languages. Three months postpartum, women were mailed the Impact of Event Scale (IES) questionnaire, which measures posttraumatic stress symptoms. Demographics and obstetric characteristics were collected from medical records. Statistical analysis was by w 2 test and stress symptoms were analyzed by forward, stepwise logistic regression.The scores showed that 41 (33%) of the women had a low SOC; 68 (56%) had a moderate SOC; and 13 (11%) had a high SOC. There was no significant association between low SOC and age or parity, but it was more frequent in women who were born abroad (P = 0.045), had undergone a previous EMCS or vacuum extraction (P = 0.045), were single (P = 0.025), had a low socioeconomic background (P = 0.002), or had received antenatal counseling due to fear of childbirth (Pr0.001). Posttraumatic stress symptoms (IES) were seen to be normal in 80 (66%) women, moderate (needing follow-up) in 31 (25%), and severe in 11 (9%). Two independent risk factors for more than normal symptoms of posttraumatic stress were a low SOC and imminent fetal asphyxia as the main indication for the EMCS. One factor appeared to be protective for these symptoms: full cervical dilation at the time of the CS (P = 0.022).In this study, symptoms of posttraumatic stress disorder following EMCS were associated both with the personal coping style of the mother and the circumstances of the event. The authors suggested that an antenatal SOC evaluation could help determine who will need more follow-up or support. Especially vulnerable are women with a low SOC (eg, with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women) and those in whom imminent asphyxia is an indication for the operation.L aparoscopic adjustable gastric banding (LAGB) has been used with greater frequency to control obesity among women of childbearing age. Little data on obstetric and neonatal outcomes in women after LAGB exist. This retrospective case-control study evaluated obstetric and neonatal outcomes in women who became pregnant after LAGB (13 cases) compared with obese women who did not undergo LAGB (14 controls). Data were gathered from a single institution in France. Women for the control group all had body mass indexes (BMIs) >30 kg/m 2 . Antepartum variables included age, race, parity, weight and BMI before LABG, weight loss before pregnancy, BMI at beginning of pregnancy, and history of cesarean delivery. Intrapartum variables were maternal weight gain during pregnancy, preterm delivery, presence of preeclampsia, gestational hypertension, or gestational diabetes mellitus, and labor and its complications. Neonatal outcomes were low birth weight (<2500 g), small for gestational age, macrosomia, Apgar score at 5 minutes, and umbilical artery blood gas analysis.All women had singleton pregnancies. The mean weight and BMI in the LAGB group were 95.2 ± 11.6 kg and 34.8 ± 3.2 kg/m 2 ; mean weight and BMI in the controls were 92.4 ± 12.8 kg and 35 kg/m 2 . The mean maternal weight gain was 5.5 kg in LAGB women compar...

Among obese women, the incidence of adverse obstetric outcomes was less in those who underwent LABG than in those who did not. These results suggest that obese women who wish to become pregnant would decrease their risk of obstetric complications if they first underwent LAGB.

Passive-active immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine provides a high level of protection against vertical transmission of hepatitis B virus (HBV). Nevertheless, 1 in 10 children of HBV carriers have chronic hepatitis B early in their lives despite immunoprophylaxis because they were infected in utero. This study of 469 pregnant women testing positive for hepatitis B surface antigen (HbsAg) was conducted to learn whether giving HBIG to HBV carriers in the third trimester can prevent vertical transmission of the virus. Of the women entered into the study, all of whom were asymptomatic, 126 (group 1) tested positive for hepatitis B e antigen (HbeAg), while 343 (group 2) did not. HBIG was given intramuscularly in a dose of 200 IU at 28, 32, and 36 weeks of pregnancy. All newborn infants received 100 IU of HBIG within 12 hours of birth as well as the first of 3 doses of hepatitis B vaccine (the subsequent doses were given at ages 1 and 6 months).In group 1, 16% of infants whose mothers received HBIG in the third trimester tested positive for HbsAg at birth and 7% at age 6 months. The respective figures for infants whose mothers were not treated were significantly higher at 39% and 23%. No such treatment-related difference was observed in group 2 infants. At age 6 months, rates of protective levels of anti-Hbs antibody were 32% in group 1 infants whose mothers were HbeAg-positive and 56% in group 2 infants when the mothers had not received HBIG while pregnant. The respective figures for infants whose mothers were treated in the third trimester were 76% and 89%. Neither mothers nor their infants experienced adverse effects related to the administration of HBIG or hepatitis B vaccine.The investigators conclude that, if all HbsAg-positive pregnant women, regardless of HbeAg status, were to receive HBIG in the last weeks of pregnancy, their infants would be better protected against chronic HBV infection. ABSTRACTFetal karyotyping of cells obtained by amniocentesis may take as long as 3 weeks, and many pregnant women experience anxiety during the interval. This randomized, controlled study evaluated 2 tactics for lessening anxiety: issuing karyotyping results on a prespecified date rather than when they become available and presenting early results Preconception and Prenatal Care 495 496 Obstetrical and Gynecological Survey ABSTRACTAbout 1 in 4 primary cesarean deliveries take place during the second stage of labor. Not only is second-stage surgery technically more difficult, but the fetus is at risk of hypoxia-related morbidity. This prospective observational study of primary cesarean deliveries was carried out at 13 university centers that make up the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Of 11,981 primary cesarean deliveries, 9265 were done in the first and 2716 in the second stage of labor. Women in the latter group were likely to be older, nulliparous, and white, and they had a smaller body mass index at the time of del...

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The aim of this retrospective study of 56 cases was to determine the risks and the limits of the Marchetti bundle nail in the treatment of femoral shaft fractures. According to the AO classification, 25 fractures were in category A, 20 in category B, 7 in category C and 4 were distal metaphysio-diaphyseal fractures with intercondylar separation classified as 33C2. Intraoperative complications were not directly related to the type of nail. Postoperative complications included nonunion, delayed union, malunion such as axial deformity, and shortening. We conclude that the Marchetti bundle nail is a successful method for the treatment of femoral shaft fractures taking into consideration the short operation time, the efficacy of distal locking and the lack of preliminary reaming. Moreover, it is clear that our results were prejudiced due to our learning experience with this new implant. Proximal locking should only be carried out when indicated, in order to prevent delayed union. It may be combined with interfragmental screw fixation, and this is useful in the treatment of complex supracondylar fractures.