An extensive remodelling process, referred to as cervical ripening, takes place in the cervical tissue during pregnancy and labour. It is recognized as softening and dilation of the cervical canal, and starts as a slow process during pregnancy, becoming rapid close to partum. In this study we focus on cytokines as possible mediators of this final remodelling. mRNA levels for interleukin (IL)-8, IL-6 and granulocyte colony-stimulating factor (G-CSF) were upregulated in the ripe postpartum cervical tissue (n = 8) compared to the unripe state (n = 9). Likewise, released cytokine concentrations increased from non-pregnant (n = 11) to the term-pregnant group (n = 13) with a further increase at partum (n = 16). IL-8 concentrations increased 4-fold from non-pregnant to term-pregnant (P<0.01), and a further 10-fold to postpartum state (P<0.0001). Concentrations of IL-6 and G-CSF were similarly increased. Specific IL-8 immunostaining was identified in the epithelia of pregnant cervical tissue (n = 7) and was most pronounced in the epithelia and stroma of postpartum tissue (n = 4). In conclusion, IL-8, IL-6 and G-CSF increase in the human cervix during the ripening process, indicating their important role in the cervical remodelling. These data demonstrate that cervical ripening is similar to an inflammatory process.

Several risk factors for sphincter tear were identified. Sphincter tear at vaginal delivery is a serious complication, and it is frequently associated with anal incontinence. Special attention should be directed toward risk factors for this complication. Symptoms of anal incontinence should explicitly be sought at follow-up after delivery.

C ancer and pregnancy are 2 conditions that rarely occur together. However, when a woman is pregnant and has cancer, her care during pregnancy may be complicated and will require a multidisciplinary approach for optimal treatment. Little published information of cases and reviews exist. Care for each patient should be individualized and must involve obstetric, oncology, anesthesiology, cardiology, and neonatology specialists. The above review by Tharmaratnam and Balki confirm that multidisciplinary care is required to optimize treatment in the pregnant patient.Pregnancy complicated by cancer may require a hastened delivery plan to optimize care and longevity for the mother and child. Anesthesia risk for these patients is increased because of the possibility of airway compromise. Lymphoma is the most common cancer seen in pregnant patients and in the study abstracted above, 12 of the 26 patients with lymphoma had either mediastinal or cervical lymphadenopathy, resulting in airway obstruction or cardiac compression. One case report of a patient with a large intrathoracic mass reported a successful cesarean delivery under continuous spinal anesthesia, with a cardiothoracic surgeon present if needed. Other case reports emphasized the need for total multidisciplinary care for these patients and their babies.Because the combination of cancer and pregnancy is rare but likely to increase as women delay childbirth, infertility therapies improve, and reproductive years are extended, a better means of documenting data on the management and outcomes of these women and their infants is necessary. A standardized national or international database would allow pertinent information to be readily available to physicians or to researchers who are developing strategies to improve care and outcomes for these women. Obstetric anesthesiologists must be prepared to evaluate these patients, obtain consults from surgeons, and develop appropriate and thorough anesthetic plans for labor analgesia or cesarean delivery.

Objective To investigate the incidence and degree of anal incontinence after vaginal delivery among Design Prospective observational study.Setting Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital.Participants Three hundred and forty-nine primiparous women.Methods Questionnaires distributed within the first days after delivery and re-distributed five and nine months postpartum. Analysis of delivery records.Results Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1 % of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery. ConclusionsThe present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.primiparous women and to define associated risk factors.

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