Peter Jakobi

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.

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.

Intracranial fetus-in-fetu.

Fetus-in-fetu is an extremely rare tumor diagnosed in utero. We present a case report of prenatal diagnosis of intracranial fetus-in-fetu.

Single-dose cefazolin prophylaxis for cesarean section

In a prospective, randomized trial, the efficacy of a single-dose, first-generation, long-acting cephalosporin was compared with a three-dose regimen in a group of 100 women undergoing cesarean section who were at high risk for postoperative febrile morbidity. Fifty women received a single 1 gm intravenous dose of cefazolin and 50 received 1 gm of the drug followed by two additional doses, 8 hours apart, to complete a three-dose regimen. Another 50 women, considered to be at low risk for postoperative febrile morbidity, were not given antibiotic prophylaxis. Outcomes of febrile morbidity (18% vs 12%) and particularly morbidity caused by endometritis (6% vs 8%, respectively) were similar for single-dose and three-dose groups. In the untreated low-risk group there were no cases of endometritis and the febrile morbidity was comparable to that of the prophylactically treated groups (14% vs 15%). Single-dose cefazolin prophylaxis appears to be comparable to multidose prophylaxis in reducing febrile morbidity after cesarean section.

Single-dose antimicrobial therapy in the treatment of asymptomatic bacteriuria in pregnancy

Fifty obstetric patients with asymptomatic bacteriuria were treated by single-dose antimicrobial therapy. The immediate cure rate was 84% and the recurrence rate was 12%. Seven of the eight patients in whom single-dose treatment failed responded to subsequent 7-day therapy with the same drug, indicating renal involvement. A 50% recurrence rate in the group of patients in whom single-dose treatment failed was compared with a 5% recurrence rate in the group cured by single-dose therapy, which indicates that failure with single-dose antimicrobial therapy can serve as a therapeutic test to identify patients at high risk for recurrent bacteriuria and its sequelae during pregnancy. It is concluded that single-dose antimicrobial therapy is a safe and effective way to treat asymptomatic bacteriuria in pregnant patients without urologic problems in their history.

Umbilical artery flow velocity during maternal cardiopulmonary bypass.

The fetal death rate associated with cardiac operations using cardiopulmonary bypass in pregnant women is as high as 9.5% to 29%. We present a case in which fetal heart rate and umbilical artery flow velocity waveforms were continuously monitored by transvaginal ultrasonography and analyzed in relation to events of the cardiopulmonary bypass. Our findings suggest that hypothermia during cardiopulmonary bypass has potentially deleterious effects on the fetus and should be avoided if possible.

Adverse effects of epidural analgesia in labor

Objective: To examine the influence of epidural analgesia on labor and delivery in nulliparous and multiparous women. Design: Data were collected on 847 consecutive parturients with singleton pregnancy and vertex presentation (384 nulliparous and 463 multiparous). The obstetrical and labor characteristics including maternal age, parity, gestational age, previous cesarean section, instrumental delivery, mode and timing of analgesia, mode of delivery, indications for cesarean section or instrumental delivery were analyzed comparing patients who received epidural analgesia with women who received systemic analgesia. Results: Epidural analgesia was administered in 233 nulliparous and 141 multiparous women. A stepwise logistic regression analysis revealed that epidural analgesia independently affected the rate of non-spontaneous delivery and the duration of the second stage of labor in nulliparous (P=0.0017 and P=0.0036, respectively) and multiparous (P=0.001 and P=0.0081, respectively) women. Epidural analgesia independently affected the duration of labor only in nulliparous women (P=0.0001). Conclusion: Women should be informed that prolongation of labor and increase in nonspontaneous deliveries should be expected when choosing epidural analgesia in labor.

Hypoglycemia During the 100-g Oral Glucose Tolerance Test: Incidence and Perinatal Significance

OBJECTIVE: To estimate and report the incidence and perinatal significance of hypoglycemia during the 100-g oral glucose tolerance test in pregnant women. METHODS: Over a 3-year period, we analyzed the incidence and perinatal outcome of pregnant women who experienced hypoglycemia, defined as a plasma glucose level of 50 mg/dL or less while undergoing the 100-g oral glucose tolerance test. The study group included women who delivered singletons at term. Women who underwent the 100-g oral glucose tolerance test during the same period and had no hypoglycemia served as the control group. RESULTS: A total of 805 women were included in the study, which comprised 51 women (6.3%) who experienced hypoglycemia during the test and 754 women in the control group. Gestational diabetes mellitus was diagnosed in 5/51 (9.8%) women in the study group, compared with 216/754 (28.6%) women in the control group (P < .03), and the neonates born to these women had significantly lower birth weights. CONCLUSION: The incidence of reactive hypoglycemia during the 100-g oral glucose tolerance test in our population is 6.3%. Women who experience hypoglycemia during the test have a significantly lower incidence of gestational diabetes and neonatal birth weights. LEVEL OF EVIDENCE: III

A 2 hour versus the 3 hour 100 g glucose tolerance test for diagnosing gestational diabetes mellitus

Abstract Aim: To determine how the omission of the third hour glucose measurement of the 100 g oral glucose tolerance test (GTT) affects the diagnosis of gestational diabetes mellitus (GDM). Methods: Retrospective chart review of 876 women delivered in a tertiary care hospital in Israel during a three-year period, who underwent a 100 g 3 hour oral GTT following an abnormal 50 g glucose screen. GDM was diagnosed according to the “criterion standard” accepted in the Fourth International Workshop Conference on GDM. The results of the 100 g 3 hour oral GTT were then retrospectively re-evaluated by omission of the third hour plasma glucose measurement from the “criterion standard”. Results: GDM was diagnosed in 28.4% of the study patients, while the omission of the third hour glucose measurement resulted in a 26.4% diagnosis of GDM. The perinatal data of the 18-omitted cases suggests that their exclusion from the GDM group would not have altered substantially the perinatal outcome of the study cohort. Conclusions: A 100 g 2 hour oral GTT is a simple and economic alternative to the 100 g 3 hour oral GTT.

Endogenous digoxin-like immunoreactivity measured in seminal fluid from a normal male population

Endogenous digoxin-like immunoreactivity (EDLI) has been detected in different biological fluids and in several pathophysiological conditions. In this study, using radioimmunoassay we reported for the first time the existence of bound and unbound EDLI in normal seminal fluid. The unusual finding was the detection of unbound EDLI in the seminal fluid, while this reactivity was undetected in plasma. Two main hypotheses are presented: (1) local secretion of unbound EDLI and/or (2) passive diffusion from plasma to the seminal fluid of unbound EDLI and subsequent local concentration.