Natural Childbirth Options
Birth trauma refers to those injuries sustained during labor and delivery. Despite skilled and competent obstetric care, some may be unavoidable. Factors predisposing infants to injury include macrosomia, prematurity, cephalopelvic disproportion, dystocia, prolonged labor, and abnormal presentation. In 1988, birth injuries ranked eight as major causes of neonatal mortality and caused 4.6 deaths per 100,000 live births. The clinician who cares for newborn infants must be familiar with the conditions caused by birth injury. Injuries are known to occur to the soft tissues, head, eyes, ears, vocal cords, neck and shoulder, spine and spinal cord, intra-abdominal organs, extremities, and genitalia. Although many are mild and self limited, others are serious and potentially lethal.
Recovered twice as often from these infants, gram-positive and gram-negative anaerobes were equally represented in those episodes. All four infants with Bacteroides spp., bacteremia not associated with gastrointestinal disease had congenital pneumonia. Three were born to mothers who did not have chorioaminoitis, but had premature rupture of membranes for less than 24 hours before birth. These infants may have aspirated organisms colonizing the birth canal or acquired infection in utero from mothers with subclinical infection (7). In contrast, three infants with congenital pneumonia born to mothers with apparent intrauterine infection had gram-positive anaerobic bacteremia.
Permitted screening of the blood supply (16). By March of 1985, universal screening of the blood supply, coupled with voluntary donor deferral and heat-treatment of blood components, had virtually eliminated new HIV infections through transfusions or the receipt of blood products by hemophiliacs. During the 5rst decade, the U.S. government and all state and territorial health departments began to conduct AIDS case surveillance to monitor the outcome of HIV infection and its impact on the population. Anonymous serologic surveys of the prevalence of HIV antibodies in some populations were implemented using blood routinely collected for other purposes in a large number of hospitals and clinics serving high-risk clients in diverse geographic settings, and in selected accessible populations such as military applicants and women giving birth. These surveys revealed that HIV was more widespread and more prevalent than AIDS case data suggested (17).
Furthermore, many clients may not have the documentation to show that parental notification or consent has legally been given even when they have discussed the procedure with their caregivers. They may not have documents such as an identification cards, birth certificates, or adoption or custody papers to confirm who their legal guardians are. Clients may also be undocumented residents of this country. While politically it may be better for the United States for these young women not to give birth on U.S. soil, in fact this is not a good health practice. However, without paperwork it can be difficult to verify the mothers' ages and identify the parents or legal guardians to insure compliance with law. Because these documents may not be readily available, services may have to be delayed even longer, further endangering the mothers' health.
There is considerable evidence that preparation for childbirth can significantly modify the degree of pain experienced. This was the basis of the 'childbirth without fear' movement, which was popular in the 1960s. Although there can be little doubt that fear, fatigue and anxiety enhance pain perception, for the majority of mothers it is misleading to suggest that good antenatal education will lead to painless childbirth. Such expectations may in fact have the reverse effect, since the mother may develop complete loss of self-confidence when she begins to experience significant labour pain. Women whose pregnancy is unplanned or unwanted are likely to experience more pain, as are those who have no birth partner to support them during labour. Conversely, the continuous presence of a midwife or female birth partner (doula) has been shown to reduce the amount of pain reported.
Several commerdal antigen detection kits are available for diagnosis of neonatal sepsis and meningitis caused by group B streptococci. Developed for use with serum, urine, or cerebrospinal fluid (CSF), the best results have been achieved with CSF false-positive results have been a problem using urine. Latex agglutination procedures appear to be the most sensitive and specific. Because neonates acquire S. agalactiae infection during passage through the colonized birth canal, direct detection of group B streptococcal antigen from vaginal swabs has also been attempted. However, direct extraction and latex particle agglutination have not been sensitive enough for use alone as a screening test.
The most serious and blatant error made by these so-called factual materials that are required to be available or actually distributed to women seeking abortion is the claim that there is a post-abortion syndrome that causes women psychological distress many years after they have an abortion. In fact, though, no psychological sequelae caused by having an abortion have been scientifically validated. We discuss the available research in Chapter 6. However, some women who have psychological issues prior to becoming pregnant and choose to terminate the pregnancy may have short-or long-term psychological reactions that are similar to what they might have when carrying a fetus to term and giving birth. These emotional issues are complex, and we discuss this further in Chapter 5 and Chapter 6. In this chapter we discuss information to assist counselors and therapists both in answering their clients' questions that require factual information and in helping their clients sort through the...
Obviously, this policy is a bias toward promoting childbirth, the costs of which are provided through public funding. Legislative battles over funding for birth control have also been part of this debate. Many believe that the so-called abortion wars set the policy for all of women's lives, making it a human rights issue (Brownmiller, 2003). Unless women can control their own reproductive functions, which only last for less than one-third of women's expected life spans today, their ability to choose other areas of their lives, including many careers, is compromised.
Using the Cre-LoxP system 43 , a cardiac-restricted exon 2 deletion in DSP was created in mice by Garcia-Gras et al. 44 . These animals were engineered by crossing mice in which the second ex-on of the murine DSP gene is flanked by loxP sequence (floxed DP mice 129 SvJ strain) with mice expressing Cre recombinase under the control of the a-MHC promoter (a-MHC-Cre mice FVB N strain). Homozygous (DP- -) mutant mice had a high rate of embryonic lethality, consistent with that previously reported by Gallicano et al. 45,46 in germline DP-null mice. These homozygous mutant mouse embryos exhibited growth arrest at embryonic stage E10-E12, appeared pale, had no circulating red blood cells in organs, and were growth retarded. Histopathologic evaluation revealed poorly formed hearts with no chamber specification and unorganized cardiac myocytes. In addition, red blood cells were localized to the pericar-dial sac instead of within the cardiac chambers. Furthermore, an excess number of cells...
Cortical neurogenesis in adult primates including the human (Eriksson et al., 1998 Gould et al., 2006) is now generally accepted, and a recent study of neurogenesis in the basal ganglia of primates (Poloskey and Haber, 2005) is highly relevant in this context. As indicated by Poloskey and Haber, it may be important in this context that the ventral striatum, and especially its shell component, is in the direct line of the so-called rostral migratory stream originating in the subventricular zone of the lateral ventricle. Acknowledging the extended column of parvicellular neurons alongside the medial edge of the ventral striatum (Fig. 3.7), it is tempting to imagine how developing neurons might stream down from the lateral ventricle to the more ventral parts of the striatal complex. Be that as it may, the point is powerfully made by the above-mentioned study, that among the various striatal regions, the most dramatic variation in the number of proliferating cells from birth to...
This is similar to the process used after childbirth when the uterus does not expel all its contents or as a way to eliminate the contents of the uterus that might be causing painful menstruation. Prior to the vacuum suction process being used to remove the contents of the uterus, its walls are scraped by the curette and contents are scraped out. The vacuum suction process is a much less invasive method of cleansing the uterus. In fact, Brownmiller describes how women used to train themselves to do a vacuum suction abortion prior to its legalization as a less lethal intervention (Brownmiller, 1999).
With the evidence as it currently stands, there is no need to warn women of the risk of backache when preparing to perform epidural or spinal anaesthesia. However, many women ask about this complication, especially at antenatal classes, and the best approach is to inform them of the high risk of long-term backache associated with pregnancy and childbirth and to reassure them that epidurals do not appear to increase this risk. The woman who presents with severe backache or a long history of back trouble in the antenatal clinic should be warned that it is very likely that this will continue after childbirth. Epidural analgesia should not be contraindicated in these cases but it may sometimes be more painful having an epidural sited in a sensitive back. A 'mobile' technique should be preferred, to allow the patient to move freely in labour, and care should be taken to avoid unnatural postures that will unduly stress the ligaments. Support of lumbar lordosis and prevention of...
Congestive heart failure (CHF) is a condition in which the heart is unable to pump an adequate amount of blood to the lungs and the rest of the body. CHF is often the result of failure to treat previously existing heart problems. It can be related to a variety of diseases and conditions, such as a heart attack, coronary artery disease, high blood pressure, heart valve defects, congenital (present from birth) heart disease, anemia, cardiomyopathy (degenerative disease of the heart muscle), or arrhythmia. All of these problems can cause the heart to pump inefficiently. When the heart cannot do its job, the body becomes overloaded with water and sodium, causing fluid backup and swelling in the lungs, liver, and
AD is typically divided into three clinical phases based on age of onset. The infantile phase is from birth to 2 yr of age. The onset in this group is typically after 2 mo of age, but onset during the first few weeks of life may be seen. The childhood phase is between 2 and 11 yr. The adolescent and adult phase begins at age 12 yr and proceeds through adulthood. Each of these phases has a typical distribution of skin lesions that can prove useful in diagnosis (Fig. 1).
The use of alcohol and other illegal substances during pregnancy exposes the developing fetus to neurological and other problems that have been studied despite difficulties in obtaining a good scientific sample from which to make conclusions that will generalize to other populations. Most of the pregnant women and subsequent babies born to them that are studied come from lower socioeconomic groups with poor nutrition, lack of access to good health care, disenfranchisement from the majority culture, and other unhealthy and unsafe lifestyle problems, in addition to the exposure to various drugs, called polysubstances in the published articles. Therefore, it is difficult to know how much of the impact to attribute to the prenatal exposure to alcohol and other drugs, particularly cocaine and crack, that have been studied. Most children born into poverty are known to suffer disproportionately high rates of low birth rates, malnutrition, anemia, lead poisoning, and other childhood diseases...
Moreover medicine became more not less dangerous over time nineteenth-century hospitals killed mothers in childbirth because doctors (trained to consider themselves scientists) unwittingly spread infections from mother to mother on their hands. Mothers and infants had been much safer in previous centuries when their care had been entrusted to informally trained midwives. For 2,400 years patients have believed that doctors were doing them good for 2,300 years they were wrong.
The situation across generations is more complex, and available data suggest that it is possible to begin with either prenatal undernutrition or overnutrition and to stabilize on a pattern of intergenerational macrosomia and diabetes. Mothers who were born as macrosomic babies are themselves at risk of gestational diabetes and thus of transmitting macrosomia to the next generation. Alternatively, mothers born in an impaired intrauterine environment are at greater risk, because of their altered insulin sensitivity, of developing subclinical or gestational diabetes, as discussed above, and may subsequently give birth to a macrosomic infant at heightened risk of developing obesity as a result (65). This intergenerational sequence has been suggested as an explanation for the extremely high prevalence of diabetes among some Native American groups (2). In India, where mothers are small owing to nutritional limitations in childhood and inter-generational stunting, women who give birth to...
C. trachomatis infections are primarily spread from human to human by sexual transmission. Some infections, such as neonatal pneumonia or inclusion conjunctivitis, are transmitted from mother to infant during birth. The various routes of transmission for C. trachomatis infection are summarized in Table 46-2.
The more recent disavowal by professional associations and federal health agencies to acknowledge the existence of PAS comes in light of earlier research purporting the claim that psychological distress is a concomitant to abortion. In reviewing historical literature, Brockington (2005) demonstrates a long-standing scientific tradition of connecting abortion, miscarriage, so-called criminal abortion, or even fetal death in utero to psychological instability. However, his methodology is flawed. Brockington cites minimally sampled studies (12 to 30 cases) of organic, psychogenic or shame-related, or manic psychosis stemming from an abortion incident that occurred between 1745 and 1917 (Brockington, 2005). The researcher goes on to cite studies comparing psychiatric admission rates between women who either took part in abortion or childbirth in California, noting higher rates of admission of the former. He used a sample of California Medicaid clients for this analysis without controlling...
Increased methodological improvements in recent abortion studies, including the use of comparison and control groups, continues to demonstrate that the psychological distress experienced after an abortion experience is similar to childbirth (Koop, 1989) or benign and infrequent (Adler et al., 1992). Research exists that supports the view that abortion does not negatively affect various aspects of women's mental health and that contextual factors have greater impact on psychological distress regardless of women's abortion experience. A comprehensive review of more current abortion literature has identified the important preexisting conditions and risk factors that relate to post-abortion distress so that attempts may be made to prevent it from being experienced. women (N 5,295). In fact, those women who reported that they had one abortion actually had higher levels of global self-esteem than other women. Also significant is that this study found that the total number of children had a...
A weakened immune system can be congenital (present from birth), or it may result from an inherited disorder or an infection. It also may occur as a side effect of drug treatment. People with weakened immune systems have difficulty fighting infections that are easily handled by a healthy immune system. When a person's immune system is ineffective, harmful microorganisms can thrive and multiply rapidly, causing life-threatening infections. HIV is transmitted by sexual contact or by direct contact with infected blood or body fluids. HIV can be transmitted from an infected woman to a fetus during pregnancy or to an infant during childbirth or through breast milk. HIV also can be transmitted by sharing needles during intravenous drug use. In the past, some people were infected with HIV through blood transfusions or contaminated blood products. Today, however, all donated blood is routinely screened for HIV, and the blood supply in the United States is safe.
Is there a causeandeffect relationship between epidural anesthesia and prolonged labor or operative delivery
This issue was highly controversial. It has been reported that epidural analgesia is associated with prolonged labor and increased operative delivery, but recent studies do not support this assertion. Although epidural labor analgesia may prolong the second stage by about 30 minutes, there appears to be no harm to mother or fetus, and the American College of Obstetricians and Gynecologists (ACOG) recommends allowing an extra hour of pushing for mothers with an epidural block in place. ACOG has stated that Neuraxial analgesia techniques are the most effective and least depressant treatments for labor pain more recent studies have shown that epidural analgesia does not increase the risks of cesarean delivery.
Transmission is by sexual intercourse (especially homosexual) and by inoculation of infectious blood or blood products. The virus can be transmitted from mother to child, transplacentally, during birth or via breast feeding. Time from exposure to HIV until onset of acute clinical illness is 1-4 weeks. After primary infection there is a period ranging from a few months to more than 10 years with no or mild symptoms before the appearance of severe immunodeficiency. The patient is infectious before appearance of antibodies and remains so.
There are a number of different ovarian-stimulation protocols namely (1) human menopausal gonadotropin (hMG) or FSH, with or without clomiphene citrate, which was typically used in the early 1980s (2) the long, short, ultrashort, and microdose flare protocols using gonadotro-pin-releasing hormone (GnRH) agonists and hMG or FSH, which have gained widespread acceptance since the long protocol was first described in the mid-1980s and, more recently, (3) protocols using hMG or FSH followed by the addition of newer GnRH antagonists. The highest pregnancy and live-birth rates reported in all age groups and for all causes of infertility have been with the long protocol, which induces pituitary desensitization with GnRH agonist followed by ovarian stimulation with hMG or FSH and which is the most widely used protocol today (7). The results of IVF today exceed spontaneous pregnancy rates in healthy fertile couples in many IVF clinics, although the success declines quite significantly with age....
From birth to death, aging is a continuous and extremely complex multifactorial process that involves the interaction of genetic, epigenetic and environmental factors, and in which the incidence of diseases increases as well as the possibility of dying. The variability of the aging phenotype among individuals of the same species as well as the variability in longevity among species strongly suggests the mediating influence of both genetic and environmental factors in dictating the life span. For example, several genetic polymorphisms are known to confer extreme longevity in animal models, and a number of observations suggest that similar polymorphisms may operate in humans. The spectrum of the aging phenotype may vary from disease and disability to absence of pathology and preservation of function. At present, humans over age 65 are more likely to be active and productive than at any other time in history and life expectancy, disability rates, and health and wealth indicators have all...
E.g. anaemia may become more pronounced mild cytotoxic-induced cardiomyopathy may become more severe. Finally, there may be direct effects of the malignancy or its treatment on the uterus and birth canal, e.g. cervical surgery and scarring, perineal scarring and abdominal adhesions.
Pertussis is a childhood disease that brings about enormous direct cost on the hospitalization and resulting complications. Pertussis vaccination is usually given along with diphtheria and tetanus. It has been shown in a simulated birth cohort of 4.1 million children from birth to 15 years that with this combined vaccination 3 million cases and 28,000 deaths could be averted with a societal cost saving of over 45 million (Ekwueme et al.
Several unresolved questions exist concerning the use of metformin in PCOS, and these may serve as future investigative directions, including (a) the efficacy of metformin in large-scale trials in increasing clinical pregnancy, live-birth rates, and its effects in multiparity (b) ovulation induction with combination therapy of metformin and gonadotropins (c) prospective studies of metformin in decreasing EPL (d) whether metformin enhances the quality of eggs retrieved for in vitro fertilization (e) whether measurable biological factor(s) exist that can be used to predict response to insulin sensitizers (f) the effects of metformin on birth defects, pre-eclampsia, and gestational diabetes in large-scale studies (g) the development of a more potent and optimal insulin-sensitizing drug for PCOS and (h) large prospective trials evaluating the chronic use of metformin in women with PCOS for long-term cardiovascular and diabetes risk reduction.
Methods used have varied from simple 'satisfaction scales,' e.g. visual analogue scale or verbal rating scale, to complex evaluations of different modalities that combine to produce a positive experience of childbirth such as fulfilment (e.g. happiness), lack of distress (e.g. pleasure) and physical wellbeing (e.g. lack of pain). The simpler systems will always be more attractive to busy clinicians such as anaesthetists than the more complex and time-consuming ones, even though simple questions such as 'Are you satisfied ' or 'Rate your satisfaction on a scale of 1-10' are next to useless as objective outcome measures.
In regard to this practice, it is important to bear in mind that the potential to implant decreases with greater amount of embryonic mass removed (91, 93). However, recent studies have shown that there is no difference in pregnancy and implantation and live birth rates when two cells are biopsied compared to one (7). This ties in with data obtained by Hardy et al. (48), who showed that there was no significant difference in the ratio of TE and ICM nuclei when up to two cells were biopsied at the eight-cell stage. The decision to take one or two cells is based on the stage of development of the embryo and the type of diagnosis. In cases of dominant disorders discovered by PCR it has become essential to analyze two cells because allele dropout can cause serious misdiagnosis if diagnosis is based on one cell analysis. However, for sex-ing by FISH as well as for diagnosis of autosomal recessive disorders, one-cell diagnosis can be considered because transferring carrier...
Women preparing for childbirth make use of many sources of information. These will typically include discussion with other women, magazine articles, books and classes. Classes may be run by the GP practice or maternity unit, or by external bodies such as the National Childbirth Trust (NCT). Antenatal education is beneficial, since it has been shown that the well-informed mother will cope better with labour, but it is important that the information received by the mother should be accurate, well balanced and relevant to local conditions (there is, after all, little point in discussing the virtues of epidural analgesia if no such service is available in the local hospital).
Some of the earliest efforts to control infection followed the recognition in the nineteenth century that women were dying in childbirth from bloodstream infections caused by group A Streptococcus (Streptococcus pyogenes) because physicians were spreading the organism by not washing their hands between examinations of different patients. Hand washing is still the comer-stone of modem infection control programs. Moreover, the first recommendations for isolation precautions in U.S. hospitals were published in the late 1800s when guidelines appeared advocating placement of patients with infectious diseases in separate hospital facilities. By the late 1950s, the advent of nosocomial infections caused by Staphylococcus aureus finally ushered in the modern age of infection control. Li the past four decades, we have learned that, in addition to hospitalized patients acquiring infections, health care workers are also at risk of acquiring infections from patients. Thus, present-day infection...
Carrier testing identifies heterozygotes (carriers) for X-linked and autosomal recessive disorders that occur with high frequencies in certain populations. Theoretically, half the sons of a female carrier for an X-linked recessive allele will inherit the disorder. And, if both parents are carriers for an autosomal recessive disorder, there is a 25 chance that each offspring will have the genetic condition. Knowledge of carrier status gives couples the opportunity to make reproductive choices. If termination of pregnancy is not acceptable, couples at risk for an affected child may decide not marry, opt not to have children, or accept the possibility of having an affected child. Other couples may have the fetus tested for the genetic abnormality and terminate the pregnancy if the test result is positive. Couples who are either at risk of having a child with a serious abnormality or have experienced repeated fetal loss due to a chromosomal abnormality may seek in vitro fertilization with...
In 1999, the Royal Colleges of Midwives and Obstetricians and Gynaecologists published Towards Safer Childbirth - Minimum Standards for the Organisation of Labour Wards, setting out recommendations for organisational aspects of maternity services and risk management (due for revision 2007).
The OAA was formed in 1969 to promote the highest standards of anaesthetic practice in the care of the mother and baby and has an international membership in the order of 2000. It provides a focus for all anaesthetists who want to improve the care and safety of women in childbirth. The Association has charitable status, supports a research fellowship and offers annual research grants
The head of an infant could not fit through the mother's pelvic outlet at birth were it not for the fact that the bones of its skull are not yet fused. The shifting of the skull bones during birth may cause the infant to appear deformed, but the head soon assumes a more normal shape. Spaces between the unfused cranial bones are called fontanels,32 after the fact that pulsation of the infant's blood can be felt there. The bones are joined at these points only by fibrous membranes, in which intramembranous ossification will be completed later. Four of these sites are especially prominent and regular in location the anterior, posterior, sphenoid (anterolateral), and mastoid (posterolateral) fontanels (fig. 8.17). Most fontanels ossify by the time the infant is a year old, but the largest one the anterior fontanel can still be palpated 18 to 24 months after birth.
The anterior and lateral walls of the abdomen are reinforced by four pairs of sheetlike muscles that support the viscera, stabilize the vertebral column during heavy lifting, and aid in respiration, urination, defecation, vomiting, and childbirth. They are the rectus abdominis, external abdominal oblique, internal abdominal oblique, and transversus abdominis (table 10.6 figs. 10.14-10.16). urination, defecation, and childbirth O pubis I xiphoid process, costal cartilages 5-7 N intercostal nn. 7-12
Positive feedback is a self-amplifying cycle in which a physiological change leads to even greater change in the same direction, rather than producing the corrective effects of negative feedback. Positive feedback is often a normal way of producing rapid change. When a woman is giving birth, for example, the head of the baby pushes against her cervix (the neck of the uterus) and stimulates its nerve endings (fig. 1.13). Nerve signals travel to the brain, which, in turn, stimulates the pituitary gland to secrete the hormone oxytocin. Oxytocin travels in the blood and stimulates the uterus to contract. This pushes the baby downward, stimulating the cervix still more and causing the positive feedback loop to be repeated. Labor contractions therefore become more and more intense until the baby is expelled. Other cases of beneficial positive feedback are seen later in the book for example, in blood clotting, protein digestion, and the generation of nerve signals. Figure 1.13 Positive...
B. fragilis can be recovered from infectious processes in the newborn. The newborn infant is at risk of developing these infections when born to a mother with amnionitis, experienced premature rupture of membranes, or acquire the infection during the newborn's passage through the birth canal, where B. fragilis is part of the normal flora (62). B. fragilis was recovered from newborns with aspiration pneumonia (63), bacteremia (11), omphalitis (64), and subcutaneous abscesses and occipital osteomylitis following fetal monitoring (65). Bilophila wadsworthia and Centipeda periodontii are new genuses and species found in abdominal and endodontic infections respectedly (66).
The initial use of metformin in the treatment of PCOS has now been widely accepted to be a valuable and inexpensive therapeutic modality. Recent systematic reviews have indicated that metformin is highly effective in inducing ovulation and increasing pregnancy rates (8,9). The numbers needed to treat for ovulation are around four patients, and there is an improvement in serum insulin levels and a reduction in free testosterone in response to metformin. The drug appears to be safe in early pregnancy with respect to congenital abnormalities, although it is controversial whether miscarriage rates are reduced. The predictors of success of metformin have not been established, although there is some evidence that patients who are substantially overweight do not respond as well. Side effects of metformin include nausea, vomiting, diarrhea, and other forms of gastrointestinal intolerance, and patients need to be warned about the interaction between metformin and alcohol. The ovulatory...
Third, treatment of genetic disorders has had varied biological consequences. Although life expectancies from birth have been extended in some cases, full reproductive fitness has not been attained. For example, males with cystic fibrosis are usually sterile. Hemophiliacs and those with hemoglobopathies, for example, thalassemia and sickle cell anemia, are often infertile. PKU females are less fit than homozygous dominant and heterozygous individuals and require treatment to ensure successful pregnancies. Between 1984 and 1996 in the US, Canada, and Germany, PKU mothers gave birth to 331 children from 468 pregnancies. Thus, this source contributed 331 mutant PHA alleles to a combined gene pool of about 7.6 X 108 PHA alleles, thereby increasing the frequency of the recessive allele by about 0.0045 . Overall, the transmission of alleles by medically treated homozygous recessive individuals has been rather insignificant.
The conjunctiva of newborns acquires facultative and anaerobic bacteria during birth primarily from the mother's cervical flora during passage through the birth canal (14). The role of anaerobes in neonatal conjunctivitis was investigated by obtaining conjunctival cultures from 35 babies prior to silver nitrate application and 48 hours later (19). On initial culture, 46 facultative bacteria, and 27 anaerobes were recovered. The organisms isolated in almost all of these cases were present also in the mother's cervical cultures and in the baby's gastric aspirates, taken concomitantly. Clostridium spp. were recovered from two infants who developed conjunctivitis (14,19).
Using data from the 1995 National Survey of Family Growth (NSFG), Cougle et al. (2005) examined survey records of women for risk of generalized anxiety to see if having an abortion or giving birth to a child during their first pregnancies made any difference to their mental states. Approximately two-thirds of them (N 1,813) carried their first pregnancies to term while approximately one-third (N 1,033) had an abortion. They excluded both women who reported a period of anxiety prior to their first pregnancy as well as women with subsequent abortions. Although the entire group who chose to have an abortion demonstrated significantly greater prevalence of anxiety than the entire group of those who had the child, the subsection of women over 20 years old in both groups showed less divergent levels of anxiety, and the entire sample had rates 5 higher than the general population (Cougle et al., 2005).
Sucking blisters (sucking calluses) on the lips are present in the newborn infant. From birth, the lips show a sharp line of demarcation where the skin meets the mucosa. The mucosa is slightly elevated, moist, glistening deep red or purple and ends abruptly with the skin which forms one-third of the visible lip. The term sucking calluses is a misnomer because they are not callosities due to pressure or friction. They have been seen at their most florid in infants who have never sucked (for example those with congenital heart disease). Efficient sucking requires a complete seal of the lips around the nipple, hence the development of these calluses.
As septal injections of AVP stimulate paternal responsiveness V1a antagonist injections reduce it (Wang et al., 1994a). The sex difference AVP innervation may contribute to the absence of sex differences in parental behaviour typically seen in other rodents (Lonstein and De Vries, 2000). As in other female rodents (Bridges, 1990), hormonal changes associated with pregnancy and parturition appear necessary to trigger parental behaviour in female prairie voles (Lonstein and De Vries, 1999b, Hayes and De Vries, 2007). As male prairie voles will never get pregnant let alone give birth, they need a different strategy to boost their parental responsiveness. This strategy may very well involve having a higher density of AVP innervation. In case of the prairie vole, therefore, the presence of a sex difference in AVP expression does not correlate with the size of sex differences in behaviour. The animal with the largest sex difference in AVP innervation reported to date shows the least...
The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...
Infection of the female reproductive organs (i.e., uterus, fallopian tubes, ovaries, and even the abdominal cavity) can occur. The organisms are believed to be frequendy acquired as they ascend from lower-tract sites of infection. Organisms may also be introduced to the reproductive organs by surgery, instrumentation, or during childbirth. Infection with N. gonorrhoeae and or C. trachomatis in the lower genital tract can lead to PID if a woman is not adequately treated. Other organisms, such as anae robes, gram-negative rods, streptococci, and mycoplasmas, may ascend through the cervix, particularly after parturition (childbirth), dilation of the cervix, or abortion. The presence of an intrauterine device (IUD) is associated with a slighdy higher rate of PID. Such infections caused by Actinomyces have been associated with the use of IUDs. While developing within the uterus, the fetus is protected from most environmental factors, including infectious agents. The human immune...
Perinatal infections Virus infections acquired by the neonate during delivery or shortly thereafter. The placenta provides a powerful barrier that allows transit of maternal IgG to the fetus whilst preventing a large number of infective agents from reaching the embryo or the fetus. However, the neonate may be exposed to a number of harmful viruses during passage through the birth canal or from breast milk.
C. sordellii causes life threatening infections after trauma, childbirth, gynecological procedures, medically induced abortions, surgery and injection of elicit drugs. It can cause rapid progressive tissue necrosis, shock, multiorgan failure and death in about 3 4 of patients (4a).
The real purpose of the TRAP laws is to make accessing an abortion even more difficult than it is presently. States already require facilities that provide abortions to have a state license including yearly inspections and reviews on top of these additional laws. When these state laws are implemented they take abortion centers outside the existing regulatory licensing procedure applicable to other physicians and impose unfair requirements that have already reduced the number of places for women who need these services to go. The legislation treats abortion differently than all comparable medical procedures and creates a double standard for those physicians who provide abortions within their medical offices (these physicians' offices do not have to have a separate state license). As a medical service, abortion is not any different from other outpatient procedures that do not have state laws regulating them. Because in the year 2007 the provision of abortion care is already...
What are the most commonly used parenteral opioids for labor analgesia Which side effects are of special concern to the
Table 60-1 summarizes commonly used parenteral opioids and their side effects. In general, intravenous medications help the parturient tolerate labor pain but do not provide complete analgesia. The incidence of side effects and efficacy of analgesia are dose dependent. Maternal sedation and nausea are common. Opioids easily cross the placenta and may cause a decrease in fetal heart rate variability. In addition, intravenous opioids may cause neonatal respiratory depression and neurobehavioral changes.
Described in patients of various ethnic origins, significant clusters of patients seem to be localized to some regions in Brazil and Lebanon. Affected patients have near-complete absence of subcutaneous AT from birth, leading to marked prominence of muscles and veins. During childhood, they are noted to have a voracious appetite, accelerated growth, and advanced bone age. Umbilical hernia or prominence of the periumbilical skin, and an acromegaloid appearance because of enlargement of hands, feet, and mandible, are other common features. Hepatomegaly from fatty infiltration may be seen at birth or later in life and may be accompanied by splenomegaly. Acanthosis nigricans is often observed over the neck, axilla, groin, and trunk. Postpubertal girls develop clitromegaly and features of polycystic ovarian syndrome. Less commonly, some patients develop multiple focal lytic lesions in the appendicular skeleton, hypertrophic cardiomyopathy, and mild mental retardation (12-15).
Clomiphene citrate has been the initial therapeutic option for the management of anovulatory infertility for many years. Metformin was directly compared to clomiphene in a recent double-blind, placebo-controlled trial in non-obese women (average body mass index BMI 27 kg m2) with PCOS (24). After progesterone-induced withdrawal bleeds, 100 women with PCOS were randomized to metformin (850 mg twice daily) or clomiphene citrate (150 mg for 5 days on a monthly basis) for 6 months. Although there was no difference in ovulation rates between the metformin and clomiphene groups, the pregnancy rate was higher (15.1 vs 7.2 p 0.009) and spontaneous abortion rate lower (9.7 vs 37.5 p 0.045) in the metformin group. There was also a favorable trend for the live-birth rate with metformin compared to clomiphene (83.9 vs 56.3 p 0.07).
Hepatitis B virus is related to but clearly distinct from retroviruses. Unlike the situation with hepatitis A, the B virus is spread mainly through blood, either during sexual activity or during other blood contamination events (sharing of needles, for instance), and primary infection is followed by persistent viremia and liver damage. Hepatitis B infection is a special risk to medical personnel owing to the possibility of transmission by needle stick from contaminated blood, and is also a virus endemic among intravenous drug users, commercial sex partners, and their customers. The disease is endemic in Southeast Asia where the virus can be spread from mother to infant by birth trauma.
The incidence of infection in the fetus and newborn infant is high. As many as 2 of fetuses are infected in utero and up to 10 of infants are infected during delivery or in the first few months of life. The predominant microorganisms known to cause these infections are cytomegalovirus, herpes simplex virus, rubella virus, Toxoplasma gondii, Treponema pallidum, Chlamydia, Group B Streptococcus, Enterococcus spp., Escherichia coli, and anaerobic bacteria. All of these agents can colonize or infect the mother and infect the fetus or newborn either intrauterinely or during the passage through the birth canal. Although anaerobic bacteria cause a small number of these infections, the conditions predisposing to anaerobic infections in newborns are similar to those associated with aerobic microorganisms. Furthermore, the true incidence of anaerobic infections may be underestimated because techniques for the recovery and isolation of anaerobic bacteria are rarely used, or are inadequate....
Pneumonia in the newborn can be classified according to the mode of acquiring the infection and the time when the infection takes place. The infection can be acquired in utero by trans-placental route or following intrauterine infection. The pneumonia could be acquired during delivery by aspiration of bacteria that colonize the birth canal. The type of infection contracted after birth is acquired by contact with environmental objects (e.g., a tracheostomy tube) or by human contact. Aspiration can occur in up to 80 of intubated premature infants (32) and is common in newborns with gastroesophageal reflux (33) or those who require general anesthesia (34), or have swallowing dysfunction (35). During vaginal delivery, the neonate is exposed to the cervical birth canal flora, which includes both aerobic and anaerobic bacteria. Almost every normal baby born by vaginal delivery swallows potentially pathogenic aerobic and anaerobic bacteria (14). These bacteria can be cultured in the infant's...
Recessive ARVC D always presents in association with hair and skin phenotype. Woolly hair is apparent from birth and palmoplantar keratoderma or similar skin defects develop during infancy or early childhood. Mutations in genes encoding the desmosomal proteins plakoglobin and desmoplakin were identified to underlie this cardiocutaneous syndrome. The heterogeneity of cardiac phenotype may be attributed to the location of the causative mutation in the desmosomal plaque. In the plako-globin mutation, functioning at the outer dense plaque of the desmosomes, the cardiac phenotype is that of the ordinary ARVC D with predominantly right ventricular involvement (Naxos disease). Mutations that truncate the intermediate filament-
The gene is selected through a complex interaction with its environment, which can usefully be considered to include several levels the genetic, the somatic, and the ecological. The ecological has many aspects, one of which, the demographic, is given special treatment. Age-specific birth rates and death rates are important factors in the selection of developmental rates and other aspects of life cycles. The importance of genetic assimilation as a creative factor is minimized.
Syphilis is a bacterial infection that can be cured by antibiotics, usually penicillin, but that can cause serious problems if left untreated. The disease is much less common today than before the development of penicillin, and safer sex practices to curb HIV transmission also helped reduce the incidence of syphilis. Congenital (from birth) syphilis, which occurs in babies born to mothers with syphilis, is very rare today.
We have not discussed the option of adoption as that is an area where there is enough information to fill the pages of another book for mental health counselors. Suffice it to say that many women who have gone through both an abortion and adoption believe that the emotional impact of the abortion is shorter and less emotionally devastating than giving up their child for adoption. The worry about the health and happiness of the child often follows the woman forever, especially on the anniversary of the child's birth each year. Many women carry the secret of childbirth and adoption to their graves, fearful of upsetting the life they made afterward.
Although the third stage of labour can be managed without oxytocic drugs ('physiological management of the third stage'), it is common practice to give an oxytocic to all women at childbirth, usually on delivery of the anterior shoulder (vaginal delivery) or following delivery of the baby (Caesarean section). In most units, the drug used is either a mixture of oxytocin analogue and ergometrine (vaginal delivery) or oxytocin analogue alone (Caesarean section), although local practice varies.
In this first stage, the infant is dealing practically and overtly with the physical and social world. During this period (roughly from birth until 2 years) the child will learn, for example, that objects do not disappear when a screen is put in front of them. So, if a marble rolls under the fridge, it remains under the fridge. If the child's father seems suddenly to have disappeared behind a newspaper, then he has not disappeared altogether. In other words, they learn the principle of object permanence which is one of the many practical ways in which they learn that the world is orderly. The stage ends with the development of symbolic thought.
A CA is a weak, bulging spot in an artery of the brain. These often result from a weakness in the tunica media (muscle layer) of the vessel that is present from birth. A CA may cause symptoms ranging from headache, drowsiness, neck stiffness, nausea, and vomiting to more severe symptoms such as mental confusion, vertigo (dizziness), and loss of consciousness. A ruptured aneurysm most often results in a severe headache demanding immediate medical attention. A CA can be diagnosed by imaging tests like x-rays, ultrasound, computed axial tomography (CAT), and magnetic resonance imaging (MRI). When detected, brain aneurysms can be treated by microsurgery.
Two major hormones are secreted during various stages of oogenesis. These hormones are estrogen (ES-troh-jen) and progesterone (proh-JES-ter-ohn). Estrogen is primarily responsible for the development of the secondary sex characteristics in the female. The secondary sex characteristics are those traits that have nothing directly to do with reproduction or childbirth. They include soft skin, higher voice, less body hair, and a greater proportion of body fat, compared to males. Progesterone prepares the female body for pregnancy, as, for example, by stimulating the thickening of the lining of the uterus (YEW-ter-us) or ''womb.'' This makes the uterine (YEW-ter-in) lining more plush and glandular, just in case a fertilized ovum is implanted into it.
Brodmann's area 28 forms the entorhinal cortex, the anterior part of the para-hippocampal gyrus, medial to the rhinal and collateral sulci. The smaller area 34 lies medial to area 28, is similar in structure, and forms the gyrus ambiens. In approximately 70 percent of human brains, the free edge of the tentorium cerebelli contacts, and grooves or notches, the anterior parahippocampal gyrus. The gyrus ambiens lies medial to the tentorial notch unprotected by dura in the tentorial aperature (Fig. A). With increased intracranial pressure in the supra-tentorial space, the gyrus ambiens can easily herniate, followed by the uncal hippocampus in severe instances. This pathology can compromise the third cranial nerve, alter the flow of CSF through the tentorial aperature, and compress the brainstem, necessitating immediate clinical attention. Traumatic head injury by accident or difficult childbirth can scar the entorhinal area along the rigid free edge of the tentorium cerebelli.
Patient preference surveys conducted throughout the 1970s and 1980s (P2, P3, P4) reproducibly demonstrated definite value in knowing genetic constitution, whether or not it affects clinical decision making. When clinical decisions are dependent on understanding genetic endowment, hereditary knowledge assumes greater importance. Medical decisions to resort to extraordinary life-saving measures in the nursery are often tempered with certain knowledge of a fatal genetic diagnosis. In less extreme circumstances, families who have already given birth to a child with Down syndrome are known to be more aggressive in seeking prenatal diagnosis than those who have not experienced coping with offspring with a life-long disability.
To put this in context, throughout most of Western Europe teenage birth rates have fallen rapidly since the 1970s, while in the United Kingdom the rates have remained at the 1980s level or above. In 2001 the United Kingdom had the highest rate of live births to teenage girls in the European Union, with an average of 29 live births per 1000 girls aged 15-19. This was nearly 44 per cent higher than Portugal, the country with the next highest rate. Sweden and Italy had the lowest rates, at around 7 live births per 1000 girls aged 15-19 (Social Trends 33,2003).
The recovery of immature oocytes (Fig. 4) followed by IVM and IVF is an attractive alternative to conventional IVF treatment in which controlled ovarian stimulation with gonadotropins is used to increase the number of available oocytes and embryos (41). Significant progress has been made in improving implantation and pregnancy rates from in vitro matured oocytes (Fig. 4). The high numbers of antral follicles in patients with polycystic ovaries or PCOS make them prime candidates for IVM treatment, even if the appearance of polycystic ovaries in the scan is not associated with an ovulation disorder. Indeed, the main determinant of clinical success rates of IVM treatment is antral follicle count (42). When hCG priming is used before oocyte retrieval, it has been found that immature oocytes retrieved from normal ovaries, polycystic ovaries, or women with PCOS have a similarly high maturation, fertilization, and cleavage potential (43). However, although the implantation rate was lower,...
The presence of polycystic ovaries and or PCOS is important for determining the results of treatment with IVF because a longer time is required for pituitary suppression and there is higher sensitivity to gonadotropins during ovarian stimulation and a higher risk of OHSS. However, clinical pregnancy rates and live-birth rates after IVF treatment are generally higher in women with polycys-tic ovary PCOS compared with women with morphologically normal ovaries. IVM is an alternative treatment option that avoids the risks of ovarian stimulation in this group. In some centers, IVM outcomes are comparable to overall IVF outcomes.
Because neonatal strokes are often clinically silent in the acute phase, the incidence has been difficult to estimate. However, a recent population-based study reported an incidence of neonatal ischemic stroke, including presumed perinatal stroke, of 1 in 5000 live births (9). Neonatal hemorrhagic stroke is particularly difficult to define and measure, given that many normal newborns have a small amount of intracerebral hemorrhage, presumably secondary to birth trauma therefore, no estimates of incidences of neonatal hemorrhagic stroke have been published.
Individuals with HIV and patients with AIDS present a variety of pathologic alterations that influence their nutritional status during various stages of the disease. Some studies have revealed a greater level of malnutrition and an elevated excretion of vitamin A in the urine of AIDS patients. Secretion of vitamin A in urine has been associated with infection, fever, and acute diarrhea. Therefore, the monitoring of nutritional status, especially in relation to vitamin A is recommended for patients with HIV and AIDS. Studies show that around 10-40 of HIV-positive women will give birth to children who are also infected. However, the risk factors for transmission from mother to child are not well understood and the effects of maternal nutritional status on fetal transmission are unknown.Vitamin A is an essential micronutrient for normal immune function. Vitamin A deficiency is common among HIV-infected pregnant women and is associated with higher mother-to-child transmission ofHIV-1 and...
In apes and other quadrupedal (four-legged) mammals, the abdominal viscera are supported by the muscular wall of the abdomen. In humans, the viscera bear down on the floor of the pelvic cavity, and a bowl-shaped pelvis is necessary to support their weight. This has resulted in a narrower pelvic outlet a condition quite incompatible with the fact that we, including our infants, are such a large-brained species. The pain of childbirth is unique to humans and, one might say, a price we must pay for having both a large brain and a bipedal stance.
Women are even less likely to have symptoms, but they are more likely to experience long-term consequences. In addition to developing PID, a woman with chlamydia can pass the infection to her baby during childbirth, causing pneumonia or conjunctivitis (inflammation of the membrane that covers the white of the eye and lines the inside of the eyelid).
There are various types of depression, or, perhaps, it is better to say, various causes of depression, that can be distinguished. For example, depression might come primarily from an external event, such as career reversal, or from an internal event such as a neurochemical imbalance. Depression might be the main problem or might be secondary to something else, such as extreme anxiety. It might occur with advancing years or after giving birth, and some depressions seem to occur seasonally for some people (seasonal affective disorder - SAD). This is as 'real' a disorder as any other and appears to be the result of very short winter days in some of the more northerly northern hemisphere countries.
These decisions are not easy ones for women or doctors to make. The possible risk to the woman for not taking the medication is that her depression, anxiety, psychotic, or manic behavior may worsen and the dysregulation in her production of neurotransmitters will also affect the fetal development. The woman's relationship with her partner and other family and friends in her support system may worsen. She may develop an impaired mother-infant attachment or serious postpartum depression should she keep the pregnancy and give birth. And, she may become actively suicidal. On the other hand, if she continues using psychopharma-cological agents, especially high doses on a regular basis during the pregnancy, there may be risks to the development of the fetus. Medications used during organogenesis (weeks two to eight of fetal development) may be particularly teratogenic, causing major or minor congenital abnormalities in physical or functional areas. In the last trimester, there can be all...
Pregnancy And Childbirth
If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?