Analysis of Maternal and Fetal Oxidative Stress During Delivery with Epidural Analgesia.

Childbirth is a stressful event for mothers, and labor epidural analgesia (LEA) may reduce mental stress. Mental stressors include labor pain, fear, and anxiety, which induce oxidative stress. In this study, we focused on oxidative stress during delivery and conducted a cross-sectional analysis of maternal and fetal oxidative stress. The participants included 15 women who received LEA (LEA group) and 15 who did not (No LEA group). Participants with a gestational age of < 37 weeks, BMI of ≥ 35 kg/m2, cerebrovascular or cardiovascular complications, multiple pregnancies, gestational hypertension, gestational diabetes, chronic hypertension, thyroid disease, birth weight of < 2,500 g, emergency cesarean section, or cases in which epidural anesthesia was re-administered during delivery were excluded from the study. Maternal blood was collected on admission, and immediately after delivery, and umbilical artery blood was collected from the fetus. The oxidative stress status was assessed by measuring diacron-reactive oxygen metabolite (an index of the degree of lipid peroxide oxidation), biological antioxidant potential (an index of antioxidant capacity) and calculating the ratio of BAP/d-ROMs (an index of the oxidative stress). The results showed that maternal oxidative stress immediately after delivery was lower in the LEA group than in the No LEA group. Moreover, the fetuses experienced less oxidative stress in the LEA group than in the No LEA group. Taken together, these results suggest that LEA may reduce maternal and fetal oxidative stress associated with childbirth.

Fever in childbirth: a mini-review of epidural-related maternal fever.

Fever during childbirth, which is often observed in clinical settings, is characterized by a temperature of 38°C or higher, and can occur due to infectious and non-infectious causes. A significant proportion of non-infectious causes are associated with epidural-related maternal fever during vaginal delivery. Therapeutic interventions are required because fever has adverse effects on both mother and newborn. Effective treatment options for ERMF are lacking. As it is difficult to distinguish it from intrauterine infections such as chorioamnionitis, antibiotic administration remains the only viable option. We mentioned the importance of interleukin-1 receptor antagonist in the sterile inflammatory fever pathway and the hormonal influence on temperature regulation during childbirth, an important factor in elucidating the pathophysiology of ERMF. This review spotlighted the etiology and management of ERMF, underscoring recent advancements in our understanding of hypothalamic involvement in thermoregulation and its link to sterile inflammation. We propose to deepen the understanding of ERMF within the broader context of autonomic neuroscience, aiming to foster the development of targeted therapies.

Outcomes of severe peripartum cardiomyopathy and mechanical circulatory support: a case series.

BACKGROUND: We present three cases of severe peripartum cardiomyopathy (PPCM) that required mechanical circulatory supports. CASE PRESENTATION: Case 1: A 33-year-old woman developed acute heart failure (AHF) after normal spontaneous delivery. Intra-aortic balloon pump (IABP) was inserted on postpartum day (PD) 10 with a peripartum cardiomyopathy (PPCM), which was withdrawn on PD 30 after medical treatment including anti-prolactin drugs. Case 2: A 44-year-old woman developed AHF 1 month after vaginal delivery. IABP or extra-corporeal membrane oxygenation (ECMO) was not effective and a biventricular assist device was inserted. It was withdrawn on PD 85 after improvement of left ventricular ejection fraction (LVEF). Case3: A 37-year-old woman was transferred with a diagnosis of PPCM. Cardiac function unimproved by IABP or ECMO, and a left ventricular assist device was implanted. It was withdrawn on PD 386 after recovery of LVEF. CONCLUSION: All the cases with PPCM recovered after mechanical circulatory supports and resumed social lives.

Absence of an association between serum interleukin-6 and brain-derived neurotrophic factor in drug-naïve first-episode major depression

ABSTRACT Peripheral and central cytokine interleukin-6 (IL-6) levels play an important role in the pathophysiology of major depression (MD). We investigated the association between serum levels of IL-6 and brain-derived neurotrophic factor (BDNF) in drug-naïve, first-episode patients with MD. This study included 28 patients (male/female: 11/17; mean [standard deviation] age, 46.7 [11.9] years) who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for MD without any physical diseases. We evaluated the severity of depression using the Hamilton Rating Scale for Depression. No associations were found between serum levels of IL-6 and BDNF (r=-0.102, P =0.605). These results suggest that IL-6 does not influence BDNF and vice versa, but both act in a peripheral manner.

A case of amniotic fluid embolism successfully treated by multidisciplinary treatment.

BACKGROUND: Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency. Because the maternal mortality associated with AFE is very high, early recognition and prompt treatment are important for improving the prognosis. We report a case of amniotic fluid embolism successfully treated by multidisciplinary treatment. CASE PRESENTATION: A 39-year-old woman with fetal congenital heart anomaly and polyhydramnios was scheduled for induction of delivery at 37 weeks of gestation with labor epidural analgesia. Uncontrollable bleeding occurred 30 min after vaginal delivery. Based on the clinical diagnosis of AFE, massive blood transfusion, insertion of an aortic occlusion balloon catheter, and hysterectomy was performed. Total blood loss was 12,000 mL. The diagnosis of AFE was confirmed by pathological examination. She was discharged with no complications. CONCLUSION: We report a case of AFE who were rescued by prompt diagnosis and treatment.