WITHDRAWN: Soft versus rigid vacuum extractor cups for assisted vaginal delivery.

Background: The original cups used for vacuum extraction delivery of the fetus were rigid metal cups. Subsequently, soft cups of flexible materials such as silicone rubber or plastic were introduced. Soft cups are thought to have a poorer success rate than metal cups.

WITHDRAWN: Vacuum extraction versus forceps for assisted vaginal delivery.

Background: Proponents of vacuum delivery argue that it should be chosen first for assisted vaginal delivery, because it is less likely to injure the mother.

Objectives: The objective of this review was to assess the effects of vacuum extraction compared to forceps, on failure to achieve delivery and maternal and neonatal morbidity.

Search Strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register.

Continuous versus interrupted sutures for repair of episiotomy or second degree tears.

Background: Millions of women worldwide undergo perineal suturing after childbirth and the type of repair may have an impact on pain and healing. For more than 70 years, researchers have been suggesting that continuous non-locking suture techniques for repair of the vagina, perineal muscles and skin are associated with less perineal pain than traditional interrupted methods.

Objectives: To assess the effects of continuous versus interrupted absorbable sutures for repair of episiotomy and second degree perineal tears following childbirth.

Staged bilateral total hip arthroplasty using rough and smooth surface femoral stems with similar design: 10-year survivorship of 48 cases.

Background: Various studies have reported good long-term results using femoral stems with either smooth or rough surfaces. In this retrospective cross-sectional survivorship study, we reviewed the 10-year results of 51 bilateral staged cemented total hip arthroplasties using the Harvard or the Charnley femoral stems-which have almost similar geometry but a different surface finish.

Methods: 51 patients were reviewed at median interval of 10 (Harvard group) and 11 years (Charnley group) after the primary operation.

Improving the standards of care for women having caesarean sections.

Improvement in the uptake of prophylactic antibiotics at caesarean section was chosen as a priority at the 1994 ASQUAM (Achieving Sustainable Quality in Maternity) meeting. The interventions used were guidelines, cyclical audit of cases and a patient-specific reminder stamp in the notes. A more detailed qualitative assessment of standards of communication and outcome was undertaken on a smaller cohort of women.

Longitudinal trends in trauma mortality and survival in Stoke-on-Trent 1992-1998.

Objectives: To identify factors related to mortality and to test the null hypothesis of no longitudinal trend in mortality in patients admitted to the North Staffordshire Hospital (NSH) with an Injury Severity Score (ISS) greater than 15, between April 1992 and March 1998.

Design: Longitudinal prospective study of 18 factors, including age, sex, mechanism of injury, anatomical injury scores and year of admission. Outcome, based on mortality at discharge, was analysed in two ways: alive or dead at discharge (mortality) and time to death or discharge (survival).

Stent graft in managing juxta-renal aortoiliac occlusion.

Endovascular procedures are frequently used as an alternative to surgical bypass in aortic and iliac occlusion. Stents have revolutionized the scope of such endovascular procedures, but there are few reports of stents or stent grafts in occlusive juxta-renal aortic occlusion. We present a case where such occlusion was managed by use of a stent graft with successful outcome.

Pulmonary toxicity of cardiac drugs.

Pulmonary damage caused by the undesired effects of cardiac drugs is being increasingly recognized. With the symptoms of breathlessness, wheeze, cough and hemoptysis common to both cardiac and respiratory diseases, an adverse pulmonary reaction to a cardiac drug may be mistakenly attributed to deterioration of cardiac status. This is especially true if the onset of symptoms are subacute or chronic.

Randomized controlled trial of nebulized adrenaline in acute bronchiolitis.

Use of both l-epinephrine and racemic epinephrine (adrenaline) has improved clinical symptoms and composite respiratory scores in acute bronchiolitis. The objective of this randomized double-blind placebo-controlled study was to assess whether there was sufficient improvement in clinical state to reduce hospital admissions. Seventy-five infants aged 1 month to 1 year with a clinical diagnosis of acute bronchiolitis were treated with either 2 ml of 1:1000 nebulized adrenaline or 2 ml of nebulized normal saline administered after baseline assessment and 30 min later.

Recent advances in intubation and mechanical ventilation.

The ideal care of the critically ill infant or child should demonstrate a seamless service starting with recognition of potential critical illness and initiation of early resuscitative interventions, escalating to advanced life support and skilled transfer to an appropriate location where intensive care can be continued. This article discusses advances in the package of respiratory care commencing with the decision to provide respiratory support, which includes the decision whether or not to intubate, leading to the choice of mechanical ventilatory support mode in the critically ill child. Indications for intubation include protection of the airway, airway toilet and the need for positive pressure support.

The difference a day makes.

A patient attended a clinic requesting Depo Provera after emergency contraception. She gave a history of normal menstruation, but a pregnancy test proved positive. Subsequently an ectopic pregnancy was diagnosed.

MOET: Bangladesh--an initial experience.

Objectives: To summarize the quantitative and qualitative immediate assessments of the Managing Obstetric Emergencies and Trauma (MOET) course and to examine the individual changes in score obtained for each of the scenarios.

Methods: Students' knowledge before and after the course was evaluated with a standardized comprehensive questionnaire.

Results: All candidates showed an improvement in postcourse, compared to precourse, scores.

Randomised study of long term outcome after epidural versus non-epidural analgesia during labour.

Objective: To determine whether epidural analgesia during labour is associated with long term backache.

Design: Follow up after randomised controlled trial. Analysis by intention to treat.

Managing Obstetric Emergencies and Trauma (MOET) structured skills training in Armenia, utilising models and reality based scenarios.

Background: Mortality rates in Western Europe have fallen significantly over the last 50 years. Maternal mortality now averages 10 maternal deaths per 100,000 live births but in some of the Newly Independent States of the former Soviet Union, the ratio is nearly 4 times higher. The availability of skilled attendants to prevent, detect and manage major obstetric complications may be the single most important factor in preventing maternal deaths.

Plasma homocysteine is not a major risk factor for vascular disease in growth hormone deficient adults.

Objective: Several cardiovascular risk factors have been investigated in patients with adult growth hormone deficiency (GHD) to explain the observed increase in vascular mortality. Plasma homocysteine concentration has been identified recently as an independent risk factor for atherosclerosis. We wished to determine whether plasma homocysteine contributes to cardiovascular risk in adult GHD.

A randomised trial of an intervention package designed to promote external cephalic version at term.

Objective: To evaluate the effectiveness of an intervention package to promote external cephalic version (ECV).

Study Design: (1) Design and Setting--A randomised-controlled trial of 20 consultant-based maternity units in the West Midlands NHS Region. (2) Intervention Units--One consultant obstetrician from each unit was encouraged to promote changes in clinical practice within their unit.