Prospective Observational Study of Serial Cardiac Output by Transthoracic Echocardiography in Healthy Pregnant Women Undergoing Elective Cesarean Delivery

Abstract

breastfeeding. Interestingly, the group with the longest duration of breastfeeding was the group that did not receive an epidural or IV analgesia with pethidine. Perhaps those who want the least medical intervention during labor are most committed to continued breastfeeding.An important difference between the Wilson et al study 9 and the Beilin et al 8 study is that Wilson et al evaluated breastfeeding success at 12 months postpartum via a postal questionnaire with a roughly 70% to 75% response rate. The women were asked how long they breastfed but there are no data as to the percentage of women breastfeeding at 6 weeks postpartum. Therefore comparison to the Beilin et al study is not possible. Furthermore, Beilin et al evaluated multiparous women who planned to breastfeed. Wilson et al evaluated nulliparous women, and there is no information as to the desire of those women to breastfeed. Indeed, 30% to 35% were not breastfeeding while in the hospital on postpartum day 1.An important limitation of the Wilson et al study is that it was not designed to assess breastfeeding but rather mode of delivery. Therefore, it is only a secondary analysis of outcome, and the study may have been insufficiently powered to detect a significant difference among the groups in breastfeeding. Furthermore, there is no information as to why the women stopped breastfeeding, and the accuracy of information collected at 1 year postpartum is debatable, especially since only 6% to 7% were still breastfeeding and most had stopped 8 months earlier.There are many reasons why women initiate and then stop breastfeeding. Most are probably practical issues, such as family support and having dedicated time to breastfeed. If epidural analgesia or epidural analgesia with fentanyl does have an impact on breastfeeding, it is clear from all the studies to date that the influence is small. This study, despite its limitations, supports that conclusion. A randomized controlled study in nulliparous women with breastfeeding as the primary outcome is still needed. Comment by Yaakov Beilin, MD

Inferior vena cava assessment in term pregnant women using ultrasound: A comparison of the subcostal and right upper quadrant views

“…4 IVC visualisation, however, can be challenging in full-term pregnant women because of the gravid uterus. Apical and parasternal views have been demonstrated to be readily obtainable in labouring parturients, 5 while subcostal views may pose a challenge in the presence of uterine enlargement. 6,7 The right upper quadrant (RUQ) window, also known as a transhepatic or mid-axillary window, may therefore offer a viable alternative to the subcostal window for IVC visualisation.…”