Twin-to-twin delivery time: neonatal outcome of the second twin.

OBJECTIVE: To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome. METHODS: We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH(art)), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II. RESULTS: A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH(art) or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH(art) of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638). CONCLUSION: Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.

[Preventive medical check-ups during pregnancy in Austria]. / Vorsorgeuntersuchungen in der Schwangerschaft in Osterreich.

The basis of the preventive medical management during pregnancy in Austria is the mother-child pass which documents all examinations serving to monitor the normal course of pregnancy. Progress during the last few years has shown that regular medical preventive check-ups during pregnancy demonstrably lead to a reduction of maternal and fetal morbidity and mortality. The aim of these preventive pregnancy check-ups is--in addition to the registration of high-risk pregnancies which need an intensified supervision--the earliest identification possible of pregnancy-induced diseases in order to be able to monitor and treat them adequately. In Austria, these medical check-ups during pregnancy are required for the mother to receive the full child care benefit also from the 21st month of life onwards. For this, 5 prenatal preventive check-ups are absolutely necessary. In addition, ultrasound examinations between the 18th and 22nd and between the 30th and 34th weeks of pregnancy are recommended. Any further tests, like ultrasonography during the 1st trimester, nuchal translucency screening, combined test, invasive diagnostics (amniocentesis, chorionic villus sampling) or the oral glucose tolerance test, are not part of the current concept of prevention according to the mother-child pass; however, they are an option in the case of certain indications or at the request of the expectant mother.

Breast metastasis 56 months before the diagnosis of primary ovarian cancer: a case study.

BACKGROUND: Breast metastasis of ovarian cancer is rare. A patient with a breast tumor which turned out to be a metastasis as the first clinical manifestation of a primary ovarian cancer diagnosed 56 months later is described. CASE REPORT: A 72-year-old patient presented with a palpable mass in the right breast. Lumpectomy was performed and primary breast cancer was excluded. Histology confirmed a poorly differentiated adenocarcinoma. However, further examination showed no evidence of extramammary primary malignancy. Fifty-six months later, a multicystic pelvic lesion with irregular septa was found. Laparotomy showed a tumor of the right adnexa. The final pathology confirmed the diagnosis of a primary serous ovarian carcinoma. The paraffin blocks of both tumors were reevaluated and showed that the cytological atypia and the immunohistochemical profiles [cytokeratin (CK) 5/6, CK 17, gross cystic disease fluid protein (GCDFP)-15 / BRST-2, estrogen- and progesterone receptor, cancer antigen (CA)125, Wilms tumor (WT-1), tumorsuppressor gene p53, MIB-1 (proliferation marker)] were similar in both the breast and the ovarian specimens. CONCLUSION: To our knowledge, this is the first report of a breast metastasis preceding the diagnosis of primary ovarian cancer by several years.

Pacifier use: what makes mothers change their mind?

AIM: To find out the reasons for mothers to either use or not use a pacifier and to find out the mother's reasons for changing their mind. METHOD: We analysed the data of 174 mother-infant pairs by means of a semistructured questionnaire performed shortly after birth, and at the age of 7 weeks and 5 months, respectively. RESULTS: The main reason for mothers primarily refusing a pacifier was their concern about malformation of the teeth or jaw. Until the end of the fifth month, 31% of the mothers changed their mind about pacifier use. Mothers primarily refusing a pacifier introduced a pacifier due to the need of soothing the infant. Mothers, who initially intended to use a pacifier, changed their mind due to rejection by the infant. The prevalence of pacifier use at the age of 5 months was 78%. The majority of mothers (69%) introduced the pacifier during the first week of life. CONCLUSION: About one third of mothers had changed their mind about pacifier use, either because of rejection by the infant or the need of settling. Breastfeeding mothers require more and better information concerning the appropriate time of pacifier onset.