Update on Fetal Monitoring: Overview of Approaches and Management of Category II Tracings.

Electronic fetal monitoring (EFM) is widely used to assess fetal status in labor. Use of intrapartum continuous EFM is associated with a lower risk of neonatal seizures but a higher risk of cesarean or operative delivery. Category II fetal heart tracings (FHTs) are indeterminate in their ability to predict fetal acidemia.

Defining and Managing Normal and Abnormal First Stage of Labor.

Modern data have redefined the normal first stage of labor. Key differences include that the latent phase of labor is much slower than was previously thought and the transition from latent to active labor does not occur until about 6 cm of cervical dilatation, regardless of parity or whether labor was spontaneous or induced. Providers should have a low threshold to use one of the safe and effective interventions to manage abnormal progression in the first stage of labor, including oxytocin, internal tocodynamometry, and amniotomy.

Don't call me crazy! Delirium occurs outside of the intensive care unit.

Introduction: Delirium has been well studied among patients in the intensive care unit (ICU); however, data beyond the ICU is limited. The purpose of this study is to prospectively evaluate the incidence and associated risk factors for delirium in noncritical care areas (NCCA).

Methods: After institutional review board approval, a prospective cohort study was conducted at our urban Level I Trauma Center from December 2015 to February 2016.

New labor management guidelines and changes in cesarean delivery patterns.

Background: In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in cesarean delivery rates that may have occurred.

Umbilical Cord Oxygen Content and Neonatal Morbidity at Term.

Objective:  The objective of this study was to investigate the relationship between umbilical cord partial pressure of oxygen (pO) at delivery and neonatal morbidity.

Study Design:  This is a secondary analysis of a prospective cohort study of term deliveries with universal cord gas collection between 2010 and 2014. The primary composite outcome of neonatal morbidity included neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermia treatment.

Leaf surface traits and water storage retention affect photosynthetic responses to leaf surface wetness among wet tropical forest and semiarid savanna plants.

While it is reasonable to predict that photosynthetic rates are inhibited while leaves are wet, leaf gas exchange measurements during wet conditions are challenging to obtain due to equipment limitations and the complexity of canopy-atmosphere interactions in forested environments. Thus, the objective of this study was to evaluate responses of seven tropical and three semiarid savanna plant species to simulated leaf wetness and test the hypotheses that (i) leaf wetness reduces photosynthetic rates (Anet), (ii) leaf traits explain different responses among species and (iii) leaves from wet environments are better adapted for wet leaf conditions than those from drier environments. The two sites were a tropical rainforest in northern Costa Rica with ~4200 mm annual rainfall and a savanna in central Texas with ~1100 mm.

Reduced-dose C-arm computed tomography applications at a pediatric institution.

Background: Reduced-dose C-arm computed tomography (CT) uses flat-panel detectors to acquire real-time 3-D images in the interventional radiology suite to assist with anatomical localization and procedure planning.

Objective: To describe dose-reduction techniques for C-arm CT at a pediatric institution and to provide guidance for implementation.

Materials And Methods: We conducted a 5-year retrospective study on procedures using an institution-specific reduced-dose protocol: 5 or 8 s Dyna Rotation, 248/396 projection images/acquisition and 0.

Risky business? Investigating outcomes of patients undergoing urgent laparoscopic appendectomy on antithrombotic therapy.

Introduction: The literature regarding outcomes in patients on irreversible antithrombotic therapy (IAT) undergoing urgent laparoscopic appendectomy is limited. The aim of this multicenter retrospective study was to examine the impact of prehospital IAT on outcomes in this population.

Methods: From 2010 to 2014, seven institutions from the Southwest Surgical Multicenter Trials (SWSC MCT) group conducted a retrospective study to evaluate the clinical course of all patients on IAT who underwent urgent/emergent laparoscopic appendectomy.

Re-examining the arterial cord blood gas pH screening criteria in neonatal encephalopathy.

Objective: Screening criteria for neonatal encephalopathy remain a complex combination of subjective and objective criteria. We examine the utility of universal cord blood gas testing and mandatory encephalopathy evaluation for infants with pH ≤7.10 on umbilical cord arterial blood gas (cABG) as a single screening measure for timely identification of moderate/severe encephalopathy.

Early Second-Trimester Fetal Growth Restriction and Adverse Perinatal Outcomes.

Objective: To estimate the risk of adverse perinatal outcomes among women with isolated fetal growth restriction from 17 to 22 weeks of gestation.

Methods: This was a retrospective cohort study of all singleton, nonanomalous pregnancies undergoing ultrasonography to assess fetal anatomy between 17 and 22 weeks of gestation at a single center from 2010 to 2014. After excluding patients with fetal structural malformations, chromosomal abnormalities, or identified infectious etiologies, we compared perinatal outcomes between pregnancies with and without fetal growth restriction, defined as estimated fetal weight less than the 10th percentile for gestational age.

Monitoring the evolution and migration of a methane gas plume in an unconfined sandy aquifer using time-lapse GPR and ERT.

Fugitive methane (CH) leakage associated with conventional and unconventional petroleum development (e.g., shale gas) may pose significant risks to shallow groundwater.

Low-intensity Physical Activity is Associated with Lower Maternal Systemic Inflammation during Late Pregnancy.

Excessive maternal inflammation during pregnancy increases the risk for maternal and neonatal metabolic complications. Fortunately, maternal physical activity during pregnancy appears to reduce maternal inflammation. The purpose of this study was to examine the relationship between maternal physical activity intensity and maternal inflammation during late pregnancy.

Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments.

Objective: To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified.

Methods: Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing.

Results: In all, 51 problems were identified among the 36 incidents related to airway and/or breathing.

Spontaneous Labor Onset and Outcomes in Obese Women at Term.

Objective: The objective of this study was to compare the rates of spontaneous labor onset and its progression in obese and nonobese women after 37 weeks.

Study Design: We performed a secondary analysis of a retrospective cohort of all women who were admitted for delivery at ≥ 37 weeks of gestation at a university-based tertiary care center between 2004 and 2010. The cohort was stratified by weeks of gestation at which the patient presented for delivery.

Three-Dimensional Power Doppler Evaluation of Cerebral Vascular Blood Flow: A Novel Tool in the Assessment of Fetal Growth Restriction.

Objectives: To determine whether fetuses with fetal growth restriction (FGR) are more likely to have abnormal cerebral vascular flow patterns compared to fetuses who are appropriate for gestational age (AGA) when quantified by using 3-dimensional (3D) power Doppler ultrasound.

Methods: We conducted a prospective cohort study of singleton gestations presenting for growth ultrasound examination between 24 and 36 weeks' gestation. Patients with FGR (estimated fetal weight < 10th percentile) were enrolled and matched 1:1 for gestational age (±7 days) with AGA fetuses.

Delirium in the ICU: What About the Floor?

Delirium was first described in the 1800s as acute, fluctuating confusion. Recent studies note an incidence of 15% in adult intensive care unit patients. Here we present the first prospective study to evaluate the incidence and risk factors for delirium in patients admitted to the trauma surgeon (TS) in non-critical care areas (NCCAs).

Extracranial Aneurysms in 2 Patients with Autosomal Recessive Polycystic Kidney Disease.

Unlike autosomal dominant polycystic kidney disease (ADPKD), autosomal recessive polycystic kidney disease (ARPKD) is not generally known to be associated with vascular abnormalities. Only 4 cases of ARPKD patients with intracranial aneurysms have been reported previously. We present 2 ARPKD patients with extracranial vascular abnormalities: a young man with infrarenal aortic and iliac artery aneurysms complicated by dissection and a teenage girl with multiple splenic and gastric artery aneurysms and arterial vascular malformations.

Markers of maternal and infant metabolism are associated with ventricular dysfunction in infants of obese women with type 2 diabetes.

BackgroundTo test the hypothesis that infants born to obese women with pre-gestational type 2 diabetes mellitus (IBDMs) have ventricular dysfunction at 1 month that is associated with markers of maternal lipid and glucose metabolism.MethodsIn a prospective observational study of IBDMs (OB+DM, n=25), echocardiographic measures of septal, left (LV) and right ventricular (RV) function, and structure were compared at 1 month of age with those in infants born to OB mothers without DM (OB, n=24) and to infants born to non-OB mothers without DM (Lean, n=23). Basal maternal lipid and glucose kinetics and maternal plasma and infant (cord) plasma were collected for hormone and cytokine analyses.

Impact of evidence-based interventions on wound complications after cesarean delivery.

Background: A number of evidence-based interventions have been proposed to reduce post-cesarean delivery wound complications. Examples of such interventions include appropriate timing of preoperative antibiotics, appropriate choice of skin antisepsis, closure of the subcutaneous layer if subcutaneous depth is ≥2 cm, and subcuticular skin closure with suture rather than staples. However, the collective impact of these measures is unclear.

Impact of Preeclampsia on Clinical and Functional Outcomes in Women With Peripartum Cardiomyopathy.

Background: Preeclampsia is a risk factor for the development of peripartum cardiomyopathy (PPCM), but it is unknown whether preeclampsia impacts clinical or left ventricular (LV) functional outcomes. This study sought to assess clinical and functional outcomes in women with PPCM complicated by preeclampsia.

Methods And Results: This retrospective cohort study included women diagnosed with PPCM delivering at Barnes-Jewish Hospital between 2004 to 2014.

Delayed Umbilical Cord Clamping at <32 Weeks' Gestation: Implementation and Outcomes.

Objectives: This study aims to evaluate the implementation of a delayed umbilical cord clamping (DCC) protocol for neonates <32 weeks. Secondarily, to evaluate the impact of DCC on maternal outcomes and on the ability to obtain umbilical cord blood gases.

Study Design: Retrospective cohort study from November 2014 to March 2016 of patients delivered by 31 weeks.

Impact of fetal growth on pregnancy outcomes in women with severe preeclampsia.

Objective: To estimate whether pregnancy outcomes in women with severe preeclampsia (sPE) with small for gestational age (SGA) fetuses differ from those with sPE without SGA or isolated SGA.

Study Design: We conducted a retrospective cohort study of consecutive non-anomalous, livebirths in a single tertiary care institution from 2004 to 2008. We compared pregnancy outcomes in women who had sPE with SGA (birthweight<10th percentile), and sPE without SGA to those with isolated SGA as reference.

Comparison of nomograms predicting lymph node invasion in patients undergoing radical prostatectomy for prostate cancer.

Introduction: The aim of this study was to compare the performance of preoperative risk nomograms or detecting lymph node invasion in a cohort of men undergoing radical prostatectomy (RP).

Methods: A retrospective analysis was performed on all men (n = 145) who underwent RP between 2012 and 2015. Preoperative data was inputted to the Memorial Sloan-Kettering Cancer Centre (MSKCC), Partin 2011 and Briganti nomograms and the University of California San Francisco- Centre of the Prostate Risk Assessment tool (UCSF-CAPRA).