Comparison of chlorhexidine-isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery.

BACKGROUND: Prevention of surgical-site infection (SSI) has received increasing attention. Clinical trials have focused on the role of skin antisepsis in preventing SSI. The benefit of combining antiseptic chlorhexidine with alcohol has not been compared with alcohol-based skin preparation alone in a prospective controlled clinical trial. METHODS: Between August and October 2014, patients undergoing abdominal surgery received preoperative skin antisepsis with 70 per cent isopropanol (PA). Those treated between November 2014 and January 2015 received 2 per cent chlorhexidine with 70 per cent isopropanol (CA). The primary endpoint was SSI on postoperative day (POD) 10, which was evaluated using univariable analysis, and a multivariable logistic regression model correcting for known independent risk factors for SSI. The study protocol was published in the German Registry of Clinical Studies (DRKS00011174). RESULTS: In total, 500 patients undergoing elective midline laparotomy were included (CA 221, PA 279). The incidence of superficial and deep SSIs was significantly different on POD 10: 14 of 212 (6·6 per cent) among those treated with CA and 32 of 260 (12·3 per cent) in those who received PA (P = 0·038). In the multivariable analysis, skin antisepsis with CA was an independent factor for reduced incidence of SSI on POD 10 (P = 0·034). CONCLUSION: This study showed a benefit of adding chlorhexidine to alcohol for skin antisepsis in reducing early SSI compared with alcohol alone.

Transvaginal sonography in the evaluation of hematometra. A report of two cases.

BACKGROUND: Transabdominal sonography is useful in the diagnosis of hematometra but may not provide information as to its cause. CASES: Two cases of postmenopausal bleeding were evaluated using both transabdominal and transvaginal sonography. Transabdominal sonography detected the presence of hematometra; transvaginal sonography detected the neoplastic lesions responsible for the hematometra. CONCLUSION: Transvaginal sonography is important in the evaluation of hematometra because it affords clear visualization of the endometrial cavity.

Cord-containing amniotic fluid pocket: a useful measurement in the management of oligohydramnios.

OBJECTIVE: To test the hypothesis that among patients with a low amniotic fluid (AF) index, those who have a large cord-containing AF pocket will have a lower risk for adverse perinatal outcome than women with a small cord-containing pocket. METHODS: Gravidas with an antepartum AF index no greater than 5 cm were studied prospectively. The vertical diameter of the single largest cord-containing pocket, which was excluded from the calculation of the AF index, was measured. Women with rupture of the membranes, multiple gestation, or fetal anomalies were excluded. RESULTS: Fifty-one women with gestational ages of 35-43 weeks were analyzed. Among 35 who had a cord-containing pocket of no more than 5 cm, eight (23%) had fetal distress necessitating operative delivery and eight neonates had cord arterial pH below 7.20. None of these complications occurred in the 16 women who had a cord-containing pocket above 5 cm (P < .05). The mean AF index (2.9 versus 2.8 cm) was not significantly different between the groups. CONCLUSION: Among women with a low AF index, a cord-containing pocket above 5 cm identifies a subgroup of women at lower perinatal risk compared with those with a smaller cord-containing pocket. The need for intervention may be reduced in women with a cord-containing pocket greater than 5 cm.

Maternal hydration increases amniotic fluid index.

Although adequate amniotic fluid (AF) volume is considered an important aspect of fetal well-being, the etiology of decreased AF volume is not well understood. A randomized blinded trial was designed to examine our hypothesis that maternal hydration would increase the AF index in women with low AF indexes. Women seen in our testing centers were randomized into control or hydration groups. The control group was instructed to drink their normal amount of fluid; the hydration group was instructed to drink 2 L of water, in addition to their usual amount of fluid, 2-4 hours before the post-treatment AF index. The women returned for the post-treatment AF index the same or following day. The mean post-treatment AF index was significantly greater in the hydration group (6.3 versus 5.1; P less than .01), as was the mean change in AF index (post-treatment AF index--pre-treatment AF index: 1.5 versus 0.31; P less than .01). These findings suggest that maternal oral hydration increases AF volume in women with decreased fluid levels.

Ambulatory tocodynamometry data interpretation: evaluating variability and reliability.

The inter- and intra-observer variabilities of interpretation of uterine activity monitoring data were determined from the interpretations of 20 ambulatory tocodynamometry records by nine physicians and nurses. The presence of contractions lasting less than 40 seconds or presenting at a frequency of fewer than four per hour was associated with significantly reduced accuracy of interpretation. The reliability was 70% with one observer, 82% with two observers, and 88% with three observers. Higher variability and lower reliability values were obtained for interpretation of low-amplitude, high-frequency contractions. Understanding the limitation of uterine activity data interpretation should help in the clinical management of monitored patients.

A new technique for reduction of prolapsed fetal membranes for emergency cervical cerclage.

A new method to replace fetal membranes that have prolapsed through an incompetent cervix, which includes overfilling of the urinary bladder, was successful in four consecutive patients who presented with this clinical entity.

Measurement of fetal shoulder width with computed tomography in diabetic women.

We conducted a feasibility study of the use of computed tomography (CT) to measure the width of the fetal shoulders and to predict large birth weight in infants of diabetic mothers. Computed tomography pelvimetry using low-dose digital radiographs was performed before delivery at term in 22 diabetic women. Shoulder width was estimated by direct electronic measurement on a single axial section through the shoulders of the fetus, and by orthopedic calipers within 48 hours of birth. Shoulder width by CT was 11.4-16.5 cm, and correlated significantly with postnatal measurements (r = 0.66, P = .01). Shoulder width by CT also correlated well with birth weight (r = 0.84, P less than .01), and measured more than 14 cm in all seven infants with birth weights more than 4200 g. Using 14 cm as a positive test and birth weight 4200 g as an abnormal result, the predictive value of a positive test was 78% and the predictive value of a negative test was 100%. This technique deserves further evaluation in assessing the risk of shoulder dystocia in potentially macrosomic infants.