D. Hochner-Celnikier

Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women.

OBJECTIVE We evaluated rate of levator ani muscle (LAM) avulsion among primiparae using 3-dimensional transperineal ultrasound to identify possible risk factors for such trauma. STUDY DESIGN We conducted a prospective observational study. Three-dimensional transperineal ultrasound was performed on all subjects. Primiparae were evaluated 24-72 hours after vaginal delivery. In all, 32 nulliparous gravidae (35-41 weeks) and 15 elective cesarean delivery primiparae were evaluated as methodological controls. We compared newborn head circumference (HC), birthweight, second stage duration, maternal age, baby sex, episiotomy, and instrumental delivery. RESULTS LAM trauma was observed in 39 of 210 (18.8%) patients and no controls. Odds ratio for LAM trauma when newborn HC >or= 35.5 cm was 3.343 (95% confidence interval, 1.33-8.42); when second stage duration >or= 110 minutes, odds ratio was 2.27 (95% confidence interval, 1.07-4.81). Logistic regression showed that HC >or= 35.5 and second stage duration >or= 110 minutes increased odds of LAM trauma by a factor of 5.32. CONCLUSION Large HC and prolonged second stage duration are risk factors in LAM trauma. Elective cesarean delivery may prevent LAM trauma.

Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode

Quantification of fetal heart ventricle volume can aid in the evaluation of functional and anatomical aspects of congenital heart disease. The aim of this study was to establish nomograms for ventricular volume using three‐dimensional (3D) inversion mode ultrasonography with the spatio‐temporal image correlation (STIC) modality and to calculate ejection fraction and stroke volume.

Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique

Intrapartum damage to the anal sphincter is an important factor in fecal incontinence. Recognized lacerations occur in 0.36–8.4% of vaginal deliveries, and occult sphincter damage in up to 35% of primiparous women. We examined the role of three‐dimensional transperineal ultrasound (3DTUS) in the evaluation of the anal sphincter in primiparous women after vaginal delivery and after surgical repair of third‐degree intrapartum tears by the overlapping technique.

Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study.

kappaB activity and nitric oxide production in rejecting cardiac allografts. Transplantation 1998; 66: 838. 28. Boyd JH, Mathur S, Wang Y, et al. Toll-like receptor stimulation in cardiomyoctes decreases contractility and initiates an NF-kappaB dependent inflammatory response. Cardiovasc Res 2006; 72: 384. 29. Andrade CF, Kaneda H, Der S, et al. Toll-like receptor and cytokine gene expression in the early phase of human lung transplantation. J Heart Lung Transplant 2006; 25: 1317. 30. Krieger NR, Yin DP, Fathman CG. CD4 but not CD8 cells are essential for allorejection. J Exp Med 1996; 184: 2013. 31. Phillips NE, Markees TG, Mordes JP, et al. Blockade of CD40-mediated signaling is sufficient for inducing islet but not skin transplantation tolerance. J Immunol 2003; 170: 3015. 32. Smiley ST, Csizmadia V, Gao W, et al. Differential effects of cyclosporine A, methylprednisolone, mycophenolate, and rapamycin on CD154 induction and requirement for NFkappaB: Implications for tolerance induction. Transplantation 2000; 70: 415.

Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women

Three‐dimensional transperineal sonography (3D‐TPS) performed in women following third‐ or fourth‐degree intrapartum tears repaired with the overlapping technique demonstrates characteristic signs. The aim of this study was to investigate the correlation of these signs with clinical complaints of incontinence.

Can pelvic floor injury secondary to delivery be prevented

The number of women suffering from pelvic floor disorders (PFD) is likely to grow significantly in the coming years with a growing older population. There is an urgent need to investigate factors contributing to the development of PFD and develop preventative strategies. We have reviewed the literature and analyzed results from our own study regarding the association between delivery mode, obstetrical practice and fetal measurements, and damage to the pelvic floor. Based on our findings, we have suggested a flowchart helping the obstetrician to conduct vaginal delivery with minimal pelvic floor insult. Primiparity, instrumental delivery, large fetal head circumference, and prolonged second stage of delivery are risk factors for PFD. Pelvic floor integrity should always be seriously considered in every primiparous woman. All efforts should be aimed at minimizing any insult, which might have a significant impact on the woman’s pelvic integrity and future quality of life.

Fetal high output cardiac failure and acute hydramnios caused by large placental chorioangioma. Case report

A 31-year-old woman was admitted to the highrisk obstetric unit in the 25th week of her third pregnancy, because of rapidly developing hydramnios. Her two previous pregnancies had resulted in normal deliveries. Thc present pregnancy was uneventful up till 22 weeks gestation. Ultrasound studies at that time revealed a single normal fetus, with an excessive amount of amniotic fluid. The placenta was located posteriorly, and contained an 8 X 8 X 9 cm solid and partially cystic mass (Fig. l ) , compatible with a placental chorioangioma. During the next 2 weeks, the patient complained of rapid increase in the size of her abdomen, severe dyspnoea, backache and uterine contractions. Upon examination, the uterine size corresponded to 40 weeks gestation. Ultrasonography disclosed severe hydramnios and a normal fetus, whose size was appropriate for gestational age. The placental mass was unchanged. Two-dimensional direct M-mode echocdrdiography with Doppler analysis revealed normal fetal cardiac anatomy, persistent sinus tachycardia (170-180 beatdmin) and a moderate amount of pericardial effusion (Fig. 2). Pulsed Doppler echocardiography (PDE) was performed. the fetal cardiac output, calculated as described by Wladimiroff et al. (1984) and

Hot flashes revisited: Pharmacological and herbal options for hot flashes management. What does the evidence tell us?

Background.  Hot flashes are the most frequent symptoms of menopause and the most common reason for climacteric women seeking medical advice. Estrogen therapy is by far the most effective therapy. However, fears of side‐effect of estrogen therapy urged many patients to seek alternative modalities for symptomatic relief.

Regular exercise is the most significant lifestyle parameter associated with the severity of climacteric symptoms: a cross sectional study

OBJECTIVE To assess the association between demographic and lifestyle parameters and perceived severity of the climacteric syndrome in perimenopausal women. STUDY DESIGN A cross-sectional study of 151 healthy women aged 45-55 years who attended the University Medical Center affiliated menopause clinics. The analysis was based on self completion of the Greene climacteric score, consisting of psychological, somatic/physical, sexual and vasomotor subscores. The Greene total score and subscores were the main outcomes of the study. RESULTS Of all demographic, anthropometric and lifestyle parameters recorded, the correlates with reduced total Greene score were high-order maternity and regular physical exercise. Mothers of 3 or more children reported significantly lower total Greene score (18±12.8 vs. 22.1±8.1) (p=0.01) as well as lower psychological subscore (8.7±6.8 vs. 11.5±5.4) (p=0.01). Regular physical activity was also associated with significantly lower total Greene score (17.0±11.0 vs. 22.6±11.3) (p=0.01) and specifically lower psychological subscore (9.5±6.6 vs. 12.8±7.7) (p=0.03) and sexual subscore (1.1±0.99 vs. 1.61±1.05) (p=0.03). Linear regression models showed that regular exercise was the lifestyle parameter most significantly correlated with a lower total Greene score (p=0.006) independent of menopausal status. Of particular note, regular exercise was significantly correlated with lower psychological (p=0.006) and physical subscores (p=0.06). Moreover, the higher the frequency of exercise (both aerobic and non aerobic), the lower the severity of the climacteric symptoms reported, yet the vasomotor and sexual subscores remained unchanged. CONCLUSIONS Regular exercise of at least 3 times a week was the most significant lifestyle parameter to be associated with the severity of climacteric symptoms.

Sex ratio is remarkably constant

OBJECTIVE To study whether the sex of the offspring is related to increasing parental age, gravidity, and parity, hypothesizing an altered male-to-female sex ratio with the advancing parental age. DESIGN A large retrospective cohort study. SETTING The study analyzed birth records of Hadassah Hebrew University Medical Center in Jerusalem from June 2003 to December 2006. PATIENT(S) 35,837 birth records were analyzed including 941 multifetal deliveries, excluding foreign inhabitants (n = 744), missing data for the main study outcome (n = 2) and parturients over 50 years to control for egg donation (n = 26). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Male-to-female sex ratio. RESULT(S) The male-to-female sex ratio of all the newborns was 1.05. This ratio did not change significantly with either maternal or paternal age. Neither gravidity nor parity affected the male-to-female ratio. The only factor that affected the regression of sex ratio was the length of gestation. CONCLUSION(S) Sex ratio at birth is remarkably constant. No association was found between parental age or birth order and neonatal sex ratio.