Analgesia: effects on the first and second stages of labor.

BACKGROUND: This controlled observational study aimed at evaluating the effects of epidural analgesia on the first and second stages of delivery in nulliparous women, referred to the birth centers of the Sant'Omero "Val Vibrata" Hospital and the "San Salvatore" Hospital in L'Aquila, selected in accordance with specific inclusion criteria. MATERIALS AND METHODS: Between May Ws, 2012 and April 3 1s, 2013, 363 patients were enrolled at the birth centres of the "Val Vibrata" Hospital in Sant'Omero (TE) and of the "San Salvatore" Hospital in L'Aquila. 139 patients received epidural analgesia during labor at the "Val Vibrata" Hospital; 224 patients constituted the control group and went through natural delivery without analgesia at the "Val Vibrata" and "San Salvatore" hospitals. RESULTS: Dilation time was different in the two groups: in the group with analgesia, the median was 2.30 and 3.35 in the control group. The median expulsion time was 2.05 in the analgesia group and 0.40 in the control group. DISCUSSION: The statistical analysis of the study has highlighted the fact the analgesia influences the dilation and expulsion time of labor, confirming on the one hand the clinical evidence, and on the other, adding important results that have not been analyzed by other scientific studies. The results have shown that in nulliparous women, with spontaneous onset of labor, analgesia causes a major reduction in the dilation time of the cervical canal with respect to the control group.

Sonoelastography as method for preliminary evaluation of uterine cervix to predict success of induction of labor.

INTRODUCTION: Induction of labor is a useful practice to solve many obstetric situations but has a large impact on the health of women and their babies and therefore needs to be clearly justified clinically. AIM: To determine the sensitivity of sonoelastography in the evaluation of the cervix to predict the success of induction. MATERIALS AND METHODS: We enrolled 53 subjects preparing for induction of labor. Transvaginal evaluation of cervical length and a sonoelastogram were performed. We preliminarily classified the sonoelastograms into five elastography index (EI) categories and examined the different distribution of cesarean or spontaneous deliveries in various subgroups of EI by χ(2) test and multivariate analysis by logistic regression. RESULTS: Statistical analysis revealed a significant difference of prevalence of spontaneous delivery (EI1-3 82.75%, EI4-5 45.8%) versus cesarean section (EI1-3 17.25%, EI4-5 54.16%) (p = 0.0072). The diagnostic validity of EI was evaluated using the receiver operating characteristic curve and cut-off of the predictive value was EI3. DISCUSSION: The results of our study indicate that sonoelastography is an innovative technique that could allow a more objective preliminary evaluation of the cervix before inducing labor, however further studies with a larger number of subjects and a standardization of image acquisition are necessary.

Reversible posterior leukoencephalopathy syndrome in pregnancy: a case report.

Posterior reversible encephalopathy syndrome (PRES), is an acute, neurotoxic state. It is a very rare clinico-neuroradiological entity, and it is a complication of multiple clinical conditions. The association of PRES with toxemia in pregnancy is established. In this article, the authors discuss the case of a 22-year-old woman, gravida 1, 36-week pregnant, with extensive, bilateral white matter hypodensity, predominantly involving the parieto-occipital lobes region. These changes were highly suggestive of posterior reversible encephalopathy. This case report demonstrates that early treatment with control of blood pressure seizures can reverse this condition and also prevent progression to an irreversible damage, thus emphasizing the need for early diagnosis and treatment.

Spontaneous rupture of splenic hemangioma in puerperium.

Atraumatic splenic rupture is a rare clinical entity and in the absence of trauma, the diagnosis and treatment are often delayed. In this article the authors discuss a case of a 45-year-old woman, gravida 5, para 4, with spontaneous splenic rupture on her second postpartum day. The rupture was related to a splenic hemangioma that is a vascular malformation and the most common neoplasm of the spleen. Despite the fact that hemangiomas are the most common primary neoplasms of the spleen, only few cases of splenic rupture have been described in pregnancy or puerperium. However, spontaneous splenic rupture is a rare event and the rupture should be suspected in woman with unexplained abdominal pain or with clear signs of haemorrhage.