Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Many studies have reported an increased arterial stiffness using pulse wave velocity (PWV) in women with polycystic ovary syndrome (PCOS). However, PWV is essentially dependent on blood pressure (BP) at the time of measurement. The cardio-ankle vascular index (CAVI) is a relatively new index for measuring arterial stiffness, and its conspicuous feature is its independency from the BP at the time of measurement. ⋯ However, CAVI showed a negative correlation with BMI only in the women with PCOS, suggesting that adiposity itself is associated with the decreased arterial stiffness in these women. This finding requires a replication, and whether adaptation to the hemodynamic consequences of adiposity occurred in the PCOS patients remains to be established. Further longitudinal studies are needed to verify the relationships among vascular stiffness, adiposity and PCOS.
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The objective of the present study was to investigate the frequency and the risk factors for restless legs syndrome (RLS) during pregnancy in an Italian population rarely studied, in epidemiological studies on the syndrome. A total of 648 women (median age: 35 years; interquartile range: 32-38), who delivered on randomly selected days at the obstetric department of our hospital, were identified. One hundred and thirty-two women (20.4%, 95% confidence interval (CI): 17.3-23.5) met the criteria for a diagnosis of RLS. ⋯ Older age and sleep-wake disturbances are the main factors associated with the condition. What are the implications of these findings for clinical practice and/or further research? Screening for RLS might be useful for pregnant women to manage the condition. Further research is needed to investigate and define the potential impact of RLS during pregnancy on foetal and maternal health.
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Randomized Controlled Trial
Clinical observation of regular intermittent epidural injection combined with different puncture points in suppressing breakthrough pain in labour analgesia.
The aim of the current study was to evaluate the clinical effects of the regular intermittent epidural injection combined with different puncture points (RIEI-dPP) in suppressing breakthrough pain during a labour analgesia. A total of 90 primipara were randomly divided into three groups (n = 30): Group L2-3 (A), Group L3-4 (B) and Group L4-5 (C). The analgesic pump parameters were set as: impact dose 8 mL, locking time 15 minutes, background dose 0, and the additional impact dose 8 mL after each hour intermittence. ⋯ What the implications are of these findings for clinical practice and/or further research? Compared with a continuous infusion, a regular intermittent epidural injection can achieve a more uniform drug distribution in the epidural space, so the block range can be more extensive, which can not only reduce the amount of anaesthetic but also effectively reduce the incidence of breakthrough pain. However, the selection of an intervertebral puncture site still lacks a uniform standard. The outcomes of this study can directly verify that regular intermittent epidural injection at L2-3, L3-4 and L4-5 can effectively inhibit breakthrough pain and achieve good analgesic effects, so selecting the intervertebral space with clear anatomical structure positioning and easier puncture pathway can benefit a labour analgesia.
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The management of vaginal delivery appears to offer an opportunity to reduce the morbidity of pelvic floor dysfunction (PFD) which is very common in the postpartum period. Research by the authors suggests that an episiotomy is protective against PFD, in particular urinary incontinence. The aim of this subsequent audit was to see if educational intervention can alter the common medical practice of episiotomy and in turn reduce postpartum PFD. ⋯ Consequently, this study explored whether an educational intervention can change the common medical practice of episiotomy and in turn reduce postpartum PFD. What are the implications of these findings for clinical practice and/or further research? No significant difference was noted overall in the episiotomy rates as a result of the educational intervention, however, the response to the educational intervention was varied among the different types of accoucheurs with the obstetricians, obstetric registrars and student midwives significantly increasing their rate of episiotomy, whilst the midwives demonstrated no significant change. This suggests that there are contributing factors which may include past education and experience; this is an area for further research.