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Background: Rotational thromboelastometry (ROTEM®) is a point‐of‐care test of coagulation. ROTEM®‐defined hypercoagulability has been identified in pregnant women and in non‐pregnant patients with diabetes mellitus. Pregnancy is known to be a hypercoagulable state, but the influence of gestational diabetes mellitus (GDM) on coagulation is unknown. Aim: The aim of this study was to assess the combined effect of pregnancy and GDM on coagulation using ROTEM® and to compare this to healthy pregnant women presenting for elective caesarean delivery. Materials and Methods: Ethics approval was granted for recruitment of women presenting for elective caesarean delivery. Women with pre‐existing conditions affecting coagulation were excluded. Group N included health pregnant women at term and Group G included pregnant women at term with GDM. Data regarding GDM management and glycaemic control were collected. Poor glycaemic control was defined by markers of accelerated fetal growth and elevated fasting or postprandial blood glucose levels. The ROTEM® parameters (extrinsically activated thromboelastometric test (EXTEM) / fibrin polymerisation test (FIBTEM) amplitude at five minutes, coagulation time, maximum clot firmness and clot formation time) were compared between the two groups using Student's t‐test. Results: There were 75 women in Group N and 21 women in Group G. Mean age and median body mass index values were comparable for both groups. There were no statistical differences found between the EXTEM and FIBTEM parameters analysed for the two groups. Conclusions: There was no association between GDM and increased hypercoagulability as demonstrated by ROTEM® parameters in healthy pregnant women presenting for elective caesarean delivery at term. [ABSTRACT FROM AUTHOR]

Introduction: Central nervous system oxygen toxicity (CNS-OT) is an uncommon complication of hyperbaric oxygen treatment (HBOT). Different facilities have developed local protocols in an attempt to reduce the risk of CNS-OT. This audit was performed to elucidate which protocols might be of benefit in mitigating CNS-OT and to open discussion on adopting a common protocol for Treatment Table 14 (TT14) to enable future multicentre clinical trials. Methods: Audit of CNS-OT events between units using different compression profiles for TT14, performed at 243 kPa with variable durations of oxygen breathing and 'air breaks', to assess whether there is a statistical diference between protocols. Data were collected retrospectively from public and private hyperbaric facilities in Australia and New Zealand between 01 January 2010 and 31 December 2014. Results: Eight of 15 units approached participated. During the five-year period 5,193 patients received 96,670 treatments. There were a total of 38 seizures in 33 patients when all treatment pressures were examined. In the group of patients treated at 243 kPa there were a total of 26 seizures in 23 patients. The incidence of seizure per treatment was 0.024% (2.4 per 10,000 treatments) at 243 kPa and the risk per patient was 0.45% (4.5 in 1,000 patients). There were no statistically significant differences between the incidences of CNS-OT using different TT14 protocols in this analysis. Conclusion: HBOT is safe and CNS-OT is uncommon. The risk of CNS-OT per patient at 243 kPa was 1 in 222 (0.45%; range 0-1%) and the overall risk irrespective of treatment table was 0.6% (range 0.31-1.8%). These figures are higher than previously reported as they represent individual patient risk as opposed to risk per treatment. The wide disparity of facility protocols for a 243 kPa table without discernible influence on the incidence of CNS-OT rates should facilitate a national approach to consensus. [ABSTRACT FROM AUTHOR]

Background: Preterm breech delivery is associated with a higher perinatal mortality rate compared with preterm vertex delivery, and some studies suggest caesarean section leads to lower mortality rates. Few studies include infants delivered less than 26 weeks gestation, and where included, results are often not stratified by gestational age. There is also a lack of consistent reporting on neonatal and maternal morbidity outcome measures. Aims: To determine if mode of delivery for singleton extreme preterm breech fetuses is associated with a difference in perinatal mortality, neonatal and maternal morbidity. Materials and Methods: Retrospective cohort study of breech deliveries from 23 + 0 to 27 + 6 weeks gestation (extreme preterm) between 2005 and 2014 at a tertiary obstetric facility. Results: One hundred and fifty deliveries met the selection criteria. Perinatal mortality was reduced in the caesarean section group (20% vs 55.5% P < 0.001). Apgar scores ≥ 7 (P = 0.008) and cord pH ≥7.1 (P = 0.025) were more likely for neonates delivered by caesarean section, with lower rates of birth trauma (P = 0.003). Caesarean section was associated with higher nursery admission rates (P < 0.001), longer intensive care nursery admission (P = 0.006), continuous positive airway pressure times (P = 0.008) and increased use of surfactant (P < 0.001). Maternal morbidity was increased with caesarean section including longer hospital stay (P < 0.001), higher postpartum haemorrhage (P < 0.001) and wound infection rates (P = 0.034). Conclusion: Caesarean section for singleton extreme preterm breech delivery is associated with reduced perinatal mortality, improved neonatal condition at delivery, and increased short‐term maternal morbidity. [ABSTRACT FROM AUTHOR]