Alexander Krafft

The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.

At last, benefits on maternal measures and risk of low birth weight are shown

Objective: The aim of this cohort study was to prospectively assess frequency, characteristics, and determinants of restless legs syndrome (RLS) in pregnancy and its impact on sleep. Methods: Pregnant women were prospectively studied in each trimester and 8 weeks postpartum. Assessments included interview about RLS symptoms and sleep disturbances; standardized sleep-wake questionnaires including the International Restless Legs Syndrome Scale (IRLSS) and the Pittsburgh Sleep Quality Questionnaire (PSQI); actigraphic recording of periodic limb movements (PLM); and blood tests including levels of hemoglobin, ferritin, and estrogen. Results: RLS was diagnosed in 58 of 501 women (12%). Positive family history was found in 37% of women with RLS; 59% reported onset of RLS symptoms before the 20th week; 45% had an IRLSS >20 and 100% had a PSQI >5. Hemoglobin levels <11 g/dL were found in 20% of both affected and unaffected women in the third trimester. Women with and without RLS had similar hemoglobin, ferritin, and estrogen levels. IRLSS and PLM in sleep dropped by more than 50% postpartum in women with RLS. Conclusion: We found lower prevalence and earlier onset of symptoms compared to previous studies and confirmed significant improvement after delivery. RLS is clinically relevant due to severe impact on sleep quality. Genetic factors and smoking, but not ferritin, anemia, or estrogen levels, seem to play a role in the pathophysiology of RLS in pregnancy.