Delivery outcomes after day and night onset of labour.

OBJECTIVE: To describe the outcome of night onset of labour as compared with the day onset of labour to investigate if labour that begins at night is more efficient. DESIGN: Retrospective review of labour and delivery data. SETTING: A large United Kingdom maternity service. POPULATION: Over the period of 10 years, there were 30,022 deliveries, of which 19,842 were studied. METHODS: A United Kingdom maternity department database was used to identify deliveries over a 10-year period, and the delivery outcomes were retrieved from these records. The 19,842 labours were divided into two categories: night onset (22.00-06.00 h) and day onset (10.00-18.00 h). MAIN OUTCOME MEASURES: Rates of operative intervention, augmentation, epidural usage and labour duration. RESULTS: A significant difference in delivery outcome was noted (P=0.004) with the night-onset labours having more normal deliveries (83.6% vs. 82.5%), fewer caesarean sections (8.7% vs. 10.1%), fewer labour augmentations with syntocinon (14.9% vs. 19.5%, P<0.001), fewer artificial rupture of membranes (14.1% vs. 15.6% P<0.001) and a significantly shorter mean first stage duration (4 h 58 min vs. 5 h 7 min, P<0.05). The proportion of women from each group who delivered between 09.00 and 17.00 h was 3660 (31.1%) in the night-onset group and 2414 (30%) in the day-onset group (χ2=1.3, P=NS) Conclusions: Labours that start at night appear to be more efficient than labours that start during the day.

First-in-man experience of percutaneous aortic valve replacement using self-expanding corevalve prosthesis.

OBJECTIVE: Percutaneous aortic valve replacement is a new emerging method for nonsurgical replacement of aortic valve in patients with severe aortic stenosis. We report the first-in-man case of percutaneous aortic valve replacement with self-expanding Core Valve aortic prosthesis. METHODS AND RESULTS: The procedure was performed on 12 July 2004 on a 62 years patient with severe aortic stenosis (peak systolic gradients across aortic valve being 90 mm Hg), moderately severe aortic regurgitation and preserved left ventricular systolic function. The patient had associated morbidities like renal failure (raised blood urea nitrogen and serum creatinine levels) and end-stage carcinoma of lung. Valve implantation was performed under general anesthesia with extracorporeal support using the retrograde approach. The patient was adequately screened prior to the procedure. The device was implanted successfully with post implantation peak systolic gradient across aortic valve being only 16 mm Hg. However, this patient died after four days due to renal failure and bleeding diathesis leading to multiorgan failure. CONCLUSIONS: Percutaneous implantation of self-expanding CoreValve prosthesis in patients with severe aortic stenosis with or without aortic regurgitation is feasible. Long-term studies will determine its future.

Interventional therapy for multiple cardiac defects.

We describe a patient with a rare combination of coronary artery disease and congenital heart disease. The patient underwent successful complex and multivessel coronary angioplasty, balloon pulmonary valvuloplasty by the Inoue balloon and transcatheter closure of an atrial septal defect in a staged manner. It is technically feasible and safe to perform multiple interventions as an alternative to open heart surgery.