Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study.

OBJECTIVE: to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. METHODS: multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. RESULTS: 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. CONCLUSIONS: The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.

Use of an antispasmodic (rociverine) to shorten the length of labor: a randomized, placebo-controlled trial.

OBJECTIVE: To determine the effectiveness of rociverine, an antispasmodic drug, for reducing the duration of labor among nulliparous women managed according to a standard intrapartum protocol. DESIGN: Randomized controlled trial. SETTING: An academic tertiary care hospital. POPULATION: Nulliparae in spontaneous active labor, with cervical dilatation between 3 and 5 cm. METHODS: Participants were randomly assigned to receive either an intramuscular injection of 20mg rociverine (n=55) or the same volume of saline (n=56). MAIN OUTCOME MEASURE: Cervical dilatation rate (from administration of study drug to full dilatation). RESULTS: Laboring women who received rociverine had faster cervical dilatation than those assigned to placebo (2.43 ± 1.84 vs. 1.85 ± 1.38 cm/hour, p=0.03). The time interval from treatment administration to full cervical dilatation was shorter in the rociverine group than in the placebo group (220 ± 125 vs. 278 ± 129 min, p=0.04). No difference was found in any other obstetric outcome. No adverse effects have been recorded from rociverine administration. CONCLUSIONS: Intrapartum administration of rociverine to nulliparous women may help to reduce the duration of the first stage of labor in a context of uniform labor management.

Hypersensitivity pneumonitis. High resolution CT findings with pathological correlations. A pictorial essay.

The diagnosis of HP is based upon the association of antigen exposure history, compatible clinical and radiological findings and high titres of precipitating serum antibodies to specific antigens. The manifestations of HP are usually divided into three typesacute, sub-acute and chronicbut a significant overlap exists. The clinical spectrum probably reflects different factors, specific to the subject, as well as the frequency and degree of exposure. The aim of this pictorial essay is to present the more common presentations of HP.