A case-control study of caesarean delivery on maternal request: who and why?

OBJECTIVE

The current study aimed to evaluate the profile of women who are most likely to undergo caesarean delivery on maternal request (CDMR) and clarify their reasons for this decision.

METHODS

For this multicentre case-control study, data were collected from 429 women who underwent CDMR and 429 matched controls who delivered vaginally from June, 2008 through February, 2009. Participants were interviewed by telephone regarding sociodemographic variables, health and lifestyle.

RESULTS

CDMR predictors were as follows: increasing age (OR = 1.09/year; 95%CI: 1.05-1.14), family status (unmarried without a steady partner versus married - OR = 3.60; 95%CI: 1.08-11.97), decreasing level of religiosity (secular versus ultra-orthodox - OR = 11.82; 95%CI: 3.75-37.21), and never having engaged, or ceasing sports activity during pregnancy (OR = 1.79; 95%CI: 1.09-2.91 and 2.38; 95%CI: 1.28-4.43, respectively). Above average income reduced the probability of CDMR (OR = 0.56; 95%CI: 0.33-0.94). The most frequent reasons for choosing CDMR were concern for pain (21.9%), concern for their own or baby's health (20.4% and 16.5%, respectively) and emotional aspects (10.0%).

CONCLUSIONS

Older, unmarried and/or secular women had increased probability of CDMR. Addressing specific concerns regarding vaginal delivery may provide the basis for a patient-oriented intervention for preventing unnecessary surgery.

VB-201, an oxidized phospholipid small molecule, inhibits CD14- and Toll-like receptor-2-dependent innate cell activation and constrains atherosclerosis

Atherosclerosis is an inflammatory disease of the vascular wall. Activated monocytes and dendritic cells (DC) in the intima layer of the vasculature promote atherogenesis. Toll-like receptor (TLR)-2 and TLR-4, which are predominantly expressed on these cells and mediate their activation, are essential for atherosclerosis development. In this study we demonstrate that VB-201, an oxidized phospholipid (Ox-PL) small molecule, inhibits TLR signalling restricted to TLR-2 and TLR-4 in human and mouse monocytes and DC. Mechanistically, we show that VB-201 binds directly to TLR-2 and CD14, the TLR-4 co-receptor, to impair downstream cues and cytokine production. In a rabbit model, oral administration of VB-201 constrained atherosclerosis progression. This effect was not due to reduced cholesterol abundance, as hyperlipidaemia was sustained. We suggest that VB-201 may counter inflammation where TLR-2 and/or CD14 complicity is essential, and is therefore beneficial for the treatment of atherosclerosis.

Determining the source of fetal adiponectin

OBJECTIVE

To determine whether maternal, placental or fetal compartment contributes to the high levels of cord blood adiponectin.

STUDY DESIGN

Serum adiponectin levels were compared from 62 newborns and their mothers as well as 32 newborns at delivery and 4 days postpartum. In addition, human placental tissues were tested for the presence of adiponectin mRNA by reverse transcriptase polymerase chain reaction.

RESULTS

Cord blood serum adiponectin levels were significantly higher and did not correlate with maternal adiponectin levels (32.5 +/- 7.5 vs. 11.0 +/- 3.6 microg/mL, p < 0.001). Cord blood and day 4 serum adiponectin did not differ significantly (32.6 +/- 7.6 vs. 29.5 +/- 8.4 microg/mL, p < 0.3). In addition, adiponectin mRNA was not expressed in the placenta.

CONCLUSION

These findings preclude the possibility of a placental or maternal origin of cord adiponectin. Thus, the high cord adiponectin levels may be attributed to fetal tissues.

Production of radially and azimuthally polarized polychromatic beams

We describe a system that efficiently provides radially or azimuthally polarized radiation from a randomly polarized source. It is constructed from two conical reflectors and a cylindrical sheet of polarizing film. Envisaged applications include a microscope illuminator for high-resolution surface plasmon resonance microscopy, illumination for high-resolution microlithography, and efficient coupling of a laser source to hollow optical fibers. The angular coherence function of light polarized by the device was measured to evaluate its usefulness for these applications.

Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage

PURPOSE

To ascertain the causes of vitreous hemorrhage and to determine the accuracy of ultrasound (U/S) in these cases, based on the degree of agreement between ultrasound and clinical findings.

METHODS

A chart review of 96 consecutive patients (106 eyes) with dense vitreous hemorrhage who underwent A- and B-scan U/S by one examiner between June 1996 and June 1999. U/S records were evaluated to determine the presence and exact distribution of areas of retinal detachment and the presence of posterior vitreous detachment, retinal tear, intraocular foreign body, or choroidal detachment. Clinical information was obtained from the medical records after the vitreous hemorrhage was reabsorbed or following vitreous surgery. Clinical and U/S findings were compared. False-positive and False-negative rates for U/S were calculated based on clinical findings.

RESULTS

In 37 eyes (35%) the vitreous hemorrhage was because of proliferative diabetic retinopathy and in 33 eyes (31%) because of ocular trauma. The false-positive rate for retinal detachment (retinal detachment by U/S without clinical confirmation) was 18.9% (seven of 37 eyes). Retinal tears were diagnosed and localized accurately in only four of nine eyes (44%).

CONCLUSIONS

The most common cause of vitreous hemorrhage was proliferative diabetic retinopathy, followed by ocular trauma. U/S correctly diagnosed all cases of retinal detachment, but less than 50% of retinal tears. A total of 18.9% of the eyes were falsely diagnosed as having retinal detachment. U/S is an effective diagnostic tool in patients with vitreous hemorrhage.

Microphthalmos and optic disc coloboma associated with a retrobulbar cyst

The combination of microphthalmos, optic nerve coloboma, and retrobulbar cyst is very rare. We present such a case, demonstrated by ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI).

Postpartum depression in an Israeli cohort: demographic, psychosocial and medical risk factors

Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied prospectively in a community cohort of 288 Israeli women. An Edinburgh Postnatal Depression Scale score of > or = 10 at 6 weeks postpartum was the criterion for PPD. Psychosocial risk factors were found to be the most potent. Lack of social support, marital disharmony, depressive symptoms during pregnancy, history of emotional problems and prolonged infant health problems were most predictive of PPD. The major role of psychosocial factors in PPD was similar to that found in other countries. The results were somewhat different for new Russian immigrants. These findings indicate that early identification of women at risk for PPD is feasible, and that consideration should be taken of subgroups that may be at heightened risk, or for whom risk factors play different roles.

Large soft contact lenses in the management of leaking blebs

PURPOSE

To investigate the efficacy of a new large permanent wear soft contact lens in the management of leaking blebs following trabeculectomy.

METHODS

Twenty-four patients with leakage from a trabeculectomy bleb, both fornix based and limbal based, with and without mitomycin adjuvant, were treated with a 78% water content soft contact lens of 17.5 mm diameter, fit according to each patient's keratometry readings.

RESULTS

The leakage from a conjunctival trabeculectomy bleb was successfully treated in 22 out of 24 patients.

CONCLUSIONS

The 17.5 mm 78% water content permanent wear soft contact lens is a preferred method of management of leaking blebs when specifically tailored to the patient's corneal curvature.

Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors

This study aimed to assess the prevalence and incidence of postpartum depression (PPD) and to identify risk factors in a community cohort of Israeli-born, as well as new and veteran immigrant women. A random sample of 288 registrants at a community clinic was assessed for depressive symptoms at 26 weeks' pregnancy using the Beck Depression Inventory (BDI) and at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Information regarding risk factors was gathered through interviews and medical record abstracting. The prevalence of PPD was 22.6%. Two-thirds of the women had scored 'depressed' during pregnancy, and one-third (6.9%) were new incident cases. Immigrant status was the only significant demographic predictor of PPD identified by either univariate or multivariate analysis, with Russian new immigrants having over twice the risk for PPD as Israeli-born subjects. The rate of PPD in this Israeli cohort was comparable to that found in other countries. The finding that immigrant status was the most potent demographic predictor may support the role of stressful life events in the etiology of PPD. The use of the EPDS for PPD screening was found acceptable and feasible in the primary health setting.

The use of mitomycin in pterygium surgery

We report on the use of mitomycin drops after the surgical removal of pterygiums in 70 patients. Our results justify the use of mitomycin as a standard postoperative procedure in preference to other treatments.

Significance of hyperprolactinemia in 70 women with amenorrhea

The clinical, radiological and hormonal findings in 70 amenorrheic patients are described. Hyperprolactinemia was found in 18 patients (25.7%) who were divided into three groups: nine patients with functional secondary amenorrhea, six patients with radiological evidence of pituitary tumor, and three patients with primary amenorrhea. One of the latter group had primary hypothyroidism. Plasma gonadotropin concentrations were normal or low in most patients, with the exception of five women with ovarian failure in whom the levels were significantly raised. Galactorrhea was diagnosed in 23 patients (32.8%), and in 16 of them plasma prolactin levels were elevated. Recent experience has shown that reduction of prolactin levels to normal by removal of prolactin-secreting tumors or by treatment with bromocriptine results in the restoration of normal menstrual cycles and fertility. The hormonal and radiological identification and characterization of hyperprolactinemic amenorrhea are therefore of prime importance.

Iris plane pseudophakoi (Copeland lens): prevention of synechiae formation

The iris plan Copeland lens was inserted in 56 cases. A high incidence of synechiae and retrolental membrane formation was noted. This could be prevented or reduced in severity by the controlled use of pupil dilatation in the postoperative period.