Objectives To compare the effect of delivering early to pre‐empt terminal hypoxaemia with delaying for as long as possible to increase maturity.
Design A randomised controlled trial.
Setting 69 ...hospitals in 13 European countries.
Participants Pregnant women with fetal compromise between 24 and 36 weeks, an umbilical artery Doppler waveform recorded and clinical uncertainty whether immediate delivery was indicated.
Methods The interventions were ‘immediate delivery’ or ‘delay until the obstetrician is no longer uncertain’. The data monitoring and analysis were Bayesian.
Main outcome measures ‘Survival to hospital discharge’ and ‘developmental quotient at two years of age’, this latter to be reported later.
Results Of 548 women (588 babies) recruited, outcomes were available on 547 mothers (587 babies). The median time‐to‐delivery intervals were 0.9 days in the immediate group and 4.9 days in the delay group. Total deaths prior to discharge were 29 (10%) in the immediate group versus 27 (9%) in the delay group (odds ratio 1.1, 95% CI 0.61–1.8). Total caesarean sections were 249 (91%) in the immediate group versus 217 (79%) in the delay group: (OR 2.7; 95% CI 1.6–4.5). These odds ratios were similar for those randomised at gestational ages above or below 30 weeks.
Interpretation The lack of difference in overall mortality suggests that clinicians participating in this trial were on average prepared to randomise at about the correct equivocal threshold between delivery and delay. However, there was insufficient evidence to convince enthusiasts for either immediate or delayed delivery that they were wrong.
To compare the effect of delivering early to pre-empt terminal hypoxaemia with delaying for as long as possible to increase maturity.
A randomised controlled trial.
69 hospitals in 13 European ...countries.
Pregnant women with fetal compromise between 24 and 36 weeks, an umbilical artery Doppler waveform recorded and clinical uncertainty whether immediate delivery was indicated.
The interventions were ‘immediate delivery’ or ‘delay until the obstetrician is no longer uncertain’. The data monitoring and analysis were Bayesian.
‘Survival to hospital discharge’ and ‘developmental quotient at two years of age’, this latter to be reported later.
Of 548 women (588 babies) recruited, outcomes were available on 547 mothers (587 babies). The median time-to-delivery intervals were 0.9 days in the immediate group and 4.9 days in the delay group. Total deaths prior to discharge were 29 (10%) in the immediate group
versus 27 (9%) in the delay group (odds ratio 1.1, 95% CI 0.61–1.8). Total caesarean sections were 249 (91%) in the immediate group
versus 217 (79%) in the delay group: (OR 2.7; 95% CI 1.6–4.5). These odds ratios were similar for those randomised at gestational ages above or below 30 weeks.
The lack of difference in overall mortality suggests that clinicians participating in this trial were on average prepared to randomise at about the correct equivocal threshold between delivery and delay. However, there was insufficient evidence to convince enthusiasts for either immediate or delayed delivery that they were wrong.
Ectopic pancreatic rests are rare. We report two cases discovered in infants who underwent surgical exploration of the umbilicus for persistent umbilical discharge with peri-umbilical excoriation. A ...shallow sinus leading to a firm cyst was excised in both infants, and histopathological study confirmed the presence of exocrine and endocrine pancreatic tissue. There is only one other case of ectopic umbilical pancreatic tissue reported, and this was in a patient presenting with an umbilical mass.
Laparoscopic ventrosuspension is simple to perform after diagnostic laparoscopy. Serious postoperative complication is unlikely. However, patient follow-up over 6 months has not confirmed the ...usefulness of laparoscopic ventrosuspension in the management of deep dyspareunia or pelvic pain in association with a retroverted uterus. The success rate of laparoscopic ventrosuspension at 6 months varies from 18.6% to 46.5%. The prior use of a Hodge pessary does not predict the success of laparoscopic ventrosuspension.
The case of a pregnant woman suffering a large placental abruption following electric shock at 32 weeks' gestation is reported. No other such cases have been published in the literature.
A case of intraglomerular metastases observed in a nephrectomy specimen removed for primary renal cell carcinoma is reported. The intraglomerular metastases arose by dissemination of malignant cells ...into the systemic circulation via invasion of the renal veins. Intraglomerular metastases are therefore an indicator of malignant dissemination which in turn should be associated with a poor prognosis. It is recommended that in nephrectomies undertaken for primary renal cell carcinoma at least one random block of renal cortex should be examined to confirm or exclude intraglomerular metastases.
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