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(Eur J Anaesthesiol. 2021;38:1059–1066) Although epidural analgesia is an effective and common method of pain management during labor and delivery, studies suggest there may be an increased risk of instrumental vaginal delivery (IVD, forceps or vacuum extractor) use. Instrumental delivery increases risk of maternal and neonatal morbidity and outcomes. This study aimed to identify women at increased risk of instrumental delivery and strategies to decrease associated maternal and neonatal morbidity.

BackgroundThermal imaging (TI) is a relatively low cost, non-invasive imaging technique that offers a quick and objective measurement of joint surface temperature. However, TI data at the elbow in patients with rheumatoid arthritis (RA) is presently lacking.ObjectivesThe aim of this study is to compare TI outcomes with ultrasound (US) joint inflammation findings at the elbow among patients with RA.MethodsTI and US imaging were performed at the same study visit. TI was carried out in a draft free room following a standardized protocol. The maximum (Tmax), average (Tavg) and minimum (Tmin) temperatures at the elbow (anterior, posterior, lateral and medial aspects) were summed up to obtain the respective MAX, AVG and MIN temperatures for the right and left elbows. Ultrasound power Doppler (PD) and greyscale (GS) joint inflammation were graded semi-quantitatively (0-3) at the anterior (humeroradial) and posterior fossa recesses of the elbow joint using previously validated scoring methods; and these were summed to obtain the respective PD and GS scores at the right and left elbows per patient. Pearson’s correlation coefficient was used to correlate the findings from TI and US imaging, while simple linear regression was used to describe the relationship between parameters.ResultsIn this cross-sectional study, 60 elbows were evaluated by TI and US imaging among 30 adult RA patients with the following patient baseline characteristics: 76.7% female; 76.7% Chinese; mean (SD) disease duration 7.3 (6.8) months; mean (SD) DAS28 3.83 (1.19). Table 1 shows the results of the comparative analysis between the TI parameters (MAX, AVG and MIN) and the US PD and GS scores. For Pearson’s correlation, the TI parameters (MAX, AVG and MIN) were all significantly correlated (P<0.05) with the US PD scores (Table 1) at both the right and left elbows. For US GS scores (Table 1), significant correlation (P<0.05) were observed with all the TI parameters (MAX, AVG and MIN) only at the right elbow but not at the left elbow (with P-values all >0.05). The simple linear regression estimates between TI and US imaging parameters at the right and left elbows are summarized in Table 1.ConclusionTo the best of our knowledge, our study is the first to report on the correlation analysis between TI parameters and US joint inflammation outcomes at the elbow from an RA cohort. Between US PD and GS joint inflammation, TI is more consistently associated with the former at the elbow in RA. TI of the elbow in RA appears promising and will require further validation in independent RA cohorts.Table 1.Comparative analysis between the thermal and ultrasound imaging parametersThermal imaging parameterPearson’s correlationSimple linear regressionvs. GS scorevs. PD scorevs. GS scorevs. PD scoreCorrelation Coefficient (95% CI)P-valueCorrelation coefficient (95% CI)P-valueEstimates (95% CI)P-valueEstimates (95% CI)P-valueRight elbowMAX0.40(0.04, 0.66)0.029*0.47(0.12, 0.70)0.009**0.16(0.02, 0.3)0.030*0.11(0.03, 0.18)0.009**AVG0.42(0.07, 0.68)0.020*0.43(0.07, 0.68)0.017*0.15(0.03, 0.28)0.020*0.09(0.02, 0.16)0.018*MIN0.39(0.03, 0.66)0.032*0.40(0.04, 0.66)0.028*0.15(0.01, 0.28)0.033*0.09(0.01, 0.16)0.029*Left elbowMAX0.32(-0.05, 0.61)0.0860.55(0.22, 0.75)0.002**0.11(-0.02, 0.23)0.0860.08(0.03, 0.13)0.002**AVG0.26(-0.12, 0.56)0.1740.52(0.19, 0.74)0.003**0.08(-0.04, 0.19)0.1720.07(0.03, 0.11)0.003**MIN0.15(-0.23, 0.48)0.4330.45(0.10, 0.69)0.012*0.04(-0.07, 0.16)0.4300.06(0.01, 0.10)0.012*Statistically significant: *P<0.05, **P<0.01REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.