Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss.

Miscarriage is generally defined as the loss of a pregnancy before viability. An estimated 23 million miscarriages occur every year worldwide, translating to 44 pregnancy losses each minute. The pooled risk of miscarriage is 15·3% (95% CI 12·5-18·7%) of all recognised pregnancies. The population prevalence of women who have had one miscarriage is 10·8% (10·3-11·4%), two miscarriages is 1·9% (1·8-2·1%), and three or more miscarriages is 0·7% (0·5-0·8%). Risk factors for miscarriage include very young or older female age (younger than 20 years and older than 35 years), older male age (older than 40 years), very low or very high body-mass index, Black ethnicity, previous miscarriages, smoking, alcohol, stress, working night shifts, air pollution, and exposure to pesticides. The consequences of miscarriage are both physical, such as bleeding or infection, and psychological. Psychological consequences include increases in the risk of anxiety, depression, post-traumatic stress disorder, and suicide. Miscarriage, and especially recurrent miscarriage, is also a sentinel risk marker for obstetric complications, including preterm birth, fetal growth restriction, placental abruption, and stillbirth in future pregnancies, and a predictor of longer-term health problems, such as cardiovascular disease and venous thromboembolism. The costs of miscarriage affect individuals, health-care systems, and society. The short-term national economic cost of miscarriage is estimated to be £471 million per year in the UK. As recurrent miscarriage is a sentinel marker for various obstetric risks in future pregnancies, women should receive care in preconception and obstetric clinics specialising in patients at high risk. As psychological morbidity is common after pregnancy loss, effective screening instruments and treatment options for mental health consequences of miscarriage need to be available. We recommend that miscarriage data are gathered and reported to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development.

Klassisk barnsängsfeber existerar fortfarande - 9 fall bland anmälningar till LÖF under 2010­2014.

Puerpural fever still exist. A rare condition that must be kept in mind All 33 claims to the Swedish National Patient Insurance (LÖF) in 2010-2014 related to obstetric infections, of which 14 were due to endometritis, were examined. Nine women suffered from fulminant infections consistent with classical puerperal fever (childbed fever), 2 of which were life-threatening. They occurred unexpectedly, mainly after uncomplicated deliveries, and were usually caused by Group A streptococci. Five women suffered from endometritis with a mild or moderate clinical course. All occurred after early birth-related complications and were caused by low-virulent bacteria. In order for an infection to occur in a healthy woman who undergoes normal delivery, more virulent bacteria appear to be required. Since these bacteria may exist in the hospital environment, improved hygiene routines are a prerequisite for reducing the number of nosocomial infections.

Outpatient post-partum antibiotic prescription: method of identification of infection control areas demanding improvements and verification of sensitivity of infection registration.

OBJECTIVES: To evaluate data on outpatient antibiotic use in women post-labour as a potential method of monitoring infections in this group of patients. METHODS: Demographic and antibiotic prescription data originated from the registries of the National Health Fund (pol. Narodowy Fundusz Zdrowia). The measure of antibiotic use in this study was the percentage of women who purchased the drugs from prescriptions and DDDs. RESULTS: Among 67917 females who gave birth in the years 2013-14, 5050 (7.4%) purchased antibiotics prescribed by the obstetrician only. The average number of antibiotics bought per person was equivalent to ∼14 DDDs; in most cases (95.7%) these were ß-lactams. Antibiotic use occurred significantly more frequently among younger patients (11.5% patients <18 years of age), those living in rural areas (8.2%) and those who underwent Caesarean section (8.1%). No significant differences were found between the reported day of labour and the post-partum use of antibiotics. CONCLUSIONS: Antibiotic prescribing data can be used to verify/complement the information originating from hospital infection registries to monitor rates of infection in obstetric patients.

Economic Evaluation of Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.

OBJECTIVE: To compare the costs associated with adjunctive azithromycin compared with standard cefazolin antibiotic prophylaxis alone for unscheduled and scheduled cesarean deliveries. METHODS: A decision analytic model was created to compare cefazolin alone with azithromycin plus cefazolin. Published incidences of surgical site infection after cesarean delivery were used to estimate the baseline incidence of surgical site infection in scheduled and unscheduled cesarean delivery using standard antibiotic prophylaxis. The effectiveness of adjunctive azithromycin prophylaxis was obtained from published randomized controlled trials for unscheduled cesarean deliveries. No randomized study of its use in scheduled procedures has been completed. Cost estimates were obtained from published literature, hospital estimates, and the Healthcare Cost and Utilization Project and considered costs of azithromycin and surgical site infections. A series of sensitivity analyses were conducted by varying parameters in the model based on observed distributions for probabilities and costs. The outcome was cost per cesarean delivery from a health system perspective. RESULTS: For unscheduled cesarean deliveries, cefazolin prophylaxis alone would cost $695 compared with $335 for adjunctive azithromycin prophylaxis, resulting in a savings of $360 (95% CI $155-451) per cesarean delivery. In scheduled cesarean deliveries, cefazolin prophylaxis alone would cost $254 compared with $111 for adjunctive azithromycin prophylaxis, resulting in a savings of $143 (95% CI 98-157) per cesarean delivery, if proven effective. These findings were robust to a multitude of inputs; as long as adjunctive azithromycin prevented as few as seven additional surgical site infections per 1,000 unscheduled cesarean deliveries and nine additional surgical site infections per 10,000 scheduled cesarean deliveries, adjunctive azithromycin prophylaxis was cost-saving. CONCLUSION: Adjunctive azithromycin prophylaxis is a cost-saving strategy in both unscheduled and scheduled cesarean deliveries.

A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement.

BACKGROUND: Misperceptions persist that intrauterine device placement is related to pelvic infections and Chlamydia and gonorrhea testing results are needed prior to placement. OBJECTIVE: We sought to evaluate the relationship of Chlamydia and gonorrhea screening to pelvic infection for up to 2 years following placement of the levonorgestrel 52-mg intrauterine system. STUDY DESIGN: A total of 1751 nulliparous and multiparous females 16 to 45 years old enrolled in a multicenter trial designed to evaluate the efficacy and safety of a new levonorgestrel intrauterine system for up to 7 years. Participants had Chlamydia screening at study entry and yearly if they were age ≤25 years. Women also had baseline gonorrhea screening if testing had not been performed since starting their current sexual relationship. Those who changed sexual partners during the trial had repeated Chlamydia and gonorrhea testing. Intrauterine system insertion could occur on the same day as screening. Participants did not receive prophylactic antibiotics for intrauterine system placement. Investigators performed pelvic examinations after 12 and 24 months and when clinically indicated during visits at 3, 6, and 18 months after placement and unscheduled visits. Pelvic infection included any clinical diagnosis of pelvic inflammatory disease or endometritis. RESULTS: Most participants (n = 1364, 79.6%) did not have sexually transmitted infection test results available prior to intrauterine system placement. In all, 29 (1.7%) participants had positive baseline testing for a sexually transmitted infection (Chlamydia, n = 25; gonorrhea, n = 3; both, n = 1); 6 of these participants had known results (all with Chlamydia infection) prior to intrauterine system placement and received treatment before enrollment. The 23 participants whose results were not known at the time of intrauterine system placement received treatment without intrauterine system removal and none developed pelvic infection. The incidence of positive Chlamydia testing was similar among those with and without known test results at the time of intrauterine system placement (1.9% vs 1.5%, respectively, P = .6). Nine (0.5%) participants had a diagnosis of pelvic infection over 2 years after placement, all of whom had negative Chlamydia screening on the day of or within 1 month after intrauterine system placement. Infections were diagnosed in 3 participants within 7 days, 1 at 39 days, and 5 at ≥6 months. Seven participants received outpatient antibiotic treatment and 2 (diagnoses between 6-12 months after placement) received inpatient treatment. Two (0.1%) participants had intrauterine system removal related to infection (at 6 days and at 7 months after placement), both of whom only required outpatient treatment. CONCLUSION: Conducting Chlamydia and gonorrhea testing on the same day as intrauterine system placement is associated with a low risk of pelvic infection (0.2%). Over the first 2 years of intrauterine system use, infections are infrequent and not temporally related to intrauterine system placement. Pelvic infection can be successfully treated in most women with outpatient antibiotics and typically does not require intrauterine system removal. Women without clinical evidence of active infection can have intrauterine system placement and sexually transmitted infection screening, if indicated, on the same day.

Consequences and economics of metritis in Iranian Holstein dairy farms.

The objectives of this study were (1) to describe the risk factors, incidence, and productive and reproductive consequences of metritis in dairy cows, and (2) to estimate the financial losses associated with metritis using data gathered from 4 Holstein dairy farms in Isfahan, Iran. Calving records from March 2008 to December 2013, comprising 43,488 calvings, were included in the data set. The effects of metritis on productive and reproductive performance were analyzed using a mixed linear model for primiparous and multiparous cows separately and in an overall data set (all cows combined), whereas risk factors on metritis incidence were examined using a multivariable logistical regression model for the overall data set. The incidence of metritis per cow per year was 13.2% on average and ranged from 9.0 to 15.8%. Results of logistic regression analysis demonstrated that calving year, parity number, calving season, twinning, dystocia, and retained placenta were significantly associated with the occurrence of metritis, whereas previous metritis incidence did not show an association. Greatest odds of metritis occurred in first-parity cows that calved in winter and had retained placenta, twinning, and dystocia in recent years. A case of metritis significantly reduced the 305-d milk yield in primiparous and multiparous cows and overall, but had no significant effects on 305-d fat and protein percentages in either primiparous or multiparous cows. Overall, a case of metritis reduced 305-d milk yield by 129.8±41.5kg/cow per lactation. The negative reproductive effects due to metritis were smaller and nonsignificant for primiparous cows compared with multiparous cows. Overall, a case of metritis increased days open and number of insemination per conception by 16.4±1.2 and 0.1±0.0 per cow per lactation, respectively. Among the individual farms, metritis costs ranged from $146.4 to $175.7 with a mean of $162.3/case. The model to calculate metritis costs proposed here could be used to estimate economic losses for metritis in other developing countries, where farm productive and economic data are generally scarce.

Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting.

OBJECTIVE: To determine the best time to administer prophylactic antibiotics at Cesarean delivery in order to reduce the postoperative maternal infectious morbidity in a low resource setting. MATERIAL AND METHODS: One hundred term primigravidae with singleton pregnancy were recruited and randomly allocated to two equal groups. Each woman received 2 g intravenous Cefazoline. Women in Group I received it prior to skin incision while those in Group II had it immediately after cord clamping. We measured the following outcome parameters: (1) Surgical site wound infection; (2) Endometritis and (3) Urinary tract infection. RESULTS: There was no significant difference in any of the patients' characteristics between both groups. In Group I, three cases developed surgical site infections but four in Group II (p > 0.05). In Group I, the infected cases had Cesarean because of malpresentations while in Group II, two cases had Cesarean because of patients' request, one because of maternal heart disease and one due to intra-uterine growth restriction. Seven and nine cases had urinary tract infection in Groups I and II, respectively, (p > 0.05). CONCLUSION: Prophylactic antibiotic administration either prior to surgery or after cord clamping is probably equally effective in reducing the postoperative infectious morbidity after Cesarean in low resource settings.

Comparison of short versus long term antibiotic prophylaxis in elective caesarean section at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

AIMS AND OBJECTIVES: This study was to determine any significant difference between the incidence of infectious morbidity with the use of a 24 hour antibiotics regimen compared to a 7-day course of antibiotics following elective caesarean section using a cheap and easily available combination of Ampicillin/Cloxacillin and Metronidazole. PATIENTS AND METHODS: Two hundred patients planned to have elective caesarean section for various indications and who satisfied the inclusion criteria were enrolled in the study in two groups of 100 patients each between the period of January to June 2010. Patients were randomized to receive either Ampiclox as 4 intravenous doses of 1g stat and 500 mg each 6 hourly and Metronidazole as 3 intravenous doses of 500 mg each 8 hourly both for 24 hours or same combination intravenously for 48 hours and subsequent oral use for 5 days. RESULTS: The mean maternal age, parity, gestational age and indication for caesarean section were similar in the two groups of participants. There was no statistical difference in the incidence of febrile morbidity (17%/18%, p=0.852), urinary tract infection (6%/4%, p=0.196), wound infection (4%/3%, p=0.056) and endometritis (3%/2%, p=0.367). The mean cost of antibiotics per patient (N730/$4.65) in the short term prophylaxis group was half that of the long term prophylaxis group (N1, 540/$9.81). CONCLUSION: There was no difference in the incidence of infection related morbidity when short term prophylactic antibiotics was used at elective caesarean section compared to long term prophylactic antibiotics.

Horse species symposium: contagious equine metritis: an insidious threat to the horse breeding industry in the United States.

Contagious equine metritis (CEM) has given rise to international concern since it was first recognized as a novel venereal disease of equids in 1977 and the etiologic agent was identified as a previously undescribed bacterium, Taylorella equigenitalis. Horse industry concerns over CEM centered on the ease with which this bacterium could be disseminated, the significance of T. equigenitalis as a cause of short-term infertility in the mare, and the existence of the carrier state in the stallion and the mare. The first known outbreak of CEM in the United States was in Kentucky in 1978. The economic impact on the Thoroughbred industry in the state was substantial. Before 2008, additional small-scale outbreaks occurred in Missouri in 1979, Kentucky in 1982, and Wisconsin in 2006, nearly all attributed to the importation of carrier animals. On each occasion, appropriate measures were taken to eliminate the infection, resulting in the United States regaining its CEM-free status. With the exception of the 1978 occurrence in Kentucky, none of the subsequent outbreaks significantly affected the horse industry. That changed dramatically in 2008, however, after the discovery of a Quarter horse stallion in Kentucky that cultured positive. Subsequent investigations turned up 23 carrier stallions and 5 carrier mares belonging to 11 breeds and located in 8 states. Shipment of infective semen and indirect venereal contact in stallion collection centers through the use of contaminated fomites were major factors in the spread of T. equigenitalis. Trace-back investigations of some 1,005 exposed and carrier stallions and mares in 48 states have failed to identify the origin of this latest CEM event. Neither clinical evidence of CEM nor decreased pregnancy rates were reportedly a feature in infected or exposed mares. In light of these findings, there was some question of whether or not the considerable expense incurred in investigating the latest CEM occurrence was warranted. Regaining CEM-free status for the United States will present considerable challenges.

Pregnancy loss in dairy cows: the contributing factors, the effects on reproductive performance and the economic impact.

This study investigated the effects of the herd, cow parity, the insemination protocol and season on the incidence of pregnancy loss (PL) in dairy herds. Furthermore, we determined the downstream effects of PL on reproductive performance and its economic impact. The overall incidence rate of PL was 6.9% in 1,001 pregnant cows and its incidence peaked (p < 0.01) during the second trimester of gestation. GLIMMIX analysis revealed that cow parity was the important risk factor for the PL. The odds ratio showed that the likelihood of PL in cows with parities of 1 or 2 was decreased by 0.6 or 0.5 fold compared to the cows with a parity of 3 or higher. Following PL, the mean rate of endometritis was 23.2% and endometritis was more common (p < 0.05) when PL occurred during the third trimester than during the first and second trimesters. The mean culling rate was 46.4% and this did not differ with the period of PL. The overall mean intervals from PL to the first service and conception were 63.4 and 101.8 days, respectively. The mean interval from PL to first service was longer (p < 0.01) for cows with PL during the third trimester than for the cows with PL during the first and second trimesters. The economic loss resulting from each PL was estimated at approximately $2,333, and this was largely due to an extended calving interval and increased culling. These results suggest that cow parity affects the incidence of PL, which extends calving interval and causes severe economic loss of dairy herds.

Deciding on route of delivery for obese women with a prior cesarean delivery.

OBJECTIVES: This study was undertaken to estimate the vaginal birth after cesarean (VBAC) success rate, compare rates of infections in women attempting VBAC and those undergoing planned repeat cesarean, and compare the cost of these two plans of care for obese women. STUDY DESIGN: We performed a historical cohort analysis of singleton deliveries at >/=36 weeks' gestation in women with a body mass index 40 or greater and one prior cesarean delivery. Outcomes included rates of VBAC success and puerperal infections and mean cost of care. RESULTS: The cohort consisted of 122 mother-infant pairs, 61 each in the VBAC and cesarean groups. In the VBAC group, 57% (95% CI 45-70) of women were delivered vaginally. The VBAC group had higher rates of chorioamnionitis (13.1% vs 1.6%, P=.02), endometritis (6.6% vs 0%, P=.06), and composite puerperal infection (24.6% vs 8.2%, P=.01). Mean cost of care was similar for mothers ($4439 vs $4427, P=.95), infants ($1241 vs $1422, P=.49), and mother-infant pairs ($5680 vs $5851, P=.64). CONCLUSION: Compared with planned cesarean delivery, VBAC trials in obese women are three times as likely to be complicated by infection and do not result in reduced costs.

[Cesarean-associated complications: the importance of a scarcely justified use]. / Complicaciones asociadas a la cesárea: la importancia de un uso módicamente justificado.

Undoubtedly, cesarean section is one of the most important surgical procedures for solving obstetrical problems. However, the steady increase in its use might be reflecting a non-medically justified utilization. This work reviews the main complications associated to cesarean section and their effect on the health of mothers and their children. An additional objective is to highlight the importance of establishing clinical protocols aimed at identifying those cases in which a cesarean section should be practiced. The implementation of these guidelines might help to reduce the effect that factors such as preferences of medical personnel or women's demand exert upon the increase of cesarean section use.

Antimicrobial prophylaxis in pregnancy: a randomized, placebo-controlled trial with cefetamet-pivoxil in pregnant women with a poor obstetric history.

OBJECTIVE: This study was undertaken to measure the impact of a single oral dose of cefetamet-pivoxil on pregnancy outcome in a population with substantial rates of low birth weight and high prevalence rates of maternal infections. STUDY DESIGN: A total of 320 pregnant women with a poor obstetric history, defined as a history of low birth weight or stillbirth, were randomized to receive a single oral dose of 2 gm of cefetamet-pivoxil or a placebo at a gestational age between 28 and 32 weeks. Patients were assessed at delivery and 1 week post partum for pregnancy outcome, postpartum endometritis, human immunodeficiency virus-1 and gonococcal infections. RESULTS: A total of 253 (79%) women gave birth at the maternity hospital, of whom 210 (83%) attended the follow-up clinic. Overall, 18.1% of these pregnant women were human immunodeficiency virus-1 seropositive, whereas 9.5% had antibodies against Treponema pallidum. There was a significant difference between cefetamet-pivoxil- and placebo-treated women in infant birth weight (2927 gm vs 2772 gm, p = 0.03) and low birth weight (< 2500 gm) rates (18.7% vs 32.8%, p = 0.01, odds ratio 2.1, 95% confidence interval 1.2 to 3.8). The stillbirth rate was 2.2% in the cefetamet-pivoxil group and 4.2% in the placebo group (not significant). Postpartum endometritis was found in 17.3% in the intervention arm versus 31.6% in the placebo group (p = 0.03, odds ratio 2.2, 95% confidence interval 1.1 to 7.6). Neisseria gonorrhoeae was isolated from the cervix in 5 of 103 (4.9%) women in the intervention and in 14 of 101 (13.9%) in the placebo group (p = 0.04, odds ratio 3.2, 95% confidence interval 1.1 to 10.5). CONCLUSION: A single oral dose of cefetamet-pivoxil administered to pregnant women with a poor obstetric history seemed to improve pregnancy outcome in this population with high rates of maternal infections. Larger studies should be carried out to examine the public health impact, the feasibility, and the overall cost/benefit ratio of this intervention.

The effect of placental removal method on the incidence of postcesarean infections.

OBJECTIVE: Our purpose was to determine whether the incidence of postoperative endometritis and wound infection is associated with the method of placental removal at the time of cesarean section. STUDY DESIGN: Parturients undergoing cesarean delivery were prospectively randomized to have the placenta removed manually or spontaneously. Patients were excluded from participation if they had received intrapartum prophylactic antibiotics or had been determined to have chorioamnionitis. After delivery of the infant women in the manual group had the placenta extracted by the primary surgeon, whereas women in the spontaneous group had the placenta delivered by gentle traction on the umbilical cord. All study subjects received perioperative prophylactic antibiotics. The primary outcome variable was a postcesarean infection, defined as postecsarean endometritis or wound cellulitis requiring drainage and antibiotic therapy. RESULTS: A total of 333 women were enrolled in the investigation, with 165 assigned to the manual removal group and 168 allocated to have spontaneous removal. There were no statistically significant differences in mean gestational age, frequency or duration of ruptured membranes, frequency or duration of labor, or mean number of vaginal examinations between the two study groups. Postoperative infections occurred in 25 of 168 (15%) women in the spontaneous delivery group compared with 44 of 165 (27%) women in which the placenta was manually extracted (relative risk 0.6, 95% confidence interval 0.4 to 0.9, p = 0.01). Subset analysis of patients delivered with ruptured membranes similarly demonstrated a statistically significant reduction in the incidence of postoperative infections with spontaneous placental removal compared with manual extraction (20% vs. 38%, relative risk 0.5, 95% confidence interval 0.3 to 0.9, p = 0.02). There was a similar trend toward a reduction in postdelivery infections associated with spontaneous placental removal in women with intact membranes; however, this difference did not attain statistical significance. CONCLUSIONS: Spontaneous delivery of the placenta after cesarean delivery is associated with a decrease in the incidence of postcesarean infections.

Comparison of case-finding methodologies for endometritis after cesarean section.

BACKGROUND: Endometritis is a possible complication of delivery among patients undergoing cesarean section, resulting in increased costs and patient morbidity. However, traditional case-finding methods for endometritis may not identify most cases. We compared various case-finding methods with a reference method to determine a simple and accurate method for collecting data on endometritis after cesarean section. METHODS: We reviewed charts of all patients undergoing cesarean section (N = 167) during March 1 through July 31, 1991. These data were compared with study case-finding methods that used microbiology data, infection report forms from nursing, and computerized reports linking patients undergoing cesarean section with intravenous antibiotic use data and admission and discharge diagnoses. RESULTS: Each case-finding method was compared separately with the reference method ("gold standard"), which was designed to capture all cases among the patients in the study population (N = 145). This review yielded nine cases of endometritis (infection rate of 5.4/100 procedures). The computerized report method linking patients who underwent cesarean section with antibiotic use had a positive predictive value of 0.53. Methods that used microbiology data and nursing report forms had lower positive predictive values of 0.18 and 0.20, respectively. CONCLUSIONS: In our institution, case finding for postcesarean endometritis by means of a computerized report linking patients undergoing cesarean section with i.v. antibiotic use data and admission and discharge diagnoses is the most effective method of detecting postcesarean endometritis. It also represents the most efficient use of the infection control department's resources.

Morphologic assessment of endometrium overlying submucosal leiomyomas.

The effect of submucosal leiomyomas on endometrial structure in women with symptomatic clinical findings was studied retrospectively. The endometrial histology from 13 hysterectomies for uterine leiomyomas was examined using three 2-mm sections of endometrium (one overlying a submucosal leiomyoma and two without underlying leiomyomas). Endometrial thickness, gland number and appearance, vessel number and diameter, and stromal inflammation were assessed. The thickness of the myometrium between the leiomyoma and the overlying 2-mm section of endometrium analyzed was also evaluated. The control group consisted of seven nonmyomatous uteri removed for benign disease. Analysis of the endometrium with underlying submucosal leiomyomas identified two groups using endometrial gland number as the criterion for this division. Five cases (group A) were found to have no endometrial glands, while the remaining eight (group B) had an average gland number of 74.5 per 2-mm section of endometrium. The mean gland number for the control group was 82.6, showing no significant difference from group B. Group A had an average endometrial area (2-mm thickness) of 0.38 mm2, and group B had an average area of 4.47 mm2, for a significant difference (t = -3.76, P = .007). Comparison of the two groups with the control group (mean area, 4.71 mm2) showed a significant difference in endometrial area only with group A (t = -7.64, P < .0005). A significant difference (t = -2.93, P = .019) was observed in the analysis of the thickness of the myometrium between the leiomyoma and overlying endometrium between groups A (mean thickness, 0.53 mm) and B (mean thickness, 1.70 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of udder disorders on culling of dairy cows.

Data from a prospective longitudinal study carried out from 1986 to 1990 in 47 commercial Holstein dairy herds from western France were used to quantify the effects of udder health disorders on the risk of culling. Logistic regression was used to assess the relationship between 4 udder health disorders and early and late culling. Teat injuries were associated with an increased risk of early culling in the current and following lactations. Mastitis and high milk cell count were associated with an increased risk of late culling in the current and following lactations, respectively.

Evaluation of surgical staples in cesarean section.

Experience with Lactomer absorbable surgical staples (Auto Suture Poly CS 57 disposable surgical stapler) in 62 cesarean sections was compared with an equal number of operations performed with standard techniques. The technique of application of the stapler evolved with experience. Countertraction to staplers with Allis' clamps prevented uterine V incisions. Operative time was longer for the stapled suture group for primary cesarean sections, but was unchanged for repeat procedures. Excellent hemostasis of the uterine incision was achieved even when varicose sinusoidal veins were present. Significant reductions of hemoglobin deficits from 2.16 to 1.31 gm/dl, postoperative anemia from 29% to 6.4%, and endometritis from 22.5% to 6.4% occurred respectively in nonstapled and stapled groups. A reduced hospital stay, shortened by 2.1 days, saved each patient +F42950. Blood loss estimates by surgeons or anesthetists were often at variance. Surgeons' acceptance of the procedure grew with experience. On the basis of these results, use of absorbable staples offers certain advantages in reducing blood loss, infection, and hospital stay in cesarean deliveries.

Induction of parturition in cattle using dexamethasone and cloprostenol: economic performance and disease incidence after treatment.

Details are given of clinical management and disease problems associated with the routine induction of parturition on a herd basis, as well as the veterinary costs involved. A review of the economic performance of cows calved by this method is made and some guidelines laid down as to the conditions under which such a technique could be used as a management tool.