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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. [ABSTRACT FROM PUBLISHER]

Objective: Heparanase plays a central role in processes of placentation. Abnormal placentation may result in inadequate uteroplacental blood flow, leading to unsuccessful pregnancy outcome and preeclampsia. We aimed to evaluate heparanase expression in placentas of preeclamptic patients. Materials and methods: Placental tissue samples were collected immediately after delivery from 9 preeclamptic patients and 3 healthy controls at term, and were analyzed by immunohistochemistry, western blot analysis and real-time PCR, with regard to the presence of heparanase Results: Immunohistochemistry staining for heparanase did not differ between normal and preeclamptic placental sections. On the other hand, western blot analysis revealed increased expression of heparanase in preeclpamptic placentas compared to controls,p = 0.001. Similarly, RT-PCR analysis showed also an increased expression of heparanase m-RNA compared to health controls,p = 0.005. Conclusion: Heparanase is over expressed in preeclamptic placentas compared to normal healthy controls, suggesting its role in the development of preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To examine the influence of cigarette smoking during pregnancy on mode of delivery. Methods: A retrospective analysis of 6105 uncomplicated term singleton pregnancies for mode of delivery was performed with respect to smoking status. Results: Of all, 680 (84.0%) smokers and 4588 (86.7%) non-smokers had a spontaneous vaginal delivery, 65 (8.0%) smokers and 393 (7.4%) non-smokers had an instrumental delivery and 65 (8.0%) smokers and 314 (5.9%) non-smokers had a cesarean delivery ( p = 0.051). Smoking during pregnancy increased the risk of any operative or instrumental intervention by OR 1.240, 95% CI 1.012-1.523. Non-reassuring fetal heart rate pattern that warranted either cesarean or instrumental intervention was present in 99 (12.2%) out of 810 smokers and in 392 out of 5295 (7.4%) non-smokers, p < 0.001). Smoking during pregnancy increased the risk of non-reassuring fetal heart rate pattern that warranted either cesarean or instrumental intervention by OR 1.650 (95% CI 1.341-2.022). Conclusion: Women with uncomplicated term singleton pregnancies who smoke during pregnancy are at an increased risk of fetal compromise during labor (as judged by non-reassuring fetal heart rate pattern), leading to increased rates of operative delivery (cesarean either instrumental). [ABSTRACT FROM AUTHOR]

Objectives: To assess whether labor length differs by week of gestation. Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36 + 0 through 40 + 6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010-2011). Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8 ± 1.0 cm/h, 1.5 ± 0.9 cm/h, 1.3 ± 0.8 cm/h, 1.6 ± 1.5, and 1.3 ± 1.0 cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively ( p = 0.040). Concurrently, the total labor duration (1st + 2nd + 3rd stages) increased as gestational age advanced: 423.6 ± 180.9 min, 496.5 ± 212.6 min, 545.9 ± 247.1 min, 483.8 ± 256.3 min, and 568.2 ± 273.8 min at 36th, 37th, 38th, 39th and 40th gestational week, respectively ( p = 0.013). Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the placental role in uncomplicated pregnancies and spontaneous term labor. Methods: Placentas were retrieved from women with uncomplicated pregnancies and compared between those with spontaneous term labor to those with elective cesarean delivery without labor. Placentas were analyzed for lesions consistent with maternal circulation abnormalities, lesions consistent with fetal thrombo-occlusive disease and inflammatory lesions, maternal or fetal responses. Results: The study included 139 pregnancies, 76 with term spontaneous deliveries (cases) and 63 with term elective cesarean deliveries (controls). Maternal age, gravidity, parity and BMI were significantly lower in the study group, but gestational age was higher as compared with the control group. Higher rate of maternal inflammatory lesions was observed in the study group compared to the control group, 21 vs. 1.6%, respectively, p = 0.001. No differences were observed in vascular lesions or in fetal inflammatory lesions between the groups. Conclusion: Placental maternal inflammatory changes play a role in spontaneous term labor, different from the involvement of the fetal compartment and placental vascular component in preterm labor. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between clinical characteristics and placental histopathology in women with intrapartum fever (IPF) at term. Methods: Maternal characteristics, intrapartum parameters, neonatal outcome and placental pathology were compared between 120 patients with IPF (≥380C) and a control group matched for mode of delivery. Placental lesions were classified as consistent with maternal circulation abnormalities or fetal thrombo-occlusive disease or inflammatory responses of maternal (MIR) or fetal (FIR) origin. Results: Compared to controls the study group was characterized by significantly higher rates of nulliparity, extra-amniotic balloon induction of labor, and epidural anesthesia, higher gestational age, higher white blood cell count, and more vaginal examinations. On multivariate logistic regression analysis, multiple vaginal examinations were independently associated with IPF. MIR was detected in 71% of the study group compared to 21% of controls (p < 0.001), and FIR, in 32.5% and 7.5%, respectively (p < 0.001). IPF was independently associated with inflammation of maternal origin (adjusted odds ratio (OR) 8.0, 95% CI 4.2-15.2, p < 0.001) and fetal origin (adjusted OR 5.2, 95% CI 2.07-13.4, p < 0.001). Neonatal outcome was similar in the two groups. Conclusions: Multiple vaginal examinations are a significant risk factor for the development of IPF. IPF at term is independently associated with placental inflammatory lesions. [ABSTRACT FROM AUTHOR]

Objective. To study the association between fetal middle cerebral artery (MCA) Doppler-flow velocity waveforms and the lateral cerebral ventricular width in fetuses diagnosed with unilateral or bilateral ventriculomegaly. Methods. A prospective cohort evaluation of the association between Doppler-flow velocity indices of the MCA and ventricular width in singleton fetuses referred because of suspected ventriculomegaly between 20 and 40 weeks' gestation. Fetuses that were diagnosed as bilateral or unilateral ventriculomegaly were assigned to the study group and those with normal ventricular width served as controls. Results. Of the 53 women recruited to the study, in 30 (57%%) fetuses (study group) at least one ventricle ≥≥10 mm was detected, of them 10 (33%%) had bilateral ventriculomegaly and 20 (67%%) had unilateral ventriculomegaly. Of the 30 fetuses 29 had mild ventriculomegaly. In 23 fetuses ventricular width was <10 mm (control group). Mean MCA pulsatility index (PI) and mean peak systolic velocity (PSV) were not different between the study group and the control group ( p == 0.935 and p == 0.743, respectively). In a linear regression model, MCA-PSV was significantly correlated with gestational age, R2 == 0.309, p < 0.001. Discussion. Unilateral or bilateral mild ventriculomegaly is not associated with fetal MCA change in Doppler-flow velocity indices, suggesting different involvement of vascular component from severe ventriculomegaly. [ABSTRACT FROM AUTHOR]

Idiopathic bilateral facial paralysis, although rare, seems to be more frequent during the last trimester of pregnancy and in the early puerperium. Unlike unilateral facial paralysis where the cause is mostly idiopathic, bilateral facial palsy is less often idiopathic, and various etiologies had been suggested.We present herein, an unusual case of simultaneous idiopathic bilateral Bell's palsy during the third trimester of pregnancy. [ABSTRACT FROM AUTHOR]