adverse events for our patients? I have no idea, but I like that level of communication. As for nursing shift changes, it was here that the study found more facial nerve palsies in the neonates due to failed forceps deliveries and more hysterectomies. But these are hardly nursing care issues, as the study acknowledges. The authors also acknowledged that their findings might be Type I errors because of the study design. So at the end of the day, has this study helped to expand our knowledge? I do not think so. The hypothesis is an interesting one but it is not answered here. Comment by McCallum R. Hoyt, MD, MBA Mid-Pregnancy Maternal Plasma Levels of Interleukin 2, 6, and 12, Tumor Necrosis Factor-Alpha, Interferon- Gamma, and Granulocyte-Macrophage Colony-Stimulating Factor and Spontaneous Preterm Delivery A.E. Curry, I. Vogel, C. Drews, D. Schendel, K. Skogstrand, W.D. Flanders, D. Hougaard, J. Olsen, and P. Thorsen (Acta Obstet Gynecol Scand, 86(9):1103–1110, 2007) Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Copyright r 2008 by Lippincott Williams & Wilkins DOI: 10.1097/01.aoa.0000326380.66627.dc I mpaired cytokine levels may play a role in the pathway from bacterial intrauterine infection to spontaneous preterm delivery (SPTD); however, only 1 study has in- vestigated the association between serum or plasma cyto- kines and SPTD in women who are not in preterm labor. This case-control study evaluated the relationship between elevated mid-pregnancy levels of maternal plasma inter- leukin-2 (IL-2), IL-6, tumor necrosis factor (TNF)-a, interferon (IFN)-g, and granulocyte macrophage colony- stimulating factor (GM-CSF), and SPTD before preterm labor. It also sought to determine whether associations vary by prepregnancy body mass index, maternal age, gravidity, and prior preterm delivery status. The study was nested within the Danish National Birth Cohort (DNBC), which recruited 101,042 parturients early in pregnancy from 1997 to 2002, following them prospectively. For this cohort, women having a singleton, live-born neonate with no major birth defects, and who had completed the first interview of the DNBC study at 12 weeks’ gestation and provided at least 1 blood sample before 22 weeks were included. Three case groups were based on gestational age: early SPTD (delivery at 24 to 29 wk), moderate (30 to 33 wk), and late (34 to 36 wk); controls were women who delivered at Z37 weeks. IL-2, IL-6, TNF-a, IFN-g, and GM-CSF concentrations were measured by multiplex flow cytometry. The final population for analysis consisted of 61 early SPTD women, 278 moderate SPTD, 334 late SPTD, and 1125 controls. Generally, women delivering preterm were more likely than controls to have undergone a prior preterm delivery or abortion and be multigravid and nulliparous. Women with an early or moderate SPTD were more likely to be Z35 years old; those with early SPTD were more likely to smoke. Mid-pregnancy levels of IL-2, IL-6, TNF-a, and GM-CSF did not differ significantly by gestational age at delivery. IFN-g levels were higher in both the moderate [median (interquartile range) 210.4 (77.4, 397.1)] and late SPTD groups [198.1 (77.4, 404.3)] than in the control group [176.3 (52.8, 348.0)]. IFN-g >90th percentile showed a weak association with delivery at 30 to 33 weeks (crude odds ratio, 1.56), while IFN-g and IL-6 >75th percentile were associated with delivery at 34 to 36 weeks (crude odds ratio, 1.32). Estimates changed little after adjusting for confounders and there was no effect-measure modification by maternal factors. The authors concluded that use of mid-pregnancy cytokine levels in predicting SPTD is limited for clinical and public health practice. Future studies might address whether these or other cytokines are of value when used in combination with other biomarkers or genetic factors, or if measured at a different gestational age. Dystocia in Labor-risk Factors, Management and Outcome: A Retrospective Observational Study in a Swedish Setting L. Selin, G. Wallin, and M. Berg (Acta Obstet Gynecol Scand, 87(2):216–221, 2008) Department of Obstetrics and Gynecology, NU Hospital Group, Trollha¨ttan, Sweden Copyright r 2008 by Lippincott Williams & Wilkins DOI: 10.1097/01.aoa.0000326381.04746.0b L abor dystocia (LD), or prolonged labor, is associated with adverse maternal and neonatal outcomes, includ- ing cesarean section (CS). A number of risk factors for LD, including epidural analgesia, have been reported in earlier studies, but little is known about the influence of intrapar- tum labor management and demographics. This observa- tional, retrospective study aimed to investigate obstetric risk factors, frequency of interventions, and delivery out- comes for LD. Two thousand patient charts were randomly selected for analysis from among 5702 deliveries in a Swedish uni- versity hospital from 2000 to 2001. Inclusion criteria were primiparity and multiparity, singleton gestation, pregnancy Epidemiologic Reports, Surveys Obstetric Anesthesia Digest  Volume 28, Number 3, September 2008 142 r 2008 Lippincott Williams & Wilkins