Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata.

OBJECTIVE: The present study aimed to investigate the perinatal morbidity associated with multiple repeat cesarean deliveries (CD) and, thus, to achieve a body of evidence for the current practice of discouraging pregnancy after undergoing three CDs. PATIENTS AND METHODS: This study prospectively reviewed a total of 500 women who consecutively underwent CD between January 1, 2009 and April 1, 2009. The patients were allocated into four groups based on the number of CDs they had undergone (Group 1: first CD, Group 2: second CD, Group 3: third CD, Group 4: fourth CD). Data related with their demographic and clinical characteristics were recorded as well as their perioperative characteristics and clinical characteristics of the neonates born to them. Cochran-Armitage test for trends and Spearman rank correlation analysis test was used to evaluate the trend of perioperative complications and neonatal outcome with the increasing number of CDs. RESULTS: The mean age, gravidity and parity were significantly higher in groups 2-4 than those of the women who had their first CD (Group 1). The average operation time and mean delivery time as well as severe adhesions, bowel injury increased significantly with the number of CD. Neonatal characteristics were similar among groups except for a trend towards a decrease in the rate of meconium stained and a trend towards increase in the rate of neonatal sepsis with the increasing number of CD. CONCLUSIONS: We have found positive correlation between the maternal morbidity and the number of CDs. The occurrence of adhesions emerges as the most significant indicator of maternal morbidity, eventually leading to the neighboring organ injury and prolonged operation time.

Leptin levels and antihypertensive treatment in preeclampsia.

INTRODUCTION: This study was carried out to investigate changes in the plasma leptin concentrations during preeclampsia treatment and to determine whether antihypertensive treatments, aimed at decreasing leptin levels, would improve foetal outcomes. METHODS: A prospective study was undertaken in 57 pregnant women with preeclampsia (37 with mild and 20 with severe preeclampsia) and 46 normal pregnant women who were matched in maternal and gestational age and body mass index. The mild preeclampsia group was treated with alpha-methyldopa, while the severe preeclampsia group was treated with a combination of alpha-methyldopa and nifedipine. RESULTS: The severe preeclampsia group had significantly lower platelet counts, higher systolic and diastolic blood pressures and elevated serum uric acid concentrations. Pre-treatment plasma leptin levels were significantly increased in the severe preeclampsia group (range 18.3-49.5) compared to the the mild preeclampsia group (range 20.7-45.4) and normal controls (range 8.6-19.2). Post-treatment plasma leptin levels in both the mild and severe preeclampsia groups (range 10.2-23.5 and 11.3-24.4, respectively) were statistically similar to those of the control group (range 9.1-20.7). Estimated foetal weight, intrauterine growth retardation and demise were statistically similar in the three study groups. CONCLUSION: Plasma leptin concentrations were found to be elevated in women diagnosed with severe preeclampsia. However, the exact mechanism underlying the increased plasma leptin levels in preeclampsia and the functional role of leptin in the development of hypertension need to be further clarified. Leptin has a promising future as a valuable marker to identity women with a high risk for preeclampsia.