Maternal and neonatal outcome after vaginal breech delivery at term after cesarean section - a prospective cohort study of the Frankfurt breech at term cohort (FRABAT)

OBJECTIVE

To compare the neonatal and maternal outcomes as well as the mode of delivery of intended vaginal breech deliveries in women with a prior cesarean section to primiparous patients.

STUDY DESIGN

The prospective monocenter cohort study was conducted among 604 women who presented for an intended vaginal singleton breech delivery at term between January 2007 and December 2016.

RESULTS

Out of 37 women with a prior cesarean 19 had a successful vaginal delivery. 344 of 567 primiparous women had a successful vaginal delivery. Neonatal morbidity and mortality as well as maternal outcome were not significantly different in successful vaginal deliveries of women with prior cesarean compared to primiparous patients. The cesarean section rate was not significantly higher in the group of women with a prior cesarean (49%) compared to the group of primipara (39%).

CONCLUSION

A prior cesarean should not be taken as an exclusion criterion for a planned vaginal delivery out of a breech presentation at term. Large multicenter, case-controlled studies are necessary to implement international guidelines.

[Human hantavirus infections]

Hantaviruses belong to the Bunyaviridae family. A large number of different subtypes are known worldwide that show a host-specific geographical distribution. Humans may become infected through contact with rodent urine, saliva or feces. In humans, hantavirus infections are an important and worldwide emerging zoonotic disease that may result in a variety of potentially life-threatening diseases, e. g. hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). There are various aspects of major occupational importance, particularly for agriculturists, veterinarians and forestry workers. This article reviews the current knowledge about epidemiology, pathology, diagnostics, therapy and prevention of human hantavirus infections worldwide.

World-wide architecture of osteoporosis research: density-equalizing mapping studies and gender analysis

OBJECTIVE

While research activities on osteoporosis grow constantly, no concise description of the global research architecture exists. Hence, we aim to analyze and depict the world-wide scientific output on osteoporosis combining bibliometric tools, density-equalizing mapping projections and gender analysis.

METHOD

Using the NewQIS platform, we analyzed all osteoporosis-related publications authored from 1900 to 2012 and indexed by the Web of Science. Bibliometric details were analyzed related to quantitative and semi-qualitative aspects.

RESULTS

The majority of 57 453 identified publications were original research articles. The USA and Western Europe dominated the field regarding cooperation activity, publication and citation performance. Asia, Africa and South America played a minimal role. Gender analysis revealed a dominance of male scientists in almost all countries except Brazil.

CONCLUSION

Although the scientific performance on osteoporosis is increasing world-wide, a significant disparity in terms of research output was visible between developed and low-income countries. This finding is particularly concerning since epidemiologic evaluations of future osteoporosis prevalences predict enormous challenges for the health-care systems in low-resource countries. Hence, our study underscores the need to address these disparities by fostering future research endeavors in these nations with the aim to successfully prevent a growing global burden related to osteoporosis.

[Sarcoidosis: A Descriptive Approach to the Global Research Network and Recent Scientific Developments]

AIMS AND SCOPE

Sarcoidosis continues to be an underestimated disease that can cause severe morbidity and mortality in individuals. There has, however, been an increasing awareness of this disease as shown by the increasing number of publications since the 1990  s. The large number of available publications makes it challenging for a single scientist to provide an overview of the topic. To quantify the global research activity in this field, a scientometric investigation was conducted.

MATERIAL AND METHODS

The total number of publications on sarcoidosis was determined in the Web of Science to obtain their bibliometric data for the period 1900-2008. According to the NewQIS-protocol, different visualisation techniques and scientometric methods were applied.

RESULTS

A total of 14,190 published items were evaluated. The U.S. takes a leading position in terms of the overall number of publications and collaborations. Prolific institutions and authors are of U.S. origin. Only a relatively small number of international co-operations were identified. The most intensive network is between the "University of Colorado" and the "National Jewish Medical Research Center". "Semenzato, G" has the highest citation rate of all authors. The most productive co-operative author is "du Bois, RM".

CONCLUSION

The scientific interest in the topic sarcoidosis is growing steadily. The influence of international co-operation on scientific progress in this area is of increasing importance.

Examining the influence of maternal bradycardia on neonatal outcome using automated data collection

BACKGROUND

Due to the increasing number of caesarean sections, we investigated the influence of maternal bradycardia during general and regional anaesthesia on seven standard paediatric outcome parameters using our online recorded data.

METHODS

Data from 1154 women undergoing caesarean section were investigated prospectively. Bradycardia was defined as a heart rate below 60 beats/min. The matched-pairs method was used to evaluate the impact of bradycardia on Apgar scores at 1, 5, and 10 min, umbilical artery pH and base excess, admission to paediatric intensive care unit, and seven-day mortality. Matched references were automatically selected among all patients from the data pool according to anaesthetic technique, sensory block height, urgency, maternal age and body mass index. Stepwise regression models were developed to predict the impact of intra-operative bradycardia on outcome variables with differences between matched pairs assessed using univariate analysis.

RESULTS

Bradycardia was found in 146 women (12.7%) for whom a control could be matched in 131 cases (89.7%). Mean 5-minute Apgar score was 9.2+/-1.1 for study patients and 9.3+/-1.1 for controls. pH and base excess were not significantly different between groups. In cases of urgent surgery, neonates had an increased risk of 1.8 (95% CI 1.36-2.44, P<0.01) for an Apgar score <or= 8 at 1 min and a 2.6-fold risk (95% CI 1.64-4.06, P<0.01) of umbilical arterial pH of <or= 7.2 compared to infants undergoing non-urgent procedures.

CONCLUSIONS

Using matched-pairs analysis we were unable to demonstrate that episodes of maternal bradycardia below 60 beats/min were associated with a poorer neonatal outcome regardless of anaesthetic technique.

[Maggot therapy in gynecology]

Ancient societies recognised beneficial effects of certain fly larvae on wound healing. Nowadays, biosurgery with living maggots has proven very useful in the therapy of infected, necrotic, acute and chronic wounds. The larvae cause a rapid and selective wound debridement, a disinfective effect and rapid formation of granulation tissue and epithelium. In our hospital, we gathered experience in wounds caused by gynecological surgery. Here, maggot therapy has been used in locations--e. g. perineal--which are difficult to provide with hydrocolloid wound dressings. Maggots can clear wounds of staphylococci and streptococci populations, are successful in wounds caused by radiation therapy and can be used after chemotherapy. Patient acceptance is very high and psychological stress has been rare. Maggot therapy is a cheap, safe and highly effective treatment of wounds. Therefore, we want to encourage the use of biosurgery in suitable wounds.

Magenkarzinom in der Schwangerschaft - Ein Fallbericht

Nausea and vomiting are common sufferings of pregnant woman. No gynaecologist would consider carcinoma of the stomach as a probable differential diagnosis according the extremely rare probability of this disease during pregnancy. Consequently, a late diagnosis in pregnancy can result in spreading throughout the whole abdomen. In this advanced stage, it is only possible to recommend palliative care to the patient followed by short survival. Fetal metastasis is a rare entity, therefore caesarean section and chemotherapy should not be performed until fetal maturity. If vomiting and nausea are prolonged after the sixteenth week of pregnancy a malignant disease of the stomach should be excluded. Only in case of short delay between symptoms and diagnosis, the stomach cancer can be resected totally followed by a better overall survival of the patient.

Nicotinic acetylcholine receptors in rat and human placenta

Smoking during pregnancy causes low birth weight, premature delivery, neonatal morbidity, and mortality. Nicotine is a main pathogenic compound of cigarette smoke, and depresses active amino-acid uptake by human placental villi. It binds to the acetylcholine binding site of the alpha-subunits of nicotinic acetylcholine receptors (nAChR). Eight different neuronal nAChR alpha-subunits have been identified in mammals. Here, we investigated their localisation and distribution in the human and rat placenta by RT-PCR and immunofluorescence. The mRNAs of all alpha-subunits are expressed in the human and rat placenta. Immunohistochemically, subunits alpha2-5, alpha7, alpha9 and alpha10 are localised in different combinations in rat cytotrophoblast, human and rat syncytiotrophoblast, vascular smooth muscle cells, endothelial cells, Hofbauer cells, human amnion epithelium and rat visceral yolk sac epithelium. Thus, all human and rat placental cell types exhibit receptor subunits with binding sites for the endogenous ligand ACh and nicotine. ACh is suggested to be an important placental signalling molecule that, through stimulation of nAChR, controls the uptake of nutrients, blood flow and fluid volume in placental vessels, and the vascularisation during placental development. Chronic stimulation of nAChR by nicotine might result in unbalanced receptor activation or functional desensitisation followed by the known pathological effects of smoking.