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Objective: To investigate whether use of ST analysis of the fetal electrocardiogram (STan) as an adjunct to continuous cardiotocography (CTG) reduces the rate of emergency Cesarean section (EmCS) compared with CTG alone. Methods: This was a randomized controlled trial of patients with a singleton fetus in cephalic presentation at ≥ 36 weeks' gestation, requiring continuous electronic fetal monitoring during labor at a tertiary maternity hospital in Adelaide, Australia, between January 2018 and July 2021. Participants were randomized to undergo CTG + STan or CTG alone. The calculated sample size was 1818 participants. The primary outcome was EmCS. Secondary outcomes included metabolic acidosis, a composite adverse perinatal outcome, and other maternal and neonatal morbidity and safety outcomes. Results: The present study enrolled 970 women, of whom 967 were included in the primary analysis. EmCS occurred in 107/482 (22.2%) deliveries in the CTG + STan arm and in 107/485 (22.1%) in the CTG arm (adjusted relative risk, 1.02 (95% CI, 0.81–1.27); P = 0.89). There was no difference in the rate of adverse maternal or neonatal outcomes between arms. Conclusions: The addition of STan as an adjunct to continuous CTG did not reduce the EmCS rate. The smaller‐than‐anticipated sample size meant that this study was underpowered to detect absolute differences of ≤ 5% and, therefore, this negative finding could be due to a Type‐2 error. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Randall, D. J., J. M. Wilson, K. W. Peng, T. W. K. Kok, S. S. L. Kuah, S. F. Chew, T. J. Lam, and Y. K. Ip. The mudskipper, Periophthalmodon schlosseri, actively transports [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] against a concentration gradient. Am. J. Physiol. 277 (Regulatory Integrative Comp. Physiol. 46): R1562-R1567, 1999.--Periophthalmodon schlosseri can maintain ammonia excretion rates and low levels of ammonia in its tissues when exposed to 8 and 30 mM [NH.sub.4]Cl, but tissue ammonia levels rise when the fish is exposed to 100 mM [NH.sub.4]Cl in 50% seawater. Because the transepithelial potential is not high enough to maintain the [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] concentration gradient between blood and water, ammonia excretion under such a condition would appear to be active. Branchial [Na.sup.+]-[K.sup.+]-ATPase activity is very high and can be activated by physiological levels of [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] instead of [K.sup.+]. Ammonia excretion by the fish against a concentration gradient is inhibited by the addition of ouabain and amiloride to the external medium. It is concluded that [Na.sup.+]-[K.sup.+]-ATPase and an [Na.sup.+]/[H.sup.+] exchanger may be involved in the active excretion of ammonia across the gills. This unique ability of P. schlosseri to actively excrete ammonia is related to the special structure of its gills and allows the fish to continue to excrete ammonia while air exposed or in its burrow. ammonia; [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII]; ouabain; amiloride

Background: The present study examines the introduction of an innovation in intrapartum foetal monitoring practice in Australia. ST-Analysis (STan) is a technology that adds information to conventional fetal monitoring (cardiotocography) during labour, with the aim of reducing unnecessary obstetric intervention. Adoption of this technology has been controversial amongst obstetricians and midwives, particularly as its use necessitates a more invasive means of monitoring (a scalp clip), compared to external monitoring from cardiotocography alone. If adoption of this technology is going to be successful, then understanding staff opinions about the implementation of STan in an Australian setting is an important issue for maternity care providers and policy makers.Methods: Using a maximum variation purposive sampling method, 18 interviews were conducted with 10 midwives and 8 doctors from the Women's and Children's Hospital, South Australia to explore views about the introduction of the new technology. The data were analysed using Framework Analysis.Results: Midwives and doctors indicated four important areas of consideration when introducing STan: 1) philosophy of care; 2) the implementation process including training and education; 3) the existence of research evidence; and 4) attitudes towards the new technology. Views were expressed about the management of change process, the fit of the new technology within the current models of care, the need for ongoing training and the importance of having local evidence.Conclusions: These findings, coupled with the general literature about introducing innovation and change, can be used by other centres looking to introduce STan technology. [ABSTRACT FROM AUTHOR]