Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020)

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Vaginal Birth at Term - Part 2. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020)

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Caesarean Section. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/084, June 2020)

Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.

Evaluation of In Vivo Mutagenicity of Low-Dose Methylene Chloride in Mice

Methylene chloride, a widely used industrial solvent, has been shown to be mutagenic by in vitro tests. The aim of this study was to determine in vivo mutagenicity. Groups of 20 Swiss-Webster (S/W) male mice were injected subcutaneously three times/week with 5 ml/kg of 5% vol/vol or 10% vol/vol solution of methylene chloride in corn oil for 4 weeks, followed by 1 week of no treatment. Other groups of 20 S/W male mice were exposed to airflow of 10 L/min carrying 100, 150, or 200 ppm of methylene chloride daily for 2 hr/day, 5 days/week for 6 weeks. Each study contained appropriate negative controls. Mating was started 1 week later for the injection group and 2 days later for the inhalation group. Each male mouse was mated with a S/W virgin adult female. The mating was allowed to continue for 2 weeks. Presence of a vaginal plug was taken as a sign of successful mating and was designated as day 0 of gestation. On day 17, the females were killed, and the fetuses were removed and processed. Male mice were killed, and the testes were removed, preserved in 10% formalin, and processed. No significant difference in any of the mutagenicity parameters was found between control and treated groups. No microscopic lesions were found in testes of the treated males.

Nurses: The agenda for change

This paper highlights the level of expertise and ability of nurses to change the clinical approach of a multi-disciplinary team in service provision. This is in relation to improving a drug clinic’s outlook and care programme approach for alcohol. The senior nurses saw a gap in service provision for alcohol and, through conducting an audit and further qualitative research, they were able to identify which clinical approaches needed updating and ‘finetuning’ in the London borough of Islington, producing updated guidelines for the clinic. The results showed that there was a cohort of clients attending for treatment who had a dual problem with alcohol and drugs. This was often missed on the initial assessment form. From the audit and further local research, the assessment was changed, which improved the identification of an alcohol dependency so that an appropriate care plan could be draw up. From the qualitative study there was also a perceived resistance from the client group to address their alcohol dependency, and on being breathalysed when receiving a script for methadone. It was felt that the reasoning for this could be the clinical procedure was not being explained. However, what was identified from the clinical research was that this reasoning from the client group was unjustified with clear clinical reasons for this procedure being given to the client from the nursing staff. Importantly, this paper aims to illustrate the clinical development role nurses can play in improving care for services through evidence-based practice and development of updated guidelines. The guidelines produced from this work have, in turn, ensured better care for clients of the service.

Blood n-hexane concentration following acute inhalation exposure in rats

Blood n-hexane concentrations in rats is reported. Groups of four rats were exposed to a n-hexane vapor/air mixture, in a glass chamber. At the end of the exposure, the animals were sacrificed by decapitation, blood was collected, and the concentration of n-hexane in blood was determined by headspace gas chromatography. Results indicate that blood becomes saturated with n-hexane in 10 minutes or less and persisted in the other exposure periods, up to and including 30 minutes.