Planned cesarean section versus planned vaginal delivery: comparison of lower urinary tract symptoms

We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p < 0.001) and 9 months (p = 0.001) follow-up. In a multivariable risk model, vaginal delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9–42] and for urinary urgency (RR 7.3 95% CI 1.7–32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5–19) and at 3 months follow-up (OR 3.9, 95% CI 1.7–8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section.     

A prospective comparison of transabdominal and transvaginal ultrasound with surgical findings in gynecologic disease

Eighty-five patients underwent transabdominal (TAU) and transvaginal ultrasound (TVU) 24 hours before elective surgery for gynecologic disease. No obstetric cases were included. The diagnostic outcome of TVU was not significantly better than that of TAU in spite of a better image quality. The evaluation of large ovarian cysts and sizeable fibroids was difficult with TVU due to the limited field of view. Endometrial pathology was clearly diagnosed by TVU. We recommend using TVU in combination with TAU, especially in cases of unclear pelvic pathology or when larger masses are present.     

Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old.

OBJECTIVE: To investigate the occurrence rate of adnexal lesions in premenopausal women. METHODS: A random sample of women 25-40 years old was invited to undergo a transvaginal ultrasound examination, and 335 women were examined. The criteria used to define an adnexal lesion were either a cystic lesion with its largest diameter of at least 25 mm within the pelvic region, or the appearance of solid parts in any lesion regardless of size. RESULTS: Adnexal lesions were found in 26/335 cases, (7.8%) (95% confidence interval (CI), +/- 2.9%). The occurrence rate of ovarian cysts was 22/335 (6.6%) (95% CI, +/- 2.7%). There were no differences between the women with or without ovarian cysts related to age, smoking habits, parity or body mass index. At follow-up 3 months later, 18 of the 22 (82%) cysts had disappeared (95% CI, +/- 16%). Women using progesterone contraception (either oral contraception or an intrauterine device with levonorgestrel) had a significantly higher relative risk of 2.7 (95% CI, 1.1-6.9) of functional cysts as compared to women with natural cycles. Polycystic ovaries were found in 10.2% (95% CI, +/- 4.2%) of the women not using any hormonal contraception. The mean volumes of the polycystic ovaries were significantly larger compared to those in natural cycles. CONCLUSION: Adnexal lesions are common in asymptomatic women in the age group 25-40 years, but four out of five ovarian cysts disappeared spontaneously after 3 months. The ultrasound appearance of the cyst, the woman's family history and her own feelings must be considered if a persisting cyst is to be surgically removed or followed by repeated transvaginal ultrasound.     

Role of perfusion CT in glioma grading and comparison with conventional MR imaging features

BACKGROUND AND PURPOSE: Perfusion imaging using CT can provide additional information about tumor vascularity and angiogenesis for characterizing gliomas. The purpose of our study was to demonstrate the usefulness of various perfusion CT (PCT) parameters in assessing the grade of treatment-naïve gliomas and also to compare it with conventional MR imaging features.MATERIALS AND METHODS: PCT was performed in 19 patients with glioma (14 high-grade gliomas and 5 low-grade gliomas). Normalized ratios of the PCT parameters (normalized cerebral blood volume [nCBV], normalized cerebral blood flow [nCBF], normalized mean transit time [nMTT]) were used for final analysis. Conventional MR imaging features of these tumors were assessed separately and compared with PCT parameters. Low- and high-grade gliomas were compared by using the nonparametric Wilcoxon 2-sample tests.RESULTS: Mean nCBV in the high- and low-grade gliomas was 3.06 ± 1.35 and 1.44 ± 0.42, respectively, with a statistically significant difference between the 2 groups (P = .005). Mean nCBF for the high- and low-grade gliomas was 3.03 ± 2.16 and 1.16 ± 0.36, respectively, with a statistically significant difference between the 2 groups (P = .045). Cut points of >1.92 for nCBV (85.7% sensitivity and 100% specificity), >1.48 for nCBF (71.4% sensitivity and 100% specificity), and <1.94 for nMTT (92.9% sensitivity and 40% specificity) were found to identify the high-grade gliomas. nCBV was the single best parameter; however, using either nCBV of >1.92 or nCBF of >1.48 improved the sensitivity and specificity to 92.9% and 100%, respectively. The sensitivity and specificity for diagnosing a high-grade glioma with conventional MR imaging were 85.7% and 60%, respectively.CONCLUSIONS: PCT can be used for preoperative grading of gliomas and can provide valuable complementary information about tumor hemodynamics, not available with conventional imaging techniques. nCBV was the single best parameter correlating with glioma grades, though using nCBF when nCBV was <1.92 improved the sensitivity. An nCBV threshold of >1.92 was found to identify the high-grade gliomas.

Gliomas, the most common primary brain neoplasms in adults, are very heterogeneous tumors. High-grade gliomas can be highly invasive and extremely vascular tumors.Glioma grading is currently based on the histopathologic assessment of the tumor, which is achieved by stereotactic brain biopsy or cytoreductive surgery; and there are inherent limitations with these techniques and their interpretation.¹ Therapeutic approaches, response to therapy, and prognosis depend on accurate grading, and thus finding the part of the tumor with the highest grade to be biopsied is critical.Conventional MR imaging has a limited role in differentiating gliomas because contrast-enhanced images reveal disrupted or absent blood-brain barrier and not necessarily microvascularity or neovascularity of the tumoral lesion.^2,3 The 2 most important factors in determining the malignancy of gliomas is their ability to infiltrate the brain parenchyma and to recruit or synthesize vascular networks for further growth.⁴Malignant brain tumors are characterized by neovascularity and increased angiogenic activity, with a higher proportion of immature and hyperpermeable vessels.^5,6 Because vascular proliferation is an important characteristic in the grading of astrocytomas,⁷ imaging techniques that provide hemodynamic information about the tumor may help in characterizing glioma malignancy, which may overcome some of the limitations of histopathologic sampling error and conventional MR imaging. Perfusion imaging has been useful in grading cerebral neoplasms^8–14 and may provide reliable information on tumor physiology such as microvascularity, angiogenesis, micronecrosis, and cellularity.Perfusion imaging of brain tumors has shown that certain cerebral perfusion parameters such as regional blood volume and blood flow correlate well with tumor grade, and it has also been helpful in distinguishing recurrent tumor from radiation necrosis.^3,15Most of the prior perfusion studies comparing histologic features with perfusion parameters have used various MR perfusion techniques.^3,15 However, recently perfusion CT (PCT) has been used as an alternative method in assessing cerebral hemodynamics for stroke and brain tumors.¹⁶ PCT allows measurement of tumor vascular physiology, and maps of tumor blood flow, blood volume, mean transit time (MTT), and permeability–surface area product can be generated. In view of the wider availability, faster scanning times, and low cost combined with its ease of quantification of various perfusion parameters as compared with MR perfusion, PCT is potentially well suited to studying brain tumors and monitoring tumor response to antiangiogenic agents.¹⁶The purpose of our study was to demonstrate the usefulness of various PCT parameters such as cerebral blood volume (CBV), cerebral blood flow (CBF), and MTT in assessing the grade of treatment-naïve gliomas and also to compare them with conventional MR features.     

Bone induction by fetal and adult human bone matrix in athymic rats

In the rat the intramuscular implantation of demineralized rat bone matrix induces local bone formation. In adult primates, however, allogenous bone matrix induces little or no bone formation in extraskeletal sites. To assay inductive properties, human demineralized bone matrix from 6 adult donors and 4 fetuses was implanted intramuscularly in athymic rats for 6 weeks. Fetal and adult matrix implants yielded about the same amount of bone: about half of the bone yield from rat or rabbit matrix in the same model. We conclude that human bone matrix has inductive properties and that failures to induce bone formation in adult primates may be due to an inability by the recipients to respond to inductive stimuli of adult bone matrix.     

Contact between mother,child and partner and attitudes towards breastfeeding in relation to mode of delivery

ObjectiveTo investigate contact between mothers and their newborn child and study if there are differences between those who requested an elective caesarean section compared to women who had a vaginal birth and those who underwent an elective caesarean section due to obstetrical indication. The psychometric properties of a scale that measure the contact between mother and child were also investigated.DesignA prospective cohort study.SettingDanderyd Hospital, Stockholm, Sweden.Sample510 primiparas from three groups: women undergoing caesarean section on maternal request (n = 96), women undergoing caesarean section on obstetrical indication (n = 116) and women planning a vaginal delivery (n = 198). The later were further divided into subgroups; women who underwent assisted vaginal delivery (n = 35) and women who had an emergency caesarean section (n = 65).MethodsThe instrument used was the Alliance Scale.Main outcome measureThe contact between mother and child in relation to mode of delivery.ResultsThe contact with the child was rated as positive on all occasions: there were no significant differences between the groups. The relation to the partner was rated as positive at all occasions. Mothers with a vaginal delivery experienced breastfeeding less stressful than the mothers with a caesarean delivery. Three and nine months after delivery the mothers with a caesarean delivery on request reported more breastfeeding problems than mothers in the other groups. Mothers with a vaginal delivery rated less sadness at every occasion.ConclusionMode of delivery does not seem to affect how mothers experience their contact towards the newborn child.     

O father, where art thou? Parental NICU visiting patterns during the first 28 days of life of very low-birth-weight infants

To study the frequency and duration of parental visits to neonatal intensive care units (NICU) during the first 28 days of life of preterm infants in relation to medical variables, sociodemographic factors, and subsequent outpatient follow-up examinations. Retrospective chart review of 127 infants with a birth weight less than 1500 g born between Jan 1, 2009, and Dec 31, 2009, at 2 tertiary NICUs. The average frequency of parental visits during the first 28 days of life declined significantly over time (P < .05) while the duration of visits remained constant. Average frequency and duration of visits per day were consistently lower in fathers than in mothers (median [interquartile range]: 0.6 [0.4-1.0] per day vs 1.1 [0.9-1.4] per day, 72.5 [32.1-108.9 [min/d vs 133.4 [75.4-174.3] min/d). While a history of treatment for infertility was correlated with significantly more frequent and longer parental NICU visits in the first 2 weeks, having older children at home was correlated with shorter visits during the first week. Visiting patterns showed no relation to attendance at follow-up examinations at 6 months corrected age. Mothers spend more time with their preterm infants in NICUs than fathers. We suggest measures to increase paternal involvement with hospitalized preterm infants.     

Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration

BACKGROUND: Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. METHODS: Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. RESULTS: Inter-individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over-estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2=0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2=0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. CONCLUSIONS: The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over-estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions.     

Neutralization of the chemokine CXCL10 reduces apoptosis and increases axon sprouting after spinal cord injury

Spinal cord injury (SCI) is followed by a secondary degenerative process that includes cell death. We have previously demonstrated that the chemokine CXCL10 is up-regulated following SCI and plays a critical role in T-lymphocyte recruitment to sites of injury and inhibition of angiogenesis; antibody-mediated functional blockade of CXCL10 reduced inflammation while enhancing angiogenesis. We hypothesized, based on these findings, that the injury environment established by anti-CXCL10 antibody treatment would support greater survival of neurons and enhance axon sprouting compared with the untreated, injured spinal cord. Here, we document gene array and histopathological data to support our hypothesis. Gene array analysis of treated and untreated tissue from spinal cord-injured animals revealed eight apoptosis-related genes with significant expression changes at 3 days postinjury. In support of these data, quantification of TUNEL-positive cells at 3 days postinjury indicated a 75% reduction in the number of dying cells in treated animals compared with untreated animals. Gene array analysis of treated and untreated tissue also revealed six central nervous system growth-related genes with significant expression changes in the brainstem at 14 days postinjury. In support of these data, quantification of anterograde-labeled corticospinal tract fibers indicated a 60-70% increase in axon sprouting caudal to the injury site in treated animals compared with untreated animals. These findings indicate that anti-CXCL10 antibody treatment provides an environment that reduces apoptosis and increases axon sprouting following injury to the adult spinal cord.