Comparing forces on the fetal neck in breech delivery in lithotomy versus all-fours position: a simulation model.

PURPOSE: To measure forces applied to the fetal neck, in a simulation model for breech delivery, in both lithotomy versus all-fours position. METHODS: We used a Laerdal SimMom simulator and a Birthing Baby together with PROMPT Flex Software. The descent of the fetus was accomplished using the Automatic Delivery Module 2. The baby was always in breech position; the SimMom in either all-fours or lithotomy positions. Sensors were located inside the fetal neck region to simulate forces applied to the plexus. RESULTS: The lowest force on the fetal neck region was recorded for the delivery in all-fours position without further maneuvers (mean force 58.70 Newton, standard deviation 2.54 N). As weight was added to the baby, the force increased (i.e. + 500 g, mean force 71.8 N, SD 3.08 N, p < 0.001). Delivery in lithotomy position resulted in a mean force of 81.56 N (SD 19.55 N). The force significantly increased in case of delivery of the head without assistance from contractions (mean force 127.93 N, SD 23.10 N). In all-fours position, the delivery of the fetal head from pelvic floor level without contractions (Frank's Nudge maneuver) resulted in a mean force of 118.45 N (SD 15.48 N, p = 0.02). Maneuvers for shoulder dystocia (the inverted type that can occur during breech delivery) led to significantly higher mean forces independent from birthing positions. CONCLUSION: Breech delivery in all-fours position was associated with the lowest force acting on the fetal neck in our simulation model.

Candidate gene variants of the immune system and sudden infant death syndrome.

BACKGROUND: Sudden infant death syndrome (SIDS) causes early infant death with an incidence between 0.5 and 2.5 cases among 1000 live births. Besides central sleep apnea and thermal dysregulation, infections have been repeatedly suggested to be implicated in SIDS etiology. METHODS: To test the risk contribution of common genetic variants related to infection, we genotyped 40 single-nucleotide polymorphisms (SNPs) from 15 candidate genes for association with SIDS in a total of 579 cases and 1124 controls from Germany and the UK in a two-stage case control design. RESULTS: The discovery-stage series (267 SIDS cases and 303 controls) revealed nominally significant associations for variants in interleukin 6 (IL6) (rs1880243), interleukin 10 (IL10) (rs1800871, rs1800872), and mannose-binding lectin 2 (MBL2) (rs930506), and for several other variants in subgroups. Meta-analyses were then performed in adding genotype information from a genome-wide association study of another 312 European SIDS cases and 821 controls. Overall associations were observed for two independent variants in MBL2: rs930506 in a co-dominant model (odds ratio (OR) = 0.82, p = 0.04) and rs1838065 in a dominant model (OR = 1.27, p = 0.03). CONCLUSION: Our study did not replicate published associations of IL10 variants with SIDS. However, the evidence for two independent MBL2 variants in the combined analysis of two large series seems consistent with the hypothesis that infection may play a role in SIDS pathogenesis.

Fear of fertility side effects is a major cause for COVID-19 vaccine hesitance in infertile patients.

Introduction: This study aims to investigate the acceptance, hesitance and attitudes of infertile female patients toward the COVID-19 vaccination. Methods: An anonymous cross-sectional online survey was conducted between 28th of January to 10th of August 2022. The questionnaire consisted of 35 questions on demographics, COVID-19 vaccination status, prior concerns of the vaccinated participants and reasons for not vaccinating among unvaccinated participants, and factors influencing the decision not to vaccinate. Results: Of 406 participants who answered all questions, 92.1% reported having received at least one dose of COVID-19 vaccine, 7.9% were unvaccinated. Factors associated with the decision for vaccination were full time or part time employment (p = 0.05), high trust in the principle of vaccination (p < 0.001), high willingness for other vaccination during fertility treatment (p < 0.001) and risk factors for severe COVID-19 (p = 0.007). Concerns about directly occurring adverse effects after vaccination (42.0%), about impact on own fertility (21.9%) or on the fertility treatment (27.5%) were the main concerns beforehand of vaccinated participants. Correlations between fertility concerns and mistrust in the general principle of vaccination were found. Beside general health concerns, unvaccinated participants reported fears about fertility impairment as the most important arguments against a COVID-19 vaccination (median of 5.0 on a five-point-Likert scale). Conclusion: Both vaccinated and unvaccinated participants stated having concerns and fears about side effects of the COVID-19 vaccination on their fertility. To increase patients' trust in medical recommendations, such as vaccination, to avoid mistrust in the medical system and to maintain patient's compliance, there should be additional educational services that address infertile patients and their needs.