The use of sonographic myometrial thickness measurements for the prediction of time from induction of labor to delivery.

BACKGROUND: Several attempts have been made to find tools for the prediction of successful induction of labor. Sonographic myometrial thickness has not yet been investigated regarding its use as a clinical tool for the course of labor induction. OBJECTIVE: To evaluate the role of sonographic measurement of myometrial thickness in the prediction of the time interval to successful vaginal delivery after induction of labor. STUDY DESIGN: A prospective study was conducted including term singleton pregnancies with a vertex presentation designated for balloon induction at 38-42 weeks gestation. Prior to induction, abdominal sonographic myometrial thickness was assessed at five locations: lower uterine segment (above and below the reflection of the urinary bladder), mid-anterior wall, fundus and posterior uterine wall. Induction of labor was then carried out with a trans-cervical Foley catheter that was substituted with intravenous oxytocin after balloon expulsion. The parameters assessed were successful induction of labor resulting in a vaginal delivery and the time interval from balloon insertion to balloon expulsion, the time interval from initiation of oxytocin administration to delivery and the total time from balloon insertion to delivery. RESULTS: Fifty-two women were recruited to the study. Indications for labor induction were: post-date pregnancy (48.1%), gestational diabetes mellitus (19.2%), oligohydramnios (11.5%), gestational hypertensive disorders (5.8%) and other indications (15.4%). Vaginal delivery was achieved in 46 patients (88.5%). A statistically significant correlation was found between fundal and posterior uterine wall myometrial thickness and time from induction to balloon expulsion (r = 0.36, p = 0.03; r = - 0.35, p = 0.05, respectively). This correlation remained significant in a multivariate logistic regression model controlling for confounders. A correlation between myometrial thickness and the total time from induction to delivery was not statistically significant. CONCLUSION: Myometrial fundal and posterior uterine wall thickness in women undergoing labor induction with a balloon catheter was found to be correlated with the interval from balloon insertion to expulsion. Our findings support further investigations into the use of sonographic myometrial thickness as part of the assessment prior to induction of labor.

The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes.

OBJECTIVE: To evaluate the effect of attending a prenatal childbirth preparation course (CPC) on labor duration and outcomes. METHODS: A cross sectional study of 53 primiparous women who attended and 54 women who did not attend a CPC was conducted. The state-trait anxiety inventory (STAI) score was used to diagnose anxiety. Clinical and obstetrical data were collected from the perinatal database of our center. Through post-partum interviews, coping strategies were assessed, patients graded their childbirth experience and breastfeeding was evaluated. Data were analyzed using description analyses and a P-value <0.05 was considered statistically significant. RESULTS: The STAI score was significantly lower in the study group compared with controls (P=0.025). The first stage and the entire duration of labor were significantly shorter (P=0.036 and P=0.026, respectively) in women who attended the CPC. No significant differences were found with regard to the mode of delivery, rate of episiotomy, use of analgesics and neonatal outcomes between the groups. Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls. CONCLUSIONS: The knowledge acquired in the CPC has positive effects on the course of labor and delivery outcomes as well as higher rates of breastfeeding.

Fertility treatment as a risk factor for maternal request of cesarean delivery in twin pregnancies.

OBJECTIVE: A marked increase in the overall cesarean delivery (CD) rate of twin pregnancies has recently been observed. We sought to examine the obstetrical characteristics of patients who chose a non-indicated CD and to investigate the trends in the rate of CD for maternal request over a 5 years period. STUDY DESIGN: A cross sectional retrospective study of twin pregnancies, compared obstetrical characteristics between patients who chose a non-indicated CD and those who delivered vaginally. Deliveries occurred during 2006 and 2011 in a regional tertiary medical center. Patients with any indication for a CD were excluded. A multivariate logistic regression was used to control for confounders. RESULTS: 525 twins were included at the study, 61.7 % (n = 324) were delivered by CD. Of these, 28.7 % (n = 93) were non-indicated. Between the years 2006 and 2011, there was a significant decrease in the rate of non-indicated CD (34.9 vs 23.8 %, OR = 0.58, 95 % CI 0.35-0.94, P = 0.02). Deliveries after fertility treatments or a previous CD had a higher rate of non-indicated CD (51.6 vs. 27.4 %, P < 0.001 and 26.9 vs. 3.5 %, P < 0.001; respectively). In the multivariate analysis, maternal age (OR = 1.08, 95 % CI 1.01-1.15), previous CD (OR = 15.75, 95 % CI 5.82-42.67) and fertility treatments (OR = 2.16, 95 % CI 1.14-4.10) were found to be independent risk factors for a non-indicated CD. Furthermore, parity was found to be an independent protective factor (OR = 0.75, 95 % CI 0.61-0.92). CONCLUSION: In our study population, there was a significant decrease in the rate of non-indicated CD over a five-year period. Maternal age, fertility treatments and previous CD were found to be independent risk factors for non-indicated CD in twin pregnancies.

The use of sonographic cervical length assessment for the prediction of time from induction to delivery.

OBJECTIVE: The objective of this study is to investigate the role of trans-vaginal cervical length measurement in the prediction of the interval to successful vaginal delivery after induction of labor with balloon catheter. METHODS: In this prospective study of cervical length measurement before induction of labor, singleton pregnancies that underwent induction of labor between 37 and 42 weeks of gestation were included. The data collected included trans-vaginal sonographic cervical measurements followed by digital cervical assessment. Bishop score was used to quantify digital assessment (before induction of labor). RESULTS: During the study period, 71 patients were included in the study. A statistically significant linear correlation was found between sonographic cervical length prior to induction of labor and the time of delivery (Pearson correlation 0.335; p values 0.005). Of the 57 vaginal deliveries, 27 patients had a cervical length of less than 28 mm. Patients with a cervical length of less than 28 mm had a significantly shorter time to delivery compared to patients with more than 28 mm length (20.4 versus 28.7, respectively; p value = 0.019). Cervical length of 28 mm remained significantly correlated even after performing several logistic regression models in order to control for confounders such as parity and age. In addition, a correlation was found between Bishop scores of above 7 to the time to delivery. CONCLUSIONS: Cervical length is correlated linearly to the time interval between induction of labor and delivery. A cervical length of less than 28 mm was found to be statistically significant in predicting a shorter time to delivery.

The clinical utility of sonographic cervical length in the management of preterm parturition at 28-32 weeks of gestation.

OBJECTIVES: The aim of this study was to evaluate the role of cervical length measurement in early third trimester (28-32 weeks) as a predictor of preterm delivery (PTD), in women presenting with preterm parturition. METHODS: Cervical length was measured prospectively, in singleton pregnancies at 28-32 weeks with preterm contractions (PTC). A multivariate linear regression model was performed to assess the association between cervical length and gestational age at delivery. Logistic regression analysis with PTD before 34 and 37 weeks of gestation as the outcome variable was performed to control for confounders. RESULTS: Fifty-six women were included, mean gestational week at presentation and at delivery were 29.88 ± 1.13 and 37.05 ± 2.86, respectively. There was a direct association between short cervical length at admission and gestational week at delivery (p = 0.027). This association remained significant even after controlling for confounders. Short cervical length was significantly associated with PTD before 34 (p = 0.045) or 37 (p = 0.046) weeks of gestation. CONCLUSIONS: Third trimester cervical length measurement in patients with PTC is associated with gestational week at delivery, as well as PTD prior to 34 and 37 weeks of gestation. Therefore, examining cervical length is clinically valuable and probably cost-effective during early third trimester.

Umbilical artery peak systolic velocity measurements for prediction of perinatal outcome among IUGR fetuses.

BACKGROUND: To evaluate the role of umbilical artery (UA) peak systolic velocity (PSV) measurements in the prediction of perinatal outcome in fetuses with intrauterine growth restriction (IUGR). METHODS: A prospective study was performed, including patients with a suspected diagnosis of IUGR. Exclusion criteria were multiple gestations, unreliable gestational age, and known fetal malformations. Doppler measurements of the UA and middle cerebral artery (MCA) were recorded. RESULTS: Seventy-two patients were enrolled and a total of 192 Doppler measurements were performed between 24 and 39 weeks' gestation. Mean gestational age at delivery was 36.9 ± 2.7 days and mean birth weight was 2,166 ± 497 grams. Nine patients (12.5%) had oligohydramnios; 50 (69.4%) delivered preterm (<37 weeks), and 26 underwent a cesarean section, of those 7 (29.2%) cesarean sections were for a nonreassuring fetal heart rate tracing. Fifty-one (70.8%) neonates were actually small for gestational age. No correlation was found between UA-PSV and MCA-PSV to perinatal outcome. Correlation was found between UA pulsatility index and cerebroplacental ratio to perinatal outcome before 34 weeks' gestation. CONCLUSIONS: UA PSV measurements do not correlate with adverse perinatal outcome. A correlation exists between UA pulsatility index and cerebroplacental ratio and perinatal outcome prior to 34 weeks' gestation. It seems that UA PSV and MCA PSV do not contribute to the management of fetuses with IUGR.

Macrophage infiltration and stress-signaling in omental and subcutaneous adipose tissue in diabetic pregnancies.

OBJECTIVE: To examine if, as in obesity, pregnancies complicated by gestational diabetes mellitus (GDM) exhibit increased macrophage infiltration and activated MAP-kinases in omental adipose tissue. METHODS: Paired omental (OM) and abdominal subcutaneous (SC) fat samples were collected from 11 GDM and 20 normal pregnancies during cesarean delivery. Tissues were stained to detect macrophages, and analyzed to assess MAP-kinases. RESULTS: OM had higher macrophage counts than SC in GDM (6.10 ± 2.20 versus 2.53 ± 1.45, p = 0.04), but not in normal pregnancies (p = 0.346). GDM pregnancies had more macrophages than normal pregnancies in OM (6.10 ± 2.20 versus 1.29 ± 0.55, p = 0.01), while only a trend was observed in SC fat (p = 0.08). Significant correlation (R = 0.619, p = 0.005) was observed between OM-macrophage infiltration and insulin resistance. Using multivariate analysis, only obesity independently associated with GDM. Expression of total p38MAP-kinase was higher in OM versus SC in both normal and GDM pregnancies, without significant differences between these groups. However, expression of activated p-p38MAP-kinase, and its upstream kinase MKK4, was comparable between fat depots. CONCLUSION: GDM pregnancies demonstrate increased macrophage infiltration to OM fat, correlating with higher insulin resistance. As in non-pregnant-patients obesity and OM macrophage infiltration may be on the same causal pathway, leading to GDM. Yet, this occurs without activation of p38MAP-kinase signaling.

Obstetric outcomes after restrictive bariatric surgery: what happens after 2 consecutive pregnancies?

BACKGROUND: The objective of this study was to compare the outcomes of 2 consecutive pregnancies of the same women who conceived after restrictive bariatric surgeries. METHODS: A retrospective study comparing consecutive pregnancy outcomes of the same women, who conceived before and twice after a restrictive bariatric surgery, was conducted. RESULTS: This study included 109 women, and therefore, 327 paired pregnancies: 109 pregnancies preceded and 218 followed restrictive bariatric surgery (87% had laparoscopic banding, and 13% had silastic ring vertical gastroplasty). Both prepregnancy and predelivery body mass index were significantly lower after bariatric surgery (36.7±4.4 versus 31. 5±5.5, P<.001; 40.6±5.5 versus 35.3±6.1, P<.001; respectively). This effect was preserved at the subsequent pregnancy (31.5±5.5 versus 31.3±6.3, P = .609, and 35.3±6.1 versus 35.1±5.9, P = .706, respectively). The rates of hypertensive disorders and gestational diabetes mellitus were significantly lower after the bariatric operation, for the first and the second pregnancy (21% versus 7.4% and 4.7%, P = .009, and 19% versus 5.6% and. 6.6%, P = .007, respectively). The rate of macrosomic newborn was significant lower in the second postbariatric pregnancy (11.1% before versus 1.1% after second pregnancy, P = .02). Using multiple logistic regression models controlling for maternal age, prepregnancy body mass index, and the type of surgery, the reduction in hypertensive disorders (adjusted odds ratio (OR) .3, 95% confidence interval (CI) .12-.82; P = .018 for the first postoperative pregnancy and adjusted OR .2, 95% CI .06-.64; P = .007 for the second postoperative pregnancy), and gestational diabetes mellitus (adjusted OR .2, 95% CI .06-.48; P = .001 for the first postoperative pregnancy and adjusted OR .3, 95% CI .05-.51; P = .002 for the second postoperative pregnancy) remained significant. CONCLUSIONS: A significant decrease in pregnancy complications, such as hypertensive disorders and gestational diabetes mellitus, is achieved after a restrictive bariatric surgery. This improvement is maintained at the second subsequent pregnancy.

The effect of cervical cerclage on pregnancy outcomes in women following conization.

OBJECTIVES: To determine the effect of cervical cerclage on obstetrical complications and perinatal outcomes of patients following conization. DESIGN: A retrospective population based cohort study. SETTING: Tertiary academic medical center that covers all the deliveries of the region. POPULATION: All patients with previous cervical conization who delivered between the years 1994-2011. METHODS: A retrospective population based study. MAIN OUTCOME MEASURES: The effect of cerclage placement on the rate of preterm birth. RESULTS: During the study period there were 109 deliveries of patients following a cervical conization. Cervical cerclage was placed in 22 deliveries that served as the study group and the rest (n = 87) served as the comparison group. The rate of early preterm delivery (PTD; <34 weeks) was significantly higher in women who had a cerclage. In a logistic regression model, cerclage was found to be an independent risk factor for early PTD. CONCLUSION: Cerclage is an independent risk factor for early PTD In patients who had a conization due to CIN.

Detection of S100B in maternal blood before and after fetal death.

BACKGROUND: S100B is a brain damage biomarker. When measured immediately after birth, it reflects neonatal brain damage following asphyxia. In this study, we used feticide as a novel model of fetal brain damage. We examined whether such damage is reflected by a rise in S100B in maternal blood before delivery. METHODS: Eight pregnant women were recruited between January and July 2012. Maternal blood samples were drawn before and after feticide at predetermined time points (0, 15, 30, 60, 120, and 240 min). S100B, lactate dehydrogenase, creatine kinase, and creatinine concentrations were measured by standard human ELISA and chemical analyzer. RESULTS: No significant difference was noted between S100B levels before and after feticide, neither in non-specific cell death markers (lactate dehydrogenase and creatine kinase), which remained within normal range. S100B ranged between 0.015-0.04 µg/L through all the predetermined time points. CONCLUSION: No statistically significant differences were demonstrated in S100B levels before and after feticide.

Clinical and microbiological characteristics of Bartholin gland abscesses.

OBJECTIVE: To examine the clinical course and causative microorganisms of Bartholin gland abscesses. METHODS: This was a retrospective study of all patients treated for Bartholin gland abscesses between the years 2006 and 2011 at the Soroka University Medical Center, a regional medical center in southern Israel. RESULTS: During the study period, 219 women were admitted as a result of an abscess of the Bartholin gland, 63% of which were primary abscesses and 37% recurrent abscesses (occurrence of a second clinical event). Pus cultures were positive in 126 (61.8%) of cases. Escherichia coli was the single most frequent pathogen found (43.7%) and 10 cases (7.9%) were polymicrobial. Culture-positive cases were significantly associated with fever (25% compared with 9.3%; P=.043), leukocytosis (50.4% compared with 33.8%; P=.027), and neutrophilia (17.9% compared with 5.9%; P=.021). The odds ratio of having any of these with a positive culture was 2.4 (95% confidence interval 1.3-4.3; P=.003). In the recurrent group, 81% recurred ipsilaterally and the mean time for recurrence was 32 ± 50 months. Infection with E coli was significantly more common in recurrent infection compared with primary infections (56.8% compared with 37%; P=.033). Three cases of resistance to most beta-lactam antimicrobials (extended-spectrum beta-lactamase-producing [E coli] strains) were identified. CONCLUSION: A substantial proportion of patients with Bartholin gland abscess are culture-positive with E coli being the single most common pathogen. Microbiological findings coupled with their clinical correlates are important parameters in the management of patients with a Bartholin gland abscess and in the selection of empirical antimicrobial treatment during the primary diagnosis. LEVEL OF EVIDENCE: : III.

Postpartum uterine artery Doppler velocimetry among patients following a delivery complicated with preeclampsia.

OBJECTIVE: To evaluate postpartum uterine artery (UtA) velocimetry in patients following severe preeclampsia (PET) as compared with normotensive controls. STUDY DESIGN: Postpartum UtA velocimetry was obtained prospectively during the early postpartum period. The right and left UtA pulsatility index (PI) was measured and the presence of an early diastolic notch was noted. For categorical variables, the χ2 test or Fisher exact was used as appropriate and for continuous variables the t-test was used. The p value <0.05 was considered statistically significant. RESULTS: Thirty-one patients following severe PET and 52 normotensive controls were included in the study. Following severe PET, higher rates of intrauterine growth restriction, cesarean delivery, preterm delivery and accordingly lower neonatal birth weight were noted. Postpartum UtA velocimetry measurements were performed on average 51.2 h after delivery (range 8-169). Right and left UtA PI was comparable between patients following severe PET and controls. The presence of unilateral and bilateral early diastolic notches were significantly higher in patients following severe PET. CONCLUSIONS: The pathophysiology of uterine involution and the physiologic return of the uterine arteries to the non-pregnant state may be different following severe PET.

Can we find the perfect oil to protect the perineum? A randomized-controlled double-blind trial.

OBJECTIVE: To determine whether perineal massage during the second stage of labor using oil enriched with vitamins, increases the chances of delivering with an intact perineum as compared to perineal massage using pure liquid wax. METHOD: A prospective, randomized, double-blind study was conducted. Women were assigned to liquid wax (jojoba oil) versus purified formula of almond and olive oil, enriched with vitamin B1, B2, B6, E and fatty acids. The caregivers used the oils during the second stage of labor. RESULTS: A total of 164 women undergoing vaginal delivery were recruited. No significant differences regarding perineal lacerations, number of sutures and length of suturing were noted between the two groups. Likewise, while analyzing separately nulliparous and multiparous women, no significant differences were noted. Controlling for birth weight >4000 g, using the Mantel-Haenszel technique, no association was noted between perineal lacerations and the type of oil used (weighted OR = 0.9, 95% CI 0.3-2.4; p = 0.818). CONCLUSION: The type of the oil used during the second stage of labor for prevention of perineal tears has no effect on the integrity of the perineum. Accordingly, it seems that there is no perfect oil.

Association between first trimester vaginal bleeding and uterine artery Doppler measured at second and third trimesters of pregnancy.

OBJECTIVE: To evaluate the prevalence of first trimester vaginal bleeding among patients with abnormal second and third trimester uterine artery Doppler. METHODS: A prospective study of patients with a uterine artery Doppler measurement between 27 and 42 weeks' gestation was undertaken. A comparison was made between two groups: patients with and without first trimester vaginal bleeding. Abnormal uterine artery Doppler was defined as PI >95th% or the presence of a diastolic notch. RESULTS: Of the 277 patients that were included in the study, 65 (23%) had first trimester vaginal bleeding. No differences were noted in uterine artery Doppler waveforms among patients with and without first trimester vaginal bleeding. Among patients with first trimester vaginal bleeding, 9 (14%) had a bilateral uterine artery notch and 56 (86%) did not, compared with 51 (24%) and 161 (76%), in the control group, respectively. Patients with first trimester vaginal bleeding, and a bilateral uterine artery notch had significantly higher rates of small for gestational age neonates, low-Apgar scores (<7) at one minute and cesarean deliveries compared to patients with first trimester vaginal bleeding who did not have bilateral uterine artery notch. CONCLUSION: First trimester vaginal bleeding was not associated with a higher incidence of abnormal uterine artery waveforms or with placental related conditions. However, adverse perinatal outcomes were found when first trimester vaginal bleeding was associated with second and third trimester bilateral uterine artery notchs.

[What do ultrasound performers in Israel know regarding safety of ultrasound, in comparison to the end users in the United States?].

OBJECTIVE: The goal was to examine the knowledge of ultrasound end users regarding safety of ultrasound in pregnancy, and to compare it to ultrasound end users in the United States. METHODS: A questionnaire was distributed to ultrasound users at obstetrics and gynecology conventions and wards throughout the country, between the years 2008-2010, and compared to an identical questionnaire distributed in the United States. RESULTS: A total of 143 end users completed the questionnaire; 92% of them are physicians, 71% gynecologists; 3.5% routinely perform Doppler ultrasound in the first trimester. Overall, 36% of the ultrasound end users thought that the number of ultrasounds performed in low-risk pregnancy should be limited. Although 44.1% were familiar with the term thermal index, only 22.4% answered the related question correctly; 26.6% were familiar with the term mechanical index, but only 4.9% described it correctly. More than 80% of the end users did not know where to find the acoustic indices while performing the examination. No significant difference in knowledge was found between the ultrasound end users in Israel and the United States. CONCLUSIONS: The poor level of knowledge regarding safety issues, found both in Israel and United States, raises the necessity to reexamine the methods of informing the relevant audience on the courses and training programs available on these matters.

Spinal versus general anesthesia in cesarean sections: the effects on postoperative pain perception.

OBJECTIVE: To compare postoperative pain perception and analgesia requirements in patients undergoing cesarean section (CS) using general versus spinal anesthesia. STUDY DESIGN: A prospective, observational study of patients undergoing elective CS during 2009 under either general or spinal anesthesia. Postoperative pain intensity and analgesia requirements were evaluated for up to 48 h after surgery. RESULTS: A total of 153 women were enrolled; 77 received general and 76 received regional anesthesia. Postoperative meperidine requirements in the first 24 h were significantly higher in the general anesthesia group. Pain scores were mostly comparable between the groups. Nevertheless, lower pain scores were graded after 8 h in the general versus the spinal anesthesia and this reversed at 48 h. CONCLUSION: Spinal anesthesia is comparable to general anesthesia in terms of post-operative pain control. In choosing the type of anesthesia in CS, other factors such as the urgency and potential maternal and fetal hazards should be taken into account.

Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery.

BACKGROUND: Overweight and obesity have been shown to be associated with increased adverse pregnancy outcomes. Weight reduction improves maternal health status and reduces the risk of pregnancy complications, as well as long-term consequences. Our objective was to compare the pregnancy outcomes of the same women who delivered before and after bariatric surgery. METHODS: A retrospective study comparing pregnancy outcomes, of the same women, delivered before and after a bariatric surgery was conducted. The observed deliveries occurred from 1988 to 2008 at Soroka University Medical Center, the sole tertiary hospital in the southern region of Israel. RESULTS: The present study included 288 paired pregnancies: 144 deliveries before and 144 after bariatric surgery. A significant reduction in the prepregnancy and predelivery maternal body mass index was noted after bariatric surgery (36.37 ± 5.2 versus 30.50 ± 5.4 kg/m(2), P < .001; and 40.15 ± 4.92 versus 34.41 ± 5.42 kg/m(2), P < .001; respectively). Only 8 patients (5.6%) were admitted during their pregnancy for bariatric complications. Pregnancy complications, such as hypertensive disorders (31.9% versus 16.6%; P = .004) and diabetes mellitus (20.8% versus 7.6%; P = .001), were significantly reduced after bariatric surgery. The rate of cesarean deliveries because of labor dystocia was significantly lower after bariatric surgery (5.6% versus 2.1%, P < .05). Using a multiple logistic regression model, controlling for maternal age, the reduction in hypertensive disorders (odds ratio .4, 95% confidence interval .2-.8) and diabetes mellitus (odds ratio .15, 95% confidence interval .1-.4) remained significant. CONCLUSION: A significant decrease in pregnancy complications, such as hypertensive disorders and diabetes mellitus, is achieved after bariatric surgery.

Trace elements' concentrations in maternal and umbilical cord plasma at term gestation: a comparison between active labor and elective cesarean delivery.

OBJECTIVE: Trace elements are minerals required in minute quantities to maintain proper physical functioning. The role of trace elements in the process of parturition is poorly understood. This study was aimed to determine levels of trace elements' concentration in maternal plasma and umbilical venous and arterial plasma at term during active labor vs elective cesarean delivery (CD). STUDY DESIGN: A prospective case-control study was conducted. Forty healthy parturients in active labor at term with their newborns were compared to 40 healthy parturients matched for maternal age, parity, and gestational age, who delivered by elective CD (before commencement of labor). Samples of maternal venous blood and umbilical cord arterial and venous blood were drawn immediately following delivery. Trace elements' concentrations were measured using the inductively coupled plasma mass spectrometer (ICP-MS). RESULTS: Significant higher levels of manganese (Mn) and selenium were found in maternal venous plasma during active labor vs elective CD. Magnesium (Mg) levels were significantly higher in maternal venous blood during elective CD compared to active labor. Umbilical cord artery levels of Mg, Mn, and zinc (Zn) were significantly higher in active term labor vs elective CD. Also, significant higher levels of copper and Zn were found in umbilical cord vein between active labor and elective CD. CONCLUSION: Trace elements' concentrations differ significantly in fetal blood during active labor vs elective CD. Hence, trace elements may play a crucial role in the process of human parturition.

Severe pre-eclampsia is associated with abnormal trace elements concentrations in maternal and fetal blood.

OBJECTIVE: The study was aimed to compare trace elements concentrations in women with and without severe pre-eclampsia (PE). METHODS: A prospective case-control study was conducted comparing 43 parturients with severe PE (who received magnesium sulfate [MgSO4]) and 80 healthy parturients and their newborns, matched for gestational age and mode of delivery. Inductively coupled plasma mass spectrometry (ICPMS) was used for the determination of zinc (Zn), copper (Cu), selenium (Se) and magnesium (Mg) levels in maternal as well as arterial and venous umbilical cord serum. RESULTS: Zn levels (µg/L) were significantly higher in fetal arterial and venous blood of the PE group (947.3 ± 42.5 vs. 543.1 ± 226, 911.1 ± 220.2 vs. 422.4 ± 145, p < 0.001; respectively). Se levels (µg/L) were significantly lower in maternal and fetal arterial and venous cord blood of the PE group (98.6 ± 24.2, 110.7 ± 19.4, 82 ± 17.8 vs. 111.6 ± 17.6, 82.1 ± 17.4 vs. 107.1 ± 25.7, p < 0.001; respectively). Cu levels (µg/L) were significantly lower in fetal arterial and venous cord blood (581.6 ± 367.4 vs. 949 ± 788.8, p = 0.022, 608.3 ± 418.1 vs. 866.9 ± 812.6, p = 0.001 respectively) but higher in maternal blood (2264.6 ± 751.7 vs. 1048 ± 851.1, p < 0.001). These differences remained significant while controlling for the mode of delivery. Mg levels were significantly higher in the PE group as compared with the control group. CONCLUSIONS: Severe PE is associated with abnormal concentrations of Zn, Cu and Se. Therefore, trace elements may have a crucial role in the pathogenesis of severe PE.

Preoperative analgesia with local lidocaine infiltration for post cesarean delivery pain management.

OBJECTIVE: To evaluate the impact of local lidocaine incision-site injection in patients undergoing cesarean deliveries (CD), on post operative pain and analgesic requirements. STUDY DESIGN: In this prospective, double-blinded, placebo-controlled study, patients undergoing elective CD were randomly assigned to receive 1% lidocaine solution or placebo to the incision site, prior to the performance of a Pfannenstiel incision. Pain intensity was evaluated for up to 48 hours after surgery and analgesic requirements of the patients were recorded. RESULTS: During the study period, 153 patients were enrolled; 77 received pre-emptive analgesia with lidocaine and 76 received a placebo. No significant differences were noted between the groups in respect to parity, previous CD, maternal age and gestational age. Pain scores or requirements of analgesia did not differ between the groups. CONCLUSION: Pre-emptive analgesia with local incision-site injection with lidocaine does not seem beneficial in reducing post cesarean pain scores and analgesic requirements.