Risk factors for emergency caesarean section in planned vaginal breech delivery.

PURPOSE: To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term. METHODS: Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared. RESULTS: Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95 % CI 1.09-3.84; p = 0.025), nulliparity (OR 2.82; 95 % CI 1.87-4.25; p < 0.001), high birth weight (OR 1.17; 95 % CI 1.04-1.30; p = 0.006) and induction of labour (OR 1.56; 95 % CI 1.003-2.44; p = 0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58-83 %, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights >3250 g. Complication rates were low in the cohort. CONCLUSIONS: Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.

Serological testing for infectious diseases in pregnant women: are the guidelines followed?

QUESTIONS: Are the guidelines for serological testing in pregnancy followed, and are the results on hand on admission to the labour ward? METHODS: From 1.1.2007 to 31.12.2007, all patients' records were checked for serological analyses on admission to the labour ward. The serologies tabulated included tests for rubella, toxoplasmosis, hepatitis B, syphilis, HIV, varicella, cytomegalovirus infection (CMV) and parvovirus B19. RESULTS: A total of 723 pregnant women were included. Rubella and toxoplasmosis serologies were missing in 1.66% of cases, hepatitis B in 2.77%, syphilis in 12.72%, and HIV in 30.57%. Serological testing for varicella, CMV and parvovirus B19 were carried out in only about 10% of patients. We found that 95.81% of Swiss/Austrian/German patients were immune to rubella compared to 89.59% for patients from other origins. A total of 50.0% of Swiss/Austrian/German patients and 27.44% of patients from other origins were immune to toxoplasmosis. As for hepatitis B antibodies (0.25 vs. 1.26%) and syphilis (only 1 patient tested positive), no significant differences were found. HIV tests were negative for all patients. CONCLUSIONS: To sum up, in our collective, serologic testing for rubella, toxoplasmosis and hepatitis B is carried out in almost all pregnant women. The high rate of women not screened for HIV infection clearly contradicts the recommendations of the Federal Office of Public Health and calls for increased education of physicians.

Expression of the BCRP gene (ABCG2/MXR/ABCP) in childhood acute lymphoblastic leukaemia.

The breast cancer resistance protein (BCRP), also known as mitoxantrone resistance protein (MXR) or placenta ABC protein (ABC-P), is the second member of the ABCG subfamily of ABC transport proteins (gene symbol ABCG2). BCRP has been detected in acute myeloid leukaemia and in breast, colon and gastric cancer but there has been no reports regarding BCRP expression in acute lymphoblastic leukaemia (ALL). We report the first results of BCRP expression in childhood ALL. Sixty-seven children (47 initial stage, 20 relapses) with ALL were analysed for BCRP gene expression by TaqMan real-time polymerase chain reaction. The expression of BCRP in mononuclear cells obtained from the bone marrow (BM) and peripheral blood (PB) of healthy donors was also investigated. There was no relationship between BCRP expression and age, sex, initial blast cell count, prednisolone response or BM response on d 15 and 33. Patients with T-lineage ALL showed a lower expression of BCRP (P = 0.044). Kaplan-Meier analysis of the relapse-free interval showed no prognostic significance of BCRP expression when different levels of BCRP expression were used as cut-off points. No significant difference in expression of BCRP mRNA was measured between initial-stage and relapsed-stage ALL or between normal MNC obtained from BM and ALL patients. The results indicate a low expression of BCRP in childhood ALL. Relationships between BCRP and clinical, molecular or in vivo resistance characteristics of the patients were not observed.