W Schöll

Rupture of endometriotic ovarian cyst causes acute hemoperitoneum in twin pregnancy

OBJECTIVE To present a case of an acute hemoperitoneum caused by a ruptured ovarian cyst in a late twin pregnancy. DESIGN Case report study. SETTING Department of Obstetrics and Gynecology, Medical University of Graz, Austria. PATIENT(S) A woman with a history of surgery for endometriosis and currently pregnant with dichorionic twins after IVF presented with acute abdominal pain. INTERVENTION(S) Serial ultrasound assessment revealed a massive hemoperitoneum that was caused by a ruptured endometriotic ovarian cyst. Emergency laparotomy was performed. MAIN OUTCOME MEASURE(S) Hemostasis. RESULT(S) Laparotomy led to operative hemostasis and preterm cesarean section of healthy twins at 27 weeks of gestation. CONCLUSION(S) Endometriosis occurs in about 10% of women of reproductive age and carries an infertility rate of up to 50%. Severe endometriosis used to be a rare event in patients with spontaneously conceived pregnancies. However, during the last decade, the increased use of assisted reproductive technologies has led to higher fertility rates in patients with endometriosis and to a higher incidence of multiple gestations. Therefore, the number of pregnant women with endometriosis and associated complications may rise.

Validation of a point-of-care (POC) lactate testing device for fetal scalp blood sampling during labor: clinical considerations, practicalities and realities.

Abstract Background: Although fetal blood sampling for pH is well established the use of lactate has not been widely adopted. This study validated the performance and utility of a handheld point-of-care (POC) lactate device in comparison with the lactate and pH values obtained by the ABL 800 blood gas analyzer. Methods: The clinical performance and influences on accuracy and decision-making criteria were assessed with freshly taken fetal blood scalp samples (n=57) and umbilical cord samples (n=310). Bland-Altman plot was used for data plotting and analyzing the agreement between the two measurement devices and correlation coefficients (R2) were determined using Passing‐Bablok regression analysis. Results: Sample processing errors were much lower in the testing device (22.8% vs. 0.5%). Following a preclinical assessment and calibration offset alignment (0.5 mmol/L) the test POC device showed good correlation with the reference method for lactate FBS (R2=0.977, p<0.0001, 95% CI 0.9 59–0.988), arterial cord blood (R2=0.976, p<0.0001, 95% CI 0.967–0.983) and venous cord blood (R2=0.977, p<0.0001, 95% CI 0.968–0.984). Conclusions: A POC device which allows for a calibration adjustment to be made following preclinical testing can provide results that will correlate closely to an incumbent lactate method such as a blood gas analyzer. The use of a POC lactate device can address the impracticality and reality of pH sample collection and testing failures experienced in day to day clinical practice. For the StatStrip Lactate meter we suggest using a lactate cut-off of 5.1 mmol/L for predicting fetal acidosis (pH<7.20).

Practicability of fetal scalp blood sampling during labor using microtubes and a point-of-care (POC) lactate testing device: difficulty assessment, sampling time and failure rates.

*Corresponding author: Philipp Reif, MD, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria, Phone: +43 316 385 80053, Mobile: +43 699 11883089, Fax: +43 316 681835, E-mail: philipp.reif@medunigraz.at Daniela Ulrich, Ioana Lakovschek, Carmen Tappauf, Uwe Lang and Wolfgang Schöll: Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria Letter to the Editor

Does a change in obstetric management influence the incidence of traumatic birth lesions in mature, otherwise healthy newborn infants?

Aim:  The incidence of lesions due to birth trauma can be generally regarded as a characteristic of obstetric management; since obstetric management has changed through the years, one might expect a decrease or increase of lesions due to birth trauma in mature newborn infants.

Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34+0 weeks of gestation.

Reduktion der operativen Entbindungsrate durch den Einsatz von Mikroblutuntersuchungen bei auffälligem CTG unter Berücksichtigung des Gestationsalters

Hintergrund/Fragestellung: Das Erkennen eines suspekten oder pathologischen CTGs lasst keine sichere Aussage uber das tatsachliche Vorliegen eines fetalen distress, bzw. das Ausmas der fetalen pH-Wert-Veranderungen zu. Ohne den Einsatz der Mikroblutuntersuchung muss das Auftreten von suspekten oder pathologischen CTG-Veranderungen eine raschest mogliche Geburtsbeendigung mittels vaginal-operativer Masnahme oder Kaiserschnitt nach sich ziehen. Diese Studie soll zeigen, wie viele Kaiserschnitte und vaginal-operative Entbindungen durch den Einsatz von Mikroblutuntersuchungen (MBU) bei suspekten oder pathologischen Geburts-CTGs verhindert werden konnen. Material und Methodik: Retrospektive Analyse des Geburtsmodus mittels deskriptiver Statistik an 669 Patientinnen im Zeitraum 2008–2009, bei denen bei suspektem oder pathologischem CTG eine Mikroblutuntersuchung durchgefuhrt wurde. Auserdem sollte untersucht werden, ob eine Abhangigkeit der MBU-Verteilung vom Gestationsalter besteht. Ergebnisse: Durch den Einsatz der Mikroblutuntersuchung konnte bei 6,4% der im Studienkollektiv eingeschlossenen Patientinnen mit suspektem oder pathologischem CTG, durch einen oder mehrere MBU-Werte im Normbereich, eine operative Entbindung verhindert werden. Weiters zeigt sich eine Haufung der Mikroblutuntersuchungen bei Gestationsaltern jenseits des Geburtstermins. Schlussfolgerung: Die fetale Mikroblutuntersuchung stellt ein effektives Hilfsmittel im geburtshilflichen Management dar und kann zur Reduktion der operativen Entbindungsrate beitragen. Das Risiko der Invasivitat des Eingriffs kann im Vergleich zur Reduktion der operativen Entbindungsrate als gering angesehen werden. Die Bereitschaft zur Durchfuhrung von Mikroblutuntersuchungen steigt mit Fortschreiten des Gestationsalters offensichtlich stetig an.