Does mode of delivery affect neonate oxidative stress in parturition? Review of literature.

PURPOSE: The production of reactive oxygen substances plays an important regulatory role in many physiologic reproductive processes. Excessive production may lead to oxidative stress (OS), and bring about pregnancy disorders. Growing evidence indicates that OS plays a major role in the pathophysiology of complications such as early pregnancy loss, placental insufficiency, preeclampsia, fetal growth restriction, and neonatal complications. Whether parturition induces oxidative stress is in dispute. In this review, we elaborate the influence of mode of delivery (vaginal delivery or cesarean delivery) on oxidative stress of neonates. METHODS: A review of old and recent literature was done. The studies were divided according to the impact of mode of delivery on oxidative stress in the newborn. RESULTS: There is a divergence in the oxidative stress production according to the mode of delivery. CONCLUSIONS: In view of neonatal oxidative stress measures, no major difference was found between uncomplicated vaginal delivery and elective cesarean section.

Psychiatric illness and adverse pregnancy outcome.

OBJECTIVES: To identify the adverse effect of psychiatric illness during pregnancy on pregnancy outcome. METHODS: A large population-based study of deliveries (1988--2005) was conducted that compared women with and without psychiatric illness. Stratified analysis included multiple logistic regression models. RESULTS: Out of 181,479 deliveries, 607 (0.3%) women reported psychiatric illness: depressive and anxiety disorders (39%), schizophrenia (11%), or other psychiatric illness (50%). The psychiatric patients were significantly older, with higher prevalence of diabetes and hypertensive disorders. Perinatal mortality rate, congenital malformations, low Apgar scores, and low birth weight (<2500 g) were significantly increased. Multivariable logistic regression models determined that psychiatric illness during pregnancy is an independent risk factor for perinatal mortality (odds ratio [OR] 2.4; 95% CI, 1.5-3.7, P<0.001) and congenital malformations (OR 1.4; 95% CI, 1.01-1.9, P=0.03). CONCLUSIONS: Psychiatric illness is an independent risk factor for congenital malformations and perinatal mortality, and prenatal care should be adjusted accordingly.

Labor augmentation with oxytocin decreases glutathione level.

Objective. To compare oxidative stress following spontaneous vaginal delivery with that induced by Oxytocin augmented delivery. Methods. 98 women recruited prior to labor. 57 delivered spontaneously, while 41 received Oxytocin for augmentation of labor. Complicated deliveries and high-risk pregnancies were excluded. Informed consent was documented. Arterial cord blood gases, levels of Hematocrit, Hemoglobin, and Bilirubin were studied. Glutathione (GSH) concentration was measured by a spectroscopic method. Plasma and red blood cell (RBC) levels of Malondialdehyde indicated lipid peroxidation. RBC uptake of phenol red denoted cell penetrability. SPSS data analysis was used. Results. Cord blood GSH was significantly lower in the Oxytocin group (2.3 +/- 0.55 mM versus 2.55 +/- 0.55 mM, P = .01). No differences were found in plasma or RBC levels of MDA or in uptake of Phenol red between the groups. Conclusion. Lower GSH levels following Oxytocin augmentation indicate an oxidative stress, though selected measures of oxidative stress demonstrate no cell damage.

Frustration from not achieving the expected reduction in maternal mortality.

BACKGROUND: Maternal mortality ratio (more commonly cited as maternal mortality rate) is the number of maternal deaths that result from the reproductive process per 100,000 live births. Unfortunately, it is estimated that more than half of maternal deaths are not recorded as such. Worldwide data are probably based upon pregnancy-associated or pregnancy-related deaths only. Persistent efforts are made to assess true mortality rates, though these are considered at most educated guesses. OBJECTIVE: This editorial was aimed to discuss the lately shared opinions regarding global reduction of maternal mortality rates, an unaccomplished goal during the past 20 years. CONCLUSIONS: Reassessment of resources and means of intervention will hopefully result in narrowing the gap between nations, and perhaps further reducing global maternal mortality subsequently creating a safer world for mothers.

Does stress effect male infertility?--a debate.

In many cultures the social and familial issues regarding reproduction are of great importance. Hence it seems only logical to conclude that a couple failing to achieve the expected goal of reproduction will experience feelings of frustration and disappointment. The present review was aimed to sort out the relationship between psychological stress and male infertility. It remains unclear weather stress and infertility are closely related, or that other parameters that affect stress are the important predictors of fertility. The majority of the studies rejected the theory of stress as a lone factor in the etiology of infertility. However, there is growing evidence that stress stands as an additional risk factor for infertility. It seems by the emerging evidence that more intervention studies should be conducted in order to assess weather reducing stress during fertility treatments can alter fertility treatment results. Meanwhile, collecting data regarding the couples stress level seems an appropriate approach, especially since many couples feel that health care systems do little to ease the psychological burden they experience during treatment.