Could the central part of the partograph,the cervicograph be improved?

Aims. Since partographs were introduced into obstetric practice, more than 50 years ago, the appearance of cervicographs as their central section has not been significantly changed. The aims of this article are to assess whether the current characteristics of cervicographs represent the optimal solution with regard to the rules for plotting data and to suggest what that optimal solution might be.

Methods. The literature was searched for papers containing reproductions of cervicographs to review their characteristics. According to the general rules for plotting data, values of three most important characteristics of cervicographs were defined.

Results. The characteristics of the majority of available cervicographs are: a dilatation scale smallest division 1 cm, a time scale smallest division 1 h and 1 cm/h dilatation rate line inclination less than 45°. The optimal characteristics of cervicographs are: a dilatation scale smallest division 2 cm, a time scale smallest division 5 min and 1 cm/h dilatation rate line inclination of 45°.

Conclusion. The scale divisions on the proposed cervicograph form are in predefined relation to the accuracy of the measurements made. This enables improved portrayal of labour.     

Measuring the best outcome for the least intervention: can the Optimality Index-US be applied in the UK?

Objectiveto pilot the Optimality Index-US (OI-US) for the first time within a UK maternity setting in a sample of women at mixed risk.Designa multidisciplinary group reviewed the items and evidence base of the OI-US. A pilot study was undertaken to compare the availability and quality of data from maternity records to complete the OI-US. Data were collected from maternity records.Settinga maternity unit of an inner city teaching hospital in England.Participantsclinical midwives, research midwives, midwifery lecturers and consultant obstetricians (n=10) reviewed the items and evidence base of the OI-US. Data were collected from the maternity records of 97 women receiving caseload care and 103 women receiving standard care.Measurements and findingswhen the multidisciplinary group reviewed the items and evidence base of the OI-US, it was noted that some social and clinical factors should be considered for inclusion as part of the Perinatal Background Index (PBI) and OI. The results suggest that the inclusion of women at higher risk in this sample within the UK maternity setting has not been captured by the OI-US.Key conclusionsthe following social and clinical factors should be included as part of the PBI and OI for the UK setting: measure of social deprivation, woman's ability to speak and understand English in relation to accessing maternity care, mental health problems during pregnancy and history of domestic violence during pregnancyImplications for practiceavailability of items in electronic records is poor and it is recommended that the OI-UK version is a useful research tool in prospective data collection. The development of an international version would be valuable for comparision of background risk and outcomes across a range of care settings.     

Is the Deep Endometriosis or the Surgery the Cause of Postoperative Bladder Dysfunction?

Study ObjectiveTo assess whether deep endometriosis surgery affects the bladder function.DesignProspective multicenter observational study (Canadian Task Force classification II-2).SettingAcademic research centers.PatientsThirty-two patients with diagnosis of deep endometriosis requiring surgery.InterventionsWomen were evaluated with urodynamic studies, International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form, and International Consultation on Incontinence Questionnaire Overactive Bladder Module questionnaires before and 3 months after surgery.Measurements and Main ResultsThe main outcome measure was the impact of deep endometriosis surgery on urodynamic parameters. All cystomanometric parameters showed an improvement postoperatively: in particular, the first desire to void (120 vs 204 mL; p <.001) and the bladder capacity (358 vs 409 mL; p = .011) increased significantly after surgery. Of the uroflow parameters, the maximal voiding flow improved significantly postoperatively (19 vs 25 mL/s; p = .026). The International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (2.5 vs 0; p = .0005) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (4.3 vs 1.2; p <.001) questionnaires showed a significant postoperative improvement too.ConclusionOur data show that in a selected population of patients with deep infiltrating endometriosis (not requiring bowel or ureteral resection), the bladder function improves after surgery, both during filling and on voiding urodynamic phases. Postoperatively, patients with deep infiltrating endometriosis become aware of bladder filling later, have a higher bladder capacity, and have a higher maximal flow. The postoperative urodynamic results are corroborated by the improved scores on the bladder questionnaires.     

What are the antigenic targets in the ovary?

The ovary can be the target of an autoimmune disease involving many different autoantigens. The clinical feature of this disease often results in premature ovarian failure or infertility and may be either isolated or associated with other autoimmune pathologies, especially with adrenal autoimmunity. The diagnosis of an autoimmune mechanism relies on the presence of anti-ovarian antibodies, whose prevalence is quite variable according to the different methods used to detect them, and to the different stages of the disease. In addition, their clinical significance is not always clear, as to their pathologic or epiphenomenal nature. However, the study of these autoantibodies has led to the identification of some of their antigenic targets which have to be known for a better understanding of the pathologic mechanisms involved. This paper reviews anti-steroid producing cells, anti-gonadotrophin receptor, anti-gonadotrophin, anti-corpus luteum, anti-zona pellucida and anti-oocyte antibodies.     

Does the way that women experience the onset of labour influence the duration of labour?

OBJECTIVE: To assess whether the way in which women experience the onset of their labour influences the duration of their labour. DESIGN: Longitudinal study on a convenient sample of women in spontaneous labour with a singleton pregnancy in cephalic presentation at term. SETTING: University hospital in Germany. POPULATION/SAMPLE: Six hundred and fifty-one women (347 primiparae and 304 parae). METHODS: Women recorded how and when labour had started. Responses were subjected to structured content analysis. Two investigators independently subdivided women's reported signs and symptoms into eight predefined categories. These data were related to maternal characteristics and to the course and outcome of labour as documented in the perinatal record. MAIN OUTCOME MEASURES: Women's perception of how labour had started, interval between onset of labour and rupture of the membranes and duration of first stage labour and overall duration of labour. RESULTS: Only 60% of women reported contractions as a sign of the onset of their labour. These women had a longer interval between the onset of labour and rupture of the membranes but a similar duration of labour when compared with women who did not report contractions as a sign of the onset of labour. Self-reported loss of amniotic fluid was the only sign that showed a consistent relationship with the duration of labour. Other patterns of labour onset had no effect on the duration of labour. CONCLUSION: Irrespective of whether they have given birth before, women experience their onset of labour in a variety of ways. A large proportion of these experiences bear no resemblance to the classical diagnosis of labour and most are unrelated to the duration of labour.     

Is it time to revisit the Pedersen hypothesis in the face of the obesity epidemic?

The Pedersen hypothesis was formulated more than 50 years ago. Jorgen Pedersen primarily cared for women with type 1 diabetes. He suggested that fetal overgrowth was related to increased transplacental transfer of glucose, stimulating the release of insulin by the fetal beta cell and subsequent macrosomia. Optimal maternal glucose control decreased perinatal mortality and morbidity. However, over the ensuing decades, there have been increases in maternal obesity and subsequently gestational diabetes mellitus (GDM) and type 2 diabetes. The underlying pathophysiology of type 1 and GDM/type 2 diabetes are fundamentally different, type 1 diabetes being primarily a disorder of beta cell failure and type 2 diabetes/GDM including both insulin resistance and beta cell dysfunction. As such the metabolic milieu in which the developing fetus is exposed may be quite different in type 1 diabetes and obesity. In this review we examine the metabolic environment of obese diabetic women and lipid metabolism affecting fetal adiposity. The importance of understanding these issues relates to the increasing trends of obesity worldwide with perinatal programming of metabolic dysfunction in the offspring.     

Sildenafil Increases the p50 and Shifts the Oxygen–Hemoglobin Dissociation Curve to the Right

IntroductionSildenafil (Viagra®) is a selective phosphodiesterase type 5 (PDE5) inhibitor that block the breakdown of cyclic guanyl monophosphate (cGMP) leading to relaxation of the smooth muscles of the corpus cavernous and an increase in blood flow resulting in penile erection. It is hypothesized that sildenafil will increase the release of oxygen from erythrocytes and shift the oxygen–hemoglobin curve to the right.AimThe aim of this study was to investigate the effect of varying doses of sildenafil on the p50 of the oxygen–hemoglobin dissociation curve in blood samples from eight (8) healthy adult male volunteers with normal hemoglobin HbAA.MethodThe hemox‐analyzer was used to generate the p50 and the oxygen–hemoglobin dissociation curves.Main Outcome MeasuresThe effect of different doses of sildenafil on the p50 values and shift of the oxygen–hemoglobin curve were the main outcome measures.ResultSildenafil caused a statistically significant increase in the p50 values and rightward shift of the oxygen–hemoglobin dissociation curve.ConclusionSildenafil caused a dose‐dependent increase in the release of oxygen from the erythrocytes as shown by the increased p50 values and rightward shift of the oxygen–hemoglobin dissociation curve. Ellis SS and Pepple DJ. Sildenafil increases the p50 and shifts the oxygen–hemoglobin dissociation curve to the right. J Sex Med 2015;12:2229–2232.