Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Background:

Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses.

Objective:

To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy.

Methods:

We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis.

Results:

A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78).

Conclusion:

Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

Carrier-envelope phase control using linear electro-optic effect

We present a new method to control the Carrier-Envelope Phase of ultra-short laser pulses by using the linear Electro-Optic Effect. Experimental demonstration is carried out on a Chirped Pulse Amplification based laser. Phase shifts greater than π radian can be obtained by applying moderate voltage on a LiNbO3 crystal with practically no changes to all other parameters of the pulse with the exception of its group delay. Time response of the Electro-Optic effect makes possible shaping at a high repetition rate or stabilization of the CEP of ultra short CPA laser systems.

[Value of postoperative urodynamic assessment for long-term urinary function results after treatment of genital prolapse. 103 examinations after treatment of genital prolapse]

OBJECTIVE

To evaluate the predictive value of postoperative urodynamic assessment on the apparition or the resurgence of genuine stress incontinence after a surgical procedure for genitourinary prolapse.

SUBJECTS

103 patients operated on for prolapse, with or without an associated surgical procedure for genuine stress incontinence. A review of the results of the urodynamic assessment carried out during the early post operative period was effected.

RESULTS

77.7% of the patients had an associated procedure for stress incontinence during surgery for prolapse. An urodynamic abnormality such as intrinsic sphincter deficiency and/or transmission ratio default was noted in 83.3% of the women who demonstrated incontinency during postoperative assessment, and in 76.7% of the patients without any problem of continence. During long term follow up, only 41.7% of the women who were incontinent shared intrinsic sphincter deficiency, and an abnormal cytometric parameter was noted in 74.4% of continent patients. 86% of the patients who were incontinent in the early postoperative period will remain so, whatever the result of the cystometric evaluation.

CONCLUSION

Our results show that there is no correlation between the various cystometric parameters evaluated during the postoperative period, and the symptoms described by the patients. The absence of abnormal urodynamic assessment cannot consistently predict normal bladder function. Only postoperative symptoms can be considered to be predictive of a satisfactory surgical cure.