Double-balloon catheter for induction of labor in 362 women with and without prior cesarean section.

OBJECTIVE: Balloon catheter is the preferred method for induction of labor in women with prior cesarean section. We sought to evaluate the rate of vaginal delivery, induction-delivery time and outcome predictors after induction with double-balloon catheter. STUDY DESIGN: We conducted a retrospective cohort study including women with prior cesarean section undergoing induction of labor with a double-balloon catheter during the period January 2007-June 2014 at a large, tertiary Danish university hospital. For comparison, we included women with no prior cesarean section undergoing induction with double-balloon catheter after failed medical induction. Inclusion criteria were singleton pregnancy, an unfavorable cervix, intact membranes, cephalic presentation and either previous cesarean section or failed medical induction of labor. Exclusion criteria included contraindications for vaginal delivery, severe fetal malformation and stillbirth. Study subjects were identified in a local computerized system and data extracted from the medical records. RESULTS: Women with prior cesarean section (n = 304) induced with double-balloon catheter had a vaginal delivery rate of 50.3% (95% CI 44.7-55.9) compared to 51.7% (95% CI 39.2-64.1) in women with no prior cesarean section but preceding failed medical induction of labor (n = 58) (p = 0.85). BMI≥30 was associated with increased frequency of cesarean section. Median time from induction to vaginal delivery was 27.1(20.4-31.1) hours and 28.4(25.5-36.1) hours, respectively (p = 0.05). The rate of complete uterine rupture was 1.0%. CONCLUSIONS: Similar success rates of approximately 50% for vaginal delivery were observed after induction of labor with a double-balloon catheter in women with and without prior caesarean section. A BMI ≥ 30 was associated with an increased frequency of caesarean section.

Fatty Liver Among Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study).

OBJECTIVE: Intrauterine exposure to maternal type 1 diabetes is associated with a less favorable metabolic profile later in life. Nonalcoholic fatty liver disease is the hepatic manifestation of a cluster of metabolic abnormalities linked to insulin resistance. This study aimed to evaluate the effect of maternal pregestational type 1 diabetes on the presence of fatty liver in offspring and the association between maternal BMI, glycemic control during pregnancy, offspring metabolic risk factors, and offspring level of soluble CD163 (sCD163) (a marker of macrophage activation) and risk of fatty liver. RESEARCH DESIGN AND METHODS: This study was a prospective nationwide follow-up study of offspring (n = 278) of mothers with pregestational type 1 diabetes between 1993 and 1999 and matched control subjects (n = 303). Mean age at the time of follow-up was 16.7 years (range 13.0-20.4 years). We used the fatty liver index (FLI) and waist-to-height ratio (WHtR) to evaluate the presence of fatty liver among the offspring. An FLI ≥60 or WHtR >0.469 were used as cutoff points for fatty liver. RESULTS: More type 1 diabetes-exposed offspring had high FLI and WHtR indices compared with unexposed control subjects. We found significant associations between increasing maternal prepregnancy BMI, being born large for gestational age, offspring level of sCD163, as well as offspring metabolic risk factors (decreasing adiponectin and HDL cholesterol and increasing leptin, HOMA of insulin resistance, and HOMA of insulin secretion) and degree of fatty liver. CONCLUSIONS: Intrauterine exposure to maternal type 1 diabetes and higher maternal prepregnancy BMI may predispose to fatty liver in the offspring. Offspring metabolic risk factors, including sCD163 levels, are associated with indices of fatty liver.

Relationship between death and infections among patients hospitalized in internal medicine departments: a prevalence and validation study.

BACKGROUND: We assessed the burden of infection-related death at internal medicine departments in Denmark and the validity of 2 population-based registries for diagnoses of infection. METHODS: We reviewed medical records of all inpatients who died at a large university hospital during 2008 with an infection diagnosis in the Cause of Death Registry (CDR) or Hospital Discharge Registry (HDR). We computed the positive predictive value of infection diagnoses and completeness of each registry with 95% confidence intervals (CIs) and the prevalence of infection-related deaths by capture-recapture analysis. RESULTS: Among 458 deaths, 193 patients (42.1%) had an infection diagnosis of which 40.0% (183 out of 458) were verified. The positive predictive value of an infection diagnosis was 96.0% (95% CI, 92.0%-98.3%) in the CDR and 95.3% (CI, 90.9%-97.9%) in the HDR. Completeness of the CDR was 79.2% (CI, 72.9%-84.6%) and completeness of the HDR was 77.0% (CI, 70.6%-82.7%). By capture-recapture analysis we estimated that 43.2% of all deaths (198 out of 458) were related to infection. CONCLUSIONS: The large proportion of deaths in internal medicine departments that are related to infection emphasizes the need for optimized infection prevention and treatment strategies. CDR and HDR are valid sources for identifying infection and may supplement each other for increased completeness of infection-related death in epidemiologic research.