Measurement of subpubic arch angle by three-dimensional transperineal ultrasound and impact on vaginal delivery.

OBJECTIVES: To assess whether antepartum measurement of the subpubic arch angle (SPAA) as a parameter of the bony pelvic outlet can predict vaginal delivery. METHODS: Between January 2007 and June 2011, 625 nulliparous women with a singleton pregnancy were recruited from the antenatal clinic to be interviewed and have a four-dimensional transperineal ultrasound examination. Ultrasound examinations were performed between 34 and 36 weeks of gestation. Volume ultrasound data were saved for offline analysis, blinded against all other data. The SPAA was measured in the axial plane and logistic regression analysis was used to examine the association between SPAA and outcomes of vaginal delivery vs Cesarean section in the second stage of labor, and normal vs assisted vaginal delivery. The association between SPAA and the duration of second stage of labor was also analyzed. RESULTS: Of the 625 women recruited initially, 14 ultrasound data files could not be retrieved, providing a total of 611 ultrasound images for measurement of SPAA. Complete obstetric and ultrasound data were obtained from 593 patients. Mean SPAA was 109.3° (range, 65.6-131.6°). There was no association between SPAA and the odds of a vaginal delivery (odds ratio, 1.01 (95% CI, 0.97-1.06)). However, there was evidence of an association between SPAA and duration of second stage of labor within the subgroup of women with a normal vaginal delivery (cause-specific hazard ratio, 1.02 (95% CI, 1.01-1.03); P = 0.003). CONCLUSIONS: SPAA is not useful for predicting vaginal delivery; however, there is an association between this parameter and the duration of the second stage of labor.

[Need for nursing care among infants of Turkish and non-Turkish origin. An analysis of registry data of the medical service of the statutory health insurance in Westphalia-Lippe, Germany, 2004-2008]. / Pflegebedürftigkeit bei türkischstämmigen und -nicht-türkischstämmigen Säuglingen. Eine Analyse der Pflegegutachten des MDK Westfalen-Lippe von 2004 bis 2008.

BACKGROUND AND AIM: Infants of mothers with an immigrant background experience poorer health outcomes than infants in Germany as a whole. The aim of this study was to investigate whether differences exist in diagnoses leading to long-term nursing care among infants of Turkish vs. non-Turkish background. METHODS: We analysed records of the medical service of the statutory health insurance of the region Westphalia-Lippe, 2004-2008. We used a name algorithm to identify cases with Turkish migrant background. RESULTS: There were 1 107 applications for long-term nursing care, 141 of which concerned infants of Turkish origin. "Inborn malformations, deformities and chromosomal abnormities" was more often the reason for application among non-Turkish infants, "Certain conditions which have their origin in the perinatal period" were twice as common among Turkish as compared to non-Turkish infants. CONCLUSIONS: Our results do not support the -assumption that mothers of Turkish origin more often apply for long-term nursing care due to malformations of their infant than other mothers.

[The length of hospital stay in patients with acute coronary syndrome is reduced by establishing a chest pain unit]. / Reduktion der stationären Verweildauer bei Patienten mit akutem Koronarsyndrom durch Einrichtung einer Chest Pain Unit.

BACKGROUND: Providing prompt and appropriate therapy, combined with the increased economic requirements of treating patients with acute coronary syndrome (ACS), places high demands on the emergency department. The aim of the present analysis is to evaluate to what extent establishing a dedicated chest pain unit (CPU) influences the length of hospital stay in ACS patients. METHODS: Patients presenting with suspected ACS between 05/2004 and 05/2006 to either the emergency department (ED) or the newly established CPU were retrospectively analyzed. The CPU became functional in July 2005. Data were obtained according to standardized procedures based on patient charts and all available clinical information. RESULTS: A total of 247 patients were treated in the ED and 765 in the CPU. In the ED patient group 29 (11.7%) were diagnosed with ST elevation myocardial infarction (STEMI), 38 (15.4%) with non-ST elevation myocardial infarction (NSTEMI) and 15 (6.1%) with unstable angina pectoris (UAP), while ACS could be excluded in 165 (66.8%) patients. Patients treated in the CPU showed a higher percentage of ACS with 75 (9.8%) STEMI, 128 (16.7%) NSTEMI and 136 (17.8%) UAP patients; ACS could be excluded in 426 (55.7%) patients. The median length of hospital stay was shorter in ACS patients treated in the CPU at 5.0 days compared to 8.0 days if admitted to the ED (p<0.001). No difference in length of hospital stay was observed in UAP patients, whereas in STEMI patients admitted to the ED the time was longer at 8.0 days compared to 7.0 days if admitted to the CPU (p=0.042). A reduction from 8.0 to 6.0 days in the length of hospital stay if admitted to the CPU compared to the ED could be observed (p=0.002) in NSTEMI patients. CONCLUSIONS: Establishing a chest pain unit with optimized diagnostic and structural processes is associated with reduced lengths of hospital stay in patients with ACS treated according to current guidelines and recommendations.