The influence of hours worked prior to delivery on maternal and neonatal outcomes: a retrospective cohort study.

Background: Long continuous periods of working contribute to fatigue, which is an established risk factor for adverse patient outcomes in many clinical specialties. The total number of hours worked by delivering clinicians before delivery therefore may be an important predictor of adverse maternal and neonatal outcomes.

Objective: We aimed to examine how rates of adverse delivery outcomes vary with the number of hours worked by the delivering clinician before delivery during both day and night shifts.

Weekend working: a retrospective cohort study of maternal and neonatal outcomes in a large NHS delivery unit.

Objectives: Mandatory weekend working for NHS consultants is currently the subject of intense political debate. The Secretary of State for Health's proposed 7-day contract policy is based on the claim that such working patterns will improve patient outcomes. We evaluate this claim by taking advantage of as-if-at-random presentation of women for non-elective deliveries throughout the week.

Factors associated with adverse clinical outcomes among obstetrics trainees.

Objectives: This study was conducted to determine whether UK obstetrics trainees transitioning from directly to indirectly supervised practice have a higher likelihood of recording adverse patient outcomes in operative deliveries compared with other indirectly supervised trainees, and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial practice under indirect supervision.

Methods: We examined all deliveries (13 856) conducted by obstetricians at a single centre over 6 years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss (EBL), maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly supervised year with those for trainees in all other years of indirect supervision.

Maternal and fetal outcomes following unplanned conversion to general anesthetic at elective cesarean section.

Objective: To investigate risk factors predicting unplanned conversion to general anesthesia during elective cesarean section, and to examine maternal and fetal outcomes associated with unplanned conversion compared with other modes of anesthesia.

Study Design: A retrospective cohort at a UK center (2008 to 2013). Women (4337) underwent elective cesarean section.

Management of fetal malposition in the second stage of labor: a propensity score analysis.

Objective: We sought to determine the factors associated with selection of rotational instrumental vs cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments vs cesarean delivery.

Study Design: We conducted a retrospective cohort study over a 5-year period in a tertiary United Kingdom obstetrics center. In all, 868 women with vertex-presenting, single, liveborn infants at term with persistent malposition in the second stage of labor were included.

Factors influencing the likelihood of instrumental delivery success.

Objective: To evaluate risk factors for unsuccessful instrumental delivery when variability between individual obstetricians is taken into account.

Methods: We conducted a retrospective cohort study of attempted instrumental deliveries over a 5-year period (2008-2012 inclusive) in a tertiary United Kingdom center. To account for interobstetrician variability, we matched unsuccessful deliveries (case group) with successful deliveries (control group) by the same operators.

Accuracy of nuchal translucency measurement depends on equipment used and its calibration.

Objectives: To determine the effect of different ultrasound machine-probe combinations on nuchal translucency (NT) measurements and to assess how this impacts on the accuracy of the NT-derived component of first-trimester screening for trisomy 21.

Methods: Sixteen different ultrasound machine-probe combinations were used for axial measurement of 2.0-, 3.

The impact of national guidance for anomaly screening and invasive testing: unintended consequences.

Recent guidance from the UK National Screening Committee (NSC) and the Fetal Anomaly Screening Programme (FASP) has led to important changes in prenatal ultrasound diagnosis and invasive testing. These relate to prenatal ultrasound investigation of what were previously known as 'soft markers' for Down's syndrome at the time of the detailed anomaly scan and as to whether full karyotype or FISH (fluorescent in situ hybridisation)/QFPCR (quantitative fluorescence PCR) testing for trisomies should be carried out when an invasive test is performed. Neither recommendation is directly related to the other but both in combination could have profound implications for the detection of chromosomal abnormalities other than trisomy 21 (Down's syndrome).

A case of recurrent spontaneous pneumothorax during pregnancy treated with video assisted thoracoscopic surgery.

Pneumothorax during pregnancy is uncommon. Recently ambulatory chest drainage has been advised to treat the pneumothorax and to cover the delivery period. This imposes restrictions on the mother with associated co-morbidity.

The NTplus method of screening for Down syndrome: achieving the 2010 targets?

Introduction: The performance of pregnancy-associated plasma protein-A (PAPP-A) as a first trimester trisomy 21 marker is hypothesized to improve below 11 weeks, whereas beta-human chorionic gonadotrophin (hCG) is better after 14 weeks. We audited a model combining early PAPP-A (9-10 weeks) with NT (11-13 weeks and 6 days) and early triple test (>14 weeks).

Methods: A total of 1507 women with viable ongoing pregnancies were screened during 2007-2008.

Vasoactive and permeability effects of vascular endothelial growth factor-165 in the term in vitro dually perfused human placental lobule.

Vascular endothelial growth factor (VEGF) is an important vasodilator and effector of permeability in systemic blood vessels. Molecular and tissue culture techniques have provided evidence for its placental synthesis and release. Using an in vitro dual-perfusion model of the term placental lobule from normal pregnancy, we report here the relative secretion of total VEGF, soluble VEGF receptor (VEGFR)-1, and free VEGF into the maternal and fetoplacental circulations of the placenta.

The receptor for advanced glycation end products (RAGE) is elevated in women with preeclampsia.

A leading theory of the pathophysiology of preeclampsia is that oxidative stress induces vascular endothelial cell dysfunction. Advanced glycation end products (AGEs) form when aldose sugars react nonenzymatically with proteins under conditions of oxidative stress. AGEs are circulating molecules and can generate reactive oxygen species and vascular dysfunction (in diabetes and atherosclerosis) through an association with cell surface receptors (RAGE).

The effects of vascular endothelial growth factor on endothelial cells: a potential role in preeclampsia.

Objectives: Preeclampsia is primarily a disorder of the maternal endothelium. An as yet unidentified circulating factor causes widespread alteration in endothelial function, and levels of vascular endothelial growth factor are elevated in preeclampsia. We hypothesized that vascular endothelial growth factor is involved in the alteration of endothelial function and set out to find further evidence for this contention.

Plasma from women with pre-eclampsia induces an in vitro alteration in the endothelium-dependent behaviour of myometrial resistance arteries.

Objective: To compare the in vitro effect of plasma from normal pregnant women and women with pre-eclampsia on the endothelium-dependent behaviour of myometrial resistance arteries from normal pregnant women.

Design: An in vitro comparative study.

Setting: Nottingham City Hospital.

VEGF via VEGF receptor-1 (Flt-1) mimics preeclamptic plasma in inhibiting uterine blood vessel relaxation in pregnancy: implications in the pathogenesis of preeclampsia.

Preeclampsia is a multisystem disorder characterized by hypertension and proteinuria. There is accumulating evidence that this is a disease of the endothelium, with an as-yet unidentified circulating factor, or factors, causing the observed alteration in vascular function. We previously reported that the function of myometrial vessels is altered on exposure to plasma from women with preeclampsia.

Preeclampsia: the endothelium, circulating factor(s) and vascular endothelial growth factor.

It has been proposed that endothelial cell activation is the primary event in the multisystem disorder of preeclampsia. Evidence for endothelial involvement in this condition abounds. The best-characterized morphologic abnormality of this syndrome, glomerular endotheliosis, involves endothelial cells.

Activation of endothelial cells by plasma from women with preeclampsia: differential effects on four endothelial cell types.

Objective: To compare the ability of plasma from a population of women with preeclampsia and a population of plasma from women with normal pregnancies to activate four different endothelial cell types.

Methods: The secretion of nitrite and 6-keto prostaglandin F1 alpha by four endothelial cell types (isolated from the microvasculature of human decidua and skin, as well as a human umbilical vein endothelial cell line and a bovine coronary microvascular cell line) was assessed following a 24-hour incubation with plasma samples from the two groups.

Results: Nitrite production (an indicator of nitric oxide release) was detectable in only the decidual endothelial cells and the bovine microvascular endothelial cells (B-88), whereas 6-keto prostaglandin F1 alpha (stable metabolite of prostacyclin) was detectable in all cells.