Brain tumour diagnostics using a DNA methylation-based classifier as a diagnostic support tool.

AIMS: Methylation profiling (MP) is increasingly incorporated in the diagnostic process of central nervous system (CNS) tumours at our centres in The Netherlands and Scandinavia. We aimed to identify the benefits and challenges of MP as a support tool for CNS tumour diagnostics. METHODS: About 502 CNS tumour samples were analysed using (850 k) MP. Profiles were matched with the DKFZ/Heidelberg CNS Tumour Classifier. For each case, the final pathological diagnosis was compared to the diagnosis before MP. RESULTS: In 54.4% (273/502) of all analysed cases, the suggested methylation class (calibrated score ≥0.9) corresponded with the initial pathological diagnosis. The diagnosis of 24.5% of these cases (67/273) was more refined after incorporation of the MP result. In 9.8% of cases (49/502), the MP result led to a new diagnosis, resulting in an altered WHO grade in 71.4% of these cases (35/49). In 1% of cases (5/502), the suggested class based on MP was initially disregarded/interpreted as misleading, but in retrospect, the MP result predicted the right diagnosis for three of these cases. In six cases, the suggested class was interpreted as 'discrepant but noncontributory'. The remaining 33.7% of cases (169/502) had a calibrated score <0.9, including 7.8% (39/502) for which no class indication was given at all (calibrated score <0.3). CONCLUSIONS: MP is a powerful tool to confirm and fine-tune the pathological diagnosis of CNS tumours, and to avoid misdiagnoses. However, it is crucial to interpret the results in the context of clinical, radiological, histopathological and other molecular information.

Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries.

OBJECTIVE: To use intrapartum sonography as a tool to investigate the development of the persistent occiput posterior position during labor, as well as to identify parameters correlating with the outcome of labor. METHODS: A prospective study of 408 women in labor after 37 weeks' gestation with a singleton fetus in a vertex position using sonography at the onset of labor was performed. Fetal position, placental location, and maternal BMI (body mass index) were recorded. Outcome of labor was monitored for all relevant parameters. RESULTS: Most (68%) of persistent occiput posterior positions develop through a malrotation during labor from an initially occipitoanterior position. Only 32% of persistent cases were occipitoposterior (dorsoposterior) at the onset of labor; operative interventions were required in 87.5% of these. Of the 61 (15%) occipitoposterior positions at the onset of labor, 53 (87%) rotated into an occiput anterior position. Persistent occiput posterior position was more common in the initially occipitoposterior group (P < 0.01, Fisher exact test), and posterior placental locations were fewer (z test, P = 0.05). Also, operative deliveries were more common in the group remaining occipitoposterior throughout labor (P < .01, Fisher exact test). A higher maternal BMI correlated with neonatal weight (P < .01, Pearson correlation), an increase in operative deliveries (P = .032, Pearson correlation), lower Apgar scores at 1 minute (P = .02, Spearman correlation), and increase in posterior placental locations (P = .037, two-tailed t test). CONCLUSION: In most cases, persistent occiput posterior position develops through a malrotation and only in a little more than one-third of cases through absence of rotation from an initially occipitoposterior position. Higher maternal BMI correlates with higher fetal weight, increased operative deliveries, lower Apgar scores at 1 minute, and posterior placental locations. Intrapartum sonography proved to be useful in investigating the development of the persistent occipitoposterior position.

Anterior placental location predisposes for occiput posterior presentation near term.

325 sonographies were performed in singleton pregnancies past 36 weeks with the fetus in a vertex position in order to examine a possible association between placental localization and occiput posterior presentation (OP). OP was found in 11.6% of all cases. The distribution of the placental locations in the OP group differed significantly from the occiput anterior (OA) group. Also, an anterior placental location was seen significantly more often in the OP group.

[Effects of persistent occiput posterior presentation on mode of delivery]. / Einwirkung der persistierenden hinteren Hinterhauptslage auf den Geburtsverlauf.

In this study of 2437 deliveries, 119 (4.9%) took place in the occiput posterior position (OP). Only 33.9% of these did not require any operative intervention, versus 82% in the occiput anterior group (OA). The total duration of labor and the duration of the second stage were significantly longer in the OP group. The Apgar scores of the newborns at 1 minute and 5 minutes were significantly lower in the OP group. Episiotomies and perineal tears were more frequent in the OP group, but the difference was not significant.

Persistent occiput posterior presentation--a clinical problem.

In order to find out how often labor is complicated by persistent occiput posterior position, (OPP), and how it affects the course and outcome of labor, the records of 3648 deliveries were reviewed, a frequency of 4.7% was found. Also, the amount of operative deliveries was surprisingly high, less than half of these cases were delivered without operative intervention. Total duration of labor, stage II of labor were both significantly longer in the OPP group. The children in the OPP group also were significantly heavier (79 g) than the average birthweight in the whole material.

Use of obstetric forceps in Finland today--experience at Vaasa Central Hospital 1984-1998.

BACKGROUND: Forceps delivery has become rare in Finland since the introduction of the vacuum extractor. Our aim was to survey the number of forceps deliveries in Finland and analyze our own material of 130 forceps deliveries during a 15-year period between 1984 and 1998. During this period there were 17,887 deliveries at Vaasa Central Hospital. METHODS: A retrospective study of 130 forceps deliveries and 11 trial forceps cases, which subsequently resulted in a cesarean section. RESULTS: There was no maternal or neonatal mortality. In 39 cases a cesarean section could be avoided by use of forceps after a failed vacuum extraction. Only in one case was maternal morbidity regarded as serious. There was no serious neonatal morbidity. Anal sphincter ruptures occurred in three cases (2.3%). All the women in the trial forceps group were nulliparous, in 73% of these the fetus was in a persistent occipito-posterior position. Failed vacuum extraction and trial forceps did not significantly influence neonatal outcome. CONCLUSIONS: Forceps delivery appears to be a safe alternative in our setting.