The effect of mode of delivery on T regulatory (Treg) cells of cord blood.

OBJECTIVE: To evaluate whether the mode of delivery (vaginal versus C-section) influences the levels of CD4+CD25+FOXP3+ Treg cells in cord blood and maternal peripheral blood and also to examine its relationship with plasma cortisol levels. METHODS: Newborns either born vaginally (n = 19) or via elective C- section (n = 20) and their mothers, as well as 20 healthy but not pregnant women, were included in the study. CD4+CD25+FOXP3 (Treg) cells were examined by flow cytometry. Total lymphocyte counts (TLC) and serum cortisol levels were also determined for all the groups. RESULTS: The percentages of CD4+CD25+FOXP3 cells and the serum cortisol levels of infants born vaginally (p < 0.004 and p < 0.0001) and their mothers (p < 0.0001 for both) were found to be significantly higher than those of newborns born by C-section and their mothers. Positive correlations were seen between CD4+CD25+FOXP3+ cells (r = 0.741) and serum cortisol levels (r = 0.468). No relationship was observed between newborns delivered by C-section and their mothers (r = 0.022 for both). CONCLUSIONS: This study suggests that mode of delivery affects cord blood Treg cells. Higher CD4+CD25+FOXP3+ Treg cells of newborns and their mothers in vaginal delivery group and their relationship with serum cortisol levels suggest a stress phenomenon related to vaginal delivery.

The influence of maternal smoking on maternal and newborn oxidant and antioxidant status.

BACKGROUND: Maternal smoking has been suggested as a source of oxidant stress in pregnant women and in newborns exposed in utero. The aim of this study was to determine the influence of maternal smoking on oxidant status and antioxidant vitamins of mother-infant pairs. MATERIALS AND METHODS: Socioeconomic and diet characteristics were recorded from 20 smoker and 20 non-smoker pregnant women of 36 weeks' gestation. On the day of delivery, venous blood samples of the women and cord bloods were taken. On postpartum day 7, milk and infant urine samples were collected. Plasma and milk beta-carotene, retinol, alpha-tocopherol and cotinine levels, plasma malondialdehyde levels, and urine cotinine levels were measured. RESULTS: Milk alpha-tocopherol levels of smoking mothers were lower than those of non-smoking mothers. In smokers, there were no correlations between maternal vitamin A intakes and milk levels of retinol, and between maternal plasma levels and milk levels of beta-carotene. CONCLUSIONS: Maternal smoking may lead to decreased milk levels of vitamin E, as a result of making use of this antioxidant in order to limit lipid peroxidation, as well as may lead to a possible limitation on the transfer of lipophilic antioxidants including vitamin A from blood plasma to milk. Further investigations conducted in large populations will be needed to assess the effects of maternal smoking on the oxidant and antioxidant status of breast milk.

Randomized comparison of Burch urethropexy procedures concomitant with gynecologic operations.

OBJECTIVE: We compared the success of laparoscopic Burch colposuspension with the laparotomic Burch colposuspension for the treatment of genuine stress incontinence (GSI) concomitant with gynecologic operations. MATERIALS AND METHODS: Fifty-two women with symptoms of GSI, also requiring additional gynecologic operations, were randomly assigned to undergo laparoscopic (n = 26) or laparotomic (n = 26) Burch colposuspension. For all patients complete histories were taken and physical examination, urinalysis, urine culture, multi-channel urodynamics with cystometry, uroflowmetry, and measurement of Valsalva leak-point pressure were performed. Variables analyzed included: age, surgical time, length of catheterization, number of days in hospital, and complications. RESULTS: Both groups were similar in age, parity and menopausal status. Valsalva leak-point pressure significantly increased in the laparoscopy group after the operation. There were no statistical differences in other urodynamics in both groups. The mean operating time in the laparoscopy group was longer than in the laparotomy group. The laparoscopy group required a significantly shorter hospitalization and catheterization than the laparotomy group. The success and complication rates did not differ significantly for both groups. CONCLUSION: The laparoscopic approach for the treatment of GSI in patients requiring additional gynecologic procedures is associated with a shorter duration of hospital stay compared with the abdominal approach.

Tension-free vaginal tape compared with laparoscopic Burch urethropexy.

STUDY OBJECTIVE: To compare laparoscopic Burch colposuspension and tension-free vaginal tape (TVT) procedure in women with genuine stress incontinence. DESIGN: Randomized clinical study (Canadian Task Force classification I). SETTING: Tertiary care university hospital. PATIENTS: Forty-six consecutive women. INTERVENTION: Laparoscopic Burch colposuspension (23) and TVT procedure (23). MEASUREMENTS AND MAIN RESULTS: Valsalva leak-point pressure increased after surgery in both groups, but TVT substantially decreased maximum urinary flow rate. Other urodynamic studies showed no statistical differences. The groups did not differ significantly with respect to intraoperative complications or objective and subjective cure rates. Operating time was significantly longer for laparoscopic Burch (p = 0.001), and three patients in that group required conversion to laparotomy. Length of hospital stay (p = 0.003) and duration of catheterization (p = 0.003) were shorter in the TVT group. CONCLUSION: TVT holds promise in women with genuine stress incontinence, with several advantages over laparoscopic Burch.