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Objective: A marked increase in the overall cesarean delivery (CD) rate of twin pregnancies has recently been observed. We sought to examine the obstetrical characteristics of patients who chose a non-indicated CD and to investigate the trends in the rate of CD for maternal request over a 5 years period., Study Design: A cross sectional retrospective study of twin pregnancies, compared obstetrical characteristics between patients who chose a non-indicated CD and those who delivered vaginally. Deliveries occurred during 2006 and 2011 in a regional tertiary medical center. Patients with any indication for a CD were excluded. A multivariate logistic regression was used to control for confounders., Results: 525 twins were included at the study, 61.7 % (n = 324) were delivered by CD. Of these, 28.7 % (n = 93) were non-indicated. Between the years 2006 and 2011, there was a significant decrease in the rate of non-indicated CD (34.9 vs 23.8 %, OR = 0.58, 95 % CI 0.35-0.94, P = 0.02). Deliveries after fertility treatments or a previous CD had a higher rate of non-indicated CD (51.6 vs. 27.4 %, P < 0.001 and 26.9 vs. 3.5 %, P < 0.001; respectively). In the multivariate analysis, maternal age (OR = 1.08, 95 % CI 1.01-1.15), previous CD (OR = 15.75, 95 % CI 5.82-42.67) and fertility treatments (OR = 2.16, 95 % CI 1.14-4.10) were found to be independent risk factors for a non-indicated CD. Furthermore, parity was found to be an independent protective factor (OR = 0.75, 95 % CI 0.61-0.92)., Conclusion: In our study population, there was a significant decrease in the rate of non-indicated CD over a five-year period. Maternal age, fertility treatments and previous CD were found to be independent risk factors for non-indicated CD in twin pregnancies.

Objective: To compare postoperative pain perception and analgesia requirements in patients undergoing cesarean section (CS) using general versus spinal anesthesia., Study Design: A prospective, observational study of patients undergoing elective CS during 2009 under either general or spinal anesthesia. Postoperative pain intensity and analgesia requirements were evaluated for up to 48 h after surgery., Results: A total of 153 women were enrolled; 77 received general and 76 received regional anesthesia. Postoperative meperidine requirements in the first 24 h were significantly higher in the general anesthesia group. Pain scores were mostly comparable between the groups. Nevertheless, lower pain scores were graded after 8 h in the general versus the spinal anesthesia and this reversed at 48 h., Conclusion: Spinal anesthesia is comparable to general anesthesia in terms of post-operative pain control. In choosing the type of anesthesia in CS, other factors such as the urgency and potential maternal and fetal hazards should be taken into account.

Objective: To evaluate the impact of local lidocaine incision-site injection in patients undergoing cesarean deliveries (CD), on post operative pain and analgesic requirements., Study Design: In this prospective, double-blinded, placebo-controlled study, patients undergoing elective CD were randomly assigned to receive 1% lidocaine solution or placebo to the incision site, prior to the performance of a Pfannenstiel incision. Pain intensity was evaluated for up to 48 hours after surgery and analgesic requirements of the patients were recorded., Results: During the study period, 153 patients were enrolled; 77 received pre-emptive analgesia with lidocaine and 76 received a placebo. No significant differences were noted between the groups in respect to parity, previous CD, maternal age and gestational age. Pain scores or requirements of analgesia did not differ between the groups., Conclusion: Pre-emptive analgesia with local incision-site injection with lidocaine does not seem beneficial in reducing post cesarean pain scores and analgesic requirements.

Objective: Trace elements are minerals required in minute quantities to maintain proper physical functioning. The role of trace elements in the process of parturition is poorly understood. This study was aimed to determine levels of trace elements' concentration in maternal plasma and umbilical venous and arterial plasma at term during active labor vs elective cesarean delivery (CD)., Study Design: A prospective case-control study was conducted. Forty healthy parturients in active labor at term with their newborns were compared to 40 healthy parturients matched for maternal age, parity, and gestational age, who delivered by elective CD (before commencement of labor). Samples of maternal venous blood and umbilical cord arterial and venous blood were drawn immediately following delivery. Trace elements' concentrations were measured using the inductively coupled plasma mass spectrometer (ICP-MS)., Results: Significant higher levels of manganese (Mn) and selenium were found in maternal venous plasma during active labor vs elective CD. Magnesium (Mg) levels were significantly higher in maternal venous blood during elective CD compared to active labor. Umbilical cord artery levels of Mg, Mn, and zinc (Zn) were significantly higher in active term labor vs elective CD. Also, significant higher levels of copper and Zn were found in umbilical cord vein between active labor and elective CD., Conclusion: Trace elements' concentrations differ significantly in fetal blood during active labor vs elective CD. Hence, trace elements may play a crucial role in the process of human parturition.