Relationship between body mass index of third trimester of pregnancy and type of delivery

Background: Maternal Body Mass Index (BMI) is considered as one of most effective determinant of delivery rout, by increase in this index, risk factor of cesarean section enhanced. Based on high prevalence of obesity in women, this study designed to assess the relationship between admission BMI and type of delivery. Methods: Five hundred and forty pregnant women in third trimester of pregnancy (≥37weeks) were studied within 1 year (from June 2012 to June 2013), at Sayad Shirazi Referral Hospital, Gorgan, Iran, through a analytic cross-sectional study. BMI was calculated for each mother at the time of labor admission. Height and weight were measured, and were categorized into 3 groups according to their BMI which included of underweight and normal (BMI<25), overweight (BMI=25-29.9) and obese (BMI≥30). And in each group route of delivery (cesarean or natural delivery) were assessed. Pregnant women with the previous cesarean delivery, history of diabetes type 1, 2 or gestational diabetes, hypertension, twin pregnancy and unwilling to participate in study were excluded from study. Results: Mean of age and mean of gestational age were 25.8±5.4 years and 38.2±2.6 week, respectively. 50.6% of mothers were undergone cesarean delivery and there was a significant relationship between BMI and type of delivery (P<0.0001). For each unit increase in BMI, risk of cesarean section rose 1.08 times (CI95%=1.04-1.13, P<0.0001) and the risk of cesarean delivery in obese pregnant women was 2.8 (CI95%=1.7-4.4, P<0.0001) times higher than those with underweight and normal weight. Conclusion: There is a significant relationship between maternal BMI at the time of labor admission and type of delivery and increasing of BMI is associated with increasing of cesarean section rate. Thus, keeping the BMI in normal range during pregnancy is suggested to pregnant women to reduce the pregnancy complications

Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis

Background: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses. Aim This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures. Methods: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A comprehensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. Results: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF. Conclusions: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF