Cynthia Chan

J Obstet Gynaecol Can 2012;34(11):1017 A 33-year-old woman presented with chronic pelvic pain and abnormal uterine bleeding. She had a BMI of 49 kg/m2. She had had three vaginal deliveries and a tubal ligation. Cervical cytology, endometrial biopsy, and saline infusion sonography were all normal. Transvaginal ultrasonography identified a normal uterus, normal right adnexa, and a 6.4 × 5.0 × 3.5 cm non-suspicious, multicystic left adnexa, with the largest cyst measuring 1.9 cm.

Inflammatory mechanisms involved in the onset and progression of labor at term may affect the fetal compartment impacting neonatal outcomes. Umbilical cord blood collected from umbilical cords after delivery of the fetus and again after delivery of the placenta in low-risk non-laboring and laboring patients was analyzed for blood gases/pH and multiple cytokines. Umbilical cord levels of IL-6, IL-8 and IL-10 were increased 6, 2 and 1.5 fold, respectively, in laboring patients without placental inflammation, and for IL-6 and IL-8 a further 12 and 6 fold, respectively, in laboring patients showing histologic chorioamnionitis, but with no evident effect of nuchal cord with FHR decelerations, fetal acidemia, nor of labor duration. For laboring patients, umbilical vein levels of IL-10 and MIP-1α were increased compared to arterial levels indicating net flux from the placenta, while umbilical artery levels of IL-6 and IL-8 were increased compared to venous levels indicating net flux from fetal sources. Placental cord levels of IL-6, IL-10, MIP-1α and MIP-1β were also increased compared to respective umbilical cord levels, confirming placental release of these cytokines into cord blood after delivery of the fetus. Labor in low-risk patients at term will result in increased cytokines in umbilical cord blood and moreso when associated with histologic chorioamnionitis with the potential to impact neonatal outcomes. IL-6 and IL-8 as the primary cytokines increased in cord blood may act synergistically in promoting the inflammatory response with labor, and are likely released from both placental and fetal tissues contributing to widespread distribution through the fetal circulation.

Background. Fibroids, which can impact pregnancies at later gestations, such as obstructing delivery, may also affect the pregnancy termination process. Case. We present the case of a 28-year-old G1 at 18 weeks who consented for a genetic pregnancy termination via dilation and evacuation. During the typical preparatory procedure with laminaria, it was noted that a 5-6cm cervical fibroid prolapsed into the vagina obstructing access to the uterine cavity. Through osmotic dilation followed by cervical Foley catheter ripening, a planned myomectomy was possible with minimal blood loss prior to uterine evacuation. Conclusion. Through appropriate counselling, planning, and effective cervical dilatation, a planned myomectomy for prolapsing fibroids at the time of termination of pregnancy is possible. This can prevent unnecessary hysterotomy and avoid need for subsequent cesarean section.