Management of term breech presentation: a protocol of external cephalic version and selective trial of labor

OBJECTIVE: The results of a program of external version and selective trial of labor for term breech presentation are reviewed. This is a follow-up to our 1987 report describing management of singleton, term breech presentations and expands our 16-year experience to 1180 cases. STUDY DESIGN: All term breech presentations cared for in 1985 through 1992 are reviewed and outcome contrasted with those predicted in our earlier report. During these 8 years a trial of external version was offered if a breech presentation was identified after 36 completed weeks' gestation and before active labor. The criteria for allowing a trial of labor are detailed. RESULTS: Four hundred sixty-four breech presentations were identified for review. Three hundred eighty-two (82%) were diagnosed before active labor. Of these, 344 (90%) underwent an attempt at external version, of which 174 (51%) were successful. The 290 breech presentations where version either was not attempted or was unsuccessful were stratified into three groups: cesarean section without labor (147), trial of labor with cesarean section (90), and trial of labor with vaginal delivery (53). The 174 cases where version was successful were stratified into two additional groups on the basis of the eventual route of delivery. Careful review of maternal and fetal variables indicates that a trial of labor in selected patients resulted in vaginal delivery in only 37% but was achieved without an increase in fetal or maternal mortality or morbidity. Surprisingly, 54 of the 174 cases where version was successful were ultimately delivered by cesarean section. This 31% rate of cesarean delivery is significantly higher than the 15% rate observed for all cases of term, singleton vertex presentation. A higher prevalence of cases complicated by failed progress in labor and failed induction contributed to the excess. CONCLUSION: External version is successful in 51% of cases of term breech presentation. With careful selection, cases where version has failed can be allowed to labor and be delivered vaginally. The incidence of cesarean section (31%) for those cases where version had been successful was surprisingly high, largely because of an increase in labor abnormalities and failed labor inductions.     

External cephalic version at term using broad criteria: effect on mode of delivery

Lack of breastfeeding promotion and support hinder successful breastfeeding. In this study, a breastfeeding peer counselor program improved both the initiation rate and duration of breastfeeding up to three months postpartum among Native American WIC participants. Trained peer counselors contacted subjects prenatally, and at one, two, and four to six weeks postpartum. Breastfeeding rates for the experimental group were compared to historical controls. Women in the peer counselor group who had complete data for three months (n = 41) had a higher rate of breastfeeding than the control group (n = 67) at initiation (84 percent vs. 70 percent; p = 0.05) and at three months postpartum (49 percent vs. 36 percent; p = 0.08).     

The effect of fetal maturity and the delivery method on fetal status in breech presentation

In a retrospective study of 363 pregnancies with one foetus in breech presentation is evaluated the effect of foetal maturity and the route of delivery on the state of the newborn, assessed by the 5 min. Apgar score. The cases are allocated in subgroups according the foetal weight and height, gestational week and the route of delivery. The results show 37% small for gestational age in the subgroup with low birth weight (1500-2500 g). From the group with low weight SGA sustain better the labor and delivery than the eutrophic. The term newborn in breech presentation are with higher Apgar score than delivered by cesarean section. In the group of newborn with low weight the route of delivery has not effect on the Apgar score. The estimated weight and gestational week should be taken in account than managing breech labor.     

The effect of the woman's age on the course of pregnancy and labor in breech presentation]

The influence of woman's age on pregnancy outcome and delivery of 362 cases of pregnancies in breech presentation was studied retrospectively. The cases are distributed in 6 interval groups of 5 years each and are compared to the data of vertex presentation. The rate of antedated and pregnancy induced diseases are the same in breech and vertex presentation and do not depend on the type of presentation. There is an increase of premature breech deliveries with the decrease of woman's age. The frequency of Cesarean sections is increased with the woman's age, especially after the thirties. The ruptures of the soft birth canal and the need of oxytocin stimulation are increases with woman's age. In case of selected and successive breech labor the state of the newborn does not depend on the woman's age.     

Small bowel injury in gastroschisis: relation to fetal presentation

The study presented here attempts to assess the cost savings attributable to having an on-site corporate medical clinic. For a period of 4 months, employees using the clinic were surveyed regarding: (1) whether they would have used an outside doctor if the corporate medical department clinic were not available, and (2) how many days per year they estimated that they came to work because there was an on-site medical center when they would otherwise have stayed at home. The results indicated that, on average, employees who used the facility saved 3.3 days of absenteeism. That total cost savings was calculated to be $499,212 per year. In addition, 69% of employees indicated that they would have sought attention elsewhere, suggesting that the presence of an on-site medical center does not induce demand. The findings concerning the hidden savings brought about by an on-site medical center are also discussed.     

Reply to Noller and Shum: Couple version of FACES III: Validity and reliability.

Replies to the article by Noller and Shum (1990; see record 1990-27249-001), which focused on the couple version of FACES III. I want to commend Noller and Shum for their well-done validity and reliability analysis which provided norms and replication of the couple version of FACES III. Since FACES III was primarily developed using family data, Noller and Shum provide a useful service by using the couple version of FACES and providing norms based on Australian couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The couple version of FACES III: Validity and reliability.

512 Australian couples completed the couple version of D. H. Olson's (1985) Family Adaptability and Cohesion Evaluation Scale III (FACES III), which was devised to measure family functioning. While the items of FACES III were all useful in discriminating between couples high and low on the 2 factors (adaptability and cohesion), the construct validity was not supported by factor analyses. Construct validity problems may be overcome, at least to some extent, by using a 17-item version of the scale consisting of a 10-item cohesion factor and a 7-item change factor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the reliability of eyewitness identification: Lineup construction and presentation.

The effects of system variables associated with lineup construction and presentation were examined in two experiments. In both experiments, subjects (university undergraduates) watched a videotaped reenactment of an armed robbery and later attempted to identify the robber from a lineup parade. In Experiment 1, lineup cues (e.g., voice, posture, and gait) and presentation mode (simulataneous vs. sequential) interacted (p p p     

The Curious Experiences Survey, a revised version of the Dissociative Experiences Scale: Factor structure, reliability, and relations to demographic and personality variables.

A revision of the Dissociative Experiences Scale, including 3 new items and a more user-friendly item format, was administered to an adult community sample. Both orthogonal and oblique factor rotations of from 1 to 5 factors provide evidence of the hierarchical structure of self-reported dissociative experiences. Reliabilities are presented for a longer and a shorter Dissociation scale, and for subscales labeled Depersonalization, Absorption, and Amnesia. Also provided are the relations of the total scale and its 3 subscales to gender, age, and education, as well as to a broad and diverse set of personality attributes. The frequency of self-reported dissociative experiences was positively related to measures of Neuroticism (particularly Depression) and Imagination, and negatively related to Conscientiousness (particularly Dutifulness), Agreeableness, and to a lesser extent age. The Dissociation scales and subscales were not related to gender, educational level, or intelligence, nor to vocational interests or self-reported skills. Three subtle measures of dissociation are provided. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Antepartum fetal intracranial hemorrhage, predisposing factors and prenatal sonography: a review

Paraoxonase (PON1) is a Ca2+-dependent enzyme whose mechanism of action is incompletely elucidated. PON1 was originally found to be responsible for the hydrolysis of paraoxon, a catabolite of the insecticide parathion, but this enzyme is equally able to hydrolyze other substrates such as phenyl acetate. PON1 exhibits two sequence polymorphisms, Arg-->Gln 192 and Met-->Leu 55, respectively, of which the former is responsible for the distinct catalytic activity of the two corresponding allozymes against paraoxon. The PON1 gene is a member of a family of at least three related genes. Although the physiologic substrate of PON1 is unknown, a protective role against the oxidative degradation of serum lipoproteins has been attributed to this enzyme. Indeed, PON1 is a component of a spectrum of circulating high density lipoprotein particles and can hydrolyze oxidized phospholipids and cholesteryl ester hydroperoxides. Studies have been conducted to evaluate the possible "protective" role of PON, and especially the influence of the Arg-->Gln 192 polymorphism, in coronary artery disease. Results from these investigations are conflicting, and recent data suggest a complex pattern with influences from other polymorphisms in either the PON1 and/or the PON2 and PON3 genes, or even another region of the gene cluster. A number of related factors, which include the heterogeneity of the high density lipoprotein particles incorporating PON(s), the metabolism of associated apolipoproteins such as apoJ/clusterin, the respective roles of PON(s) and other high density lipoprotein-associated enzymes such as platelet-activating-factor acetyl-hydrolase and lecithin-cholesterol acyltransferase, modifications of high density lipoprotein composition and activity under acute-phase conditions, the dietary and environmental regulation of PON(s), and the actual in situ availability of PON in the atherosclerotic artery wall, must equally be taken into account.     

The problems of radon therapy: its benefits and risks]

Local administration of drugs by means of aerosol device is widely used in the treatment of asthma. Nevertheless, the effectiveness of this method depends on an adequate inhalation technique (IT), which available evidence has shown to be rather problematic. The aim of this study was to assess IT in out-patients with bronchial asthma who frequently use aerosol therapy with Pressurized Metered dose inhalers (MDI), pressurized inhalers with spacer (MDI-S) and the Astra-Draco Turbuhaler system (TH). A sample of 150 adults with asthma were evaluated. These patients had been followed up for than two years and they often used one of the devices mentioned above. The IT has broken down into several steps for each procedure. Percentages of patients with one error in the IT were 50%, 44% and 42% for MDI, MDI-S and TH procedures, respectively. 18%, 20% and 14% of patients committed three errors in the IT, respectively. Differences detected were not significant. Seven patients committed errors in every step of the IT. In conclusion, the level of errors found in our study is high, similar to that cited in the existing literature. It is also roughly equivalent for the three devices tested. We believe that the proper teaching monitoring of IT skills is highly important in the treatment of bronchial asthma.     

Recurrent hyperparathyroidism due to parathyroid autografts: incidence, presentation, and management

Recurrent hyperparathyroidism (HPT) occurs in a small percentage of patients undergoing parathyroidectomy for primary HPT and is usually due to inadequate excision of hyperfunctioning parathyroid tissue in the neck, a missed ectopic and hyperplastic parathyroid, or, less commonly, parathyroid carcinoma and parathyroid autografts. In order to determine the incidence, clinical characteristics, and outcome of patients with recurrent HPT due to parathyroid autografts, we reviewed our experience with 604 consecutive patients operated on for primary HPT between 1965 and 1989. One hundred of these patients received parathyroid autografts consisting of portions of one or more parathyroid glands. Three patients with autografts, placed in the sternocleidomastoid muscle, developed recurrent HPT due to their autografts for an incidence of 3 per cent. Recurrent disease was diagnosed between 62 and 113 months with an average of 89 months. The autotransplants in all three of these patients were from hyperplastic or adenomatous parathyroid tissue. Two patients had a history of neck irradiation. Preoperative thallium scans accurately localized the hyperfunctioning parathyroid tissue in all three patients. At operation, the hyperfunctioning autografts had grown into a discrete mass with a single vascular pedicle and were resected. Histologic examination disclosed either hyperplastic or adenomatous tissue, and corresponded to the histology and location of the original tissue transplanted in each case. Follow-up ranges from 12 to 67 months, with an average of 48 months. All patients remain cured and none require oral calcium supplementation. We conclude that graft-dependent recurrent HPT is due to the autotransplantation of hyperplastic or adenomatous parathyroid tissue and that thallium scanning is instrumental for diagnosis and localization.(ABSTRACT TRUNCATED AT 250 WORDS)     

New subscales for an anchored version of the Brief Psychiatric Rating Scale: Construction, reliability, and validity in acute psychiatric admissions.

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postviral gastroparesis: presentation, treatment, and outcome

We describe the clinical features and long-term outcome of 11 children who had persistent gastroparesis after an acute viral illness, eight of whom tested positive for rotavirus. Gastric emptying was delayed in the 10 children evaluated with scintigraphy. Antroduodenal manometry confirmed postprandial antral hypomotility in 10 subjects. All children recovered within 6 to 24 months.     

Conversion from phacoemulsification to extracapsular cataract extraction: incidence, risk factors, and visual outcome

PURPOSE: To evaluate the incidence, risk factors, and visual outcome in cases converted from phacoemulsification to routine extracapsular cataract extraction (ECCE). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: A retrospective study was performed in 540 eyes that had clear corneal phacoemulsification performed by an experienced phacoemulsification surgeon. The cases in which phacoemulsification was initiated and then converted to ECCE were studied. The main parameters evaluated were the factors responsible for the conversion, corneal endothelial cell loss, and visual outcome. RESULTS: Twenty eyes (3.7%) required conversion to ECCE during phacoemulsification. Pupillary miosis (6 cases), posterior capsule rupture (5 cases), prolonged phaco time (4 cases), posterior extension of the capsulorhexis (2 cases), corneal thermal burn (1 case), subluxation of the lens (1 case), and malfunctioning of the ultrasonic handpiece (1 case) were the reasons for the conversion. The mean percentage of endothelial cell loss was 11.06% +/- 2.3 (SD); 18 cases (90.0%) achieved a visual acuity of 20/40 or better at 6 weeks. CONCLUSIONS: Intraoperative pupillary miosis, posterior capsule rupture, and very hard nuclear cataract causing prolonged phacoemulsification were the major risk factors for conversion to ECCE. Optimal preoperative preparation and prompt recognition of complications during phacoemulsification can lead to timely conversion to ECCE to achieve a good visual outcome.     

Xenotransplantation: risks, clinical potential, and future prospects

Psychodynamic clinical studies as well as empirical research have pointed out the importance and the specificity of object relations in eating disorders. Given this, the aim of this work was to identify the presence of significant differences in the object relations patterns, as described by the Parental Bonding Instrument (PBI), between anorectic and bulimic subjects. PBI was administered to 42 anorectic female and 26 bulimic female subjects, consecutively admitted to the Eating Disorders Outpatient Unit of H San Raffaele of Milan. Profile analysis revealed the presence of significant (T2 = 11.3453, d.f. 3,64, p = 0.017) qualitative differences in PBI profiles between anorectic and bulimic subjects. The most striking difference was represented by the bulimics' view of their parents as both caring and overwhelming, which contrasted with the anorectics' perception of their parents as absolutely caring.