Protruding vs. visible prolapsed fetal membranes adversely affects the outcome of cervical insufficiency

OBJECTIVE

This study aimed to determine how prolapsed fetal membranes (PFM) affect perinatal outcomes in cases of cervical insufficiency undergoing emergency cerclage or expectant management.

PATIENTS AND METHODS

This retrospective study analyzed perinatal outcomes in 100 pregnant women with cervical insufficiency, including those with visible PFM at the cervical external os and those with protruding PFM to the vagina. The participants were subjected to either expectant management involving prescribed bedrest or emergency cerclage.

RESULTS

In the study population, 41 (41%) preferred bedrest, while 59 (59%) chose emergency cerclage. Among those managed expectantly, 10 (10%) had visible PFM, and 31 (31%) had protruding PFM. Among those who underwent emergency cerclage, 32 (32%) had visible PFM, and 27 (27%) had protruding PFM. Delivery after 32 weeks of gestation showed similar rates between women with visible and protruding PFM, regardless of the management approach chosen. These rates were significantly higher compared to those with protruding PFM managed with bed rest and emergency cerclage. Prolongation of pregnancy in protruding-cerclage and protruding-bedrest groups was 42.3±34 and 17.9±22 days, respectively.

CONCLUSIONS

Our findings provide support for considering emergency cerclage as a viable option when addressing cases involving a visible form of PFM, although the recommendation is somewhat less robust in instances of protruding PFM. The implementation of an emergency cerclage procedure has the potential to extend the time frame between diagnosis and delivery, enhance neonatal survival rates, and increase the likelihood of births occurring after 28 weeks of gestation. However, it does not seem to significantly affect the rate of births taking place after 32 weeks of gestation. This could potentially lead to complications associated with premature births and extended stays in the postnatal neonatal intensive care unit. Therefore, it is crucial to offer families detailed information regarding the pros and cons of emergency cerclage.

A rare presentation of Susac syndrome: Report of three pediatric cases

Susac syndrome is a rare disorder that is clinically characterized by encephalopathy, retinopathy and hearing loss. Most of the reported cases in the literature are adult patients, pediatric presentation is extremely rare. Here we present three pediatric patients aged between 10-15; diagnosed as Susac syndrome. They all had thalamic involvement in addition to typical callosal lesions. All of the three patients had a monophasic course and good treatment response.

PLASMA CONCENTRATIONS AND CORRELATIONS OF NATRIURETIC PEPTIDES AND OXYTOCIN DURING LABOR AND EARLY POSTPARTUM PERIOD

Context

Natriuretic peptides (NP) and oxytocin (OT) play an important role in cardiovascular and hydro-electrolytic homeostasis. Changes in NP levels and their roles in cardiovascular adaptations in pregnancy and labor have not been clear.

Objective

The present study aimed to investigate the changes and correlations in plasma levels of atrial natriuretic peptide (ANP), C-type natriuretic peptide (CNP), B-type natriuretic peptide (BNP) and OT during labor and the postpartum period.

Study design

Blood samples were collected from 29 healthy pregnant women in the active phase of spontaneous labor, 15 minutes after delivery and 3 hours postpartum. Plasma levels of OT and the stable N-terminal fragments of NPs (NT-proANP, NT-proCNP, NT-proBNP) were measured using enzyme or electrochemiluminescence immunoassays.

Results

The plasma levels of NT-proANP and NT-proCNP significantly decrease 3 hours postpartum compared to the active phase of labor and to 15 minutes after delivery. The plasma NT-proBNP levels significantly higher after delivery and 3 hours postpartum compared to the active phase of labor. A significant correlation exists between OT and NT-proANP levels during the active phase of labor and 15 minutes after delivery.

Conclusions

The data show that during labor and postpartum, the plasma concentrations of the NPs change differently. Elevations in NT- proBNP after delivery suggest that BNP may be involved in postpartum adaptations. The correlations between OT and ANP levels indicate that OT may be partly responsible for the increased levels of ANP and may have a role in the modification of the cardiovascular system.

Obstetric outcomes of intramural leiomyomas in pregnancy

AIM

The authors aimed to study larger intramural leiomyoma with a size of ≥ three cm on pregnancy outcome of singleton pregnancies compared with control group.

MATERIALS AND METHODS

The hospital records of all pregnancies followed between years of 2009 and 2013 were searched for the diagnosis of intramural leiomyoma in the second trimester ultrasonographic screening, past medical history, demographics, pregnancy follow up, and pregnancy outcomes of pregnant women. In the data analyses, 112 singleton pregnant women with intramural leiomyoma were included in the study group and 168 singleton pregnant women without leiomyoma were included in the control group.

RESULTS

The presence of pregnancy associated leiomyoma was found to be a risk factor for abortion (odds ratio (OR):12.6, 95% confidence interval (CI) 2.5-63.6) hospitalization for pain (OR: 19.6, 95% CI 5.8-66.5), premature rupture of mem- branes (OR: 6.7, 95% CI 1.4-32.4), oligohydramniosis (OR: 5.3, 95% CI 1.4-20.0), preterm birth (OR: 4.7, 95% CI 1.9-11.6), and breech presentation and other abnormal presentations (OR: 9.7, 95% CI 2.8-34.2) and neonatal intensive care need (OR: 3.0, 95% CI 1.2-7.5). No correlation with the rate of intrauterine growth restriction, intrauterine fetal death, placenta previa, abruption of placenta, and cesarean section was found.

CONCLUSIONS

Pregnancy associated intramural leiomyoma is a risk factor for some perinatal complications and these results may be useful for prenatal counseling.

A method for multi-group inter-participant correlation: abnormal synchrony in patients with schizophrenia during auditory target detection

The general linear model (GLM) approach is the most commonly used method in functional magnetic resonance imaging analysis in predicting a particular response. Recently, a novel method of analysis, referred to as inter-participant correlation (IPC), was developed which attempts to determine the level of blood oxygen level-dependent (BOLD) synchrony among subjects. The IPC approach enables detection of changes in inter-participant BOLD synchrony in a manner that does not rely on an explicit model of the hemodynamic activity. In this paper, we extend IPC to the case of two groups and derive an approach for thresholding the resulting maps. We demonstrate our approach by comparing 35 patients with paranoid schizophrenia (DSM-IV sub-type 295.30) to 35 healthy matched controls during an auditory target detection paradigm. Results showed significantly lower inter-participant BOLD synchrony in patients versus healthy controls in areas including bilateral temporal lobes, medial frontal gyrus, anterior cingulate cortex, dorsolateral prefrontal cortex, thalamus, insula, and cerebellum. The IPC approach is straightforward to use and provides a useful complement to traditional GLM techniques. This approach may also be sensitive to underlying, but unpredictable, changes in inter-participant BOLD synchrony between patients and controls.

Effects of bupivacaine used with sevoflurane on the rhythm and contractility in the isolated rat heart

BACKGROUND AND OBJECTIVE

The effects of sevoflurane on bupivacaine cardiotoxicity are mainly attributed to systemic effects. The purpose of this study was to investigate the direct myocardial effects of sevoflurane on bupivacaine toxicity.

METHODS

Hearts of 30 Wistar albino rats were isolated and mounted on a Langendorff apparatus perfused by modified Tyrode solution. Experimental groups were: a sevoflurane group (Group S, n = 10)--following baseline and 20 min (Stage 1) recordings, sevoflurane was added in doses of 1.4% (1 MAC) and 2.8% (2 MAC). In the two bupivacaine groups, bupivacaine 5 micromol (Group B5, n = 10) and bupivacaine 10 micromol (Group B10, n = 10) was added to the solution at Stage 1, and sevoflurane was added to the system as in Group S. Haemodynamic variables, i.e. heart rate, PR interval, QRS duration, left ventricular systolic pressure, contractility (+dp/dtmax), relaxation, time to reach peak systolic pressure, change in left ventricular diastolic pressure from baseline, and rate-pressure product were recorded.

RESULTS

In Group S, there was no change in cardiac rhythm. In bupivacaine groups, severe rhythm disturbances occurred and both the PR intervals and QRS complexes were prolonged significantly. All contractility variables deteriorated and the rate-pressure product decreased by 67-90% with the addition of bupivacaine. In all groups, 2 MAC sevoflurane lowered +dp/dtmax further.

CONCLUSIONS

Sevoflurane does not have any untoward effect on bupivacaine-induced cardiotoxicity in clinically relevant doses in the isolated rat heart.