Etan Z. Zimmer

Postcesarean section pain prediction by preoperative experimental pain assessment.

Background Postcesarean section pain is a common cause of acute pain in obstetrics, yet pain relief and patient satisfaction are still inadequate in many cases. The present study was conducted to determine whether preoperative assessment of experimental pain perception by quantitative sensory tests could predict the level of postcesarean section pain. Methods Fifty-eight women who were scheduled for elective cesarean section were enrolled in the study. Heat pain threshold and magnitude estimation of suprathreshold pain stimuli at 44°–48°C were assessed for both algosity (the sensory dimension of pain intensity) and unpleasantness 1 or 2 days before surgery. The day after the operation, the women reported the level of pain at the surgical wound on a visual analog scale at rest and during activity. Regression analysis was performed to evaluate the usefulness of preoperative scores in predicting postcesarean section pain. Results Postoperative visual analog scale scores at rest and during activity significantly correlated with preoperative suprathreshold pain scores at 44°–48°C (r = 0.31–0.58 for algosity and r = 0.33–0.74 for unpleasantness). The stimulus of 48°C was found to be the best predictor of postoperative pain for both conditions (r = 0.434–0.527;P < 0.01). In contrast to suprathreshold pain stimuli, pain threshold was not correlated with postoperative pain. Conclusions The results show that a simple and quick preoperative test is useful in identifying those women who will experience greater pain after a cesarean section. This test may be suggested for caregivers to tailor the postoperative treatment to specific patient needs and to improve postoperative outcome and patient satisfaction.

Enhancement of the perception of systemic pain in women with vulvar vestibulitis

Objective The aim of this study was to determine whether the characteristics of systemic pain perception and anxiety differ between women with vulvar vestibulitis and healthy women.

Pain perception in women with dysmenorrhea.

OBJECTIVE To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS Twenty‐two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra‐threshold magnitude estimation to heat stimuli, pain‐evoked potentials by laser stimuli, and anxiety scores four times across their menstrual cycles. RESULTS Significant differences were found between dysmenorrheic and nondysmenorrheic women. In all four examinations across the menstrual cycle, dysmenorrheic women had longer latencies of pain‐evoked potentials (383.08 ± 6.8 msec versus 345.05 ± 7.0 msec, P < .001), higher magnitude estimations on visual analog scale of supra‐threshold pain (83.29 ± 2.87 versus 63.50 ± 3.82, P < .001), and higher state anxiety scores (37.69 ± 1.7 versus 29.20 ± 1.9, P = .002). CONCLUSION Women with dysmenorrhea show enhanced pain perception compared to nondysmenorrheic women. This augmentation of pain perception may be part of the development of dysmenorrhea.

Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods

OBJECTIVE: Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing. METHODS: A prospective study was conducted of 180 term newborn infants who were undergoing heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding. Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel-lancing. RESULTS: Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided. Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (−2 and −2.4, respectively, vs 1.2; P < .02) compared with the other groups. CONCLUSIONS: Any method of pain control is better than none. Feeding and breastfeeding during heel-lancing were found to be the most effective methods of pain relief.

Tetra-amelia with multiple malformations in six male fetuses of one kindred.

An Arab Moslem kindred is reported in which six abnormal male fetuses were born in three closely related sibships. They had amelia, malformed head and other severe skeletal and visceral malformations. The similarities and differences between the developmental and inherent characteristics found in our patients and in families with Roberts syndrome are discussed.

Oral analgesia in the treatment of post-cesarean pain

OBJECTIVE Cesarean section is one of the most common operations. The new technologies of postoperative pain treatment such as patient-controlled analgesia, are expensive and may limit women caring for their newborns shortly after delivery. The present study assessed patient satisfaction with oral analgesia following cesarean section. STUDY DESIGN An open prospective study was conducted on all women who had a cesarean section with epidural analgesia, during two consecutive periods of 3 months each. In the first group of 109 women, an oral solution of 1 g dipyrone was allowed every 4 h, upon patient request. Patients requesting additional analgesia were administered a tablet of 30 mg immediate-release morphine sulfate. In the second group of 90 women, the same protocol was used; however, oral morphine was the drug of choice and dipyrone was used for rescue analgesia. Pain intensity and satisfaction were self-evaluated by patients using a visual analog scale. RESULTS The results of each study period were independently evaluated. The demographic and obstetrical variables were similar in both groups. The duration of analgesic effect of dipyrone was 6.5 h and the satisfaction score was 90. The duration of analgesic effect of oral morphine was 5.05 h and the satisfaction score was 83.7. Overall, patients in both groups requested only 25% of the permissible dosage of analgesia. CONCLUSIONS Oral analgesia following cesarean section provides satisfactory pain relief, is easily administered, and is a substantially less costly alternative to the new pain treatment technologies currently in use.

NATURAL HISTORY OF FETAL SIMPLE RENAL CYSTS DETECTED IN EARLY PREGNANCY

PURPOSE In this 12-year prospective, longitudinal study we investigated the natural history of fetal simple renal cysts identified by ultrasonography in early pregnancy. MATERIALS AND METHOD A detailed sonographic examination of the fetus was performed between January 1987 and June 1998 in 29,984 consecutive pregnancies at 14 to 16 weeks of gestation. Amniocenteses and chromosomal investigations were done in all cases in which a simple renal cyst was detected in the fetus. Followup sonography was done in all cases of renal cyst during pregnancy, infancy and, when indicated, childhood. RESULTS Simple renal cysts were diagnosed at 14 to 16 weeks of gestation in 28 fetuses (1/1,100 pregnancies, 0.09%). In 25 fetuses the cysts resolved during pregnancy. In 2 fetuses the cysts remained benign but persisted postnatally and in 1 a renal cyst that was initially defined as simple was the first sign of unilateral multicystic dysplastic kidney. Except for nonseptated cystic hygroma in 1 fetus, none of the others had associated anomalies of the urinary or other organ systems and no chromosomal anomalies. Postnatal followup in all cases revealed healthy children. CONCLUSIONS A fetal simple renal cyst can be identified by ultrasonography in early pregnancy. In the absence of associated anatomical or chromosomal abnormalities, the majority of cysts will resolve during pregnancy without any sequelae. Given the transient nature of most fetal simple renal cysts detected in early pregnancy, it is possible that these cysts represent a distinct entity within the spectrum of cystic kidney diseases.

Maternal exposure to music and fetal activity

Abstract The influence of music on fetal behavior was examined in 20 women to whom two different types of music were played via earphones. A real-time ultrasound scanner was used for direct observation of fetal body movements and breathing movements. A significant decrease in breathing activity was observed in fetuses while their mothers listened to a preferred type of music.

Sonographic imaging of cervical scars after Cesarean section

To investigate whether uterine contractions at the time of a Cesarean section have an impact on future presence and location of a cervical Cesarean scar.

The influence of increased seismic activity on pregnancy outcome

The influence of increased seismic activity on pregnancy outcome was evaluated. A significant increase in delivery rate was noted during the 48 hours following an earthquake on all instances. In two out of five events, a significant increase in premature delivery rate was noted (p less than 0.05). Possible signs of fetal distress in utero were documented following these events.