Kielland's forceps: role of antenatal factors in prediction of use.

The association between certain antenatal factors and the use of Kielland''s forceps was analysed retrospectively in liveborn singleton births that occurred at this hospital between January and December 1976. Factors significantly associated with the use of Kielland''s forceps were primiparity, short maternal stature, induction of labour, late engagement of the fetal head, low ratio of maternal height to fetal occipitofrontal head circumference, slow dilatation of the cervix in labour, and the use of epidural analgesia in labour. The findings support a contribution of cephalopelvic disproportion in the genesis of malposition, and when associated with slow dilatation of the cervix delivery should be expedited. Long-term follow-up studies are needed, however, before the role of caesarean section in reducing morbidity associated with malposition can be properly assessed.     

Labour: when to worry.

To ensure an optimum result in pregnancy it is essential that the physician be alert in the antenatal period to recognize those women and their babies who are at risk during labour. Premature labour, with its attendant risk of respiratory distress syndrome in the newborn, continues to be an important factor in perinatal morbidity and mortality. Early recognition of predisposing factors and the judicious use of myometrial inhibiting agents have helped to reduce the incidence of fetal prematurity in these cases. A long interval between rupture of the membranes and delivery continues to be a danger to both mother and fetus. Delivery is recommended when gestation is beyond 36 weeks or when there are signs of incipient infection, and once labour has begun antibiotics should be used prophylactically. Failure of labour to progress should be recognized and managed aggressively in its early stages. Amniotomy and oxytocin infusion have reduced considerably the incidence of prolonged labour and its risks to both mother and fetus. The role of intrapartum monitoring of the fetal heart rate, measurement of the pH in the fetus''s scalp blood and assessment of amniotic fluid is discussed, as is the monitoring of maternal well-being.     

Severity of labour pain: influence of physical as well as psychologic variables.

The role of physical factors in the severity of labour pain has been neglected. The amount of cervical dilation, the frequency of the contractions, the woman''s height and usual weight before the pregnancy and other physical factors were therefore examined in relation to the intensity of labour pain in 141 primiparous and 99 multiparous women. In general, pain increased gradually during labour in both groups of women, though the severity of the pain was lower in the women who had received prepared childbirth training than in those who had not. Although the average pain scores in this study were high, there were striking individual differences, some women having extremely severe pain and others having almost none. The pain scores in both groups of women were significantly correlated with the ratios of the women''s usual weight to height. In the multiparous women the scores were also correlated with the woman''s usual weight and the baby''s weight but not with the woman''s weight gain during pregnancy. Thus, the results show that physical as well as psychologic factors contribute to the severity of labour pain.     

Toxic Dilatation of the Colon in the Course of Ulcerative Colitis

Toxic dilatation of the colon has been observed in a patient suffering from ulcerative colitis during an acute relapse of the disease. This uncommon and serious complication was suspected because there was a gradual worsening of the patient''s condition, accompanied by toxic phenomena. The diagnosis was confirmed by a flat plate of the abdomen which disclosed considerable dilatation of the colon. The etiology of toxic dilatation is not known but the use of opiates and anticholinergic agents has been suggested as a possible factor. These therapeutic agents should be avoided in the acute stage. Barium enema examination during acute relapses of ulcerative colitis may also precipitate the onset of this complication. It is recommended that, during the acute stage of the disease, the barium enema be replaced as often as possible by flat films of the abdomen which also enable diagnosis of this complication.     

Maternal Circulating Levels of Activin A,Inhibin A,sFlt-1 and Endoglin at Parturition in Normal Pregnancy and Pre-Eclampsia

Background

Maternal circulating levels of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1), endoglin (sEng) and placental proteins like activin A and inhibin A are increased before the onset of pre-eclampsia. There is evidence for oxidative stress in pre eclampsia. Recently it was shown that placental oxygen concentration is related to sFlt-1 and inhibin A. In addition it is reported that oxidative stress markers are increased in placental tissue delivered after labour. Therefore, the objective of this study is to investigate if these proteins are altered in maternal circulation of labouring pre-eclampsia and normal pregnancies.

Methodology

To assess the effects of labour, samples were taken from 10 normal pregnant (NP) and 10 pre-eclamptic (PE) women pre-labour, full dilation, placental delivery and 24 h. To assess the effects of placental delivery, plasma samples were taken from 10NP and 10PE women undergoing elective Caesarean section, pre-delivery, placental delivery and 10 min, 60 min and 24 h post delivery. SFlt-1 and sEng and activin A and inhibin A were measured using commercial and in house ELISA''s respectively.

Results

The levels of sFlt-1 and sEng were significantly higher in PE compared to NP women in both groups. In labour, sFlt-1 levels increased significantly at full dilatation in PE women, before declining by 24 hr. However there was no significant rise in sEng levels in labour. Activin A and inhibin A levels declined rapidly with placental delivery in NP and PE pregnancies. There was a significant rise in activin A levels during labour in PE compared to pre labour, but inhibin levels did not increase.

Conclusion

Labour in pre-eclamptic women increases the levels of sFlt-1 and activin A. This pilot data suggests that increase in the maternal levels of these factors in labour could predict and/or contribute to the maternal syndrome postpartum.     

Intrathecal morphine as sole analgesic during labour.

In 12 consecutive unselected patients admitted to a consultant maternity unit one single injection of subarachnoid morphine sulphate 1.5 mg abolished pain during the first stage of labour. Pain in the second stage was abolished in four patients and lessened in three. During the early puerperium, pain at the site of the episitotomy was much reduced. Side effects included itching of the face, nausea and vomiting, and frontal headache, but these were mild and simply treated. They were even less severe in the last four patients, in whom barbotage was not used in administering the morphine. The high rate of forceps delivery and caesarean section (three cases of each) was not thought to be associated with the use of intrathecal morphine. These findings show that intrathecal morphine can abolish the pain of labour, whether spontaneous or induced, while preserving the mother''s full awareness of labour and her co-operation in the second and third stages of labour. Further, controlled, trials are warranted.     

Englerin A Selectively Induces Necrosis in Human Renal Cancer Cells

The number of renal cancers has increased over the last ten years and patient survival in advanced stages remains very poor. Therefore, new therapeutic approaches for renal cancer are essential. Englerin A is a natural product with a very potent and selective cytotoxicity against renal cancer cells. This makes it a promising drug candidate that may improve current treatment standards for patients with renal cancers in all stages. However, little is known about englerin A''s mode of action in targeting specifically renal cancer cells. Our study is the first to investigate the biological mechanism of englerin A action in detail. We report that englerin A is specific for renal tumor cells and does not affect normal kidney cells. We find that englerin A treatment induces necrotic cell death in renal cancer cells but not in normal kidney cells. We further show that autophagic and pyroptotic proteins are unaffected by the compound and that necrotic signaling in these cells coincided with production of reactive oxygen species and calcium influx into the cytoplasm. As the first study to analyze the biological effects of englerin A, our work provides an important basis for the evaluation and validation of the compound''s use as an anti-tumor drug. It also provides a context in which to identify the specific target or targets of englerin A in renal cancer cells.     

Self-assembly,self-organization and division of labour

The prospect of generic principles of biological organization being uncovered through the increasingly broad use of the concepts of ''self-assembly'' and ''self-organization'' in biology will only be fulfilled if students of different levels of biological organization use the same terms with the same meanings. We consider the different ways the terms ''self-assembly'' and ''self-organization'' have been used, from studies of molecules to studies of animal societies. By linking ''self-assembly'' and ''self-organization'' with division of labour, we not only put forward a distinction between the underlying concepts but we are also able to relate them to the question: Why has a certain structure been favoured by natural selection? Using the particularly instructive case of social resilience in ant colonies, we demonstrate that the principle of self-organizing self-assembly may apply to higher levels of biological organization than previously considered. We predict that at the level of interactions among organisms within the most advanced animal societies, specialization through learning has a crucial role to play in re-assembly processes. This review may also help important commonalities and differences to be recognized between ordering mechanisms up to the social level and those further up the biological hierarchy, at the level of ecological communities.     

Ecological theory as a foundation to control pathogenic invasion in aquaculture

Detrimental host–pathogen interactions are a normal phenomenon in aquaculture animal production, and have been counteracted by prophylactic use of antibiotics. Especially, the youngest life stages of cultivated aquatic animals are susceptible to pathogen invasion, resulting in disease and mortality. To establish a more sustainable aquatic food production, there is a need for new microbial management strategies that focus on ‘join them'' and not the traditional ‘beat them'' approaches. We argue that ecological theory could serve as a foundation for developing sustainable microbial management methods that prevent pathogenic disease in larviculture. Management of the water microbiota in aquaculture systems according to ecological selection principles has been shown to decrease opportunistic pathogen pressure and to result in an improved performance of the cultured animals. We hypothesize that manipulation of the biodiversity of the gut microbiota can increase the host''s resistance against pathogenic invasion and infection. However, substantial barriers need to be overcome before active management of the intestinal microbiota can effectively be applied in larviculture.     

The Spread of Sleep Loss Influences Drug Use in Adolescent Social Networks

Troubled sleep is a commonly cited consequence of adolescent drug use, but it has rarely been studied as a cause. Nor have there been any studies of the extent to which sleep behavior can spread in social networks from person to person to person. Here we map the social networks of 8,349 adolescents in order to study how sleep behavior spreads, how drug use behavior spreads, and how a friend''s sleep behavior influences one''s own drug use. We find clusters of poor sleep behavior and drug use that extend up to four degrees of separation (to one''s friends'' friends'' friends'' friends) in the social network. Prospective regression models show that being central in the network negatively influences future sleep outcomes, but not vice versa. Moreover, if a friend sleeps ≤7 hours, it increases the likelihood a person sleeps ≤7 hours by 11%. If a friend uses marijuana, it increases the likelihood of marijuana use by 110%. Finally, the likelihood that an individual uses drugs increases by 19% when a friend sleeps ≤7 hours, and a mediation analysis shows that 20% of this effect results from the spread of sleep behavior from one person to another. This is the first study to suggest that the spread of one behavior in social networks influences the spread of another. The results indicate that interventions should focus on healthy sleep to prevent drug use and targeting specific individuals may improve outcomes across the entire social network.     

X-Ray Pelvimetry

The results of x-ray pelvimetry performed on 66 pregnant women, with a view to predicting the outcome of pregnancy, were reviewed. It was concluded that such pelvimetry was most valuable in cases in which it indicated a normal pelvis or gross bony disproportion. It was least effective in those with a “borderline” pelvis, in which the correct management of the patient requires an adequate trial of labour. The authors believe that pelvimetry in the later stages of pregnancy has no ill effects on the unborn baby or the mother.Indications for use of x-ray pelvimetry in obstetrics, the technique employed, the various types of female pelvis and the relation of these to the course of labour are considered. Pelvimetry findings are compared with the eventual outcome of labour in women with suspected cephalopelvic disproportion. It is emphasized that the pelvic assessment should be made jointly by the radiologist and obstetrician.     

Bleomycin in the Reticuloses

Bleomycin alone was used in the treatment of 54 patients with Hodgkin''s disease in its later stages, 17 with generalized lymphosarcoma, 22 with reticulum cell sarcoma, and 7 with mycosis fungoides. The patients had had radiotherapy and full courses of conventional chemotherapy. Bleomycin was given in doses of 30 mg weekly to an average total dosage of 200 mg, though up to 800 mg could be given because of its marrow-sparing properties. Sixteen (29%) of the patients with Hodgkin''s disease remitted, most of them achieving only a partial remission, and similar results were obtained in the other three reticuloses. Bleomycin would seem to have some beneficial action in the late stages of Hodgkin''s disease, though it is less effective than some drug regimens recently introduced. Nevertheless it may be useful when there is diminished bone marrow reserve. It would be a suitable drug to use in combination therapy of these four reticuloses.     

Stereotaxic Device for Optical Imaging of Mice Hind Feet

Imaging of in vivo model systems, especially mouse models, has revolutionized our understanding of normal and pathological developments. However, mice present several challenges for imaging. They are living and therefore breathing organisms with a fast heart rate (>500 beat/min), which necessitates the need for restraints and positioning controls that do not compromise their normal physiology. We present here a device that immobilizes the rear legs of a mouse while retaining the ability to position both the hind feet and legs for reproducible imaging deep below the skin''s surface. The device is highly adjustable to accommodate mice, 5 weeks of age and older. The function of this device is demonstrated by imaging the vasculature ∼250 μm beneath the skin in the hind leg. Whereas the overall dimensions are for a motorized stage (Märzhäuser Wetzlar GmbH, Wetzlar, Germany), minor modifications would allow it to be customized for use with most commercially available stages that accept an insert.     

Perineal massage in labour and prevention of perineal trauma: randomised controlled trial

ObjectiveTo determine the effects of perineal massage in the second stage of labour on perineal outcomes.DesignRandomised controlled trial.ParticipantsAt 36 weeks'' gestation, women expecting normal birth of a singleton were asked to join the study. Women became eligible to be randomised in labour if they progressed to full dilatation of the cervix or 8 cm or more if nulliparous or 5 cm or more if multiparous. 1340 were randomised into the trial.InterventionMassage and stretching of the perineum during the second stage of labour with a water soluble lubricant.ResultsRates of intact perineums, first and second degree tears, and episiotomies were similar in the massage and the control groups. There were fewer third degree tears in the massage group (12 (1.7%) v 23 (3.6%); absolute risk 2.11, relative risk 0.45; 95% confidence interval 0.23 to 0.93, P<0.04), though the trial was underpowered to measure this rarer outcome. Groups did not differ in any of the secondary outcomes at the three assessment points.ConclusionsThe practice of perineal massage in labour does not increase the likelihood of an intact perineum or reduce the risk of pain, dyspareunia, or urinary and faecal problems.

What is already known on this topic

Perineal trauma during vaginal birth and its sequelae, including urinary and faecal incontinence, dyspareunia, and persistent pain, have a negative impact on the sexuality, self esteem, and quality of life of countless women each yearPerineal massage conducted antenatally has some benefit in reducing the risk of perineal traumaPerineal massage in the second stage of labour has been promoted and practised without sound evidence of its effectiveness

What this study adds

Perineal massage in the second stage of labour did not have any effect on the likelihood of an intact perineum, perineal trauma, pain, or subsequent sexual, urinary or faecal outcomes but was not harmfulThe results support midwives in following their usual practice while taking account of the preferences of individual women     

Prolonged pregnancy: the management debate.

A prospective trial was conducted to compare the effects of conservative management of prolonged pregnancy (conservative group) with routine induction of labour at 42 weeks'' gestation (active group) in otherwise uncomplicated pregnancies. Of the 402 pregnancies studied, 207 (51%) were allocated to conservative management and 195 (49%) were allocated to have labour induced. The groups were well matched for age, parity, and smoking habits. One hundred and sixty six (80%) of the patients in the conservative group went into spontaneous labour. Of the remainder, two underwent elective caesarean section, 19 had labour induced because of clinical concern, and the remaining 20 had labour induced at the patient''s own request. One hundred and twenty five (64%) of the patients in the planned active group underwent induction of labour. Of the remaining 70, 49 went into spontaneous labour and 21 (11%) asked that they should not have labour induced. Comparison of the two groups showed no difference in the length of the first stage of labour but a trend towards an increased need for intervention for fetal distress (p less than 0.06) in the active group. There were no differences in the length of the second stage, the need for intervention, or the mode of delivery. In terms of Apgar scores the neonatal outcome was not significantly different between the two groups, but a greater proportion of the babies (15% v 8%) in the active group required intubation. Umbilical cord venous pH estimated in the last 183 consecutive deliveries in the study showed a significantly lower mean value in the active group (p less than 0.05). There was no difference in birth weight between the two groups. Two deaths occurred in the study. There was a stillbirth in the conservative group at 292 days after massive abruption, and one neonatal death in the active group owing to multiple congenital abnormalities. The outcome for mother and baby in patients from both groups who went into spontaneous labour was generally good. The outcome for patients for whom conservative management was planned but induction became necessary was no different from that of patients who underwent planned induction at term. Thus from our results we can find no evidence to support the view that women with normal prolonged pregnancy should undergo routine induction of labour at 42 weeks'' gestation.     

HIRSCHSPRUNG'S DISEASE—The Clinical Differentiation and Treatment of Children with Hirschsprung's Disease and Pseudo-Hirschsprung's Disease

Hirschsprung''s disease is marked by constipation from the time of birth, with the development, if uncorrected, of a protuberant abdomen and flared costal margins. The rectal ampulla is empty and the abdomen is filled with fecal masses. Pain is not prominent. Flatus is passed in large amounts. Encopresis does not occur. Barium enema shows the characteristic narrowed distal rectal segment and biopsy of the rectum shows absence of the ganglion cells of the myenteric plexus.Treatment is operative resection of the distal narrow segment and a primary anastomosis.Hirschsprung''s disease may be mimicked in children with:1. Psychogenic constipation—pseudo-Hirschsprung''s disease. Unlike Hirschsprung''s disease, symptoms do not appear at birth, encopresis is common, and the barium enema shows no narrow distal segment.2. Mental retardation and cerebral defect.3. Corrected imperforate anus—on the basis of stenosis, imperfect innervation or poor habit training.4. Cretinism—with severe constipation and intestinal dilatation perhaps the presenting symptoms.Treatment of these four groups of children with severe constipation not due to Hirschsprung''s disease is:For Group 1, open discussion with parent and child. Assumption by the physician of full control of the details of treatment, and relegation of parent to the role of the physician''s agent in following the prescribed regimen.For Group 2, an enema regimen. Whereas fairly rapid restoration (and then persistence) of normal bowel habit can be expected in Group 1, the basic defects in Group 2 may require indefinite continuation of treatment.For Group 3, regular enema regimen, in the less severe cases—one identical with that used in Group 1, and dilatation of strictures or anoplasty.In Group 4, thyroid hormone therapy relieves the constipation of hypothyroidism and causes reversion of radiographic changes in the colon and rectum.     

Kielland's forceps: association with neonatal morbidity and mortality.

The incidence of certain neonatal complications associated with the use of Kielland''s forceps was analyzed retrospectively in liveborn singleton babies delivered at this hospital between January and December 1976. The neonatal mortality rate attributable to use of the forceps was 34.9 per 1000. The incidences of delayed onset of respiration (17.4%), birth trauma (15.1%), and abnormal neurological behaviour--namely, apathy or irritability or both--(23.3%) significantly exceeded those in a matched group of babies born spontaneously. Fetal asphyxia played a major part in the aetiology of neonatal complications. Babies on whom Kielland''s forceps were used, however, had a significantly greater incidence of abnormal neurological behaviour even in the absence of fetal asphyxia (14.3%), and in all of these babies the abnormal behaviour was transient and did not necessitate admission to the special-care baby unit. Neither maternal height nor the infant''s birth weight or occipitofrontal head circumference influenced the occurrence of neonatal complications. The results also suggest that neither the speed of cervical dilatation nor the timing of engagement of the fetal head is of help in predicting the occurrence of neonatal complications after the use of Kielland''s forceps.     

Norway rats reciprocate help according to the quality of help they received

Direct reciprocity, according to the decision rule ‘help someone who has helped you before’, reflects cooperation based on the principle of postponed benefits. A predominant factor influencing Homo sapiens'' motivation to reciprocate is an individ­ual''s perceived benefit resulting from the value of received help. But hitherto it has been unclear whether other species also base their decision to cooperate on the quality of received help. Previous experiments have demonstrated that Norway rats, Rattus norvegicus, cooperate using direct reciprocity decision rules in a variant of the iterated Prisoner''s Dilemma, where they preferentially help cooperators instead of defectors. But, as the quality of obtained benefits has not been varied, it is yet unclear whether rats use the value of received help as decision criterion to pay help back. Here, we tested whether rats distinguish between different cooperators depending purely on the quality of their help. Our data show that a rat''s propensity to reciprocate help is, indeed, adjusted to the perceived quality of the partner''s previous help. When cooperating with two conspecific partners expending the same effort, rats apparently rely on obtained benefit to adjust their level of returned help.     

Impact evaluation to communicate and improve conservation non-governmental organization performance: the case of Conservation International

The rising prominence of more rigorous approaches to measuring conservation outcomes has included greater adoption of impact evaluation by conservation non-governmental organizations (CNGOs). Within the scientific literature, however, little consideration has been given to the unique and specific roles of CNGOs in advancing impact evaluation. We explore these issues in the context of one CNGO—Conservation International (CI)—and its experiences producing, using and funding impact evaluations over the past decade. We examine the contributions of impact evaluation to CI''s mission at three different stages of CI''s strategy: innovation, demonstration and amplification. Furthermore, we review incentives and barriers encountered by CI in its 10+ years'' experience in impact evaluation. More coordinated and strategic use of impact evaluation by CNGOs would facilitate learning and promote accountability across the conservation community.