INTRODUCTION:A recently published expert opinion on interpretation and management of category II fetal heart tracings was adopted at our institution in 2014. Local Providers expressed concern that implementation of the algorithm may lead to an increase in the primary cesarean section rate for non-reassuring fetal heart tracings. METHODS: A retrospective chart review was performed to assess the potential effect of the algorithm on the cesarean section rate. Term Delivery records for pre and post implementation were reviewed. Inclusion criteria were singleton term pregnancies. Exclusion criteria were preterm pregnancies, multiple gestations, fetal anomalies, abnormal placentation, fetal malposition, uterine anomalies, prior uterine surgery, and other indications for cesarean delivery. Patient data included maternal demographics, obstetrical history and delivery outcomes. The primary outcome was the cesarean section rate. Secondary outcomes included NICU admissions, maternal and neonatal morbidity, and Apgar scores.
This article discusses the growing complexity of Safe Drinking Water Act (SDWA) regulations, and how small water systems may find that treatment practices for complying with one regulation will affect compliance with other regulations. The article discusses potential concerns with simultaneous compliance and disinfection byproduct rules and surface water treatment rules, along with problems when using disinfectants as oxidants for treating certain issues. The article lists considerations for using alternative technologies for total organic carbon removal. Chemical stability vs. DBP risks, microbial contamination, and conflicts between the Ground Water Rule and the Arsenic Rule including arsenic release, oxidation of arsenic and dissolved metals, membrane compatibility, and pH adjustments are all discussed.
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