failure to progress
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Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1977
Author(s):  
Eun-Ju Kim ◽  
Ji-Man Heo ◽  
Ho-Yeon Kim ◽  
Ki-Hoon Ahn ◽  
Geum-Joon Cho ◽  
...  

Accurate prediction of failure to progress and rapid decision making regarding the mode of delivery can improve pregnancy outcomes. We examined the value of sonographic cervical markers in the prediction of successful vaginal delivery beyond 34 weeks of gestation. A retrospective chart review was carried out. Medical information of singleton gestations delivered at a single center from 1 July 2019 to 30 August 2020 was collected. Transvaginal sonographic records of cervical length, anterior and posterior cervical angles, and cervical dilatation were obtained and re-measured. The value of these markers and clinical characteristics of mother and baby on vaginal delivery were investigated and compared to women who underwent cesarean section. A total of 90 women met the inclusion criteria. The rate of vaginal delivery was 75.6%. There were no differences found in terms of maternal age, rate of abortion, induction of labor, premature rupture of membranes, preterm labor, hypertension, diabetes, cervical length, and neonatal sex and weight. The prediction of vaginal delivery was provided by parity, maternal body mass index, and posterior cervical angle. The area under the receiver operating characteristic curve for prediction of vaginal delivery was 0.667 (95% CI 0.581–0.864, p = 0.017) for the posterior cervical angle, with a cutoff of 96.5°. Regression analysis revealed a posterior cervical angle ≥96.5° in the prediction of vaginal delivery (adjusted odds ratio: 6.24; 95% confidence interval: 1.925–20.230, p = 0.002). Posterior cervical angle ≥96.5° is associated with successful vaginal delivery. It is simple and easy to measure and can be useful in determining the mode of delivery.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Oliver Luton ◽  
Osian James ◽  
Katie Mellor ◽  
Catherine Eley ◽  
Richard Egan ◽  
...  

Abstract Aim Core Surgical Training (CST) programs are associated with a 60% risk of burnout and failure to progress. This study aimed to assess the influence of a novel Enhanced Stress and Resilience Training (ESRT) course delivered alongside a focused induction at the start of CST in a single UK Statutory Education Body. Method All CST1s were invited to participate in a six-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. Primary outcome measures were compliance with ESRT programme and degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. Results Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate (63.2%; male 13, female 11, median age 28 yr.) Burnout was identified in 23 trainees (60.5%) with no evident difference in baseline MBI scores between participants or not (p = 0.77, median 4 [0-11] vs. 4 [1-11]). MBI scores were comparable before and after ESRT in the intervention cohort (p = 0.63, median 4 [0-11] vs. 4 [1-10]). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas and time pressures related to academic curriculum demands. Despite these challenges, 22 (91.6%) considered the course valuable, 14 (58.3%) continued to use the techniques in daily clinical work there was and unanimous support to continue the program in future. Conclusion ESRT was feasible and further research is warranted to determine its medium-term efficacy.


2021 ◽  
Vol 1 (1) ◽  
pp. e31
Author(s):  
Sathyaseelan Arumugam ◽  
Emily Leivers ◽  
Ishmael Chasi

There is no clear guidance about the use of intraluminal rectal contrast combined with computerised tomography (CT) scan when assessing for anastomotic leak (AL) following colorectal resections. ALs most commonly manifest after post-operative day 5, presenting with fevers, abdominal pain, tachycardia and rising inflammatory markers. However, some patients with AL also present with subtle symptoms and failure to progress. CT with or without luminal contrast is the most commonly used investigation for diagnosis; however, there is no consensus on the best protocol. This case report highlights a need for having criteria, which include intra- and post-operative pointers when having a luminal contrast may aid diagnosis, in difficult cases. Studies show that routine contrast enema is not recommended, and furthermore, no gold standard investigation is available. This case report explores the need for a low threshold to use rectal contrast in CT in cases of prolonged ileus.


Author(s):  
Ijeoma C. Okwandu ◽  
Meredith Anderson ◽  
Debbie Postlethwaite ◽  
Aida Shirazi ◽  
Sandra Torrente

Abstract Objective To compare cesarean delivery rates and indications by race/ethnicity among nulliparous women with term, singleton, vertex presentation deliveries. Methods This is a retrospective cohort study of nulliparous women delivering term, singleton, vertex neonates at Kaiser Permanente Northern California from 1/1/2016 to 6/30/2017. Women with cesarean for elective, malpresentation, or previa were excluded. Multivariable logistic regression models adjusting for maternal, neonatal, and facility factors were used to assess the likelihood of cesarean by race/ethnicity. Further modeling was performed to examine odds of cesarean for the indications of failure to progress and fetal intolerance by race/ethnicity. Results The cohort of 16,587 racially/ethnically diverse women meeting inclusion and exclusion criteria consisted of 41.62% White, 27.73% Asian, 22.11% Hispanic, 5.32% Black, and 3.21% multiple race/other women. In adjusted logistic regression models, all race and ethnic categories had higher odds of cesarean deliveries in comparison to White women. Black women had the highest odds of cesarean delivery (adjusted OR [aOR] = 1.73, 95% CI: 1.45–2.06), followed by Asian (aOR = 1.59, 95% CI: 1.45–2.06), multiple race/other (aOR = 1.45, 95% CI: 1.17–1.80), and Hispanic (aOR = 1.43, 95% CI: 1.28–1.59) women. Compared with White women, Asian (aOR = 1.46, 95% CI: 1.22–1.74) and Hispanic (aOR = 1.25, 95% CI: 1.03–1.52) women had higher odds of failure to progress as the indication. Among women with failure to progress, Black (aOR = 0.50, 95% CI: 0.30–0.81), Hispanic (aOR = 0.68, 95% CI: 0.53–0.87), and Asian (aOR = 0.77, 95% CI: 0.61–0.96) women were less likely than White women to reach 10 cm dilation. Compared with White women, Black women were more likely to have cesarean delivery for fetal intolerance (aOR = 1.51, 95% CI: 1.10–2.07). Among women with fetal intolerance of labor, there were no significant differences by race/ethnicity for Apgar score or neonatal intensive care unit admission. Conclusions Race/ethnicity was significantly associated with the odds of cesarean and indication. All other race/ethnicity groups had higher odds of cesarean compared with White women. Compared with White women, Black women had greater odds of fetal intolerance as an indication, while Hispanic and Asian women had greater odds of failure to progress. Maternal, neonate, and facility factors for cesarean delivery did not explain the observed disparities in cesarean delivery rates.


2021 ◽  
Vol 14 (6) ◽  
pp. e242160
Author(s):  
Shanika Wijayanayaka ◽  
Abir Guha ◽  
Kanapathippillai Sivanesan ◽  
Mayooran Veerasingham

Extra-axial haemorrhage following epidural anaesthesia is extremely rare. We present the case of an 18-year-old G1P0 woman with Alport syndrome who had a ventouse delivery for failure to progress that was complicated by a postpartum tonic–clonic seizure. Clinically, and confirmed radiologically, the patient was found to have experienced an extra-axial haemorrhage (extradural and subdural haemorrhage) secondary to a cerebrospinal fluid leak caused by a dural puncture during epidural anaesthesia. Differentiating between postdural puncture headache, subdural haemorrhage and extradural haemorrhage can be extremely challenging, but it is important to consider these rare conditions when evaluating patients presenting with postpartum headache and seizure.


eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Duncan Greig ◽  
Jasmine Ono

Experiments on yeast cells that are hosts to a killer virus confirm that natural selection can sometimes reduce fitness.


2020 ◽  
Vol 13 (7) ◽  
pp. e234249
Author(s):  
Henry Armes ◽  
Sarah Anne Williams ◽  
Jonathan Dunne ◽  
Simon James Eccles

A female infant born at 41+6 weeks via emergency caesarean section due to failure to progress and maternal sepsis was found to have a small fibrous band connecting the upper and lower eyelids of the right eye. This was diagnosed as ankyloblepharon filiforme adnatum. The child was investigated for multisystemic malformations by the paediatric department, but none were found, and the partially fused right eyelid was dissected using microsurgical scissors to allow full opening of the eye. We summarise the management of a rare oculoplastic disorder.


Author(s):  
Bentolhoda Jafary ◽  
Lance Fiondella ◽  
Ping-Chen Chang

Checkpointing is a technique to back up work at periodic intervals so that if computation fails, it will not be necessary to restart from the beginning but will instead be able to restart from the latest checkpoint. Performing checkpointing operations requires time. Therefore, it is necessary to consider the tradeoff between the time to perform checkpointing operations and the time saved when computation restarts at a checkpoint. This article presents a method to model the impact of correlated failures on an application that performs a specified amount of computation and implements checkpointing operations at equidistant periods during this computation. We develop a Markov model and superimpose a correlated life distribution. Two cases are considered. The first assumes that reaching a checkpoint resets the failure distribution. The second allows the probability of failure to progress. We illustrate the approach through a series of examples. The results indicate that correlation can negatively impact checkpointing, necessitating more frequent checkpointing and increasing the total time required, but that the approach can still identify the optimal number of equidistant checkpoints, despite this correlation.


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