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Objective: The Robson ten group classification system is used as a global standard for assessing, monitoring and comparing caesarean delivery (CD) rates within and between maternity services. Our objective was to compare the changes of CD rates at our institution between the years 2008-2010 and 2017-2019 using the Robson ten group classification system., Study Design: Data was collected retrospectively and all women were classified using the obstetric concepts and parameters described in the Robson ten group classification system., Results: During 2008-2010 7,832 deliveries were performed, increasing to 9,490 in 2017-2019. The CD rate also increased from 29.1% to 32.2% (p<.05) during this 10 year period. In both observed periods group 5 (single cephalic multiparous women at term with a previous CD) was the largest contributor to the overall CD rate accounting for 20.2% of all CD during 2008-2010 and increasing to 26.9% in 2017-2019 (p<.001). The overall size of group 5 also increased from 8.3% to 11.6% (p<.001). Furthermore, an increase in CD rate in group 7 (multiparous women with a single breech pregnancy, including women with a uterine scar) from 92.9% to 98.2% (p = .752) could be observed. In group 8 (women with multiple pregnancies, including women with a uterine scar) a slight shift towards vaginal delivery (VD) can be reported with CD rates decreasing from 82% to 79.2% (p = .784). There was no observed difference with CD rates in group 1 although the group size decreased from 29.4% in 2008-2010 to 24.2% in 2017-2019 (p<.001). The CD rate in group 10 experienced a slight elevation, in 2008-2010 46.2% were delivered per CD and in 2017-2019 48.8% (p = .553). The overall size of group 10 decreased, contributing 8.9% in 2008-2010 and 8% in 2017-2019 (p<.05) to the overall birthrate., Conclusion: The biggest contributors to the CD rate in our hospital remain multiparous women at term with a previous CD. The CD rates, as well as the overall size of this group, keep rising, resulting in a need to establish more effective ways to motivate women with one previous CD towards vaginal birth after caesarean delivery (VBAC). Furthermore, the CD rate in preterm deliveries is increasing and approaching 50%. This illustrates the need to discuss whether CD is the appropriate mode of delivery in half of the preterm infants., Competing Interests: The authors have declared that no competing interests exist.

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).

Objective: The aim of this study was to compare the efficacy and side effect profile of atosiban with hexoprenaline when used for intrauterine resuscitation of intrapartum fetal distress., Study Design: Women in labour with acute intrapartum fetal distress detected by cardiotocography were randomly assigned to receive intravenous atosiban or hexoprenaline., Setting: Department of Obstetrics and Gynecology, Karl Franzens University of Graz and General Hospital Graz, Austria., Population or Sample: One thousand and four hundred and thirty-one women with singleton pregnancy at term and cephalic presentation were enrolled in the study during October 2000 and May 2001., Methods: A prospective, randomised, pilot study with no a priori sample size calculation., Main Outcome Measure: Efficacy of treatment for stopping uterine contractions and the resumption of contractions determined by fetal heart rate monitoring., Results: Tocolysis was achieved in 92% (12/13) of the women receiving atosiban and 100% (13/13) of those receiving hexoprenaline. Maternal tachycardia developed in 1/13 women, receiving atosiban and 10/13 women hexoprenaline. Hypertension occurred in 1/13 on atosiban and 3/13 women on hexoprenaline. Palpitations were only reported by 10/13 women receiving hexoprenaline. Uterine contractions resumed after 8 minutes (+/-3) in the atosiban group and 14 minutes (+/-4) in the hexoprenaline group (P < 0.001)., Conclusion: Atosiban and hexoprenaline were similarly effective for stopping uterine contractions. Women receiving atosiban had significantly fewer adverse events than those receiving hexoprenaline. Uterine contractions resumed more promptly in the atosiban group. Considering the low incidence of mild maternal adverse events, atosiban may be an option for acute intrapartum tocolysis for fetal distress.

Objectives: The aim of this study was to compare the histopathologic features and prognosis of patients with endometrial carcinoma with and without concomitant hyperplasia., Methods: Histologic slides of the surgical specimens of 214 consecutive patients who underwent surgery as primary treatment for endometrial carcinoma from 1985 through 1991 were reviewed., Results: Ninety-two of the 214 patients (43%) with endometrial carcinoma had concomitant endometrial hyperplasia. Patients with endometrial carcinoma with hyperplasia were significantly younger than those without hyperplasia (mean age 62 +/- 10 vs 65 +/- 9 years, P < 0.05). Carcinomas associated with hyperplasia were better differentiated and of lower surgical stage. By univariate analysis the frequency of recurrence was significantly lower (4% vs 17%, P < 0.004) and the estimated 5-year survival rate significantly higher (96% vs 85%, P < 0.01) in patients with endometrial carcinoma with concomitant hyperplasia. However, in multivariate analysis the presence of endometrial hyperplasia was not an independent prognostic factor and the 5-year survival rates of patients with or without hyperplasia did not differ significantly in any surgical stage., Conclusion: The presence or absence of concomitant endometrial hyperplasia is strongly correlated with the surgical stage of endometrial carcinoma.

The incidence of S. typhimurium infections among fowl increased in thr region of Potsdam in general, and on various big farms in particular, 1976 and over the first half of 1977. The outbreaks included subclinical infections and clinically manifest diseases which caused remarkable loss of broilers from the affected stocks (up to 15.92 per cent). Parent stocks contaminated with S. typhimurium were to be the sources of infection in all cases. A total of 1,220 Salmonella strains were isolated from fowl and its environment, with 1,151 of them being S. typhimurium (2.98 per cent of all samples tested). The following amounts of S. typhimurium strains were isolated from different types of samples which had been collected from infected broiler stocks: 8.10 per cent from dead broilers, 5.86 per cent from dead broiler parents, 2.11 per cent from pulp linings of transport cages for day-old chicks, 1.23 per cent from litter, 1.0 per cent from hatching material (eggs or dead and jammed embryos, and 0.12 per cent from swabs used in hygiene supervision). No Salmonellae were isolated from feedstuff. The transmission of S. typhimurium, therefore, is though to have taken the route via the hatching egg and via congenitally infected chicks traded between breeders and propagation farms. The control and prophylaxis of S. typhimurium infections, therefore, should be based primarily on action in the centralised breeding stocks. Specific steps of such action are proposed. Fifty-three strains were biochemically and lysotypically analysed, with the following types being determined: ut/Ph 30 BT b, ut/Ph 30 BT c, n.c. 1/72/n.c. BT b, 2 n.c. BT a, and 1A/6 BT a. The first two types covered 84.9 per cent of all strains isolated from the fowl. All lysotype ut/Ph 30 strains isolated from fowl fell under the copenhagen variant which had rarely been isolated from man in the past. These results are likely to support the demand for a joint control programme for enteritis Salmonellae, with particular emphasis on S. typhimurium, for implementation in human and veterinary medicine.

An account is given of all immune preparations which had been available by summer 1976 and their uses in public disease control, with reference being made to the epizootiological role and detrimental effects of Salmonella cholerae suis (S. c.-s.). The need for using live Salmonella strains to test their immunogenic properties is derived from a thorough assessment of inactivated S.-c.-s.-vaccine, Salmoporc "Dessau", which had been used in the past. Salmonellae are pathogens of zoo-anthroponoses by their very nature, and the point is made that, therefore, comprehensive attention should be given to all aspects relating to genetic stability and identity of potential live vaccines. An S.-c.-s.-R-strain is described as the point of departure from which to develop a doubly attenuated strain, the basis of Salmonella cholerae suis live vaccine Suisaloral "Dessau". The live vaccine proper is characterised on the basis of results obtained from bacteriologico-serological, clinical, and epizootiological laboratory tests as well as preclinical and clinical tests applied to the animals (field testing). Suisaloral "Dessau" is the first Salmonella live vaccine on the basis of a non-reproduction-limited mutant with two independent genetic markers, and it is suitable for both oral and parenteral application. The vaccine also is widely applicable for combination with other live vaccines.

Experiments on the immunization of sows were conducted on six premises. The results justify immunization of breeding animals as part of a control programme for salmonellosis in pigs.

The potential advantages offered by live vaccines, as compared to inactivated vaccines, are described, with reference being made to experience so far obtained from the use of live vaccines in livestock farming. The favourable properties of live vaccines seem to promise more widespread use in the future. Certain demands have to be made on live vaccines against the background of production processes in livestock farming. These are described in greater detail. Demands, finally, are derived from the above aspects regarding immunobiological action.

Immunisation of pregnant sows prior to parturition has long proved to be a good method to forestall coli dysentery in piglets before weaning. Inactivated vaccines of the pathogenetically important E. coli serogroups with and without adjuvant so far were primarily used at international level. A vaccine of that kind has become available in the GDR more than eight years ago. Its name is Coliporc "Dessau". A live vaccine has been developed from two R-mutants at the authors' institute. The effectiveness of that live vaccine on laboratory animals and in field experiments is reported in this paper together with possibilities of differential diagnosis to distinguish wild strains from the mutants. The live vaccine was commercially registered under the name of Suicolpex "Dessau", in spring 1976.