Comparison of placental pathology between severe preeclampsia and HELLP syndrome.

OBJECTIVE: This study was performed to evaluate and compare the placental pathology in patients with severe pre-eclampsia (PE) and HELLP syndrome. Moreover, neonatal birth weight was compared between the two groups. MATERIALS AND METHODS: This cross-sectional prospective study was conducted in Alzahra and Beheshti Hospitals (Isfahan, Iran) between 2007 and 2009. Placentas from 32 patients having severe pre-eclampsia without HELLP (referred to as preeclampsia group) and 25 patients having severe preeclampsia with HELLP syndrome (referred to as HELLP group) were evaluated. The studied parameters included placental weight, chorioamnionitis (either acute or chronic), retroplacental hematoma, placental infarction, intervillous thrombosis, and decidual arteriopathy. Birth weight adjusted for gestational age was also compared between the two groups. RESULTS: We found statistically more significant frequency of retroplacental hematoma in the PE group compared to the HELLP group (P value 0.00). Despite the relatively high frequency of accelerated villous maturation and decidual arteriopathy in both groups, the difference between the two groups regarding these two parameters was not statistically significant. Other placental features did not show any significant difference between the two groups either. The frequency of small for gestational age births showed no statistically significant difference between the two groups. CONCLUSION: Retroplacental hematoma was the only placental pathology that showed statistically significant different frequencies between the two groups. Although this may suggest different underlying pathogenetic mechanisms in these two conditions, further studies are needed to confirm this hypothesis.

Evaluating the effectiveness of local dexamethasone injection in pregnant women with carpal tunnel syndrome.

BACKGROUND: Most of the medical treatments for carpal tunnel syndrome (CTS) have focused on suppressing the inflammatory process. An injection of dexamethasone acetate might provide the necessary cellular and humoral mediators to induce a healing cascade. Dexamethasone is a water-soluble steroid which is safe to be used in the third trimester, especially as a local treatment. The aim of this study was to evaluate the effectiveness of 4 mg dexamethasone acetate injection to treat carpal tunnel syndrome in pregnancy period. METHODS: Twenty pregnant women with CTS were recruited using strict inclusion and exclusion criteria. All the patients had been injected with 4 mg of dexamethasone acetate and 0.5 ml lidocaine 1% under the carpal tunnel. Pain intensity (based on visual analog scale or VAS) and electro physiologic parameters of median nerve (transcarpal median sensory nerve conduction velocity (SNCV), distal motor latency (DML) and distal sensory latency (DSL) were recorded before and 3 weeks after the injection. RESULTS: The average pain scores before and 3 weeks after the dexamethasone acetate injection was 8.70 ± 0.92 and 4.30 ± 0.76 respectively (p < 0.005). In addition, transcarpal SNCV of median nerve was 33.7 ± 6.3 m/s and 24.5 ± 6.8 m/s (p = 0.001); DML of median nerve was 5.16 ± 1.04 ms and 4.70 ± 0.53 ms (p = 0.001) and DSL of median nerve was 4.84 ± 0.77 ms and 4.2 ± 0.6 ms (p = 0.001), respectively. CONCLUSIONS: After dexamethasone acetate injection, pain intensity and electrophysiological parameters were significantly improved. This study offered encouraging results for an alternative minimally invasive treatment for CTS in pregnant women.