Vaginal breech delivery at term and neonatal morbidity and mortality – a population-based cohort study in Sweden

Introduction: The routine to deliver almost all term breech cases by elective cesarean section (CS) has continued to be debated due to the risk of maternal and neonatal complications. The aims of the study were (1) to investigate if mode of delivery impacts on the risk of morbidity and mortality among term infants in breech presentation and (2) to compare the rates of severe neonatal complications and mortality in relation to presentation and mode of delivery.

Methods: This population-based cohort study used data from the Swedish Medical Birth Register. All women (and their newborn infants) with singleton pregnancies who gave birth at term to an infant in breech (n?=?27,357) or cephalic presentation (n?=?837,494) between 2001 and 2012 were included. Births with vacuum extraction and induced labors were excluded, as well as antepartum stillbirths, births with infants diagnosed with congenital malformations and multiple births.

Results: On one hand, the rates of neonatal complications and mortality were higher among infants born in vaginal breech compared to the vaginal cephalic group. On the other hand, after CS, the rates of all neonatal complications under study and neonatal mortality were lower among infants in breech presentation than in those in cephalic presentation. After adjustment for confounders, infants delivered in vaginal breech had 23.8 times higher odds AOR (ratio) for brachial plexus injury, 13.3 times higher odds ratio for Apgar score <7 at 5?min, 6.7 times higher odds of intracranial hemorrhage (ICH), or convulsions and 7.6 higher odds ratio for perinatal mortality than those delivered by elective CS.

Conclusions: Despite a probable selection of women who before-hand were considered at low risk and, therefore, could be recommended vaginal breech delivery, infants delivered in vaginal breech faced substantially increased risks of severe neonatal complications compared with infants in breech presentations delivered by elective CS.

• Key message

• Vaginal breech delivery is associated with increased risk for severe neonatal complications.

     

Percutaneous epiphysiodesis using transphyseal screws for limb-length discrepancies: high variability among growth predictor models

Purpose

Percutaneous epiphysiodesis using transphyseal screws (PETS) was developed as a minimally invasive outpatient procedure to address limb-length discrepancy (LLD) that allowed immediate postoperative weight bearing and was potentially reversible by removing the screws. The aims of our study were to report our results using PETS for LLD and evaluate the accuracy of three growth predictor models.

Methods

Sixteen patients with an average age of 14 years were treated for LLD using PETS. Thirteen patients had screws inserted in a parallel fashion and 3 had crossed screws. We compared the predicted LLD at skeletal maturity using the three growth predictor methods with the actual LLD at skeletal maturity and preoperative LLD with the final LLD at skeletal maturity.

Results

The mean LLD at skeletal maturity between the predicted and final measurements was 0.2 cm using the Green−Anderson method, 1.4 cm using the Moseley method, and −0.1 cm using the Paley method. The mean preoperative LLD of 3.1 cm was corrected to 1.7 cm at skeletal maturity (p < 0.001). Six patients complained of pain over the screw heads; however, no patient developed an infection or angular deformity.

Conclusions

The three growth predictor methods predicted the final LLD within an average of 1.4 cm, but there was high variability. Although PETS improved the LLD by a mean of 1.4 cm, we believe the results would have been better if PETS was performed at an earlier skeletal age.     

Ankle fractures in children

Computed tomography is useful for preoperative planning and postreduction assessment for intra-articular pediatric ankle fractures. Nondisplaced pediatric ankle fractures can be effectively managed with cast immobilization and close radiographic follow-up evaluation. Physeal ankle injuries in younger children with considerable growth remaining should be followed closely for at least one year after injury as growth arrest may result in substantial angular deformity. Open reduction and internal fixation should be strongly considered when an articular step-off of <2 mm cannot be maintained by closed means for Salter-Harris type-III and IV and transitional ankle fractures.     

Comparison of chronic widespread pain prevalence with different criteria in two cohorts of rheumatoid arthritis

Clinical Rheumatology - This study aims to investigate chronic widespread pain with the 1990 (CWP1990) and 2019 (CWP2019) definitions 6&nbsp;years after the onset of rheumatoid arthritis (RA),...     

The influence of cardiac triggering time and an optimization strategy for improved cardiac MR spectroscopy

Purpose

To study how cardiac motion affects the spectral quality in cardiac MR spectroscopy and to establish an optimization strategy for the cardiac triggering time for improved quality and success rate of cardiac MRS.

Rapid diagnosis of Clostridium difficile-associated diarrhoea using a latex agglutination test

A rapid latex agglutination test, Culturette Brand CDT from Marion Laboratories, was evaluated and compared to a tissue culture assay (TCA) and isolation of Clostridium difficile in 380 faecal specimens from 226 patients with clinically suspected Clostridium difficile-associated diarrhoea. The sensitivity and specificity of the latex test compared with the TCA were 83% and 80% respectively, and the positive and negative predictive values were 55% and 94% respectively. In patients with repeated sampling the sensitivity increased to 95%. The latex test may be useful as a screening test for negative specimens in laboratories where TCA is not available, but positive specimens have to be confirmed by TCA.     

Dimensions of control as related to work organization, stress, and health

The aim of this article is to examine how increased worker control-on the individual as well as on collective level-may be a means to reduce the risk of work environment-related stress and diseases. Control is also an important element in socialization processes and in work reform activities directed to a democratization of working life. The concept of control connects a number of research perspectives. It deals with the individual and the collective level, as well as the relationship between them, and it may be a bridge between a social psychological and a psychobiological perspective. In this article, the author considers the control concept primarily from a stress perspective, but also examines how production techniques, legislation, and management strategies create the structure of control at work.     

Beh?et's syndrome in two brothers

Two brothers, born in 1944 and 1950, had been brought up in separate homes since 1951. In 1978 they were both afflicted with Beh?et's syndrome. This condition is uncommon in Scandinavia, and there are no other known reports of familial cases from the Scandinavian countries. The etiology of the disease is obscure and controversial. In our two cases a hereditary disposition seems more probable than an infectious origin.     

The distribution of choline acetyltransferase- and acetylcholinesterase-like immunoreactivity in the palmar skin of patients with palmoplantar pustulosis

The distribution of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in involved skin in patients with palmoplantar pustulosis (PPP) and in normal palmar skin in healthy non-smokers and smokers has been studied by immunohistochemistry, especially in relation to the sweat gland apparatus. The sweat gland and its duct showed ChAT- and AChE-like immunoreactivity (LI) of varying intensity in all three groups and with stronger reactivity than in the epidermis. ChAT-LI was present in the coil and in the duct except in the corneal layer. Smokers and patients with PPP displayed significantly fewer ChAT+ acrosyringia than non-smokers. In the patients with PPP, the granulocytes in the pustules and in the papillary dermis displayed ChAT-LI. Western blot analysis of granulocytes from peripheral blood from healthy donors confirmed the presence of ChAT-like proteins in large amounts in neutrophils and small amounts in eosinophils. AChE-LI of varying intensity was found in all parts of the sweat gland apparatus in all three groups. The strongest AChE-LI in the acrosyringia was seen in the lowest part of the stratum corneum, where the PPP pustules are located. No significant differences in staining pattern or intensity were found between the coils, nerve fibres surrounding the coils or ducts. The number of mast cells in the papillary dermis was about four times larger in the patients with PPP than in the control subjects. AChE-LI was observed in about 25% of the mast cells in non-smoking control subjects and in patients with PPP, but only in 10% of those in the smoking control subjects. Our findings indicate that the (non-neuronal) cholinergic system may be involved in cutaneous inflammatory processes.