Broth dilution minimal inhibitory concentration (MIC) readings were compared after different incubation periods and with different inoculum concentrations. The purpose was to determine the best conditions for obtaining early results as close as possible to overnight readings. Initially, 76 antibiotic-organism combinations were tested using the International Collaborative Study technique and inoculum and were read after 3, 8, and 18 h of incubation. Approximately 28% of tests showed fourfold or greater increases in MICs after 18 h of incubation compared with the 3-h readings. No overnight MICs were lower than early readings. MICs of single antibiotics against seven organisms were also read with an automatic particle counter to confirm the validity of the visual readings. Experiments were made to determine whether inoculum manipulation could reconcile the differences between 3-and 18-h MIC results. One hundred and eight organism-antibiotic combinations were tested comparing 3-h MIC readings using an inoculum of 107 organisms per ml with overnight readings using 105 per ml. In 71 cases, readings with both inocula were within the range tested and 57 (86%) were within i 1 log2 of each other and followed an approximately normal distribution. Improved comparability between early read and overnight MICs thus may be achieved by inoculum manipulation, and this may be a suitable approach in the future development of automated procedures.

Objectives To assess the applicability of a standardized multidisciplinary protocol for managing placenta accreta spectrum (PAS) disorders and its impact on the outcomes. Methods We compared patients with PAS manage by a standardized multidisciplinary protocol (T2) to historic controls managed on a case-by-case basis by individual physicians between (T1). The primary outcome is composite maternal morbidity. Secondary outcomes were the rates of surgical complications, estimated blood loss, number of blood products transfused, intensive care unit admissions, ventilator use, and birth weight. Multivariate logistic analysis was used to identify independent predictors of composite maternal morbidity. Results During T1 and T2, we managed 39 and 36 patients with confirmed PAS, respectively. During T2, the protocol could be implemented in 21 cases (58%). Compared to T1, patients managed during T2 had 70% less composite maternal morbidity (95% CI: 0.11–0.82) and lower blood loss (median, 2,000 vs. 1,100 mL, p=0.008). Also, they were 68% less likely to require transfusion of blood products (95% CI: 0.12–0.81; p=0.01), including fewer units of packed red blood cells (median, 2 vs. 0, p=0.02). Management following the protocol was the only independent factor associated with lower composite maternal morbidity (OR: 0.22; 95% CI: 0.05–0.95; p=0.04). Selected maternal and neonatal outcomes were not different among 12 and 15 patients with suspected but unconfirmed PAS disorders managed during T1 and T2, respectively. Conclusions Most patients can be managed under a standardized multidisciplinary protocol for PAS disorders, leading to improved outcomes.

MethodsFifty-two emergency caesareans were assessed over a calendar month. A questionnaire was completed per delivery by the obstetric, midwifery and anaesthetic staff involved. Data analysis was via Excel spreadsheets. ResultsFor category-1 deliveries, 100% of cases were communicated with the anaesthetist within 2 min of the decision to deliver. For category-2 deliveries, the anaesthetist was informed within 2 min for only 50% of cases. The mean (range) communication times was 6.3 min (0-28 min). The person communicating with the anaesthetist should ideally be an obstetrician of appropriate seniority. In category-1 sections, this was only achieved in 33% of cases. Category-2 sections achieved this in 38% of cases. DiscussionThis audit shows that anaesthetists are not promptly notified regarding emergency caesarean sections, and are often not notified by an obstetrician of appropriate seniority when these cases arise. After the decision is made to deliver a woman by caesarean section, the most senior obstetrician should contact the duty anaesthetist promptly [1]. This will allow discussion of the patient's clinical issues, and improve anaesthetic assessment and management.

When women who share common concerns for the environment come together, powerful learning occurs through critical reflection on tensions between daily-life decisions and emotional connections to social and ecological concerns.