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Objective  This article systematically reviews the literature to establish the normal range of lactic acid in healthy pregnant women. Study Design  Ovid MEDLINE, Embase.com, and Clinicaltrials.gov were searched to identify studies that reported maternal lactic acid in healthy pregnant women. Pooled aggregate means and two standard deviations for each time period were computed using the inverse variance weighting technique. Analyses were performed separately for 1st, 2nd, and 3rd trimesters, scheduled cesarean delivery, early labor, active labor, 2nd stage of labor, and delivery. Results  Overall, 22 studies met the inclusion criteria. There were 1,193 patients, and 2,008 observations identified. All time periods had maternal venous lactic acid aggregate means and two-standard-deviation ranges less than 4 mmol/L. Outside of labor, all ranges were less than 2 mmol/L. All labor periods had a range higher than 2 mmol/L. While the pooled ranges were less than 4 mmol/L, many individual studies reported ranges > 4 mmol/L during labor. Conclusion  This meta-analysis suggests that venous lactic acid levels can be used as a screening tool in pregnant women just as the test would be used in nonpregnant women, except that elevations may be seen during labor, especially later in labor when there is maximal skeletal muscle contraction. [ABSTRACT FROM AUTHOR]

Vulvar abscesses can progress to cause significant illness requiring disfiguring surgical debridement, broad spectrum antibiotics, and require hospitalization. A retrospective review of de-identified charts of 13 patients admitted for inpatient care for vulvar abscesses from 2004-2009 at West Virginia University Hospitals was conducted. Risk factors for vulvar abscess in these patients included obesity and diabetes. Body mass index (BMI) is directly proportionate to the size of the abscess and increased risk of intensive care unit admission. Most patients did not seek medical care prior to hospital admission. Polymicrobial infections were common, and methicillin resistant Staphylococcus aureus was seen in two cases. The presence of multiple risk factors increased the length of hospitalization. Clinicians should be aware of these risk factors and initiate aggressive therapy for patients with elevated BMI or multiple risk factors.