Acute paracetamol poisoning due to a single overdose may be effectively treated by the early administration of N-acetylcysteine (NAC) as an antidote. The prognosis may be different in the case of intoxication due to multiple ingestions or when the antidote is started with delay. The aim of this work was to investigate the outcome of paracetamol poisoning according to the pattern of ingestion and determine the factors associated with the outcome. We performed a retrospective analysis over the period 2007–2017 of the patients who were referred to a tertiary hospital for paracetamol-related hepatotoxicity. Inclusion criteria were: accidental or voluntary ingestion of paracetamol, delay for NAC therapy of 12 h or more, liver enzymes (ALT) >1000 IU/L on admission. Ninety patients were considered. Poisoned patients following multiple ingestion were significantly older (45 ± 12 vs. 33 ± 14) (p = 0.001), with a higher incidence of liver steatosis (p = 0.016) or chronic ethanol abuse (p = 0.04). In comparison with the subgroup of favorable outcome, the patients with poor outcome were older, had higher values for ALT, bilirubin, lactate, and lower values for factor V and arterial pH. In multivariate analysis, the arterial lactate value was associated with a bad prognosis (p < 0.02) (adjusted odds ratio 1.74 and CI 95:1.09–2.77). The risk of poor outcome was greater in the subgroup with staggered overdose (p = 0.02), which had a higher mortality rate (p = 0.01). This retrospective analysis illustrates the different population patterns of patients who were admitted for a single ingestion of a paracetamol overdose versus multiple ingestions. This last subgroup was mainly represented by older patients with additional risk factors for hepatotoxicity; arterial lactate was a good predictor of severity.

A 32 year old, gravida 2 para 1 at 33 week’s gestation, was referred for a third opinion regarding a large fetal liver mass. The couple sought approval for a termination of pregnancy, following a differential diagnosis of hepatoblastoma. A specialised ultrasound (US) and fetal magnetic resonance imaging (f-MRI) were repeated in our unit and the results were consistent with a diagnosis of haemangioma. A Tru-Cut® (Meritmedical, Utah, USA) liver biopsy was performed confirming a benign haemangioma and the couple opted to continue with the pregnancy.

Background: Medical literature supports planned caesarean delivery (CD) for breech presentation at term, due to observed reductions in neonatal morbidity and mortality when compared to normal vaginal delivery (NVD). Objectives: We want to compare perinatal outcomes of singleton pregnancies with breech presentation at term in two University hospitals. One where the option of NVD is routinely offered (Protocol I), a second where these babies are routinely delivered by CD (Protocol II). Study design: A retrospective matched cohort-study was conducted between January 2015 and May 2021. We included singleton pregnancies with frank or complete breech presentations, delivered from 34+0 weeks gestation with known outcomes. Primary outcomes were a composite of adverse obstetrical outcomes (CAOO) and a composite of neonatal adverse outcomes (CANO). Results: 1079 women were eligible for analysis. After matching for possible confounding factors, the final analysis was conducted in 257 patients in each group. CAOO was similar in the two groups (24.1% versus 24.5%, p-value = 1.000), CANO was significantly higher in patients of Protocol I (17.9% versus 1.2%, p-value < 0.001). No neonatal death or birth trauma were reported in either group. The rates of NICU admission (4.3% vs 0.4%; p=0.004), respiratory distress at birth (17.5% vs 1.2%; p<0.001) and APGAR scores <7 after 5 minutes (5.8% vs 0.4%; p<0.001) were significantly higher for Protocol I. Conclusion: Short-term, non-severe adverse neonatal outcomes are significantly increased in the Protocol I group. These must be balanced against the possible negative impacts of caesarean birth on long-term infant and maternal health.

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