Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of the late preterm delivery regardless of the membrane status.

OBJECTIVES: To compare the immunohistochemical expression of IL-6 in placental membranes of late preterm delivery in women with histologically proven chorioamnionitis with and without preterm premature rupture of membranes (PPROM). METHODS: Fetal membranes were collected from 60 women who had late preterm delivery with histologic chorioamnionitis with and without PPROM (30 in each group). Immunohistochemistry for IL-6 was performed on formalin fixed and paraffin-embedded sections. The two groups were matched for age, body mass index and parity. SPSS Version 17.0 was used for statistical analysis. RESULTS: There was no difference in immunohistochemical expression of IL-6 in placental membranes of women with histologic chorioamnionitis regardless of the membrane status. CONCLUSIONS: Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of women with late preterm delivery despite the clinical presentation.

Internal manual rotation in intrapartal arrest of fetal head engagement.

OBJECTIVE: The success of internal manual or digital rotation of the head in mechanical dystocia due to malpresentation, malposition or malrotation is presented in this paper on our own clinical material with reference of today's research and clinical recommendations. STUDY DESIGN: Through a retrospective bicentric clinical study, we investigated the success of internal head rotation in two University Clinics for gynecology and obstetrics from year 2017 to 2023. In 152 singleton term (37-42 weeks) in cases of persistens intrapartum arrest of the fetal head. After palpatory and ultrasonographically verified arrest of fetal head engagement, a therapeutic manual (Liepmann) or digital rotation was performed. RESULTS: In 152 cases, manual rotation was performed in 108 (71.05 %) and digital rotation in 44 (28.94 %) cases in 73 (48.02 %) primiparous and 79 (51.97 %) multiparous. Intrapartum identification by digital palpation was done in all cases, and the following are: persistent occipital posterior position in 68 (44.73%), persistent deep transverse head presentation in 12 (7.89%), persistent high (longitudinal) occipital presentation in 64 (42.10 %) and persistent anterior asynclitism in 8 (5.26 %) cases. Episiotomy was used in 36 (23.68%) cases. Vacuum extraction was completed in 14 (9.21 %) deliveries, and cesarean section due to unsuccessful internal rotation in 15 (9.8 %) cases (%) without other indication. We did not record any intrapartum complications or cardiotocographic abnormalities. Cervical lacerations were treated with sutures in 4 cases (2.63 %). Successful correction of internal rotation procedure with spontaneous vaginal delivery was found in 80.92 % of cases. If we exclude delivery assisted by vacuum extraction whose indications were fetal hypoxia or dystocia after successful internal head rotation procedure, then the success rate of this method was 90.13 %. CONCLUSION: Internal head rotation is a simple, safe and successful obstetric manual intervention that directly increases the rate of vaginal deliveries after correction of the birth mechanism anomaly and directly reduces the percentage of cesarean section. Manual or digital head rotation is an established midwifery/obstetric skill in several centers which, based on numerous clinical researches and experience, should become protocolized and included in the guidelines of professional associations.

A Retrospective Study of Discordant Twin Growth in Dichorionic Twin Pregnancies and Risk of Preterm Delivery at Split University Hospital Centre: Three-Year Experience.

The aim was to determine whether discordant twin growth has an impact on preterm birth in dichorionic pregnancies. This retrospective study included dichorionic twin pregnancies in the period from January 1, 2013 to December 31, 2015. The following variables were investigated: maternal age (years), parity, body mass index (kg/m2), week (≤366/7 and ≥37) and mode of delivery (vaginal and cesarean section), birth weight (grams) and Apgar score (≤7, 8-10). Discordant twin growth in dichorionic pregnancies was found to be associated with preterm birth (χ2=4.74; p=0.03) but had no impact on the mode of delivery (χ2=0.119; p=0.73). There was a statistically significant difference in the rate of small for gestational age (SGA) neonates (χ2=16.4556; p=0.000267) and Apgar score (χ2=7.9931; p<0.05) between the study groups. Mode of conception in dichorionic pregnancies was not a risk factor for preterm delivery (χ2=1.417; p=0.23). In conclusion, discordant twin growth in dichorionic pregnancies is a risk factor for preterm delivery and has no impact on the mode of delivery but has an impact on the rate of SGA and Apgar score.