Biomedical subjects

Alexandra Kaider

Publications and source records attributed to Alexandra Kaider.

17 recordsLinked to original sources

PubMed2006

The role of intensity upon pitch perception in cochlear implant recipients.

OBJECTIVES: Pitch plays a key role in the perception of speech and music, the recognition of a speaker's voice, and in analyzing complex auditory patterns. To date, little consideration has been given to the influence of stimulation level on pitch perception. The aim of this study was to investigate the impact of a sound's intensity on pitch perception in cochlear implant recipients using monopolar stimulation. STUDY DESIGN: Thirteen patients with an average implant use of 4.13 years took part in this study. All patients were implanted with MedEl Combi 40/40+ cochlear implants. METHODS: In the first part of the study, we performed a pitch ranking procedure to confirm that all patients were able to judge pitch changes. Using a visual scale, study participants were then asked to compare the pitch of an intensity-constant reference tone with the pitch of a test tone of varying intensity. RESULTS: Eleven (85%) patients were found to perceive a clear change in pitch with changing stimulus intensity. Statistical analysis showed a strong positive correlation in 10 patients (correlation coefficients between 0.99 and 0.71) and a strong negative correlation in 1 patient (r = -0.92). CONCLUSIONS: The results suggest that a distinct relationship exists between pitch perception and intensity of the stimulus. To date, speech coding strategies do not support these findings. Nevertheless, we believe that for the optimized most natural perception of sounds, especially music, the described particularities of pitch perception need to be respected, and further investigations on this topic are necessary.

Acoustic Stimulation↗

PubMed2006

Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem. A concise follow-up, at a minimum of fifteen years, of a previous report.

Between October 1986 and November 1987, 208 total hip arthroplasties were performed with use of the cementless Zweymüller stem and a threaded cup in 200 consecutive patients. Of 102 patients (108 hips) who were available for follow-up at a minimum of 180 months postoperatively, eighty-three (eighty-nine hips) had the primary joint replacement still intact. No stem had been revised because of aseptic loosening, but we found various degrees of osteolysis around sixteen (18%) of the implants. The probability of survival of the stem at fifteen years was 0.98 (95% confidence interval, 0.96 to 1.00). The probability of survival of the cup was 0.85 (95% confidence interval, 0.79 to 0.91).

Adult↗

PubMed2006

Interleukin-6 and interleukin-6 promoter polymorphism (-174) G > C in patients with spontaneous venous thromboembolism.

Increased levels of interleukin-6 (IL-6) have been reported in patients with a history of venous thromboembolism (VTE); however, prospective studies did not confirm an association between inflammatory markers that are highly correlated with IL-6 and the risk ofVTE. It was the aim of our study to investigate the association of IL-6 and its promoter polymorphism (-174) G > C with the risk of spontaneousVTE. IL-6 was measured in 128 patients with deep venous thrombosis (DVT,70 w/58 m),105 with pulmonary embolism (PE, 58 w/47 m) and 122 healthy controls (60 w/62 m) with a highly sensitive ELISA (Quantikine HS Human IL-6 Immunoassay, RnDSystems). The promoter polymorphism was determined by genotyping, allele specific PCR was followed by high resolution gel-electrophoresis. Median concentrations [interquartile ranges] were 2.37 [1.51-3.89] (pg/ml) in patients with DVT, 2.83 [1.83-4.87] in those with PE and 2.51 [1.71-4.78] in controls (p = 0.6, p = 0.4). Hetero- or homozygous carriers of the C allele (71% in DVT, 67% in PE and 59% among controls) did not have higher IL-6 levels than homozygous carriers of the G allele (median 2.60 vs. 2.59 pg/ml, p = 0.7). In conclusion, we found no association of IL-6 and its promoter polymorphism (-174) G > C with the risk of spontaneous VTE.

Adult↗

PubMed2005

Perturbation of the tumor necrosis factor--related apoptosis-inducing ligand cascade in ovarian cancer: overexpression of FLIPL and deregulation of the functional receptors DR4 and DR5.

PURPOSE: Epithelial ovarian cancer is the most common cause of mortality from gynecologic malignancies. Due to advanced stage at diagnosis, most patients need systemic treatment in addition to surgery. Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF family with a promising toxicity profile and synergistic activity with chemotherapeutic agents. EXPERIMENTAL DESIGN: We used an arrayed panel of epithelial ovarian cancer tissue to assess the protein expression of TRAIL and the clinically most relevant members of its pathway death receptors 4 and 5 (DR4 and DR5) and the long form of FLICE inhibitory protein (FLIPL). RESULTS: We could show that a majority (66.2%) of the tumor tissues displayed either reduced DR4/DR5 expression (20.6%), increased FLIPL expression (39.7%), or both (5.9%) as determined by immunohistochemistry. Furthermore, higher TRAIL expression in the surrounding connective tissue but not in the tumor cells is significantly (P<0.05) linked with favorable overall survival in advanced-stage patients. CONCLUSIONS: Mechanisms to escape the immune surveillance mediated by TRAIL are developed by ovarian cancer cells in a high percentage. TRAIL expression in the ovarian cancer microenvironment has an effect on overall survival. These findings enhance our understanding of ovarian cancer pathology and might be helpful in guiding TRAIL-based therapy in future.

Apoptosis↗

PubMed2004

Prospective evaluation of coagulation activation in pregnant women receiving low-molecular weight heparin.

Pregnancy is a major risk factor for venous thromboembolism (VTE), and low-molecular weight heparin (LMWH) seems to be safe and effective in pregnant women. Normal pregnancy is accompanied by a state of hypercoagulability, indicated by an increase in markers of coagulation activation. In a prospective cohort study, we followed 61 women who received LMWH thromboprophylaxis throughout pregnancy because of a history of VTE, hereditary thrombophilia and/or previous pregnancy-related complications. The control group consisted of 113 healthy pregnant women without antithrombotics. D-Dimer, prothrombin fragment F1+2 (F1+2) and the resistance to activated protein C (APC-ratio) were measured in all women during the first, second and third trimester. Patients and controls did not significantly differ with regard to baseline characteristics and pregnancy outcome. A (recurrent) VTE was seen in one patient despite LMWH. D-Dimer levels significantly increased among patients and controls during pregnancy (p < 0.0001), and were significantly higher among patients compared with the controls (p <0.0001) [395 ng/ml (95% CI 340-458) and 249 ng/ml (95%CI 234-266); 710 ng/ml (95% CI 602-838) and 475 ng/ml (95% CI 431-523); 1089 ng/ml (95% CI 931-1273) and 822 ng/ml (95% CI 741-911); respectively]. Levels of F1+2 significantly increased while the APC-ratio significantly decreased during pregnancy among patients and controls. Despite LMWH, pregnancy is accompanied by a substantial activation of the coagulation system.

Adult↗

PubMed2003

The effect of epidural analgesia on obstetric lacerations and neonatal outcome during spontaneous vaginal delivery.

The aim of this study was to determine if epidural analgesia is associated with increased risk of obstetric lacerations during spontaneous vaginal delivery. We also assessed the effect of epidural analgesia on maternal and neonatal parameters. This multicenter study consisted of an analysis of data from the delivery databases of the University Hospital of Vienna and the Semmelweis Women's Hospital Vienna. This study was restricted to a sample that included all women with uncomplicated pregnancy, a gestational age >37 weeks and a pregnancy with cephalic presentation. Epidural analgesia was started during the first stage of labour. Techniques and management styles of epidural analgesia were the same in both hospitals. We found that women undergoing epidural analgesia had a prolonged second stage of labour, a higher rate of episiotomy and an increased use of oxytocin. Some of these adverse effects might be caused by the higher rate of primipara in the epidural group. However, epidural analgesia showed no evidence of a detrimental effect on the integrity of the birth-canal and on neonatal outcome during spontaneous vaginal delivery.

Analgesia, Epidural↗

PubMed2003

Comparison of 4 methods for quantifying posterior capsule opacification.

PURPOSE: To compare the results of posterior capsule opacification (PCO) quantification and the repeatability of a fully automated analysis system (Automated Quantification of After-Cataract [AQUA]) with that of 2 other quantification methods and subjective grading of PCO. A test set of digital retroillumination images of 100 eyes with PCO of varying degrees was used. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: One hundred digital retroillumination images of eyes (100 patients) with PCO were selected to attain an even distribution from mild to severe cases. The images were evaluated by 4 methods: subjective grading by 4 experienced and 4 inexperienced examiners, the subjective Evaluation of Posterior Capsular Opacification (EPCO) system, posterior capsule opacification (POCO) software, and the AQUA system. Ten images were presented twice to assess the reproducibility of the analysis systems. RESULTS: Subjective grading correlated best with the subjective EPCO system and the objective AQUA system (r = 0.94 and r = 0.93, respectively). The POCO system showed very early saturation and therefore a much weaker correlation (r = 0.73). The POCO scores reached the maximum of 100% in several minimal to mild PCO cases. The reproducibility of the AQUA software was perfect and that of the other analysis systems, comparably satisfactory. CONCLUSION: The objective AQUA score correlated well with subjective methods including the EPCO system. The POCO system, which assesses PCO area, did not adequately describe PCO intensity and includes a subjective step in the analysis process. The AQUA system could become an important tool for randomized masked trials of PCO inhibition.

Cataract↗

PubMed2003

Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of antibiotic treatment of bacterial vaginosis in pregnancy to reduce preterm delivery. STUDY DESIGN: We performed a meta-analysis of published, English-language, randomized, placebo-controlled clinical trials of antibiotic treatment of bacterial vaginosis in pregnant women with intact amniotic membranes at <37 weeks of gestation. Primary outcomes included preterm delivery, perinatal or neonatal death, and neonatal morbidity. RESULTS: Ten studies with results for 3969 patients were included. In patients without preterm labor, antibiotic treatment did not significantly decrease preterm delivery at <37 weeks of gestation, in all patients combined (odds ratio, 0.83; 95% CI, 0.57-1.21) nor in high-risk patients with a previous preterm delivery (odds ratio, 0.50; 95% CI, 0.22-1.12). In both groups, significant statistical heterogeneity was observed. A significant reduction in preterm delivery and no statistical heterogeneity were observed in 338 high-risk patients who received oral regimens with treatment durations of > or =7 days (odds ratio, 0.42; 95% CI, 0.27-0.67). Nonsignificant effects and no statistical heterogeneity were observed in low-risk patients (odds ratio, 0.94; 95% CI, 0.71-1.25) and with vaginal regimens (odds ratio, 1.25; 95% CI: 0.86-1.81). In one study antibiotic treatment in patients with preterm labor led to a nonsignificant decrease in the rate of preterm deliveries (odds ratio, 0.31; 95% CI, 0.03-3.24). CONCLUSION: The screening of pregnant women who have bacterial vaginosis and who have had a previous preterm delivery and treatment with an oral regimen of longer duration can be justified on the basis of current evidence. More studies are needed to confirm the effectiveness of this strategy, both in high-risk patients without preterm labor and in patients with preterm labor.

Anti-Bacterial Agents↗

PubMed2003

Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis.

OBJECTIVE: We performed a meta-analysis to evaluate bacterial vaginosis as a risk factor for preterm delivery. STUDY DESIGN: Selection criteria were (1). the data appeared in original, published English-language reports of prospective studies or control groups of clinical trials that included women at <37 weeks of gestation with intact amniotic membranes, (2). all the women had to have been screened for bacterial vaginosis that was diagnosed by either clinical criteria or criteria that were based on Gram stain findings, and (3). the outcomes were preterm delivery, spontaneous abortion, maternal or neonatal infection, and perinatal death. RESULTS: Eighteen studies with results for 20,232 patients were included. Bacterial vaginosis increased the risk of preterm delivery >2-fold (odds ratio, 2.19; 95% CI, 1.54-3.12). Higher risks were calculated for subgroups of studies that screened for bacterial vaginosis at <16 weeks of gestation (odds ratio, 7.55; 95% CI, 1.80-31.65) or at <20 weeks of gestation (odds ratio, 4.20; 95% CI, 2.11-8.39). Bacterial vaginosis also significantly increased the risk of spontaneous abortion (odds ratio, 9.91; 95% CI, 1.99-49.34) and maternal infection (odds ratio, 2.53; 95% CI, 1.26-5.08). No significant results were calculated for the outcome of neonatal infection or perinatal death. CONCLUSION: Bacterial vaginosis, early in pregnancy, is a strong risk factor for preterm delivery and spontaneous abortion.

Abortion, Spontaneous↗

PubMed2003

Serum cobalt levels after metal-on-metal total hip arthroplasty.

BACKGROUND: Systemic cobalt dissemination from the Metasul Co-28Cr-6Mo-0.2C metal-on-metal total hip prosthesis has been demonstrated in the first year after implantation. The aim of this prospective study was to monitor the serum cobalt concentrations in patients during the first five years after total hip arthroplasty with a metal-on-metal articulation. METHODS: A total hip arthroplasty was performed without cement in 100 consecutive patients who had either unilateral osteoarthritis or unilateral osteonecrosis. Fifty patients were randomized to be treated with a metal-on-metal articulation, and fifty patients, with a ceramic-on-polyethylene bearing. The femoral stem was made of a Ti-6Al-7Nb alloy, and the threaded acetabular cup was made of commercially pure titanium. Blood samples were taken before the operation and at multiple time-points for five years after the operation. Serum cobalt concentrations were measured with use of atomic absorption spectrometry. RESULTS: In the metal-on-metal group, the median serum cobalt concentration was 1 micro g/L at one year after surgery and 0.7 micro g/L at five years. The median of the serum cobalt concentrations measured from three to twelve months did not differ from the median of subsequent measurements, with the numbers available. The median serum cobalt level in the control group of patients treated with the ceramic-on-polyethylene articulation was below the detection limit at all time-points. CONCLUSIONS: Systemic cobalt release from Metasul metal-on-metal articulations was demonstrated throughout the five-year study period. The median serum cobalt concentrations were found to be slightly above the detection limit and remained in a constant range. The serum cobalt concentrations did not reflect a so-called run-in wear period of the metal-on-metal articulations.

Adolescent↗

PubMed2003

Fetal fibronectin--how useful is it in the prediction of preterm birth?

OBJECTIVE: To determine the value of cervicovaginal fetal fibronectin as a marker for preterm delivery, a previously published meta-analysis was updated. STUDY DESIGN: Selection criteria confined the analysis to English-language original reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. For the outcomes of delivery <37 or <34 weeks' gestation or delivery within 7, 14, or 21 days after fibronectin sampling, we calculated sensitivity and specificity rates for each study, for subgroups of studies, and for all studies combined. RESULTS: A total of 40 studies were included. Statistical heterogeneity was seen in the majority of calculations of combined results and a random-effects model was used in these cases. For the outcomes of delivery <37 and <34 weeks' gestation, overall sensitivity rates were 52% and 53%, and overall specificity rates were 85% and 89%, respectively. For the outcomes of delivery within 7, 14, and 21 days, we calculated sensitivity rates of 71%, 67%, and 59% and specificity rates of 89%, 89%, and 92%, respectively. For the subgroup of women with symptoms of preterm labour, sensitivity rates for delivery <37 and <34 weeks' gestation or delivery within 7, 14, and 21 days of 54%, 63%, 77%, 74%, and 70% and specificity rates of 85%, 86%, 87%, 87%, and 90% were calculated. CONCLUSIONS: Cervicovaginal fetal fibronectin is an effective short-term marker of preterm delivery, especially in women with symptoms of preterm labour. Because results appear to be heterogeneous in different studies, caution should be taken when they are applied to a specific population.

Biomarkers↗

PubMed2002

Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism.

There is strong evidence that the incidence of venous thromboembolism (VTE) is increased during pregnancy. However, it is unknown whether and to which extent pregnancy influences the risk for recurrent VTE in women with previous thrombosis. To investigate whether pregnancy temporarily increases the risk for recurrent thrombosis, we retrospectively evaluated the recurrence rate in 109 women who had at least one pregnancy after an episode of VTE by comparing the time period during pregnancy with the nonpregnant period. Forty-three women had a first recurrence during a total observation time of 1014 years. Eight events (73 observation years) occurred during pregnancy, and 35 events (941 observation years) occurred outside pregnancy. Recurrence rates per 100 patient-years were 10.9% during and 3.7% outside pregnancy. Relative risk during pregnancy was 3.5 (95% confidence interval, 1.6-7.8; P =.002). Our data suggest that pregnancy leads to a temporary increase in the risk for recurrent thrombotic events.

Female↗

PubMed2002

Drug therapy of urinary urge incontinence: a systematic review.

OBJECTIVE: To review the efficacy of drug therapy for urinary urge incontinence by examining the published literature. METHODS OF STUDY SELECTION: In October 1999, we searched the medical databases MEDLINE, EMBASE, and Cochrane Controlled Trials Register to identify prospective randomized, double-blind, placebo-controlled clinical trials in the English literature evaluating drug therapy (except hormonal therapy) of urinary urge incontinence. Trials were categorized by type of drug and outcome variables. TABULATION, INTEGRATION, AND RESULTS: Forty-seven trials were identified. Twenty-four, 12, and 11 trials evaluated anticholinergic drugs, drugs with anticholinergic and calcium antagonistic properties, and alternative regimens, respectively. Data regarding treatment effects of anticholinergic drugs are consistent with a high therapeutic efficacy and characteristic side effects. Therapeutic efficacy and side effect patterns of terodiline, an agent with anticholinergic and calcium antagonistic properties, were comparable to those of anticholinergic agents. Terodiline, however, has been withdrawn from the market because of its association with cardiac arrhythmia. Of the investigated alternative drug regimens, the papaverine-like smooth muscle relaxant flavoxate was reported to be ineffective. Studies investigating the dopamine agonist bromocryptine, the alpha-adrenoceptor blocker prazosin, or the gamma-aminobutyric acid receptor agonist baclofen showed subjective and/or objective improvement of symptoms without reaching statistical significance, whereas the tricyclic antidepressant doxepin, the neurotoxin capsaicin, and the prostaglandin synthase inhibitor flurbiprofen led to statistically significant subjective and/or objective improvement of symptoms. No data for subjective and/or objective improvement of symptoms could be extracted from the studies using the anticholinergic and calcium antagonistic agent propiverine and the calcium antagonist thiphenamil. CONCLUSION: Published trials support anticholinergic drugs as efficacious therapy for urinary urge incontinence, with predictable side effects. At present, these agents represent the pharmacological treatment of choice for this condition. The potential value of selected alternative drugs is underscored by the available data.

Calcium Channel Blockers↗

PubMed2002

Magnetic resonance imaging contrast enhancement of brain tumors at 3 tesla versus 1.5 tesla.

RATIONALE AND OBJECTIVES: To compare the diagnostic efficacy of a standard dose of MRI contrast agent in the evaluation of primary brain tumors and metastases using a high-field 3 tesla MR unit versus a 1.5 tesla MR unit. METHODS: Sixteen patients with brain tumors were examined at both field strengths using identical axial T1-SE protocols pre- and postcontrast (0.1 mmol/kg gadolinium), and postcontrast coronal 3D GRE with magnetization preparation (MP-RAGE), which was adjusted separately for each field strength. Evaluation of the images was performed quantitatively and, in the case of T1-SE images, also by visual assessment. RESULTS: Tumor-to-brain-contrast after gadolinium administration using statistical evaluation of MP-RAGE scans was significantly higher at 3 tesla (97.5) than at 1.5 tesla (46.3). The same was true for T1-SE sequences (93.0 vs. 72.1). Signal enhancement of the lesions in T1-SE sequences was not significantly different between both field strengths. CONCLUSIONS: Administration of a gadolinium contrast agent produces higher contrast between tumor and normal brain at 3 tesla than at 1.5 tesla.

Adult↗

PubMed2002

Cementless total hip arthroplasty with a tapered, rectangular titanium stem and a threaded cup: a minimum ten-year follow-up.

BACKGROUND: We report the results of cementless total hip arthroplasty with a tapered, rectangular titanium stem that was introduced in 1979 and continues to be used today with only minor changes. The aim of the design is to achieve primary stability to resist rotational and axial forces through precision rasping and press-fit implantation of a tapered, rectangular femoral component. METHODS: Between October 1986 and November 1987, 208 total hip arthroplasties with insertion of a tapered, rectangular titanium stem and a threaded cup without cement were performed in 200 consecutive patients (average age, sixty-one years; range, twenty-two to eighty-four years). RESULTS: At the time of the latest follow-up, fifty-one patients (fifty-two hips) had died and sixteen patients had been lost to follow-up, leaving 133 patients. Twelve hips had been revised, two in patients who subsequently died, leaving 123 living patients without revision. The median follow-up time was 120.7 months. Five cups needed revision surgery because of aseptic loosening; two, because of massive polyethylene wear; one, because of posttraumatic migration; and one, because of breakage. Three femoral stems were revised: one because of malpositioning (the reoperation was done five days after implantation); one, because of infection; and the third, after multiple failed acetabular revisions. The mean Harris hip score for the patients who did not have revision was 85.4 points (range, 46 to 100 points) at the time of the latest follow-up. Four patients (3%) complained of thigh pain that was not associated with another disorder. According to the criteria of Engh et al., all femoral implants were graded as stable bone-ingrown. The probability of survival of both the femoral and the acetabular component at ten years, with any revision as the end point, was 0.92 (95% confidence interval, 0.88 to 0.97). The probability of survival of the cup was 0.93 (95% confidence interval, 0.89 to 0.97), and that of the stem was 0.99 (95% confidence interval, 0.97 to 1.00). CONCLUSIONS: The results of arthroplasty with a tapered, rectangular titanium stem combined with a conical threaded cup inserted without cement were excellent at a minimum of ten years. Our data suggest that femoral stem fixation continues to be secure, while the threaded cup is prone to aseptic loosening.

Adult↗

PubMed2002

Cyclin D3 is a predictive and prognostic factor in diffuse large B-cell lymphoma.

Cyclin D3 is an important regulator for transition from G(1) to the S phase of the cell cycle. Cyclin D3 expression is associated with cell proliferation in lymphoid tissues, but its impact on clinical outcome in non-Hodgkin's lymphomas has not been studied. Therefore, we determined the clinical relevance of cyclin D3 expression in patients with diffuse large B-cell lymphoma. We examined the relation between cyclin D3 expression at diagnosis and response to conventional polychemotherapy and overall survival in 81 previously untreated patients with diffuse large B-cell lymphoma. Cyclin D3 expression was assessed by immunohistochemistry. Cyclin D3 immunostaining ranged from 0-100% (median, 30%) of the lymphoma cells. Patients with high (>or=50% cyclin D3-positive lymphoma cells) cyclin D3 expression had a more advanced clinical stage (P = 0.003) and more often had extranodal disease in more than one site (P = 0.007) than patients with low cyclin D3 expression. Patients with high cyclin D3 expression had a significantly lower complete response rate (17% versus 74%; P < 0.001) and a shorter overall survival (3-year survival rate, 18% versus 74%; P < 0.001) than those with low cyclin D3 expression. Multivariate analyses that included cyclin D3 and the International Prognostic Index demonstrated that cyclin D3 expression had independent effects on the complete response rates and overall survival of the patients. In conclusion, high cyclin D3 expression is an independent predictive and prognostic factor associated with poor clinical outcome in patients with diffuse large B-cell lymphoma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1,076 women.

OBJECTIVE: To investigate the influence of the traditional hands-on versus the innovative hands-poised method on the risk of perineal trauma during vaginal delivery and on neonatal outcomes. STUDY DESIGN: In a prospective, randomized, multicenter study, 1,161 of 1,505 women giving birth at the Departments of Obstetrics and Gynecology of the University Hospital of Vienna and Semmelweis Women's Hospital, Vienna, between February and September 1999, were randomized into the trial. In the hands-on method, the left hand of the midwife puts pressure on the infant's head, and the right hand is placed against the perineum. In the hands-poised method, the midwife guides the parturient through the birth without touching the perineum, prepared to apply light pressure on the infant's head. RESULTS: One hundred eighty-seven of 574 women (32.5%) in the hands-on group and 180 of 502 women (35.8%) in the hands-poised group experienced perineal tears (P = .5). Sixteen women (2.7%) treated with the hands-on method developed third-degree perineal tears as compared with five women (0.9%) treated with the hands-poised method (P < .05). In the hands-on group, 103 women (17.9%) underwent episiotomy as compared with 51 cases (10.1%) in the hands-poised group (P < .01). No significant differences in neonatal outcomes were observed between the two groups. CONCLUSION: Our data suggest that a policy of hands-poised care is more suitable for preserving the perineum during birth and is a safe and effective birthing alternative for women.

Adult↗