the Bishop score was more than six, amniotomy was performed and an oxytocin intravenous drip was started. If the Bishop score was less than six, 25/50 mcg. Misoprostol (PGE1) was placed high in the vagina. OBSERVATIONS: Primies that had abruption were 27/116 = 23.27% and multies were 89/116 = 76.72%. In our study 68/116, (58.62%) had preeclamsia. In our series, gestational age at abruption was less than 36 weeks in 89/116, (76.72%) and >36 weeks in 27/116 (23.27%) at presentation. It is significant to note that 100/116 (86.2%) were unbooked and 16/116 (13.79%) were booked cases at our institute. Vaginal deliveries were 84 (74.2%) and caesarean deliveries were 30 (25.8%) in 116 placental abruptions. There were four maternal deaths 3.4%, two died undelivered. Perinatal mortality in our series was 92/116 (79.3%). PGE1 induced labours—49: When PGE1 was used for labor induction in 49 women, 40 (81.63%) had vaginal delivery and caesarean delivery was done in 9 (18.36%) cases for non progress of labor. Induction delivery interval was less than 12 hours in 45 (91.83%), more than 12 hours in 4 (8.1%). Preterm delivery in PGE1 induced cases was 40/49 = 81.63% versus preterm in 116 cases, 76.72%. This indicates that more numbers of preterm deliveries were allowed vaginal delivery. DISCUSSION: Maternal mortality: Better facilities of transfusion of blood products may have reduced maternal mortality in our series. Government maternity hospital is a public sector tertiary health facility providing free treatment. Early referral would make some difference. Acute defibrination leading to disseminated intravascular cougulation was the cause of three deaths, irreversible haemorrhagic shock in another. CONCLUSION: Induction of labor with PGE1 was useful and effective when cervix was unfavorable and Bishop score was less than six. With PGE1 induction (49) 91.83% delivered in less than 12 hours. There were no maternal deaths and PPH in 49 women induced with PGE1. Hence PGE1 was safe to use in these emergency high-risk obstetric patients. PGE1 usage to expedite delivery can reduce Caesarean section rate.

Dynamic Priority Based Reliable Real-Time Communications for Infrastructure-Less Networks

This paper proposes a dynamic priority system at medium access control (MAC) layer to schedule time sensitive and critical communications in infrastructure-less wireless networks. Two schemes, priority enabled MAC (PE-MAC) and optimized PE-MAC are proposed to ensure real-time and reliable data delivery in emergency and feedback systems. These schemes use a dynamic priority mechanism to offer improved network reliability and timely communication for critical nodes. Both schemes offer a notable improvement in comparison to the IEEE 802.15.4e low-latency deterministic networks. To ensure more predictable communication reliability, two reliability centric schemes, quality-ensured scheme (QES) and priority integrated QES, are also proposed. These schemes maintain a pre-specified successful packet delivery rate, hence improving the overall network reliability and guaranteed channel access.

Clinical analysis and countermeasures of the perinatal outcome of vaginal birth after cesarean delivery

Objective To provide midwives evidence for the evaluation of pregnant women during the process of vaginal birth after cesarean delivery (VBAC) by analyzing the clinical data of perinatal outcome of VBAC, so as to develop supporting interventions, ensure maternal safety and improve the success rate of vaginal delivery. Methods Totals of 284 pregnancy women who were pregnant after cesarean section and admitted from April 2015 to July 2016 were selected. According to the perinatal outcome of delivery, they were divided into VBAC group (n=119) , elected repeat cesarean delivery (ERCS) group (n=106) , and the unsuccessful trial of labor after cesarean (TOLAC) group (n=59) . Maternity outcomes were compared among these three groups. Results In 284 cases, 62.7% (178 cases) selected vaginal delivery, of which 119 were successful, with a success rate of 66.85%, and the remaining 59 cases transferred to cesarean section. Compared with the ERCS group, the VBAC group had lighter prenatal weight, higher cervical score, and shorter postpartum hospitalization time, with a statistical difference (P<0.05) . Compared with the unsuccessful TOLAC group, the cervical score and the natural fertility rate of the fetus of the VBAC group were higher (P<0.05) . Conclusions Midwives can conduct a comprehensive assessment of pregnant women who are pregnant after cesarean according to their individual problems, and provide targeted nursing management and support during delivery. It is recommended prenatal knowledge education should be given in outpatient clinic to promote the success of the VBAC. Key words: Cesarean section; Vaginal birth after cesarean; Perinatal outcome; Countermeasures

Safety and effectiveness of labour induction after caesarean section using balloon catheter or oxytocin.

Induction of labour after previous caesarean section (CS) is a challenge for obstetricians due to the increased risk of uterine rupture. Common methods for labour induction are balloon catheters and oxytocin as they are considered safe. However, the effectiveness remains unclear as currently available data are limited. Therefore, we aimed to determine safety and effectiveness of balloon catheter or oxytocin for labour induction after CS. We included 179 consecutive women with a previous CS and labour induction in this retrospective study. We performed labour induction using a balloon catheter in case of a Bishop score of <6 and intact membranes, or oxytocin in the case of a Bishop score of >6 and/or premature rupture of membranes. The primary outcome was the rate of successful vaginal deliveries. We adjusted for multiple factors that may have impacted on the rate of vaginal delivery as well. The secondary outcomes were the rate of maternal and neonatal morbidities. We detected a vaginal delivery success rate of 45.8% in the catheter and of 63.9% in the oxytocin group. We identified previous vaginal birth as an independent predictive factor for successful vaginal delivery in both groups. Induction using oxytocin was a negative predictive factor for neonatal admissions. Multivariate analysis showed that post-term pregnancy decreased the likelihood of vaginal delivery. We did not detect any factors predicting uterine rupture or uterine dehiscence, which occurred with similar frequency in both groups. Finally, the neonatal admission rate was less likely with higher gestational age and oxytocin as an induction method, whereas previous vaginal birth increased the risk. Our study indicates that induction of labour with balloon catheter or oxytocin seems to be safe in women with previous CS. Labour induction using a balloon catheter in women with previous CS and unfavourable cervix has a disappointingly low success rate. We identified factors influencing vaginal delivery success rates. Women with previous CS and indications for labour induction should be informed about vaginal birth success rates and the alternative of elective repeat CS needs to be discussed.

Shoulder Dystocia Delivery by Emergency Medicine Residents: A High-fidelity versus a Novel Low-fidelity Simulation Model-A Pilot Study.

Shoulder dystocia (SD) requires emergent intervention to prevent maternal and fetal harm, and simulation models for training can be expensive. We developed a novel, cheap and easily transportable low-fidelity simulation (LFS) model to compare to a commercially available high-fidelity simulation (HFS) model. Emergency medicine residents were randomized to training on the HFS or novel LFS model. Subjects completed a pretest and a 1-week and 6-month posttest including a self-assessment and a simulated SD delivery. Twenty-seven of the 43 residents completed the study (63%). The number of individuals performing dangerous maneuvers at baseline was similar, 1week after training was five in HFS and 11 in LFS (p=0.08) groups and at 6 months was again similar between groups. Mean checklist scores for appropriate actions increased 1 week after training but returned to baseline by 6 months and were similar between groups. The rate of successful delivery, median time to successful delivery, and maximum force applied improved at 1 week and was sustained at 6 months in both groups. Within our limited study population, we did not find a large difference in the occurrence of dangerous actions during simulated SD delivery following HFS and LFS training. Our novel and easily transportable LFS trainer, assembled for less than US$10 each, may be a useful tool to train inexperienced providers on the steps of this procedure. However, this requires further study, as does whether HFS models with force monitoring capabilities may be helpful to train providers to minimize dangerous maneuvers such as the application of excessive force.

Ultrasound-guided Intracardiac Injection of Human Mesenchymal Stem Cells to Increase Homing to the Intestine for Use in Murine Models of Experimental Inflammatory Bowel Diseases.

Crohn's disease (CD) is a common chronic inflammatory disease of the small and large intestines. Murine and human mesenchymal stem cells (MSCs) have immunosuppressive potential and have been shown to suppress inflammation in mouse models of intestinal inflammation, even though the route of administration can limit their homing and effectiveness 1,3,4,5. Local application of MSCs to colonic injury models has shown greater efficacy at ameliorating inflammation in the colon. However, there is paucity of data on techniques to enhance the localization of human bone marrow-derived MSCs (hMSCs) to the small intestine, the site of inflammation in the SAMP-1/YitFc (SAMP) model of experimental Crohn's disease. This work describes a novel technique for the ultrasound-guided intracardiac injection of hMSCs in SAMP mice, a well-characterized spontaneous model of chronic intestinal inflammation. Sex- and age-matched, inflammation-free AKR/J (AKR) mice were used as controls. To analyze the biodistribution and the localization, hMSCs were transduced with a lentivirus containing a triple reporter. The triple reporter consisted of firefly luciferase (fl), for bioluminescent imaging; monomeric red fluorescent protein (mrfp), for cell sorting; and truncated herpes simplex virus thymidine kinase (ttk), for positron emission tomography (PET) imaging. The results of this study show that 24 h after the intracardiac administration, hMSCs localize in the small intestine of SAMP mice as opposed to inflammation-free AKR mice. This novel, ultrasound-guided injection of hMSCs in the left ventricle of SAMP mice ensures a high success rate of cell delivery, allowing for the rapid recovery of mice with minimal morbidity and mortality. This technique could be a useful method for the enhanced localization of MSCs in other models of small-intestinal inflammation, such as TNFΔRE6. Future studies will determine if the increased localization of hMSCs by intra-arterial delivery can lead to increased therapeutic efficacy.

Socially-Aware Multimedia Dissemination in Personal Mobile Networks

Mobile multimedia entertainment is pervasive on mobile devices, leading people to access, store and disseminate a diversity of multimedia contents anytime and anywhere. The main challenge comes from achieving high successful delivery rates with low end-to-end delays for dissemination of multimedia content at last-hop devices. This article presents a novel approach to disseminate multimedia content merging technical with social behaviors and preferences to better perform device associations. Those technical and social preferences allow to understand and infer a full social-aware behavior, aiming to create the possibility to maintain the best associations between devices through their activities and interactions in the network. The potential to consider a real social-aware behavior is presented as a solution to enhance the dissemination of multimedia content process over mobile infrastructureless networks. Through two proposed case studies: (1) Mobile Tour Guide and (2) Soccer Stadium with its own peculiarities and characteristics, we show how our proposed solution enhances the dissemination and reception of multimedia content beyond the baselines analyzed.

Multi‐constrained QoS routing based on PSO for named data networking

Named data networking (NDN) is a representation and implementation of an information centric network, which is considered as one of the next generation of network architectures. To the best of the authors' knowledge, very few studies have considered multiple constrained quality-of-service (QoS) routing in NDN. In this study, a particle swarm optimisation-forwarding information base (PSO-FIB) algorithm that uses the forwarding experiences of particles to maintain the forwarding probability of each entry in the FIB is proposed. Illustrating the interaction of PSO-FIB with the routing layer, the simulation results show that PSO-FIB can support multi-constrained QoS routing and achieve better performance in terms of successful delivery rate and average cost compared with random and ant colony optimisation strategies.

Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Implantation: Systematic Review and Meta-Analysis.

Silent ischemic embolic lesions are common after transcatheter aortic valve implantation (TAVI). The use of embolic protection devices (EPD) may reduce the occurrence of these embolic lesions. Thus, a quantitative overview and credibility assessment of the literature was necessary to draw a robust message about EPD. Therefore, the aim of this meta-analysis was to study whether the use of EPD reduces silent ischemic and clinically evident cerebrovascular events associated with TAVI. We conducted a comprehensive search to identify studies that evaluated patients undergoing TAVI with or without EPD. Random-effects meta-analyses were performed to estimate the effect of EPD compared with no-EPD during TAVI using aggregate data. Sixteen studies involving 1170 patients (865/305 with/without EPD) fulfilled the inclusion criteria. The EPD delivery success rate was reported in all studies and was achieved in 94.5% of patients. Meta-analyses evaluating EPD versus without EPD strategies could not confirm or exclude any differences in terms of clinically evident stroke (relative risk, 0.70; 95% confidence interval [CI], 0.38-1.29; P=0.26) or 30-day mortality (relative risk, 0.58; 95% CI, 0.20-1.64; P=0.30). There were no significant differences in new-single, multiple, or total number of lesions. The use of EPD was associated with a significantly smaller ischemic volume per lesion (standardized mean difference, -0.52; 95% CI, -0.85 to -0.20; P=0.002) and smaller total volume of lesions (standardized mean difference, -0.23; 95% CI, -0.42 to -0.03; P=0.02). Subgroup analysis by type of valve showed an overall trend toward significant reduction in new lesions per patient using EPD (standardized mean difference, -0.41; 95% CI, -0.82 to 0.00; P=0.05), driven by self-expanding devices. The use of EPD during TAVI may be associated with smaller volume of silent ischemic lesions and smaller total volume of silent ischemic lesions. However, EPD may not reduce the number of new-single, multiple, or total number of lesions. There was only very low quality of evidence showing no significant differences between patients undergoing TAVI with or without EPD with respect to clinically evident stroke and mortality.

A comparison of induction of labor success rates over three time periods in 20 years at a single academic tertiary care center: are we improving vaginal delivery rates?

Objective: To compare the rates of successful induction of labor during three one-year periods over 20 years at a single institution.Methods: All women at 37 weeks or beyond with a living, singleton, cephalic fetus admitted for induction of labor in 1992, 2002, and 2012 were included. The use of induction agents and rates of successful vaginal delivery were compared.Results: A total of 627 women were evaluated, 219 in 1992, 220 in 2002, and 188 in 2012. Various induction agents were employed over the 20 year period. However, the rates of successful vaginal deliveries did not significantly vary over the three time periods, 79.5% in 1992, 72.3% in 2002, 76.1% in 2012, p = .21. In subgroup analysis, no significant differences were found among women with one or more prior vaginal delivery, no prior vaginal delivery, or after excluding those with a prior cesarean section. In multiple variable logistic regression analysis, no induction agent besides amniotomy improved successful vaginal delivery rates.Conclusions: Despite the multiple induction agents available at our tertiary care institution over the past 20 years, we were unable to demonstrate any significant improvement in successful vaginal delivery rates after induction of labor.

Trial of labour after caesarean section: Two-year analysis at a Portuguese centre

We conducted a retrospective study aimed at determining variables associated with a higher success rate for vaginal delivery after caesarean section, and assessing the impact of induction of labour. Secondarily, we aimed to describe our vaginal delivery and uterine rupture rates with the use of a controlled-release dinoprostone vaginal insert for cervical ripening. Of 292 women who met the inclusion criteria, induction of labour occurred in 48% (94% with dinoprostone). There was a non-significant difference between the vaginal delivery rate of spontaneous labour (57%) and induction of labour (33%), after adjusting for confounding variables. The success rate was influenced by a Bishop score ≥6, previous vaginal delivery and previous caesarean for dystocia or failed induction. There was only one case of uterine rupture, which was associated with dinoprostone use (overall rate 0.34%, 0.77% for dinoprostone).Impact statementTrial of labour after caesarean section is considered an alternative to elective repeat caesarean.Both present associated benefits and risks, the most fearsome of which is uterine rupture during labour (0.78% in term pregnancies).Induction is also possible but carries a higher risk of uterine rupture and lower success rate for vaginal birth. Prostaglandins have been of particular concern due to a higher risk of uterine scar rupture, estimated at 2% for dinoprostone; however, its use as a controlled-release vaginal insert has been under-reported.Our study confirms the reported impact of previous vaginal delivery, previous caesarean indication and Bishop score at admission on success rate for vaginal birth after caesarean.We were unable to prove a lower success rate for induction of labour after adjusting for other variables. Despite our study limitations, we report on the use of a controlled-release vaginal insert with 10mg of dinoprostone in 130 women with a uterine rupture rate of 0.77%, lower than previously reported and similar to the overall rate estimated for term pregnancies.This dinoprostone formulation may be safer than previously reported but larger studies, and preferably randomised controlled trials, are needed to confirm these findings.

Self-expanding STENTYS stents in daily routine use.

In the era of modern interventional cardiology, implantation of a balloon expandable stent is the finishing touch of almost every coronary angioplasty. However, sometimes we face a clinical situation in which the decision regarding the stent diameter is complicated, especially in the ectatic part of arteries, in situations when the artery lumen is obscured with the thrombus, or when the reference diameter of the proximal and distal part of the lesion vary greatly. That is why the idea of a self-apposing stent similar to the one used in peripheral vascular interventions was adopted into cardiology. The aim of this study was to present a single-centre registry of STENTYS® stent implantation in 40 selected patients with acute coronary syndromes (ACS) or with stable angina (coronary artery disease [CAD]) treated with this self-expandable stent. The device was successfully implanted in all patients. During in-hospital observation and 30-day follow-up there were two cases of death, but none of the patients had acute stent thrombosis or ACS ST elevation myocardial infarction. In one case ACS type 4b was diagnosed. In all patients the stent was delivered in the target lesion. In two cases the procedure was performed in patients with multivessel CAD extending into the left main stem in a state of cardiogenic shock. These patients died immediately after the procedure. There were two procedure complications: in one case dissection after post dilatation occurred distally to the stent, and in one patient the calcified proximal part of the left anterior descending artery was dissected with system passage. Thirty-eight patients survived the 12-month follow-up period, and three (7.8%) patients underwent repeated target-lesion revascularisation. In the presented single-centre registry the STENTYS® stent was used with a high delivery and procedural success rate. Satisfactory clinical long-term outcome both in stable patients and ACS patients with a repeated revascularisation ratio of 7.8% was observed. The stent design allowed successful treatment of bifurcation lesions.

Risk factors of disease progression and adverse pregnancy outcome in patients with systemic lupus erythematosus during pregnancy

Objective To investigate the risk factors of disease progression and adverse pregnancy outcome in patients with systemic lupus erythematosus (SLE) during pregnancy. Methods Clinical data of 118 pregnant women with SLE admitted from June 2004 to October 2015 were retrospectively analyzed. The patients were divided into selective pregnant group (group A, n=72 cases) and non-selective pregnant group (group B, n=46) according to the disease activity of SLE. The disease progression and pregnancy outcomes were compared between two groups. Results The various system damages occurred in group B, including hematological damage in 16 cases, kidney damage in 19 cases, erythra in 10 cases, arthritis in 10 and serositis in 12 cases; while the corresponding cases in group A were 10, 14, 6, 4 and 4( χ2=7.133, P= 0.008; χ2=6.658, P=0.010; χ2=4.304, P=0.038; χ2=7.030, P=0.008; χ2=10.095, P=0.001). SLE exacerbation occurred in 28 cases (74%) of group B and 12 cases (17%) of group A (χ2=34.944, P= 0.000). The logistic regression analysis showed that hypocomplementemia, proteinuria, SLEDAI score before pregnancy and positive anti-dsDNA antibody were the risk factors of SLE disease exacerbation during pregnancy. The maternal complications occurred in group B, including pregnancy-induced hypertension in 7 cases, preeclampsia in 10 cases and infections in 11 cases/times; while the corresponding cases (case/time) in group A were 2, 6 and 4 (χ2=4.526, P= 0.033; χ2=4.304, P=0.038; χ2=8.525, P=0.004). There were 14 cases of therapeutic induced labor, 7 case of stillbirth and 27 cases of total fetal loss in group B, while the corresponding cases in group A were 2, 0 and 4 (χ2=18.317, P= 0.000; χ2=9.080, P= 0.003; χ2=40.920, P= 0.000). The logistic regression analysis showed that positive anticardiolipin antibody, proteinuria, SLEDAI score before pregnancy and renal dysfunction during pregnancy were risk factors of fetal loss. There were 87 cases of successful delivery (73.7%), the successful delivery rates were 41.3% (19/46) in group B and 94.4% (68/72) from group A, respectively. The infant complications occurred in group B, including premature birth in 15 cases, low birth weight in 13 cases, neonatal jaundice in 5 cases and mild asphyxia in 5 cases; while the corresponding cases in group A were 24, 18, 4 and 2 (χ2=11.442, P=0.001; χ2=11.395, P=0.001; χ2=4.664, P= 0.031; χ2=8.035, P=0.005). Conclusion SLE patients whose disease conditions are not well controlled would lead to higher percentage of disease deterioration during pregnancy and worse pregnancy outcomes. Key words: Lupus erythematosus, systemic; Disease progression; Pregnancy outcome

Trial of Labor in Twin Pregnancies: A Retrospective Cohort Study

(BJOG. 2016;123:940–945) Retrospective studies on vaginal deliveries for twin pregnancies have reported greater fetal risk, primarily for the second twin, than cesarean deliveries. The Twin Birth Study was a recent prospective, randomized study that assigned women to planned vaginal or cesarean delivery. It assessed the success rate and safety of vaginal delivery compared with cesarean delivery among a total of 2804 twin pregnancies. This study found that both delivery modes were equally safe; however, 43.8% of women in the planned vaginal delivery group ultimately delivered by cesarean section. The current investigators analyzed the success rate of trial of labor for twin pregnancies at their tertiary care medical center in Israel.

Randomized controlled trial of induction at 38 weeks versus 40 weeks gestation on maternal and infant outcomes in women with insulin-controlled gestational diabetes

To compare the impact of induction of labor at 38weeks of gestation with the induction of labor at 40weeks of gestation in women with insulin-treated gestational diabetes on maternal and fetal outcome. In this study 100pregnant women with insulin-treated gestational diabetes were randomized to either induction of labor at 38(groupI) or 40weeks (groupII) to evaluate the rate of large for gestational age newborns, neonatal hypoglycemia, success rate of deliveries within 48h and cesarean section rate after induction in both groups. The difference of large for gestational age newborns was not significant between the two groups (6.8% vs. 12.8%, p= 0.49), 16(36.4%) newborns in groupI and 8(17.0%) newborns in groupII developed hypoglycemia <35 mg/dl (p= 0.04). The success rate for deliveries within 48h after induction of labor for groupsI andII was 77.3% and 92.3%, respectively (p= 0.25). The cesarean section rate after induction of labor was not significantly different between the two groups (24.1% vs. 18.7%, p= 0.49). In acohort of women with insulin-treated gestational diabetes, induction of labor at 38weeks did not significantly reduce the rate of large for gestational age newborns compared to induction at 40weeks but seems to increase the rate of neonatal hypoglycemia.

A data forwarding algorithm based on Markov thought in underwater wireless sensor networks

The underwater wireless sensor networks composed of sensor nodes are deployed underwater for monitoring and gathering submarine data. Since the underwater environment is usually unpredictable, making the nodes move or be damaged easily, such that there are several vital objectives in the data forwarding issue, such as the delivery success rate, the error rate, and the energy consumption. To this end, we propose a data forwarding algorithm based on Markov thought, which logically transforms the underwater three-dimensional deployment model into a two-dimensional model, and thus the nodes are considered to be hierarchically deployed. The data delivery is then achieved through a “bottom to top” forwarding mode, where the delivery success rate is improved and the energy consumption is reduced because the established paths are more stable, and the proposed algorithm is self-adaptive to the dynamic routing loads.

Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E2.

ObjectiveTo evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery.MethodsA retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction.ResultsThe vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery.ConclusionAn understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.