[Delivery during time of shift change is not a risk factor for obstetric complication: a historical cohort study].

BACKGROUND: The time of shift change is a unique time because the continuity of routine care is interrupted. The association between delivery during time of shift change and obstetric complications has not been evaluated. OBJECTIVE: We hypothesized that delivery during time of shift change is at risk for obstetric complications. METHODS: A historical cohort study was performed of all women with a singleton pregnancy undergoing a trial of labor at term during 2006-2010. Data was extracted from a computerized database that is continuously updated during Labor. The hour of delivery was divided into two categories: "morning shift" (09:30-15:00) and "time of shift change" which was defined 30 minutes prior to and 90 minutes past the official time of shift change, which occurs twice daily at 07:30 and 15:30. Multivariate logistic regression models were implemented to estimate the association between deliveries during "time of shift change" compared to "morning weekdays", with instrumental delivery (primary outcome) and prolonged second stage, unplanned cesarean section, postpartum hemorrhage, 5 minutes Apgar score < 7, admission to neonatal intensive care unit (NICU) and prolonged maternal hospitalization (secondary outcome). RESULTS: A total of 16,341 deliveries were included in the cohort. No statistical difference in instrumental vaginal delivery was documented for women delivering during "time of shift change compared to morning shift weekdays (OR = 0.96, 95% CI: 0.83- 1.11, p = 0.605). None of the secondary outcomes were found at risk for women delivering during "time of shift change". CONCLUSIONS: Delivery during "time of shift change" does not pose additional risk for obstetric complications.

Cardiomyopathy and Pregnancy: Considerations for Women With Severely Reduced Left Ventricular Dysfunction.

Women with dilated cardiomyopathy or left ventricular (LV) dysfunction (LV ejection fraction [LVEF] < 40%) from other etiology are at increased risk of maternal and fetal mortality and morbidity. They should undergo preconception evaluation, risk assessment, and treatment modification including discontinuation and replacement of contraindicated medications. A close follow-up and treatment by a multidisciplinary team is recommended at all stages: preconception, gestation, delivery, and postpartum. An early gestational and delivery plan has to be prepared to face complications and to achieve a successful delivery and outcome. Long-term postpartum cardiac follow-up is recommended anticipating potential adverse effects of pregnancy. The recommended mode of delivery for most patients is vaginal. The indications for cesarian section are mainly obstetric, unless the patient is in severely decompensated heart failure or urgent delivery if the patient is receiving warfarin therapy. Cardiac events during pregnancy or in the first months postpartum occur in 32%-60% of patients. Prepregnancy signs of heart failure, atrial fibrillation, and New York Heart Association functional classification (NYHA FC) > II were associated with a poor cardiac outcome. Predictors of deterioration during pregnancy that are considered very high risk and should be advised to avoid pregnancy are: patients with NYHA FC III/IV unless improved under treatment and LVEF < 20%. Predictors for high risk of adverse outcome include: LVEF < 30%, NYHA FC II, ventricular tachyarrhythmias (including patients with implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator),atrial fibrillation with rapid ventricular rate, severe mitral regurgitation, significant right ventricular failure, and hypotension. Overall, despite a high rate of complications, most women with LV dysfunction can undergo a successful pregnancy.

Care for infants born at 23 weeks gestational age: 5 years' experience from a large medical center.

OBJECTIVES: Assessing parental choice regarding care of infants born at 23 weeks' gestation. METHODS: Neonatal records review. RESULTS: During 2010-2014, of 26 births (33 infants), 13 families (17 newborns) conceded comfort care only with no survivors, while 13 families (16 babies) requested full medical care and three survived. With birth year, gender, multi-fetal pregnancy, assisted reproductive technology, religious background and specialization of physician counseling at delivery as independent variables, none significantly affected parental decision; yet, that decision impacted outcome. CONCLUSIONS: Parental choice regarding infants born at 23 weeks' gestation cannot be predicted from demographics; counseling should concentrate on local experience/outcome.

The pattern of Protease Activated Receptor 1 (PAR1) expression in endometrial carcinoma.

OBJECTIVE: Protease Activated Receptors (PARs) form a family of G-protein-coupled proteins uniquely activated by proteolytic cleavage. While the role of either soluble or matrix-immobilized protease in tumor invasion is well established, the part of cell surface PARs is beginning to emerge. We sought to investigate the expression pattern of Protease Activated Receptor 1 (hPar1) in endometrial carcinoma, the most common type of gynecological malignancy. METHODS: Tissue biopsy specimens taken from seventy-four formalin-fixed, paraffin-embedded endometrial tissue blocks were obtained from archival material. Analysis of PAR1 expression was evaluated by riboprobe in situ hybridization for detection of RNA and immunohistochemistry techniques for localization of protein. Histological scoring was performed. RESULTS: The levels of hPar1 mRNA and protein were high and abundant in high-grade endometrial carcinoma, regardless of the histological subtype. In contrast, no hPar1 was detected in endometrial epithelia with conserved glandular structure represented by normal, hyperplastic or low-grade carcinomas. CONCLUSIONS: PAR1 over-expression is selectively confined to the highly aggressive, high-grade endometrial carcinoma and absent in tissue obtained from benign endometrium or low-grade endometrial cancer. This finding highlights the significance of hPar1 gene involvement in invasive endometrial carcinoma and appoints it an attractive candidate for anti-cancer therapy.