INTRODUCTIONImmediate postpartum haemorrhage (PPH) is defined as blood loss ≥ 500 mL after normal vaginal delivery.(1-3) This obstetric complication is a leading cause of maternal death worldwide. To prevent the occurrence of PPH, current evidence supports active management of the third stage of labour, especially the prescription of oxytocin, as standard obstetric care.(1-3) However, the optimal method for determining the volume of postpartum blood loss for early detection of PPH remains unclear.Although the ideal measurement of postpartum blood loss involves the use of objective tools, visual estimation is still commonly used in daily obstetric practice.(4) Photospectometry is the gold standard blood loss measurement technique due to its accuracy. However, this technique is complicated, costly and impractical. Additionally, photospectrometry cannot be applied at all levels of healthcare and is more suitable for clinical research.(4,5) In a previous study, an alternative method weighed soaked swabs or drapes after delivery, which proved to be effective for the early detection of PPH.(6) However, this method substantially increases the workload of medical staff members and may not be suitable in a busy hospital setting.The use of sterile under-buttock or postpartum drapes is another method of postpartum blood loss measurement. This method is suitable for low-resource hospitals, as it is inexpensive, convenient and easy to use. Previous studies have shown that it produced results that highly correlated with those of standard photospectrometry (correlation coefficient [r] = 0.93), with a reduction in postpartum haemoglobin levels reported. (5,7,8) Therefore, this method was chosen as the gold standard in the present study.The purpose of this study was to compare the efficacy of visual estimation and objective measurement using the sterile under-buttock drape to determine the volume of postpartum blood loss in PPH. We hope that the results of this study will lead to improvements in standard obstetric care for the early detection of immediate PPH. METHODSWith the ethical approval of the Siriraj Institutional Review Board, the present study was prospectively conducted from June 2013 to December 2013. Pregnant Thai women aged ≥ 18 years who were admitted in the early phase of labour were included in the study. Women who had painful contractions, were near delivery, or were under the sedative effect of morphine or its derivatives were excluded. This study also excluded women who had bleeding disorders (e.g. idiopathic thrombocytopenic purpura), dependence on bleeding-related medication (e.g. aspirin), a Caesarean delivery, fetal anomalies or a stillbirth. All the

TCTR20160715004.

Parecoxib did not demonstrate effectiveness in reducing patient requirement for supplementary meperidine after CD. However, administration of a single 40-mg dose of i.v. parecoxib after elective CD demonstrated effectiveness in reducing pain scores, with a resulting increase in patient satisfaction.

Maternal serum magnesium and calcium levels were correlated with cord blood levels in pre-eclamptic pregnant women who received MgSO4 therapy.

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Neuropeptide Y (NPY) has been reported as a vasoconstrictive substance that might be associated with preeclampsia. NPY mediates different effects via its specific NPY receptors. NPY action via Y1 receptor (Y1R) and/or Y5 receptor (Y5R) induces vascular smooth muscle cells proliferation while it is implicated in angiogenesis via Y2 receptor (Y2R) and/or Y5R. The objectives of this study were to (1) compare placental NPY, Y1 receptor (Y1R), Y2 receptor (Y2R), and Y5 receptor (Y5R) expressions between normal (NP) and preeclamptic (PE) pregnancies to determine whether gene expression of different NPY receptors are altered in the PE condition; (2) compare maternal serum NPY levels between NP and PE subjects; and (3) determine correlations between placental gene expressions as well as serum NPY levels with maternal and neonatal clinical parameters. There were 22 subjects each in the NP (gestational age 37-42 weeks) and PE (gestational age !34 weeks) groups. Clinical parameters and serum NPY levels were measured before delivery. NPY expression and serum NPY levels were comparable between NP and PE subjects. Y1R, Y2R, and Y5R expressions were significantly lower in PE than NP subjects. In all and NP subjects, placental Y2R showed the highest expression, tended to be higher than Y5R, and was significantly higher than Y1R. In PE subjects, placental Y2R was comparable to Y5R and both Y2R and Y5R were significantly higher than Y1R. The NPY receptor expression ratio between the PE/NP groups showed that it was lowest for Y2R (0.27) compared to Y1R (0.42) and Y5R (0.40) suggestive of decreased Y2R expression in PE subjects. In summary, a decrease in placental Y2R mRNA might be associated with abnormalities of placental angiogenesis which probably contributes to the pathophysiology of preeclampsia. The roles of NPY receptors mediating placental vascularization need to be further investigated.

Objective To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. Methods A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations. Results The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m 2 at delivery. Of these, 469 were morbidly obese (BMI 40–49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption ( p = 0.027 and 0.030), intravenous fluids ( p = 0.006), and bleeding during surgery ( p = 0.017). They also had more hypotensive episodes ( p = 0.038). The two groups’ incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable. Conclusions Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section. Trial registration www.clinicaltrials.gov ID: NCT04657692.