bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Effects of Manual and Mechanical Airway Clearance Techniques on Intracranial Pressure in Patients With Severe Traumatic Brain Injury on a Ventilator: Randomized, Crossover Trial
Authors: Tomar Gaurav Singh , Singh Gyaninder Pal , Bithal Parmod , Upadhyay Ashish Datt , Chaturvedi Arvind 
Published: November 2018

Abstract

Background
Physical therapist intervention can play a significant role in the prevention of mechanical and infectious complications in patients with traumatic brain injury (TBI) who are mechanically ventilated.

Objective
The objective of this study was to observe and compare the effects of manual and mechanical airway clearance techniques on intracranial pressure (ICP) and hemodynamics in patients with severe TBI.

Design
The design was a prospective, randomized, crossover trial.

Setting
The setting was a neurointensive care unit at a level 1 trauma center.

Patients
Forty-six adult patients aged 18 to 75 years, of either sex, with severe TBI, receiving mechanical ventilatory support with continuous ICP monitoring, and undergoing regular airway clearance techniques participated in this study.

Intervention
Two techniques were performed by a single trained physical therapist. Treatment A was a manual chest percussion technique and treatment B used a mechanical chest wall vibrator. Each treatment was applied for 10 minutes alternately, separated by an interval of 4 hours.

Measurements
ICP was measured from the start of intervention to 10 minutes postintervention. Secondary measurements included cerebral perfusion pressure, heart rate, mean arterial pressure (each from the start of the intervention until 10 minutes postintervention at 1-minute intervals), and arterial blood gas parameters (from just before the start of the intervention and 10 minutes postintervention).

Results
The increases in mean (95% CI) intracranial pressure of 2.4 (1.4–3.4) and 1.0 (0.2–1.8) mmHg, during and after the intervention with treatment A, respectively, were statistically significantly higher than for treatment B, irrespective of sequence. In contrast, a mean heart rate rise of 6.4 (3.3–9.5) beats/min and mean arterial pressure rise of 5.3 (2.0–8.6) mmHg were significantly higher only during the intervention phase of treatment A compared with treatment B. Peak mean values of ICP, heart rate, and arterial pressure were also significantly higher during treatment A. However, mean values of cerebral perfusion pressure or its degree of change were statistically comparable in both treatment groups.

Limitations
Patients with high baseline ICP values (&gt;20 mmHg) were excluded, and, because of the crossover design, the effect of individual technique on final (long-term) neurological or respiratory outcomes could not be studied.

Conclusion
Manual chest percussion technique in patients with severe TBI was associated with statistically significant transient increases in ICP and hemodynamics, compared with the mechanical method. However, such transient increases in ICP by either technique were not clinically relevant in patients with moderate-to-severe TBI without intracranial hypertension on a mechanical ventilator.
H1N1 in the ‘A1 Empire’: Pandemic Influenza, Military Medicine, and the British Transition from War to Peace, 1918–1920
Authors: Harris James J 
Published: November 2018

Summary
The article reexamines the history of the 1918–19 influenza pandemic to better place it in its war-time context. Using Britain as a case study, the essay examines how British military medicine took a leading role in studying and developing a (still largely ineffective) public health response to the epidemic, whereas domestic public health leaders did almost nothing to stem the spread of the pandemic due to the impact measures such as quarantine would have had on the war effort. The article ends by briefly considering how the pandemic affected efforts to restore Britain to ‘normalcy’ during the immediate post-war recovery. In so doing, this essay further argues how it is essential to consider the deep connections between the Great War and the influenza pandemic not simply as concurrent or consecutive crises, but more deeply intertwined.
Snakebite Mitigation Project of the Madras Crocodile Bank/Centre for Herpetology, India: background and a brief summary of activities
Authors: Whitaker Romulus 
Published: November 2018

Abstract
Snakebite is a serious problem in rural India where several highly venomous species are commonly found in and around agricultural areas where prey such as rodents and amphibians are abundant. Four snake species, referred to as the Big Four, are responsible for the most serious and fatal bites: spectacled cobra (Naja naja), Russell’s viper (Daboia russelii), common krait (Bungarus caeruleus) and saw-scaled viper (Echis carinatus). A polyvalent antivenom is made to treat these bites but public awareness and distribution of this life-saving drug is inadequate. The Madras Crocodile Bank and its partners are conducting a snakebite project which includes venom sampling and research, snake and snakebite treatment centre mapping, and a nationwide awareness campaign for snakebite mitigation.
Safe Surgery Globally By 2030: The Essential Role of Anesthesia, The View From Obstetrics
Authors: Shaw D. , Christilaw J. , Munjanja S.P. 
Published: November 2018

(Anesth Analg. 2018;126:1109–1111)
Although meaningful progress has been made in reducing maternal mortality, the Millennium Development Goal of a 75% reduction in maternal mortality is still to be met, with many of the deaths occurring in low- and middle-income countries (LMICs). The authors of the present editorial discussed Global Surgery 2030, which was commissioned by the Lancet and published in 2015, to identify barriers to safe obstetric surgery, training anesthesia providers, providing regional versus general anesthesia, and the use of cesarean delivery in low-income countries (LICs).
Aspirin for the Prevention of Preterm and Term Preeclampsia: Systematic Review and Meta-Analysis
Authors: Roberge S. , Bujold E. , Nicolaides K.H. 
Published: November 2018

(Am J Obstet Gynecol. 2018;218(3):287–293)
Preeclampsia is a major contributor of maternal and fetal morbidity and death, especially in the case of preterm births. Numerous studies have investigated the effect of prophylactic aspirin in the prevention of preeclampsia; however, the results have been contradictory. This study aimed to evaluate the effect of aspirin in preventing preeclampsia at term and preterm in relation to gestational age at onset of treatment as well as the therapeutic dose.
Placenta Accreta Spectrum
Authors: Silver R.M. , Branch D.W. 
Published: November 2018

(N Engl J Med. 2018;378:1529–1536)
Placenta accreta spectrum, also known as morbidly adherent placenta, refers to an abnormal adherence of the placenta trophoblast to the uterine myometrium, which can lead to severe bleeding, multisystem organ failure, disseminated intravascular coagulation, need for admission to an intensive care unit, hysterectomy, and death. It results from the absence of a normal decidua basalis, usually from surgical trauma, and its incidence has increased during the past decades, along with increasing rates of cesarean delivery (increased by a factor of 8 since the 1970s). The potential for bleeding correlates with the degree to which the placenta has invaded the myometrium, the area of abnormal adherence involved, and the presence or absence of invasion into extrauterine tissues, such as the bladder or parametrial tissues. It is an important contributor to maternal mortality and morbidity in the United States.
Association of the Affordable Care Act Dependent Coverage Provision With Prenatal Care Use and Birth Outcomes
Authors: Daw J.R. , Sommers B.D. 
Published: November 2018

(JAMA. 2018;319(6):579–587)
Since 2010, young adults up to age 26 in the United States have been extended dependent coverage from their parent’s health insurance plans through the Affordable Care Act (ACA). Nearly one-third of births in the United States are to women between ages 19 to 25. These changes could lead to improved prenatal care use and neonatal outcomes, compared with uninsured women who become eligible for Medicaid pregnancy benefits. This study aimed to investigate whether this dependent coverage provision of the ACA was associated with changes in birth outcomes, utilization of prenatal care, or payment methods for birth.
Contribution of Maternal Age, Medical, and Obstetric History to Maternal and Perinatal Morbidity/Mortality for Women Aged 35 or Older
Authors: Morris J.M. , Totterdell J. , Bin Y.S. , Ford J.B. , Roberts C.L. 
Published: November 2018

(Aust N Z J Obstet Gynaecol. 2018;58:91–97)
Pregnancy at advanced maternal age (defined as 35 y or greater at the time of birth) is becoming more common due to advanced fertility and contraceptive techniques and changing sociocultural trends. Pregnancy complications have been reported to occur at a higher rate in these women, including fetal chromosomal abnormalities, gestational diabetes, and hypertensive disorders of pregnancy. It is established that chromosomal abnormalities are directly related to maternal age. The other complications, however, have also generally been attributed to advanced maternal age with limited consideration given to whether the women’s medical history and previous pregnancies might contribute to the increased risk of these complications. The goal of this study was to determine the frequency of severe maternal and perinatal morbidity and mortality in women of advanced maternal age, on the basis of preexisting medical conditions and prior pregnancy complications, and to assess whether maternal age independently affected the risk of adverse pregnancy outcomes.
Health Care Utilization, Induced Labour and Cesarean Section in the Pregnancy After Stillbirth: A Prospective Study
Authors: Gravensteen I.K. , Jacobsen E.M. , Sandset P.M. , Helgadottir L.B. , Rådestad I. , Sandvik L. , Ekeberg Ø. 
Published: November 2018

(BJOG. 2018;125:202–210)
In Norway, there are no national antenatal care guidelines concerning women with previous stillbirths. According to a recent international survey, pregnant patients who had previously delivered a stillbirth had additional ultrasounds and visits. Previous studies demonstrated increased rates of induced labor, preterm birth, forceps delivery, and cesarean delivery in pregnancies after unexplained stillbirth. The cause of these findings is unknown. This study aimed to investigate induced labor, cesarean delivery, and health care utilization in patients with a previous stillbirth and assess if anxiety and dread of childbirth may be possible causes of the increased cesarean rate and increased frequency of antenatal visits.
The Relationship Between Women’s Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study
Authors: Orbach-Zinger S. , Landau R. , Harousch A.B. , Ovad O. , Caspi L. , Kornilov E. , Ioscovich A. , Bracco D. , Davis A. , Fireman S. , Hoshen M. , Eidelman L.A. 
Published: November 2018

(Anesth Analg. 2018;126:1590–1597)
At the Beilinson Campus of the Rabin Medical Center in Petach Tikva, Israel, a proportion of women who intend to deliver with labor epidural analgesia (LEA) are often unable to receive it due to a lack of available nursing staff, labor rooms, or anesthesiologists at the time of request. As there is no study to date that has specifically examined the relationship between birth plan, satisfaction with LEA, and development of postpartum depression (PPD), the authors of the present study examined the impact of delivering without analgesia when such was not the intended plan. They hypothesized that the PPD rate at 6 weeks would be highest among women who intended to deliver with LEA but who actually delivered without.
Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study
Authors: Lim G. , Farrell L.M. , Facco F.L. , Gold M.S. , Wasan A.D. 
Published: November 2018

(Anesth Analg. 2018;126:1598–1605)
There is an established association between chronic pain and depression in nonobstetric populations. However, only a few studies in obstetric patients have examined the possible association between labor pain and postpartum depression (PPD), the latter of which places mothers and infants at risk for suicide, infanticide, and developmental/behavioral problems. Consequently, the authors of the present study assess whether or not the use of effective epidural analgesia during labor is associated with reduced PPD symptomatology.
Looking Beyond the Pain: Can Effective Labor Analgesia Prevent the Development of Postpartum Depression?
Authors: Toledo P. , Miller E.S. , Wisner K.L. 
Published: November 2018

(Anesth Analg. 2018;126:1448–1450)
There is emerging evidence of an association among acute postpartum pain, chronic pain, and postpartum depression (PPD). Authors of this editorial discuss the relationship of pain during labor and delivery to PPD found in recent studies. In 2014, Ding et al found the use of labor epidural analgesia to be associated with a reduced risk of PPD [odds ratio, 0.3; 95% confidence interval (CI), 0.12-0.79]. However, this observational study was limited by potential misclassification bias and uncontrolled confounding. A 2018 study by Orbach-Zinger et al found that the rate of PPD among women who intended to use epidural analgesia but delivered without was not different compared with all other groups. In secondary analysis, they found that the relative risk of PPD was, in fact, higher among women who ultimately received epidural analgesia than those who did not use epidural analgesia (risk difference, 7.2%; 95% CI, 2.3%-12.1%). The authors acknowledged that unplanned epidural analgesia may be an indicator for physiologically difficult delivery. Lim et al examined the relationship between quality of intrapartum analgesia and PPD, finding an inverse association between greater improvements in pain and Edinburgh Postnatal Depression Scale scores. Although the effect of labor analgesia on the scores was found to be relatively small, worse labor analgesia was significantly associated with positive score screen (adjusted odds ratio, 6.6; 95% CI, 1.9-22.4).
Relaxation of the One Child Policy and Trends in Cesarean Section Rates and Birth Outcomes in China Between 2012 and 2016: Observational Study of Nearly 7 Million Health Facility Births
Authors: Liang J. , Mu Y. , Li X. , Tang W. , Wang Y. , Liu Z. , Huang X. , Scherpbier R.W. , Guo S. , Li M. , Dai L. , Deng K. , Deng C. , Li Q. , Kang L. , Zhu J. , Ronsmans C. 
Published: November 2018

(BMJ. 2018;360:k817)
Overuse of cesarean sections throughout the world is a cause of concern due to the potential adverse health effects on the mother and the child. In China, between 2008 and 2014, the cesarean section rate increased from 29% to 35%, although wide variations among provinces existed. To address this issue, the Chinese government introduced various policies and programs at central, provincial, district, county, and hospital levels in an attempt to decrease the rate. As a result, cesarean section rates started to decline, particularly in large urban areas, for example, from 60% in 2009 to 43% in 2014 in Beijing. An important societal change occurred within the country in 2013 when China relaxed its one child policy. The present study examined how the relaxation of the one child policy as well as the introduction of policies to reduce cesarean sections might have affected trends in cesarean section rates and perinatal and pregnancy related mortality rates in hospitals in China between 2012 and 2016.
Racial Disparities in Comorbidity and Severe Maternal Morbidity/Mortality in the United States: An Analysis of Temporal Trends
Authors: Metcalfe A. , Wick J. , Ronksley P. 
Published: November 2018

(Acta Obstet Gynecol Scand. 2018;97:89–96)
In the United States, there has been a temporal increase in the incidence of severe maternal morbidity and mortality (MMM) over the past several years. In fact, between 1998 and 2009 severe maternal morbidity occurring during hospitalization for delivery increased by 75%. However, this increase has not been consistent across all racial groups. The current population-based study aimed to demonstrate the racial disparities in maternal comorbidities and severe maternal morbidity/mortality.
Improved Neonatal Outcome After Active Management of Prolonged Pregnancies Beyond 41+2 Weeks in Nulliparous, But Not Among Multiparous Women
Authors: Lindegren L. , Stuart A. , Herbst A. , Källén K. 
Published: November 2018

(Acta Obstet Gynecol Scand. 2017;96:1467–1474)
Postterm pregnancies (defined as ≥42+0 wk) are associated with increased risks of adverse fetal and maternal outcomes, with some studies reporting that infants of primiparous women have a higher risk of adverse outcomes when compared with infants of multiparous women in the setting of postterm pregnancy. Therefore, many national guidelines recommend induction before or at the latest at 42+0 weeks of gestation. However, Sweden lacks any guidelines regarding induction for prolonged pregnancies. This study aimed to assess obstetric management in prolonged pregnancies in Sweden, by comparing maternal and fetal outcomes depending on the timing of delivery in primiparous and multiparous women.
Association Between Inadequate Antenatal Care Utilization and Severe Perinatal and Maternal Morbidity: An Analysis in the PreCARE Cohort
Authors: Linard M. , Blondel B. , Estellat C. , Deneux-Tharaux C. , Luton D. , Oury J.F. , Schmitz T. , Mandelbrot L. , Azria E. 
Published: November 2018

(BJOG. 2018;125:587–595)
While antenatal care has been thought to be beneficial to women since its inception more than a century ago, it is difficult to evaluate modern antenatal care as both patients and providers are reluctant to take part in randomized trials. The associations between antenatal care utilization and severe maternal and perinatal morbidity have not been extensively investigated, in part due to the many confounding factors to be considered. Because of this lack of evidence, there are vastly differing recommendations worldwide. This study aimed to assess the association between the adequacy of antenatal care utilization and severe maternal and perinatal morbidity (SMM and SPM) in France.
Airway Changes Following Labor and Delivery in Preeclamptic Parturients: A Prospective Case Control Study
Authors: Ahuja P. , Jain D. , Bhardwaj N. , Jain K. , Gainder S. , Kang M. 
Published: November 2018

(Int J Obstet Anesth. 2018;33:17–22)
Pregnancy-related changes impact airway management in obstetric anesthesia and this can be especially challenging in unplanned, urgent situations when there is less time available for anesthetic preparation. Though preeclampsia is associated with more airway edema than in normal pregnancy, it is not clear whether these changes worsen further during labor and delivery. Therefore, this study was undertaken to evaluate and compare airway changes in preeclamptic and normotensive parturients during labor and delivery.
The Accuracy of a Handheld Ultrasound Device for Neuraxial Depth and Landmark Assessment: A Prospective Cohort Trial
Authors: Seligman K.M. , Weiniger C.F. , Carvalho B. 
Published: November 2018

(Anesth Analg. 2018;126:1995–1998)
Widespread use of neuraxial ultrasound may be limited by technical expertise, as blocks are usually performed using body surface landmarks to guide the epidural needle insertion point. A wireless handheld ultrasound (US) device with pattern recognition software programmed to calculate depth to the epidural space and identify bony landmarks has been developed (Accuro, Rivanna Medical, Charlottesville, VA) (AU). In the present study, the authors evaluated the accuracy of this device for neuraxial depth and landmark assessment.
Defining Failed Induction of Labor
Authors: Grobman W.A. , Bailit J. , Lai Y. , Reddy U.M. , Wapner R.J. , Varner M.W. , Thorp J.M. , Leveno K.J. , Caritis S.N. , Prasad M. , Tita A.T.N. , Saade G. , Sorokin Y. , Rouse D.J. , Blackwell S.C. , Tolosa J.E. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Published: November 2018

(Am J Obstet Gynecol. 2018;218:122.e1–122.e8)
Labor is induced in approximately a quarter of pregnant women. When a laboring patient spends an extended period of time in the latent phase, clinicians must decide whether it would be beneficial to continue labor. There is no consensus on the criteria for labeling labor as “failed,” which is important in decreasing unnecessary cesarean deliveries. This study aimed to analyze the maternal and neonatal outcomes associated with the length of the latent phase of labor in a large population of nulliparous women.
Maternal Body Mass Index as a Predictor for Delivery Method
Authors: Pettersen-Dahl A. , Murzakanova G. , Sandvik L. , Laine K. 
Published: November 2018

(Acta Obstet Gynecol Scand. 2018;97:212–218)
The risk of complications during pregnancy and delivery—such as gestational diabetes, preeclampsia, need for labor induction or cesarean delivery, macrosomia, shoulder dystocia, and admission to the neonatal intensive care unit—increases with maternal obesity [body mass index (BMI) ≥30]. The objective of this retrospective register study was to assess the association between maternal prepregnancy BMI and the risk for operative delivery.
Maternal Prepregnancy Obesity and the Risk of Shoulder Dystocia: A Meta-Analysis
Authors: Zhang C. , Wu Y. , Li S. , Zhang D. 
Published: November 2018

(BJOG. 2018;125:407–413)
Shoulder dystocia has been reported to affect between 0.1% and 2.4% of pregnancies, and is associated with maternal and fetal complications. While obesity is associated with many adverse pregnancy outcomes, including preeclampsia, postpartum hemorrhage, and cesarean delivery, previous studies examining a link between prepregnancy obesity and shoulder dystocia have yielded conflicting results. This meta-analysis aimed to assess the risk of shoulder dystocia in obese parturients using combined results from all available observational studies.
Vaginal Progesterone for Preventing Preterm Birth and Adverse Perinatal Outcomes in Singleton Gestations With a Short Cervix: A Meta-Analysis of Patient Data
Authors: Romero R. , Conde-Agudelo A. , Da Fonseca E. , O’Brien J.M. , Cetingoz E. , Creasy G.W. , Hassan S.S. , Nicolaides K.H. 
Published: November 2018

(Am J Obstet Gynecol. 2018;218(2):161–180)
Approximately 15 million babies worldwide are born preterm every year. A short cervical length has high predictive accuracy for spontaneous preterm birth before 34 weeks’ gestation, and a lower predictive accuracy for spontaneous preterm birth before 37 weeks. A 2012 study found vaginal progesterone was associated with a reduction in risk of preterm birth between <28 weeks gestation and <35 weeks gestation, as well as a reduction in adverse neonatal outcomes, in pregnant women with a short cervix (≤25 mm). In 2016 a randomized controlled trial (RCT) published conflicting results and showed vaginal progesterone did not reduce the risk of preterm birth or perinatal morbidity. This systematic review and meta-analysis aimed to determine whether vaginal progesterone reduced the incidence of preterm birth in women with a singleton gestation and short cervix.