RxPG News : Obstetrics

progesterone can prevent apoptosis in fetal membranes and therefore prevent pre-term birth

Sat, 06 Feb 2010 13:07:46 PST

( from http://www.rxpgnews.com ) Researchers at Yale School of Medicine believe they may have discovered how the hormone progesterone acts to prevent preterm birth.

The findings will be presented at the Annual Scientific Meeting of the Society for Maternal-Fetal Medicine (SMFM) in Chicago by Errol Norwitz, M.D., professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale.

Preterm birth—delivery prior to 37 weeks gestation—has become increasingly common over the past 40 years. Currently, one in eight pregnancies in the U.S. are delivered prematurely. These premature infants are at least seven times more likely to die or have long-term neurologic injury compared with infants delivered at term. Efforts to date to prevent preterm birth have been largely unsuccessful. Several recent studies have suggested that progesterone supplementation from weeks 16-20 of gestation through 36 weeks may prevent preterm birth in about one-third of high-risk women, but the molecular mechanism by which progesterone acts was not known until now.

One-third of preterm birth is linked to premature rupture of the fetal membranes. Prior studies have suggested that rupture results from weakening of the membranes by apoptosis (programmed cell death). Norwitz and his Yale colleagues have shown for the first time that progesterone can prevent apoptosis in fetal membranes.

"We were able to demonstrate that progesterone prevents apoptosis in an artificial environment in the laboratory in which we stimulated healthy fetal membranes with pro-inflammatory mediators," said Norwitz. "Interestingly, and somewhat unexpectedly, we also saw an inhibition of apoptosis under basal conditions without the presence of pro-inflammatory mediators. This suggests that the same mechanism may also be important for the normal onset of labor at term."

Anxious women more likely to have smaller babies

Wed, 04 Nov 2009 12:13:19 PST

( from http://www.rxpgnews.com ) Women with severe and chronic anxiety during pregnancy are more likely to have smaller babies, says a new study.

The study authors demonstrated that the mother's anxiety during pregnancy impacts birth outcomes, including smaller babies, over and beyond factors such as drug use, education, and race.

Low to moderate levels of anxiety in women during either the first or second trimester did not significantly affect the birth outcomes, but women who are severely anxious during much of their pregnancy should be considered for anxiety-reducing interventions.

Shahla M. Hosseini of the University of Pittsburgh Medical Centre, co-authored the study with Minhnoi W. Biglan, Cynthia Larkby, Maria M. Brooks, Michael B. Gorin, and Nancy L. Day.

'One way to prevent health problems in children and adults is to focus care on the prenatal period,' the authors note.

'It is key to pursue further research which addresses interventions to ameliorate the effects that a woman's trait anxiety has on the development of foetuses,' they said.

The study was published in Paediatric and Perinatal Epidemiology.

Preeclampsia -a disorder of protein misfolding

Fri, 30 Jan 2009 15:06:27 PST

( from http://www.rxpgnews.com ) Clues to the cause of preeclampsia, a common, but serious hypertension complication of pregnancy that has puzzled doctors and researchers for decades, point to proteins that misfold and aggregate, according to Yale School of Medicine researchers.

These misshapen proteins can be easily detected in the urine, affording a new approach to early diagnosis of the disease, the Yale researchers report in new findings presented at the Society for Maternal Fetal Medicine scientific meetings in San Diego, Calif.

Preeclampsia is one of the most common causes of death in pregnant women in the United States and is responsible for about 76,000 maternal deaths worldwide each year. It is also a leading cause of preterm delivery. Delivery is the only reliable treatment for preeclampsia, and establishing a correct diagnosis can be difficult, especially in women with preexisting hypertension, lupus or kidney disease.

"These results support the hypothesis that preeclampsia is a pregnancy-specific protein misfolding disease," said lead author on the abstract, Irina Buhimschi, M.D., associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences. "Our urine dye test is a rapid and non-invasive test that can be used to definitively diagnose preeclampsia."

In a study of 111 pregnant women, Buhimschi and her team used proteomics to identify key abnormal proteins in the urine weeks before preeclampsia becomes clinically apparent. In order to carry out their individual functions properly, proteins must fold themselves correctly into three-dimensional structures. Misfolding, or failure to fold into the intended shape, produces proteins with different properties that are mainly guided by their shape rather than their amino acid sequence. Proteins of different amino acid sequences may share common shapes when misfolded.

Buhimschi and her team designed a test based on a dye that sticks to misfolded proteins. They analyzed the urine of women in the study starting in the first trimester of pregnancy. Buhimschi was able to use this simple test to identify a study participant who went on to develop severe preeclampsia and required early delivery.

Further work in Buhimschi's lab, using conformation-specific antibodies developed in Charles Glabe's laboratory at University of California-Irvine, showed that misfolded shapes similar to those found in Alzheimer's disease are also present in the urine of preeclamptic women. In contrast to the misfolded proteins identified in Alzheimer's disease, however, the misfolded aggregates identified in preeclampsia are composed of a group of different proteins, including SERPIN-A1 (also known as alpha-1-antitrypsin).

"Our findings are compelling for several reasons," said Buhimschi. "This novel identification of preeclampsia as a disorder of protein misfolding opens a door for researchers that may lead to testing of new drugs or developing new therapies. Our future work will seek to determine whether the different shapes employed by the misfolded proteins in preeclampsia are linked to specific clinical symptoms and the different ways this intriguing disease manifests."

Depression during pregnancy doubles risk of premature delivery

Fri, 24 Oct 2008 13:33:16 PST

( from http://www.rxpgnews.com ) Washington, Oct 23 - Depressed pregnant women face twice the risk of premature delivery than their counterparts with no such symptoms, according to a new study.

Besides the increased risk of premature delivery, the study found that the risk grows with the severity of the depressive symptoms, among pregnant women.

These findings also provide preliminary evidence that social and reproductive risk factors, obesity, and stressful events may aggravate depression-premature delivery link, according to researchers.

'Premature delivery is the leading cause of infant mortality, and yet we don't know what causes it,' said co-author De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland.

'This study adds to emerging evidence that depression during early pregnancy may interfere with the neuroendocrine pathways and subsequently placental function,' Li said.

'The placenta and neuroendocrine functions play an important role in maintaining the health of a pregnancy and determining the onset of labour,' Li explained.

Because the majority of the women in the study did not use anti-depressants, the study provides a clear look at the link between depression and preterm delivery.

The study, among the first to examine depression and premature delivery in a representative and diverse population in the US, looked at 791 pregnant Kaiser Permanente members in San Francisco city and county from October 1996 through October 1998.

Researchers interviewed the women around their 10th week of pregnancy and found that 41 percent of the women reported significant or severe depressive symptoms, according to a Kaiser Permanente press release.

The women with less severe depressive symptoms had a 60 percent higher risk of premature delivery -- defined as delivery at less than 37 completed weeks of gestation -- compared with women without significant depressive symptoms, and the women with severe depressive symptoms had more than twice the risk.

In addition to being the leading cause of infant mortality and morbidity, preterm delivery is also the leading medical expenditure for infants, with estimated annual cost of about $26 billion in the US alone.

The study is published online in the Oxford University Press' journal Human Reproduction.

Computer programme to predict premature births under development

Mon, 15 Sep 2008 10:26:19 PST

( from http://www.rxpgnews.com ) Sydney, Sep 15 - Universities of Melbourne and Newcastle are jointly developing a computer programme to predict premature births.

About 17,000 premature births occur in Australia each year. It accounts for 70 percent of deaths among newborns and 50 percent cerebral palsy cases.

Roger Smith, professor, University of Newcastle, said identifying patterns in hormone levels could be the key to determining high risk pregnancies.

'The mechanisms that regulate the onset of human labour are still unknown, which makes it difficult to predict the event. However by detecting patterns in hormone levels, we could see when a pregnancy was going 'off course',' said Smith.

'This would identify women who may benefit from medical treatments currently available to prevent premature birth.'

David Smith of the University of Melbourne said: 'We are creating software and other computational methods to analyse pathology samples, determine patterns in blood hormone levels, and display the results.

'The programme will not only identify women at risk of giving birth early - it will also identify women not at risk, who could have their pregnancies managed by midwives in hospital or a home birth setting.'

Researchers hope to have the computer programme fully developed in three years.

Predictor of miscarriages

Thu, 13 Mar 2008 10:34:58 PST

( from http://www.rxpgnews.com ) A medical team from the University of Leicester has been able to establish for the first time a predictor for pregnant women who may have miscarriages and those who won’t. Their research is published in the highly prestigious Journal of the American Medical Association.

The researchers measured the levels of a naturally occurring ‘cannabis’ (an endocannabinoid) known as anandamide in women who presented with a threatened miscarriage (bleeding in early pregnancy with a viable baby) and found that those who at the time of the test had significantly higher levels of anandamide subsequently miscarried.

Professor Justin Konje, who heads the Endocannabinoid Research Group of the Reproductive Sciences Section in the Department of Cancer Studies and Molecular Medicine at the University of Leicester, said: “We are extremely excited by these findings. Essentially, we have for the first time been able to use the levels of this naturally occurring cannabis, anandamide in 45 women presenting with threatened miscarriage and a viable pregnancy to predict the eventual outcome of the pregnancy. Using a threshold we defined from this study, we were able to predict all the women who then went on to have a subsequent miscarriage and 94% of those who went on to have a live birth.

“This is the first time that this has been reported. It has very significant implications and if the results are replicated, we would eventually be able to reassure women who present with bleeding in early pregnancy about the outcome of their pregnancies.

“Obviously for those whose pregnancies are identified by this measurement as destined to end in a miscarriage, knowing this may cause grief and upset but it may also help them to come to terms quickly with the outcome of the pregnancies.

“This is the first stage of this study but the results are very encouraging and we are undertaking further studies to confirm our observations. Once these are confirmed, we plan to develop a bed-side test which could then be applied in clinical practice.”

In the paper, the authors state that approximately 40%-50% of all human conceptions are lost before 20 weeks of gestation. They conclude:

“In this pilot study of women with threatened miscarriage, high plasma anandamide level was associated with subsequent miscarriage. The study is limited by the small number of participants and requires replication in larger and more diverse populations. Compared with tests based on peripheral blood mononuclear cells, anandamide-level measurement has an advantage of being based on whole blood and not requiring separation. If established as valid and clinically practical, anandamide measurement has the potential for improving the prediction and counselling of women presenting with threatened miscarriages.”

Elevated autoantibodies linked to preeclampsia

Thu, 15 Mar 2007 08:31:01 PST

( from http://www.rxpgnews.com ) Women who develop preeclampsia during pregnancy are more likely to develop certain dangerous autoantibodies than women with normal pregnancies, and these autoantibodies are still present two years after childbirth in about 20 percent of women who had the disorder, scientists from the University of Pittsburgh report in the March issue of Hypertension, the journal of the American Heart Association.

Also known as toxemia, preeclampsia affects some 5 percent of pregnancies and is a leading cause of maternal and fetal illness and death, particularly in developing nations. Signs include high blood pressure, swelling of the ankles and the presence of protein in the urine. The condition typically appears after the mid-point of pregnancy. The only effective treatment is immediate delivery, which can be dangerous for the baby if it is too early. Untreated, the condition can lead to organ failure, coma and death. Preeclampsia also has been linked to an increased lifetime risk for heart disease.

"Further study is required to determine whether the presence of these autoantibodies could be an early marker for preeclampsia risk, but early data are promising," said Carl A. Hubel, Ph.D., the studys lead author and assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. "Learning more about these autoantibodies also might enable us to identify a subset of women who are at greater risk for heart disease later in life, and give us a closer understanding of what causes preeclampsia."

For most women, the autoantibodies eventually go away after pregnancy. "But in some, they persist or reappear, consistent with other data showing that many of the risk factors for preeclampsia are the same as those for cardiovascular disease," added Dr. Hubel, who also is an associate investigator at the university-affiliated Magee-Womens Research Institute.

Autoantibodies are immune system proteins that attack the bodys own cells instead of microorganisms that represent a real threat, such as viruses, bacteria or other toxins. Dr. Hubel and his colleagues studied the development of autoantibodies capable of activating the angiotensin II type 1 receptor (AT1-AA). The AT1 receptor is part of an amino acid group that works within cells to maintain healthy blood vessels and manage inflammation. Too much AT1 receptor activation, such as takes place when the autoantibodies are present, can lead to high blood pressure and inflammation.

"These antibodies are similar to antibodies in other conditions, such as those related to the autoimmune thyroid disorder Graves disease," said Dr. Hubel. "These kinds of antibodies also are related to high blood pressure, which is one of the signs of preeclampsia. Women with a history of preeclampsia have a substantially higher cardiovascular risk later in life, compared to women who experienced normal pregnancies."

While the cause of preeclampsia remains unknown, evidence is mounting that the disorder relates to poor formation and placement of the placenta combined with underlying maternal factors including insulin resistance, obesity and inflammation that are magnified during the physiological stress of pregnancy.

Elevated levels of AT1-AA are evident in nearly all women with preeclampsia, the researchers report. Blood samples from 29 women with preeclampsia and 35 women who had normal pregnancies at Magee-Womens Hospital of UPMC in Pittsburgh and Massachusetts General Hospital in Boston were studied. The samples were collected between six months and two years postpartum to allow for stabilization of normal, pregnancy-induced cardiovascular changes.

"AT1-AA were detected in 17.2 percent of postpartum women who had developed preeclampsia, as opposed to 2.9 percent of postpartum women whose pregnancies were uncomplicated," said Dr. Hubel.

Vitamin D intake inadequate during pregnancy

Tue, 27 Feb 2007 23:00:44 PST

( from http://www.rxpgnews.com ) Even regular use of prenatal multivitamin supplements is not adequate to prevent vitamin D insufficiency, University of Pittsburgh researchers report in the current issue of the Journal of Nutrition, the publication of the American Society for Nutrition. A condition linked to rickets and other musculoskeletal and health complications, vitamin D insufficiency was found to be widespread among women during pregnancy, particularly in the northern latitudes.

"In our study, more than 80 percent of African-American women and nearly half of white women tested at delivery had levels of vitamin D that were too low, even though more than 90 percent of them used prenatal vitamins during pregnancy," said Lisa Bodnar, Ph.D., M.P.H., R.D., assistant professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH) and lead author of the study. "The numbers also were striking for their newborns 92.4 percent of African-American babies and 66.1 percent of white infants were found to have insufficient vitamin D at birth."

A vitamin closely associated with bone health, vitamin D deficiency early in life is associated with rickets a disorder characterized by soft bones and thought to have been eradicated in the United States more than 50 years ago as well as increased risk for type 1 diabetes, asthma and schizophrenia.

"A newborn's vitamin D stores are completely reliant on vitamin D from the mother," observed Dr. Bodnar, who also is an assistant investigator at the university-affiliated Magee-Womens Research Institute (MWRI). "Not surprisingly, poor maternal vitamin D status during pregnancy is a major risk factor for infant rickets, which again is becoming a major health problem."

For their study, Dr. Bodnar and her colleagues evaluated data that was collected on 200 black women and 200 white women who were randomly selected from more than 2,200 women enrolled in the MWRI's Pregnancy Exposures and Preeclampsia Prevention Study between 1997 and 2001. Samples of maternal blood were collected prior to 22 weeks pregnancy and again just before delivery, Samples of newborn umbilical cord blood also were tested for 25 hydroxyvitamin D, an indicator of vitamin D status. Finding such a proliferation of vitamin D insufficiency in spite of prenatal multivitamin use is troubling, she noted, suggesting that higher dosages, differing vitamin formulations or a moderate increase in sunlight exposure might be necessary to boost vitamin D stores to healthier levels.

"In both groups, vitamin D concentrations were highest in summer and lowest in winter and spring," said senior author James M. Roberts, M.D., MWRI director and professor and vice chair of research in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. "But differences were smaller between seasons for African-American mothers and babies, whose vitamin D deficiency remained more constant."

Since vitamin D is made by the body in reaction to sunlight exposure, it has long been known that vitamin D deficiency is more common among darker-skinned individuals, particularly in more northern latitudes, where less ultraviolet radiation reaches the Earth. Indeed, vitamin D deficiency is more than three times as common in winter than in summer for all women of childbearing age in the United States. Even so, the Pittsburgh researchers' study is cause for concern.

"This study is among the largest to examine these questions in this at-risk population," Marjorie L. McCullough, Sc.D., senior epidemiologist at the American Cancer Society, wrote in an accompanying editorial. "By the end of pregnancy, 90 percent of all women were taking prenatal vitamins and yet deficiency was still common."

Vitamin D is found naturally in fatty fish but few other foods. Primary dietary sources include fortified foods such as milk and some ready-to-eat cereals and vitamin supplements. Sun exposure for skin synthesis of vitamin D also remains critical.

"Our study shows that current vitamin D dietary intake recommendations are not enough to meet the demands of pregnancy," Dr. Bodnar said. "Improving vitamin D status has tremendous capacity to benefit public health."

Non-invasive alternative to amniocentesis ?

Sun, 11 Feb 2007 04:19:44 PST

( from http://www.rxpgnews.com )

Invasive techniques involve sampling amniotic fluid that surrounds the baby in the uterus or tissue sampling of the placenta.

Research studies demonstrating the viability of an approach to routinely detect the presence of fetal DNA in a mother's blood to accurately diagnose or rule out genetic defects -- as early as the first trimester -- was presented today at the 27th Annual Meeting of the Society for Maternal-Fetal Medicine being held in San Francisco. This future diagnostic technology, currently under development at Sequenom, Inc. (Nasdaq: SQNM), shows promise that a universal alternative to such invasive genetic screening procedures as amniocentesis and chorionic villus sampling, may be available in the future.

These implications are important to women with high-risk pregnancies, in that this future non-invasive screening technique will have significant benefit to all expectant mothers, especially on the heels of new guidelines endorsed by the American College of Obstetricians and Gynecologists (ACOG) that call for risk assessment of all pregnancies for fetal chromosomal abnormalities.

Previous guidelines recommended testing women 35 years and older using amniocentesis or chorionic villus sampling, both considered invasive procedures that carry risks. ACOG now recommends screening before the 20th week of pregnancy using a less invasive screening option that includes ultrasound in conjunction with the measurement of certain blood hormones.

Invasive techniques involve sampling amniotic fluid that surrounds the baby in the uterus or tissue sampling of the placenta. Sequenom's proprietary Fetal Nucleic Acid Technology, currently being developed, may be applicable to a range of non-invasive prenatal tests that use a mother's blood sample for fetal genetic screening. Sequenom's technology, based in part on the foundational research of Professors Dennis Lo and James Wainscoat while at the University of Oxford, isolates and analyzes circulating fetal nucleic acid from a maternal blood sample.

In the opinion of Dr. Kenneth Moise, Professor of Obstetrics and Gynecology and a specialist in Maternal-Fetal Medicine at Baylor College of Medicine in Houston, Texas, this is a major research breakthrough in prenatal medicine.

"This is potentially one of the biggest steps forward to determine genetic conditions in the fetus. The ability to make an early diagnosis is the key that opens the door for the future treatment of many birth defects before the child is born," says Dr. Moise. "This shows promise as an excellent alternative to amniocentesis and may give expectant parents peace of mind."

Through technology licensing agreements with clinical laboratories, Sequenom expects a non-invasive application of its technology for fetal Rhesus D (RhD) typing to become available in these laboratories beginning in the first half of 2007. Rhesus disease can occur when the blood of the expectant mother is incompatible with her unborn child. According to the Centers for Disease Control and Prevention (CDC), the incidence of hemolytic disease caused by RhD incompatibility in newborns occurs in approximately 1 in 1,000 live born infants. Complications from RhD disease can lead to jaundice, anemia, brain damage, heart failure, and death.

"We are making significant progress in developing our proprietary Fetal Nucleic Acid Technology and anticipate applying our novel approach to multiple prenatal tests such as tests for RhD, cystic fibrosis, Down syndrome, and others," said Dr. Harry Stylli, Sequenom President and Chief Executive Officer. "We believe our technology has great potential to substantially improve the standard of care for all pregnant mothers."

Advanced Maternal Age is an Independent Predictor of Intrauterine Fetal Death at Term

Sun, 11 Feb 2007 04:06:48 PST

( from http://www.rxpgnews.com )

Pregnant patients of advanced maternal age (AMA) are at increased risk for a multitude of pregnancy complications, including gestational diabetes mellitus, preeclampsia, placenta previa and intrauterine growth restriction. All of these conditions have been associated with a higher rate of stillbirth.

Pregnancy at age 40 and beyond is an independent risk factor for intrauterine fetal demise or stillbirth, according to an abstract presented by Yale School of Medicine researchers at the Society for Maternal-Fetal Medicine Conference February 10 in San Francisco.

The researchers also found that fetal testing at 38 weeks gestation has the greatest impact at reducing stillbirth rates in older women.

Pregnant patients of advanced maternal age (AMA) are at increased risk for a multitude of pregnancy complications, including gestational diabetes mellitus, preeclampsia, placenta previa and intrauterine growth restriction. All of these conditions have been associated with a higher rate of stillbirth.

To determine if AMA was an independent risk factor for stillbirth, and when fetal testing would be most beneficial for reducing stillbirth rates, the authors conducted a cross-sectional study using the United States CDC perinatal mortality database. The database is made up of 11,061,599 singleton deliveries between 1995 and 1997. The women in the study were between 15 to 44 years of age who were at least 37 weeks pregnant.

"Our results support routine antenatal testing in those women who are over age 40, beginning at 38 weeks gestation," said first author Mert Ozan Bahtiyar, M.D., professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "This will help identify women who are most at risk for stillbirth.

Eat fruit and vegetables to cut miscarriage risk

Tue, 05 Dec 2006 17:57:50 PST

( from http://www.rxpgnews.com ) London, Dec 5 - Including fruit and vegetables in one's daily diet could reduce the chances of miscarriage by almost half, says a new research that stresses the importance of a healthy, balanced diet during pregnancy.

The study of nearly 7,000 pregnant women by researchers from the London School of Hygiene and Tropical Medicine looked for links between diet, lifestyle and miscarriage, reported the online edition of Daily Mail.

Maureen Maconochie and colleagues found that pregnant women who included fruit and vegetable regularly in their diet were 46 percent less likely to miscarry.

Though the study did not look at the amount of fruit and vegetable that should be eaten, pregnant women - like the general population - are usually advised to eat five servings a day.

Vitamin tablets were also found to be highly beneficial, halving the risk of miscarriage.

Eating dairy products like milk, yoghurt and cheese daily cut the risk by a quarter, while twice-weekly meals of white meat or fish reduced it by around 15 percent, the researchers said.

Those with a sweet tooth also benefited, with regular chocolate eaters 15 percent less likely to miscarry, said the study published in BJOG: An International Journal of Obstetrics and Gynaecology.

It emphasised that women should be happy and relaxed during pregnancy as separation, divorce, illness and a stressful job - all raised the likelihood of miscarriage.

Children born to younger mothers may live longer

Mon, 27 Nov 2006 16:49:43 PST

( from http://www.rxpgnews.com ) Washington, Nov 27 - Children of younger mothers may live longer as the women are less likely to have acquired latent infections that could harm the health of the foetus, says scientists.

Researchers Natalia Gavrilova and Leonid Gavrilov of the University of Chicago studied 991 centenarians born in the US between 1875 and 1899 for the study.

The younger mothers are less likely to have acquired various infectious diseases during their life that could damage the health of the foetus, the researchers were quoted in the online edition of New Scientist as saying.

The researchers used US Census and Social Security Administration records to reconstruct the family histories of 198 of them, searching for anything they had in common.

It turned out that first-born children were 1.7 times as likely as their siblings to live to be 100. An even stronger predictor of longevity was how young their mother was when they were born.

Those whose mothers were less than 25 years old were twice as likely to survive beyond a century, the researchers found.

Younger mothers may also have better-quality eggs, according to the research.

Medical induction of labor increases risk of amniotic-fluid embolism

Fri, 20 Oct 2006 23:30:37 PST

( from http://www.rxpgnews.com ) A Canadian population-based cohort study has revealed that medical induction of labour increases the risk of amniotic-fluid embolism. The study was led by Dr. Michael Kramer, Canadian Institutes of Health Research (CIHR) Senior Investigator from McGill University, and will be published in the October 21st issue of The Lancet.

Amniotic-fluid embolism (AFE) is a rare, but serious and even fatal maternal complication of delivery. While its cause is unknown, it is one of the leading causes of maternal mortality in developed countries, accounting for seven of 44 direct maternal deaths in Canada in the period 1997-2000.

This population-based study examined the association of AFE and medical induction of labour in a cohort of three million hospital births in Canada, for the twelve fiscal years 1991-2002.

"AFE remains a rare occurrence," said Dr. Michael Kramer, principal investigator of the study and Scientific Director of CIHR's Institute of Human Development, Child and Youth Health. "Of the 180 cases of AFE we found, 24 or 13% were fatal. AFE arose almost twice as frequently in women who had medical induction of labour as in those who did not; fatal cases arose 3½ times more frequently."

"Dr. Kramer's research has resulted in a discovery that will benefit physicians who look after pregnant women as they will now be aware of this potential complication should they induce labour", said Dr. Joseph Shuster, Interim Scientific Director of the MUHC. "This is an example of how academic university teaching hospitals improve the quality of patient care."

The research team also found several other factors to be associated with higher rates of AFE, including multiple pregnancy, older maternal age (35 years or older), caesarean or instrumental vaginal delivery, eclampsia (a serious complication of pregnancy characterised by convulsions), polyhydramnios (too much amniotic fluid), abnormal placental position or separation, and cervical laceration or uterine rupture.

"Our findings confirm the hypothesis that medical induction of labour is related to an increased risk of AFE," added Dr. Kramer. "Although the absolute risk increase of AFE for women is very small (four or five total cases and one or two fatal cases per 100,000 women induced) and is unlikely to affect the decision to induce labour in the presence of compelling clinical indications, women and physicians should be aware of this risk if the decision is elective."

Senior obstetrician are less hasty about caesarean sections

Fri, 22 Sep 2006 16:58:37 PST

( from http://www.rxpgnews.com ) Many emergency caesareans could be prevented by the attendance of a more skilled obstetrician, say senior doctors in this week's BMJ.

They call for better training in instrumental vaginal delivery (use of forceps or ventouse) for obstetric trainees to help reduce rates.

A recent UK study found that decisions made by senior (consultant) obstetric staff are important in determining whether a second stage caesarean section is the best method of delivery for women with delay in advanced labour. It found that a consultant obstetrician who performed a vaginal assessment was more likely to reverse a decision made by an obstetric trainee for a caesarean and proceed to a safely conducted instrumental delivery.

The authors warn that, without increases in junior doctors' experience and recruitment into the specialty, the problems with second stage caesareans will rise.

According to the Royal College of Obstetricians and Gynaecologists audit figures, about 35% of caesareans for singleton pregnancies are performed because of failure to progress in labour, of which a quarter occur at full cervical dilatation. In 55% of these cases no attempt was made to achieve a vaginal birth with either forceps or ventouse. In those births where instrumental delivery was attempted, the audit noted a "failed" rate of 35% for ventouse and 2% for forceps.

Breech and twin deliveries can also lead to second stage caesareans. In the absence of an experienced and skilful obstetrician to perform assisted vaginal breech delivery, women are advised to undergo an emergency caesarean.

For twin deliveries, currently about 10% of second twins are delivered by caesarean section after the first has been delivered vaginally: 10 years ago, the rate was 5%. As many as two thirds of these caesareans are preventable, say the authors.

Despite problems relating to the inexperience of obstetric trainees, the United Kingdom is making great strides in terms of structured training, assessment of competencies, and consultant delivered intrapartum care, they write. Nevertheless, it is essential to recognise the need for obstetricians to maintain and develop their skills if women are to be offered safe alternatives to caesarean section when complications arise in labour.

Carbon monoxide may be beneficial in pre-eclampsia

Wed, 06 Sep 2006 00:43:37 PST

( from http://www.rxpgnews.com ) New findings by Queen's University researchers suggest that administering low doses of carbon monoxide to pregnant women may help prevent the potentially damaging effects to mother and baby of pre-eclampsia.

The study was precipitated by the fact that mothers who smoke cigarettes during pregnancy have a 33 per cent decreased risk of developing pre-eclampsia compared to nonsmokers.

A debilitating condition that affects five to seven per cent of pregnancies, pre-eclampsia is characterized by high blood pressure in pregnant women and is one of the leading causes of baby and maternal deaths. "At present there is no cure or effective treatment for this condition, other than delivery of the baby," says research team leader Dr.Graeme Smith (Obstetrics and Gynecology), an expert in high-risk obstetrics.

In the Queen's study, published in the September issue of the American Journal of Pathology, tissue from the placentas of nonsmoking women who had delivered babies by caesarian section was exposed to the same kind of oxidative stress not enough oxygen being supplied through the blood experienced by women with pre-eclampsia. When the tissues were treated with carbon monoxide, at levels similar to those found in the blood of smoking mothers, cell death in the placenta was significantly reduced.

"We believe that carbon monoxide found in cigarette smoke, and subsequently carried in a smoking mother's blood, may be the cause of their lower risk of developing pre-eclampsia," says Dr. Smith. He stresses however that any perceived benefit of smoking during pregnancy is outweighed by the many risks: premature membrane rupture, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome.

Produced naturally by the body at low levels, carbon monoxide relaxes blood vessels and may prevent the death of placental cells, which can cause injury to fetus and mother. Future studies will determine whether carbon monoxide can prevent placental cell death in animal models and whether other approaches similar to carbon monoxide may provide protection.

Prenatal diagnostic tests decrease the risk of miscarriage

Fri, 01 Sep 2006 17:01:37 PST

( from http://www.rxpgnews.com ) Pregnant women who seek prenatal diagnostic testing to identify genetic or chromosomal abnormalities have a lower risk of miscarriage than previously believed, according to a UCSF study.

The findings are published in the September 2006 issue of the journal "Obstetrics and Gynecology."

Two standard tests--amniocentesis and chorionic villus sampling (CVS)--are common prenatal tests performed during the first and second trimester of pregnancy. Early testing using the CVS procedure has typically been thought to have a higher rate of miscarriage than amniocentesis. However, in a 20-year retrospective comparison study of the two procedures, researchers found that the loss rates for both procedures decreased over time.

"This is a significant finding for use as information in both patient counseling and in establishing widespread prenatal diagnostic and screening programs," said study co-author Mary E. Norton, MD, who is medical director of the Prenatal Diagnostic Center at UCSF Medical Center and associate clinical professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.

Both amniocentesis and CVS are invasive diagnostic screening methods that carry a small risk of pregnancy loss. Amniocentesis requires insertion of a hollow needle through the abdominal wall and into the uterus to withdraw amniotic fluid. CVS is a biopsy procedure that involves removing a piece of tissue from the placenta. These samples are then cultured and chromosomes analyzed to determine abnormalities associated with Down syndrome and other genetic diseases such as cystic fibrosis, Tay-Sachs disease, and sickle cell disease.

CVS can be performed at an earlier gestation period (10-12 weeks) than amniocentesis (16-20 weeks), and therefore is preferred by some patients because of earlier detection of possible abnormalities, according to Norton.

The study looked at data from 9,886 CVS and 30,893 amniocentesis procedures performed at UCSF Medical Center from 1983 to 2003. Overall, the pregnancy loss rate for patients undergoing CVS was greater (3.12 percent) than that of amniocentesis (0.83 percent). However, when examining the data at five-year intervals, the difference between the two procedures coincided with the highest occurring from 1983 through 1987 and lowest from 1998 through 2003.

"We saw that the rate of miscarriage risk attributable to CVS had declined over time," said Norton. "One possible reason is that over time practitioners have become more proficient in performing CVS procedures."

When the researchers controlled for gestational age and maternal age, they found that there were no differences between the losses from CVS or amniocentesis.

Over the past several years, non-invasive screening tests for birth defects have seen marked improvement, according to Norton. While screening in the past was primarily available only in the second trimester, more recent studies have demonstrated that tests such as a specialized ultrasound of the fetal neck, known as "nuchal translucency " ultrasound, combined with early blood screening have a better detection rate and can be completed much earlier in pregnancy. Pre-screening using these techniques is often performed as the precursor for the more invasive diagnostic procedures.

"We have advanced significantly in our ability to screen for and detect birth defects," said Norton. "Where the primary criteria for determining a high risk pregnancy used to be maternal age, we are now able to perform blood tests or ultrasound in the first trimester, enabling us to determine much more accurately if a pregnancy is indeed at high risk."

In the past, women were faced with the decision to have CVS earlier in the pregnancy but with a higher risk of miscarriage, or to wait until their second trimester for amniocentesis, which was thought to be safer but doesn't provide results until several weeks later, according to Norton. With more and more women undergoing first trimester screening, an increasing number of them will be faced with the choice between amniocentesis and CVS, she added.

"If there is no difference in risk associated with CVS and amniocentesis, women are more likely to choose CVS because information can be provided much sooner," Norton said.

The authors emphasized that these results were obtained in a single center with a large volume of procedures. Because rates of miscarriage vary with experience of the providers, the results may not be applicable in all situations.

Miscarriage significantly associated with increasing paternal age

Sun, 06 Aug 2006 06:50:37 PST

( from http://www.rxpgnews.com ) In a study conducted at Columbia University's Mailman School of Public Health and the New York Psychiatric Institute researchers found that increasing paternal age is significantly associated with increased rates of spontaneous abortion, a pregnancy loss occurring before twenty weeks of gestation. Results indicate that as the male partner ages there is a steady increase in rate of miscarriage. Women with partners aged 35 or older had nearly three times as many miscarriages as compared with women conceiving with men younger than 25 years of age. This finding is independent of the woman's age and not explained by other factors such as diabetes, smoking, or previous spontaneous abortions, and adds to the growing realization of the importance of paternal characteristics for successful reproductive outcome.

"There has been a tremendous amount of research on women, and how their characteristics affect pregnancy outcomes. Of course, women's importance and centrality to pregnancy cannot be overstated. However, scientists seem to have forgotten that men are equal partners in reproduction, and their influence should be studied to the same degree. Our group has focused on men's influence on the health of their offspring, and we have made some fascinating discoveries," said Karine Kleinhaus, MD, MPH currently in Columbia's Department of Psychiatry and first author of the study. "This study shows how a man's age affects the likelihood of miscarriage."

Earlier research by the Columbia scientists showed that older men's wives suffer from preeclampsia, while the offspring of older men are more likely to get schizophrenia. "This is not as surprising as it may sound at first, as it was already shown by other researchers that older men have more abnormalities in their sperm, and that their children are more susceptible to certain birth defects," observes Dr. Klienhaus. In fact, the American Society for Reproductive Medicine has set an upper age limit of 40 years old for semen donors because of the increased risk of genetic abnormalities in the offspring of older fathers.

The international team of scientists involved in the study used a large historical data set containing information on many characteristics of mothers and fathers that might contribute to spontaneous abortion. The researchers analyzed data from the ante-natal or post-partum interviews of 13,865 women. This data was recorded in the Jerusalem Perinatal Study, a population-based cohort derived from 92,408 births in Jerusalem in 1964-1976.

Accordingly, the study, which focused exclusively on spontaneous abortion as the outcome, has as one of its strengths its large sample size and its extensive data, which permit consideration of important potential confounders not included together in other analyses. These include variables such as maternal diabetes, parity, history of prior spontaneous and induced abortions, and history of maternal smoking, and socioeconomic status.

The cohort used for this study is unique, with immigrants from many origins, including Iran, Iraq, Afghanistan and countries of North Africa, as well as Central and Eastern Europe. "This broad mix of backgrounds makes our study findings more generalizable," observed Susan Harlap, MD, professor of clinical epidemiology in the Mailman School of Public Health's Department of Epidemiology, and the leader of this research team. "While several previous studies suggested that father's age might contribute to miscarriage, they failed to clarify whether there is a cut-off age or a progressive trend over the whole range of ages."

The study findings generate strong support for the association of increasing paternal age with increasing rates of spontaneous abortion, and are corroborated by other published studies. "Advanced paternal age may result in only a slight increase in the chance of spontaneous abortion for a specific couple. Nevertheless, as child bearing is increasingly delayed in Western societies, this study provides important information for people who are planning their families," said Dr. Kleinhaus. "The study also adds to a growing understanding of how men's age, health, and occupations can affect their partner's pregnancies and the offspring's future development."

Clinical examination not sensitive enough to detect breech babies

Fri, 04 Aug 2006 19:32:37 PST

( from http://www.rxpgnews.com ) The routine examination doctors use to check if a baby is lying in the correct position before birth is not sensitive enough, concludes a study published on bmj.com today. The authors suggest that there is room for improvement by all pregnancy care providers.

The position of a baby in the womb in late pregnancy is important because if it is not lying in the normal head-down position (known as cephalic presentation) vaginal delivery may be difficult or impossible. Diagnosis of non-cephalic presentation after the onset of labour is associated with increased complications and death.

Fetal presentation is usually assessed by palpating the abdomen, but little is known about the accuracy of this in late pregnancy. So researchers in Australia decided to examine the diagnostic accuracy of this procedure.

They identified 1633 women with a single pregnancy at 35-37 weeks' gestation attending an antenatal clinic at an obstetric hospital in Sydney. Each woman underwent clinical examination to assess the position of their baby. This was followed by an ultrasound scan to confirm the diagnosis.

Clinical examination detected 70% of non-cephalic presentations. Correct diagnosis was greater for women with a previous pregnancy and lower body mass index.

If this figure was applied to a general maternity population of 1000 women, clinical examination would identify 101 women as having a non-cephalic presentation but in only 56 would this be correct; 24 women with non-cephalic presentation would be missed altogether, say the authors.

Introduction of routine ultrasonography to assess fetal presentation in late pregnancy would improve diagnostic accuracy, but costs, resource availability, and feasibility need to be considered, as well as the potential deskilling of care providers in performing clinical examination, they write. However, lower rates of accuracy found among overweight or obese women suggest that ultrasonography in late pregnancy for these women is required.

Clinical examination to assess fetal presentation is a relatively simple procedure and, with ongoing diligence and regular audit and feedback, accuracy may be increased. Variability in accuracy rates by examiner and level of experience also suggest there is room for improvement by all pregnancy care providers, they conclude.

Preeclampsia risk reduced by regular multivitamins near time of conception

Thu, 27 Jul 2006 09:01:37 PST

( from http://www.rxpgnews.com ) Women who are considering becoming pregnant may significantly reduce their risk of developing a common life-threatening complication called preeclampsia by taking a multivitamin supplement regularly three months before conception and during the first trimester of pregnancy. This finding is being reported in a University of Pittsburgh study available online now through an "advance access" feature of the American Journal of Epidemiology.

Overall, women who used multivitamins regularly showed a 45 percent reduction in preeclampsia risk, according to the study. However, results were even more remarkable for women who were not overweight prior to pregnancy.

"Our data show that women who are not overweight before pregnancy and who used multivitamins at least once a week before conception and in the first three months of pregnancy reduced their risk of preeclampsia by a striking 72 percent compared to those who didn't take a multivitamin during this time period," said Lisa Bodnar, Ph.D., M.P.H., R.D., assistant professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH). "At this time, multivitamin use makes little apparent difference in preeclampsia rates for women who are overweight before pregnancy. Even so, the results suggest that regular multivitamin use in the pre-pregnancy period may help to prevent preeclampsia."

Also known as toxemia, preeclampsia affects about 7 percent of first pregnancies and is a leading cause of premature delivery and maternal and fetal death. Signs of preeclampsia include high blood pressure, protein in the urine and swelling of the hands and feet. Untreated, the condition may progress to the far more serious eclampsia, which can lead to seizures, coma and death.

Preeclampsia is more prevalent in the developing world, where it accounts for up to 80 percent of maternal deaths. And while treatment is more readily available in developed countries, preeclampsia remains the leading cause of maternal death. Infants born to mothers with preeclampsia have a risk of mortality five times greater than those born to women with normal pregnancies. In the United States alone, nearly 15 percent of preterm deliveries are a result of preeclampsia.

Dr. Bodnar and her colleagues evaluated data from 1,835 women who were enrolled in the University of Pittsburgh's Pregnancy Exposures and Preeclampsia Prevention Study between 1997 and 2001. Overall, the prevalence of preeclampsia was 4.4 percent for non-multivitamin users and 3.8 percent for those who used multivitamins, with the most significant differences being noted among women who had a body mass index (a common body weight measure) of less than 25. Most authorities define overweight at a BMI of 25 and obesity as a BMI of 30 or above.

Because multivitamins contain many nutrients, it is difficult to know the exact mechanism by which the risk of preeclampsia is reduced, noted Dr. Bodnar, who also is an assistant investigator at the university-affiliated Magee-Womens Research Institute (MWRI). Other recent studies have shown limited benefits and some risk associated with large doses of vitamins C and E in women at high risk of preeclampsia. "However, the study does show further evidence that nutrition is relevant for the prevention of preeclampsia," she said.

Although Dr. Bodnar and her colleagues tried to adjust for possible complicating factors such as smoking, exercise habits, fruit- and vegetable-intake, demographic and other socioeconomic factors, it is possible that the study findings could be attributed to other differences among multivitamin supplement users and nonusers that investigators did not identify. In addition, the analysis depended on self-reporting of multivitamin use rather than a random assignment of supplement use. Even so, the association between multivitamin use and diminished risk of preeclampsia strongly continues inasmuch as adjustments are possible.

"Preeclampsia is a potentially devastating condition for mother and baby," observed James M. Roberts, M.D., director of the Magee-Womens Research Institute and senior author of the paper. "It may be that taking a multivitamin prior to conception positively influences embryonic implantation, which is a physiologic process known to be abnormal in preeclampsia. More study is needed to clarify these findings."

Researchers are unsure of the reasons why multivitamin use appears to have no benefit to preeclampsia risk in overweight women, Dr. Bodnar said. "It may be that typical multivitamins, which contain low nutrient doses, may not be adequate to overcome the metabolic challenges associated with the development of preeclampsia along with being overweight and pregnant," she added. "But again, more study is needed to test these ideas."

Why Listeriosis rates are 20-fold higher during pregnancy

Wed, 05 Jul 2006 15:03:37 PST

( from http://www.rxpgnews.com ) For years, doctors have puzzled over why pregnant women are 20 times more likely than others to be infected by the bacterium Listeria monocytogenes. Researchers at the University of California, Berkeley, now think they have the answer, and it isn't pretty.

Their research, conducted in guinea pigs, shows that the bacteria can invade the placenta, where - protected from the body's immune system - they proliferate rapidly before pouring out to infect organs such as the liver and spleen. The illness they cause often results in miscarriage or infection of the fetus.

The study is the first to trace such a pathway of infection, and it dashes the widely-held assumption that immune-system changes during pregnancy are to blame for elevated Listeria infection rates.

"The reason the mother is more susceptible is not necessarily because her immune system is compromised, but because the bacteria that got into her placenta are infecting her," said Anna Bakardjiev, the study's lead author and a postdoctoral researcher with Daniel Portnoy, professor of biochemistry and molecular biology at UC Berkeley. "The miscarriages that result from these infections may be a natural defense mechanism to dispel this source of infection."

The study will be posted on June 30 in the June issue of the online journal PLoS Pathogens.

Listeriosis is a foodborne illness caused by Listeria monocytogenes. Every year in the United States, about 2,500 people fall seriously ill with the disease. About one in three cases occur in pregnant women, and about one in five of all cases results in death, according to the Centers for Disease Control and Prevention (CDC). Apart from pregnant women, the illness primarily affects infants and people with compromised immune systems.

Fever, muscle aches and sometimes gastrointestinal problems are among listeriosis's most common symptoms. In pregnant women, however, the symptoms are often mild, yet the illness frequently causes miscarriage, stillbirth or premature delivery. Babies that are born to infected mothers are often themselves infected, and many die.

From their earlier work, Portnoy and Bakardjiev knew that Listeria bacteria could not easily infect the placenta but, once there, could not be effectively eliminated. For this study, they wanted to know how the bacteria were able to invade the placenta in the first place: Their hypothesis was that the pathogens first infected organs such as the liver and moved from there to the placenta, an organ that, once infected, provides a protective niche for pathogens.

Bakardjiev, who is a pediatric infectious diseases specialist, chose guinea pigs for these studies because of similarities between the placentas of these rodents and women. Pregnant guinea pigs and women also respond similarly to Listeria infection, exhibiting few symptoms, yet almost invariably miscarrying.

To induce infection, Bakardjiev injected the pregnant guinea pigs with Listeria. When she examined the animals' organs, she found that for every bacterium present in the placenta, there were 1,000 to 10,000 times as many in the liver and spleen, an indication that the placenta was fairly well protected from infection.

She then infected the animals with a mixture of two distinct strains of Listeria, adjusting the dose so low that placental infections resulted only half the time. When she examined the animals' placentas 24 hours after the injection, she found, with few exceptions, only one of the two bacterial strains. This told her that it had been a single bacterium that had infected the organ, and that what she was finding were its progeny.

In the liver and spleen, on the other hand, the bacterial strains were present in equal numbers 24 hours after injection.

After 48 hours, the picture changed. At that point, Bakardjiev found a mixture of both strains in the placenta. In the liver and spleen, however, the numbers were now strongly skewed toward whichever strain had originally infected the placenta.

"We reasoned that this meant that a few bacteria had migrated early on from the liver or spleen to the placenta, so now both strains were in the placenta and their populations were burgeoning," Bakardjiev said. "But there must have been a much larger number that had moved from the placenta back to the liver and spleen. These would have originally been just the single strain, so their numbers skewed the ratio."

Bakardjiev and Portnoy, who is the study's principal investigator, called on Julie Theriot, associate professor of biochemistry and of microbiology and immunology at Stanford University School of Medicine, to do the mathematical modeling for the bacterial migrations. Theriot determined that only about one bacterium migrated to the placenta every five hours, while it would have taken a migration of 100,000 bacteria from the placenta to the liver to skew the numbers to the degree they found. Thus, the vast majority of the bacteria in the placenta were a result of bacterial growth there and not from migrations from the liver and spleen.

"It was surprising to find that a single bacterium is sufficient to cause placental infection," Portnoy said, "but even more surprising to find that they (the bacteria) migrated from the placenta back to the mother's liver and spleen in such large numbers."

When Portnoy and Bakardjiev ran the same experiment in non-pregnant guinea pigs, they found that 72 hours after injection, the non-pregnant animals had 1,000-fold lower numbers of Listeria in their livers and spleens than the pregnant animals, and no bacteria in their bloodstreams. In contrast, pregnant animals at 72 hours had the bacteria in their livers, spleens and blood, while the bacterial numbers continued to increase in their placentas, and their fetuses had also become infected.

"I feel that these numbers are an indication that miscarriage is a defense mechanism," Bakardjiev said. "It's rare for a pregnant woman to get infected, but once she is, she can't clear the infection unless the placenta is expelled."

Portnoy and Bakardjiev are now studying how Listeria moves from the digestive tract to the placenta. "An understanding of these mechanisms," Portnoy said, "might contribute to designing methods for prevention and therapy of listeriosis in pregnant women."

The study was supported by funds from the National Institutes of Health. Anna Bakardjiev's work was also supported by a Career Development Award for physician scientists from the NIH.

Why birth interventions are on the rise

Fri, 23 Jun 2006 14:18:37 PST

( from http://www.rxpgnews.com ) C-sections, amniocentesis, spinal blocks, CVS testing - having a baby might be one of the most natural things in the world, but a University of Western Sydney conference will explore why growing numbers of Australian women want modern medicine to intervene in the 'risky business' of childbirth.

The University is hosting, 'Risking birth: culture, technology, and politics in 21st century maternity care' - a conference organised by UWS, La Trobe and Deakin Universities. It's being held at UWS this Friday and Saturday, 23-24 June.

Experts from around Australia will discuss the politics of maternity care - issues such as society's constructions of childbirth, obstetricians' views on maternity care, the shifting role of midwives, the safety of birthing services for Indigenous women in remote communities, and the rise in medical negligence cases and litigation.

The conference is bringing together speakers from across the disciplines, including midwifery researchers, registered nurses and health specialists, obstetrics professors, medical anthropologists, sociologists, and medical litigation lawyers.

Conference co-convenor, Dr Alphia Possamai-Inesedy from the UWS Social Justice Social Change Research Centre, says Australia is going the way of other western countries, with higher rates of intervention during pregnancy and childbirth, particularly among women from wealthier socio-economic backgrounds.

"Recent statistics published by the Australian Institute of Health and Welfare show a rise in caesarean sections from 18 per cent in 1992, to 25.4 per cent in 2004, with even higher rates in the private sector.

"Some researchers predict that in a few years, the majority of babies will be born by surgery," says Dr Possamai-Inesedy.

"Today's consumer-driven, desire-for-perfection society has constructed pregnancy and childbirth as a very risky business. Women are bombarded with all sorts of warnings about the hazards of pregnancy and childbirth, and the inherent faultiness of their bodies.

"This preys on the concerns and anxieties of pregnant women, making them acutely aware of all the things that could possibly go wrong, and the need to plan against those risks.

"As a result, the expectant woman more readily engages with the myriad of prenatal screenings, medical tests and other medicalised birthing 'choices', to help ease her fears.

"Increasingly, we are seeing women opt for invasive procedures because it's viewed as acceptable, responsible and a kind of 'insurance policy' against possible prenatal, delivery or postnatal problems."

Dr Possamai-Inesedy says the conference will explore how pregnant women's experiences are being shaped by social and cultural factors, and the current conservative political landscape.

"We'll look at how fear of litigation and medical negligence is affecting Australian women's prenatal and postnatal care," she says.

"The group will also discuss issues surrounding new reproductive technologies, midwife-led models of care, and discuss how women from different cultures and remote areas experience pregnancy and childbirth.

"It's one of the few times that such a diverse group of researchers and health practitioners have come together to focus on Australian maternity policy and practice."

Pregnancy Complications Still High For Women With Diabetes

Tue, 20 Jun 2006 23:52:37 PST

( from http://www.rxpgnews.com ) The risk of death and major birth defects are still high in babies born to women with diabetes, despite an international strategy to raise standards of diabetes care, say researchers in a study published on bmj.com.

They also warn that these problems will get worse as the number of young women diagnosed with type 1 and type 2 diabetes continues to rise.

Researchers analysed deaths shortly after birth (perinatal mortality) and congenital anomalies in babies born to women with type 1 or type 2 diabetes who delivered between 1 March 2002 and 28 February 2003 in England, Wales, and Northern Ireland.

Of 2,359 women with diabetes, 1,707 had type 1 diabetes and 652 had type 2 diabetes. Women with type 2 diabetes were more likely to come from an ethnic minority group and from a deprived area.

Perinatal mortality was similar in babies of women with type 1 (31.7 per 1000 births) and type 2 diabetes (32.3 per 1000 births), and was nearly four times higher than that in the general maternity population.

The rate of major congenital anomaly (mainly heart and nervous system defects) was 46 per 1000 births in women with diabetes (48 per 1000 births for type 1 diabetes and 43 per 1000 for type 2 diabetes), more than double than that in the general maternity population.

Because of this increased risk, the authors say that women with diabetes should take a higher than usual dose (5 mg) of folic acid from before conception up to week 12 of pregnancy. They also suggest that pregnant women with diabetes should be routinely screening for heart defects.

In the past, type 2 diabetes has been viewed as a less serious condition than type 1 diabetes and may have been subject to less vigilant care, add the authors. However, in view of these findings, and the increasing prevalence of type 2 diabetes in young adults, raised awareness of the increased risk of adverse pregnancy outcomes in this group of women is needed.

This study is substantially larger than any previous ones in this field, but more work is needed to find out how women with either type of diabetes can best be enabled to improve the outcomes of their pregnancy, they conclude.

Researchers identify protein associated with severe preeclampsia

Mon, 05 Jun 2006 17:03:37 PST

( from http://www.rxpgnews.com ) Building on their earlier discovery which found that elevated levels of the sFlt1 placental protein leads to the onset of preeclampsia, researchers at Beth Israel Deaconess Medical Center (BIDMC), in collaboration with a research team from The Hospital for Sick Children, Toronto, have identified a second protein which, in combination with sFlt1, escalates preeclampsia to a severe and life-threatening -- state.

These new findings, reported in the June 4, 2006 on-line issue of Nature Medicine, provide another critical piece of information about this puzzling disease, which complicates five percent of all pregnancies worldwide and is a major cause of maternal and fetal mortality, particularly in developing nations.

"Preeclampsia typically develops in the third trimester of pregnancy and is characterized by high blood pressure, edema and protein in the urine," explains the study's senior author S. Ananth Karumanchi, MD, a nephrologist in the Center for Vascular Biology at BIDMC and Assistant Professor of Medicine, Obstetrics and Gynecology at Harvard Medical School.

Three years ago, Karumanchi and his colleagues demonstrated that the placenta plays a central role in the course of these events, and that elevated levels of a placental protein called sFlt1 (soluble fms-like tyrosine kinase) are key to the onset of the disease.

However, for unknown reasons, a subset of preeclampsia patients will go on to experience severe preeclampsia a group of dramatically escalated symptoms characterized by a sudden, massive rise in blood pressure, which can lead to the onset of seizures, as well as the development of fetal growth restriction and the HELLP syndrome. HELLP, which stands for hemolysis, elevated liver enzymes and low platelets, indicates that the mother's liver and blood-clotting systems are not functioning properly, and the health of both mother and infant are in serious danger.

"During the course of our previous experiments [to confirm the role of sFlt1 in the disease] we observed that although all of the animals treated with sFlt1 exhibited telltale symptoms of hypertension and proteinuria, they did not all go on to develop symptoms of the HELLP syndrome," notes Karumanchi.

"We, therefore, hypothesized that other placenta-derived proteins must be acting jointly with sFlt1 to induce vascular damage and escalate the disease to its severe form."

Using microarray analysis of human placental specimens from patients with preeclampsia, Karumanchi and his coauthors observed that a protein known as endoglin was significantly upregulated. (Endoglin was discovered 20 years ago in the laboratory of study collaborator Michelle Letarte at The Hospital for Sick Children, Toronto.) A co-receptor for transforming growth factor beta family proteins, endoglin is expressed on endothelial cells lining the blood vessels, and thereby plays an important role in maintaining the health and integrity of the vascular system.

"Our further investigations revealed that the extracellular region of the endoglin protein is shed into maternal circulation," explains Karumanchi. "We discovered that this shed form -- referred to as 'soluble endoglin' was circulating in very high quantities among women with severe forms of preeclampsia."

In order to understand the protein's biological role, the investigators next administered soluble endoglin to pregnant rats; their results showed that this protein was indeed amplifying the vascular damage mediated by sFlt1, resulting in the symptoms of severe preeclampsia.

"What is apparently happening is that both sFlt1 and soluble endoglin are inhibiting the functions of two angiogenic growth factors vascular endothelial growth factor [VEGF] and transforming growth factor beta," explains Karumanchi. "The diminished signaling of these growth factors in the vasculature adversely affects the health of the mother's small blood vessels." The result is the onset of severe preeclampsia and its dangerous consequences for both mother and infant.

"We believe that these latest findings will have important diagnostic and therapeutic implications for the management of this disease," says Karumanchi.

Adds Benjamin Sachs, MBBS, DPH, Chief of the Department of Obstetrics and Gynecology at BIDMC, "Preeclampsia affects 200,000 pregnancies a year in the United States and often leads to premature births. Severe preeclampsia is one of the world's leading causes of maternal and fetal mortality and poses a particular risk to women in developing countries. This new information provides us with another key piece of evidence as we work toward developing the means to diagnose, and eventually treat, this disease."

Female Genital Mutilation (FGM) cause difficulties during childbirth

Sat, 03 Jun 2006 08:42:37 PST

( from http://www.rxpgnews.com ) The first comprehensive study of the effects of female genital mutilation on women and babies during childbirth has been published by leading medical journal, The Lancet.

The study, which provides the first reliable evidence that female genital mutilation can adversely affect birth outcomes, was undertaken by African and international researchers, including Associate Professor Emily Banks from the National Centre for Epidemiology and Population Health at ANU.

It involved 28,393 women in 28 obstetric centres in six countries: Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan.

The study found that women who have had Female Genital Mutilation (FGM) are significantly more likely to experience difficulties during childbirth and that their babies are more likely to die as a result of the practice.

Complications include the need to have a caesarean section, dangerously heavy bleeding after the birth of the baby and prolonged hospitalisation following the birth.

The degree of complications increased according to the extent and severity of the FGM.

According to the WHO, FGM is a common practice in a number of countries around the world, and over 100 million women and girls are estimated to have had FGM. The study used a three level scale set out by the WHO on FGM severity.

In the case of caesarean section, women who have the most severe form of FGM will have on average 30 per cent more C-sections compared with those who have not had any FGM. Women affected by severe FGM are 70 per cent more likely to suffer haemorrhage after birth.

The researchers also found there was an increased need to resuscitate babies whose mother had experienced FGM, and the death rate among babies during and immediately after birth is also higher.

In all, the study estimated that in the African context an additional one to two babies die per 100 deliveries as a result of the practice.

"This collaborative African study provides the first reliable evidence on the impact of FGM on complications during childbirth, and shows that the practice is likely to be responsible for large numbers of infant deaths and an increased burden of maternal illness, affecting millions of deliveries," Associate Professor Banks said.

Joy Phumaphi, the Assistant Director General, Family and Community Health at the World Health Organization, which organised the study, said: "We should not underestimate the significance of this study. For the first time we have the evidence that deliveries among women who have been subject to FGM are significantly more likely to be complicated and dangerous."

Study Challenges Myth that Sex Late in Pregnancy Hastens Birth

Sat, 03 Jun 2006 00:56:37 PST

( from http://www.rxpgnews.com ) A new study debunks the widely held belief that engaging in sexual intercourse during the final weeks of pregnancy can hasten labor and delivery.

In fact, just the opposite was true in 93 women studied at Ohio State University Medical Center. Women who were sexually active in the final three weeks of their pregnancies carried their babies an average of 39.9 weeks, compared to average delivery at 39.3 weeks among women who abstained from sexual activity at term.

Patients may continue to hear the old wives tale that intercourse will hasten labor, but according to this data, they should not hear it from the medical community, concludes Dr. Jonathan Schaffir, an obstetrician at OSU Medical Center and author of the study published in the June issue of the journal Obstetrics & Gynecology.

Schaffir also said the data dont support a recommendation to engage in sexual activity, either.

Of the 93 women enrolled, 47, or 50.5 percent, reported they had sex during the final weeks of their pregnancies more than any other similar study has indicated.

The participating women were those with low-risk single pregnancies enrolled at their doctors office visit after the 37th week of pregnancy. At this and subsequent routine visits, patients were asked whether they had engaged in sexual intercourse during the preceding week and if so, how many times. Cervical examinations also were performed at each visit to gauge whether the sexual activity had a ripening effect on the cervix.

Schaffir found no correlation between the frequency of sexual intercourse and the score assigned to measure the cervix. That lack of change in the cervix among sexually active women, combined with the lack of difference in delivery dates among the two groups, suggests that sexual intercourse has no effect on inducing labor, Schaffir said.

He acknowledged that women who are more comfortable late in pregnancy may be more likely to engage in sexual activity, and that women who experience abdominal discomfort or pelvic pressure possible signs of earlier delivery wont be inclined to want to have sex. Schaffir also said that because of the highly personal nature of sexual behavior, the study does not address specific components of sexual behavior that might have varying effects on the onset of labor.

Longer labour for obese women

Sun, 14 May 2006 18:24:37 PST

( from http://www.rxpgnews.com ) Labor can be longer for obese pregnant women, a new Saint Louis University study finds.
The research, presented at the annual meeting of the American College of Obstetricians and Gynecologists in May, finds that it takes obese pregnant women who are given medication to induce labor longer to deliver their babies than women of normal body weight.

The obese women also needed more medication a dinoprostone vaginal insert to activate labor, and it took longer for the medicine to start working. The obese women also are more likely to have a cesarean deliver than a vaginal delivery.

The study included 195 patients, and was conducted by Erin Brousseau, M.D., an obstetrics, gynecology and women's health resident at Saint Louis University, who presented the research.

She says the take home message is that doctors need to tell obese women that electing to have labor induced can place them at higher risk of longer labor and could increase the possibility that they will need a cesarean section. In addition, doctors may want to wait for labor to begin spontaneously rather than choosing to induce labor early in obese women, given these risks.

Low intake of milk during pregnancy linked to decreased birth weight

Tue, 25 Apr 2006 19:58:37 PST

( from http://www.rxpgnews.com ) A new study published in the Canadian Medical Association Journal gives expectant mothers yet another reason to drink their milk. Researchers found that women who rarely drank milk during their pregnancy gave birth to smaller babies compared to women who drank more milk.

Low birth weight affects one out of every 13 babies born each year in the United States, and it's a factor in 65 percent of infant deaths, according to the March of Dimes. This new study suggests that drinking the recommended amount of milk each day - three 8-ounce glasses -may help increase birth weight.

The Canadian researchers followed 279 women throughout their pregnancy. They found that women who limited their intake of milk to one cup or less per day consumed significantly less protein and vitamin D, and they gave birth to babies that weighed less compared to women who drank more milk.

Milk consumption and vitamin D intake from fortified milk and supplements during pregnancy were found to be each associated with infant birth weights, independently of other risk factors. Analysis of the data predicted that each cup of milk consumed daily was associated with a 41 gram increase in a baby's birth weight.

The researchers believe vitamin D may not only affect an infant's skeletal formation, but also neurodevelopment, immune function and chronic disease susceptibility later in life. Previous research has suggested that milk intake may help reduce the risk of pre-eclampsia or pregnancy-induced hypertension.

Meeting nutrient intake needs is especially important during pregnancy. The researchers highlight a significant need for vitamin D for calcium absorption, among other things, and the important contribution of milk as a source of vitamin D, calcium and protein. Consuming the recommended three servings of lowfat or fat-free milk each day provides 90 percent of the U.S. daily intake for calcium and 75 percent of the vitamin D.

Pregnancy gap puts baby at risk

Thu, 20 Apr 2006 15:41:37 PST

( from http://www.rxpgnews.com ) Spacing pregnancies too closely or too far apart can increase the risk of premature birth for the second baby, suggests a study.

An interval of less than 18 months and more than 59 months - just under five years - increases the risk, Colombian researchers have said.

The researchers, led by Agustin Conde-Agudelo, from the Santa Fe de Bogotá Foundation reviewed 67 previous studies conducted over the past four decades, including more than 11 million pregnancies.

They said that women should use contraception and breastfeed to avoid becoming pregnant too soon after giving birth. However, the delay should not be too far apart.

According to the study, it was best to leave between two and five years between pregnancies, the online edition of BBC News reported.

More than one million children worldwide are thought to die each year in the first four weeks of life as a direct result of pre-term birth.

Infants born to women who conceived within six months of their previous birth have a 40 percent increased risk of pre-term birth, the researchers found.

They also found that pregnancies spaced longer than five years have a significantly higher risk of problems - including premature birth and low birth weight - than those spaced 18 to 23 months apart.

Women who have just had a baby have temporarily diminished nutritional stores, especially if they breastfeed or have low levels of essential vitamins. This could reduce the ability of mother to support a foetus conceived shortly after a birth.

High meat intake by pregnant women not advisable

Mon, 03 Apr 2006 15:21:37 PST

( from http://www.rxpgnews.com ) Babies of women who eat high protein, including meat, and low carbohydrate diets during pregnancy may develop stress, says a study.

Researchers led by Rebecca Reynolds at the Universities of Edinburgh and Southampton studied a group of 86 children born in 1967-8 to mothers who were told to eat a pound of red meat a day to avoid pregnancy complications.

The study found the more meat the mother ate, the higher were the levels of stress hormone cortisol in the child, the online edition of BBC News reported.

Cortisol is a body hormone that is involved in the response to stress. It increases blood pressure and blood sugar levels and suppresses the immune system.

Antioxidant tempol prevents pre-eclampsia

Mon, 03 Apr 2006 15:14:37 PST

( from http://www.rxpgnews.com ) The antioxidant tempol prevents the onset of pre-eclampsia in pregnant mice, a finding that further implicates oxidative stress in the illness, which is widespread among pregnant women.

According to lead researcher Darren S. Hoffmann, tempol

* cut fetal deaths in half
* normalized birth weight and placental development
* prevented the onset of high blood pressure and proteinuria

"The results strongly suggest that antioxidant therapy will be useful for women with pre-eclampsia," Hoffmann said. Hoffmann received a Caroline tum Suden/ Frances A. Hellebrandt Professional Opportunity Award from The American Physiological Society (APS) for the exemplary research. The paper will be presented in an APS session at Experimental Biology 2006.

Cause of pre-eclampsia unclear

Pre-eclampsia has been recognized as a threat to maternal health for centuries and is the leading cause worldwide of mortality during pregnancy. But its cause has remained a mystery, Hoffmann said. The condition is marked by high blood pressure and kidney dysfunction, and occurs in about 5% of pregnancies. The only way to reverse the condition, which occurs in the third trimester, is to induce early delivery, he said.

The condition is often treated by complete bed rest. But managing the condition is a delicate balance pitting the needs of the mother, who is suffering a potentially harmful condition, against the needs of the fetus, which is best served by remaining in the womb.

Pre-eclampsia occurs when the placenta fails to develop properly and the fetus is unable to get adequate nutrients from the mother, Hoffmann explained. That sets off a cascade of events that can result in damage not only to the fetus, but also to the mother's kidney and blood vessels. If left unchecked, the condition could lead to eclampsia, an even more serious illness marked by seizures.

In areas where women do not have access to medical care, the condition causes death in one in 650 pregnant women, Hoffmann said. Even in the U.S., pre-eclampsia is the leading cause of maternal mortality. And even when the condition is well managed, it often results in having to induce a premature birth, which carries substantial economic cost. On average, neonatal care for premature infants costs $40,000, he said.

Oxidative stress a suspect in pre-eclampsia

Oxidative stress is a disturbance in the oxidant-antioxidant balance and is caused by reactive oxygen species (ROS) -- negatively charged oxygen-containing molecules -- that includes superoxide, Hoffmann said. ROS can damage the cell's DNA, proteins, lipids and can affect the cell's signaling mechanisms. High levels of ROS are implicated in cardiovascular disease, cancer, and other diseases.

Cells produce an antioxidant, superoxide dismutase, to deal with the reactive oxygen species. Superoxide dismutase grabs the superoxide molecule and, over several steps, neutralizes it by converting it to water and oxygen.

Pre-eclampsia is not well understood because it is difficult to conduct experiments in high-risk pregnant women, and there haven't been good animal models for the condition, Hoffmann said. But the Iowa lab has begun using a mouse strain which has moderately elevated blood pressure, because women who have moderately elevated blood pressure have a five times greater chance of developing pre-eclampsia compared to women with normal blood pressure.

"We discovered these mice develop pregnancy-induced high blood pressure, proteinuria and placental abnormalities," Hoffmann said. The mice, like humans, are more likely to have impaired placental development and their fetuses are smaller, further making them a good model for the research.

Superoxide dismutase prevents pre-eclampsia

"In earlier studies, we discovered that there's a reduction in expression of one of the superoxide dismutase genes in the placenta of the model strain during early pregnancy. This leads to decreased levels of antioxidants, creating a potential for uncontrolled oxidant stress," Hoffmann said. "When we found less dismutase, we decided to try an antioxidant supplement to see if this would relieve the pre-eclampsia syndrome in the mice."

In this study, the researchers used an oral treatment of the antioxidant tempol, which mimics superoxide dismutase, to treat the superoxide imbalance. They started the antioxidant treatment before pregnancy and continued through pregnancy.

The tempol restored the oxidative balance in the placenta early in the pregnancy, Hoffmann said. The placentas of the tempol-treated mice and the weight of their fetuses were significantly improved compared to the mice that did not receive the treatment.

Tempol also reduced fetal deaths. This strain of mice typically "resorbs" about 30% of conceptuses, he said. But the tempol group resorbed only 15%.

In addition, the blood vessels in the placenta of the tempol-treated mice widened normally as they are supposed to. During a normal pregnancy, cells in the placenta interact with the mother's uterine blood vessels, making the vessels open wider to provide more blood supply to the fetus. The arteries of the non-tempol treated mice retained abnormally thick muscular walls, Hoffmann said.

Next step

The researchers will next perform studies to ensure the tempol does not have serious side effects that might interfere with the development of the fetuses and pups, Hoffmann said. Then, understanding exactly how reducing oxidative stress during pregnancy leads to improved outcomes will be a key component of future research.

High vitamin doses may harm pregnant mother

Fri, 31 Mar 2006 17:50:37 PST

( from http://www.rxpgnews.com ) High doses of vitamin supplements may cause harm to pregnant women and their children, says a study.

Vitamin C and E were thought to cut the risk of pre-eclampsia, a condition of hypertension occurring in pregnancy. It is the most common cause of maternal and perinatal morbidity and mortality.

Up to 25,000 British women every year are affected by this disorder, which causes blood pressure to rise to levels that threaten mother and baby.

But a Lancet study by the charity Tommy's found women at high-risk should not take large doses of the vitamins, reported the online edition of BBC News.

Researchers gave some 2,400 expectant mothers with high blood pressure, kidney problems, clotting disorders or diabetes either extra vitamin supplements or a placebo.

The team discovered that pre-eclampsia appeared about a week earlier among those who received high doses of the vitamins and such women were also 15 percent more likely to deliver low birth-weight babies.

'We had high hopes for the use of high dose vitamins C and E in reducing the risk of developing pre-eclampsia,' a researcher was quoted as saying.

'However, a good thing that has come out of the trial is that it will prevent the use of high dose vitamin C and E slipping into clinical practice,' he said.

Daughters of Indian immigrants continue trend of giving birth to small babies

Thu, 30 Mar 2006 14:52:37 PST

( from http://www.rxpgnews.com ) U.S.-born Asian-Indian women are more likely than their Mexican-American peers to deliver low birth weight infants, despite having fewer risk factors, say researchers at Lucile Packard Children's Hospital and Stanford's School of Medicine. The finding confirms previous research that showed a similar pattern in more recent immigrants, and suggests that physicians should consider their patients' ethnic backgrounds when planning their care.

"Now we see that the daughters of foreign-born women have similar issues," said Packard Children's neonatologist Ashima Madan, MD, "and that the indicators we have traditionally used to predict pregnancy outcomes - maternal educational level and age, and access to early prenatal care, for example - aren't reliable for every population." Madan is the lead author of the research, to be published in the March issue of the Journal of Pediatrics.

Researchers call the previously identified differences in pregnancy outcomes between Indian and Mexican immigrants the "dual paradox." That's because Mexican women giving birth in the United States are more likely than women from India to have healthy-sized newborns, even though they are less likely to have completed high school or to have initiated prenatal care during the first trimester of their pregnancy. In contrast, newborns of Indian immigrants, most of whom have completed college and begun prenatal care early, are more likely to deliver a low birth weight infant.

Madan, associate professor of pediatrics at the medical school, and her colleagues set out to determine for the first time whether this pattern persisted in the U.S.-born daughters of these immigrants. They surveyed more than 6 million births that occurred in 11 states between 1995 and 2000 to white, foreign and U.S.-born Asian-Indian and Mexican women. In addition to collecting data about the mother's birthplace and ethnic group, the birth records documented maternal age, history of prenatal care, maternal use of alcohol or tobacco, maternal educational level, and common complications of pregnancy and labor.

They found that Asian-Indian women were more than twice as likely to have low birth weight infants as were white women. These infants weigh 2,500 grams (about 5.5 pounds) or less at birth, either because they grew poorly in the womb or were born prematurely. They were also more than twice as likely to have babies that were small for their gestational age, regardless of whether they were premature. In other words, a generation in America didn't significantly improve or worsen the outcome for the Asian-Indian infants.

In contrast, although infants of foreign-born Mexican-American women closely mirror white infants in weight, the infants of U.S.-born Mexican-American women didn't fare as well, despite the fact that their mothers were more likely to have completed high school and tended to initiate prenatal care earlier. But even though they were more likely to be premature or smaller than infants of foreign-born Mexican-American mothers, they still weighed more, on average, than the infants of Asian Indians.

"You might ask, 'What's so bad about being small?'" said Madan, who points out that the growth curves used for this and other similar studies are based on white infants. "Is this just normal for Asian Indians? But we're concerned because we know that abnormally small babies run a higher risk of fetal distress and often require more intensive medical care and longer hospital stays after birth."

In addition, unusually small babies are known to be at higher risk for a variety of medical problems in adulthood, including diabetes, hypertension and an increased risk of heart disease - conditions that some studies have reported to be higher in Asian Indians.

Madan and her colleagues speculate that, among other things, maternal birth weight, stress, attitudes toward pregnancy and family support or other biological risk factors may play a role in fetal growth. In addition, Indian mothers were more likely than either Mexican Americans or whites to have diabetes, which in severe cases can restrict fetal growth.

"Our findings point out how much more we have to learn about fetal growth and well-being," said Madan. "Hopefully by continuing to study these populations we may identify new interventions that improve perinatal outcomes for women of all ethnic backgrounds."

Non-pneumatic anti-shock garment holds promise in preventing deaths due to obstetrical hemorrhage

Mon, 27 Feb 2006 17:30:37 PST

( from http://www.rxpgnews.com ) A simple, low-tech garment has the potential to prevent a major cause of death among women who give birth in many Third World countries, according to a new study by maternal health researchers.

Study findings show the use of a neoprene suit can save the lives of women suffering from obstetrical hemorrhaging due to childbirth. Hemorrhaging accounts for about 30 percent of the more than 500,000 maternal deaths worldwide each year due to childbirth, nearly all in poor countries, according to the researchers.

Results from a pilot study on the use of the suit, conducted at selected sites in Egypt, appear in today's online edition of the British Journal of Obstetrics and Gynecology. The findings will be published in the April issue of the journal.

Suellen Miller, CNM, PhD, who is an international maternal health expert and director of the Safe Motherhood Programs of the UCSF Women's Global Health Imperative, directed the pilot study, which evaluated use of a non-pneumatic anti-shock garment, or NASG.

The NASG is a simple, lightweight reusable neoprene suit similar to the bottom half of a wetsuit. It is made up of five segments that close tightly with Velcro. Crucial compression is achieved by combining the three-way stretch of the neoprene and the tight Velcro closures.

When in shock, the brain, heart and lungs are deprived of oxygen because blood accumulates in the lower abdomen and legs. The compression from the NASG shunts blood from the lower extremities and abdominal area to the essential core organs: heart, lungs and brain. Within minutes of application, a hemorrhaging woman can regain consciousness and vital signs will normalize, according to Miller.

In the pilot study, 158 obstetrical hemorrhage patients underwent standard hemorrhage treatment and 206 patients with obstetrical hemorrhaging underwent standard treatment plus the NASG.

Study results showed a 50 percent decrease in blood loss among women treated with the NASG, which is statistically significant, according to Miller. Findings showed a 69 percent decrease in death and severe illness.

"These results are dramatic, particularly given that the NASG can be easily applied by anyone. No medical training is necessary," said Miller.

In developing countries, the majority of women give birth at home with poorly trained or untrained attendants, Miller explained. This suit is intended to keep a woman alive for several hours until she can be transported to a hospital where she can receive blood products and definitive treatment, such as surgery, in an effort to save her life.

"In our research, women who appeared clinically dead, with no blood pressure and no palpable pulse, were resuscitated and kept alive for up to two days while waiting for blood transfusions," said Miller.

In the United States, the suit had been used most recently by emergency medical technicians during transport of patients with lower body trauma to help prevent severe obstetrical hemorrhage by reversing shock and decreasing bleeding.

"Even though there have been variations of this suit used in the past, we see this as being somewhat revolutionary," said Miller. "We have demonstrated its efficacy in a limited way with the Egypt pilot study and will continue now with larger, more rigorous studies."

Stress levels could lead to miscarriages

Fri, 24 Feb 2006 02:26:37 PST

( from http://www.rxpgnews.com ) Pregnant women who exhibit signs of stress are three times more likely to face the risk of miscarriage, says a study.

Around 31 to 89 percent of all conceptions result in miscarriage, earlier studies indicated. Most studies begin when women notice they are pregnant, about six weeks after conception. Most miscarriages, however, are known to happen during the first three weeks of pregnancy.

University of Michigan researchers have found a link between increases in cortisol levels - a stress induced hormone - to very early-stage pregnancy loss, reported science portal EurekAlert.

They studied 61 women in a rural Guatemalan community and measured their cortisol levels in urine samples taken three times weekly for a year.

The study, the first known study to link increases in cortisol levels to very early-stage pregnancy loss, found 22 pregnancies occurred in 16 women and each woman's cortisol levels were measured against their own baseline levels.

Researchers found that 90 percent of women, whose ages ranged from 18 to 34, with elevated levels of the stress-induced hormone miscarried during the first three weeks of pregnancy, compared to 33 percent of those with normal levels.

Stress may be more likely to lead to loss during the earliest stages of pregnancy, while the embryo is just beginning to develop, researcher Pablo Nepomnaschy and colleagues said.

They caution, however, that more research is necessary on this topic before definitive conclusions can be reached.

Diagnosing preeclampsia with proteomic analysis

Sat, 04 Feb 2006 21:28:37 PST

( from http://www.rxpgnews.com ) Researchers at Yale School of Medicine have found that analyzing proteins in urine is a simple and objective method to diagnose and classify preeclampsia (PE), a complication of pregnancy causing high blood pressure after 20 weeks of gestation.

Delivery of the baby is the only treatment for PE, which is more prevalent in obese, older, diabetic and black women. Buhimschi and her team had the goal of discovering a biomarker for predicting, diagnosing and monitoring severity and treatment effectiveness of PE.

The team analyzed 122 urine samples collected prospectively from different patients. The team applied proteomics to define the best combination of urinary biomarkers that set PE apart from other proteinuric hypertensive conditions during pregnancy.

"The presence of a combination of specific fragments of albumin and serpina-1 are highly characteristic for preeclampsia superimposed on chronic hypertension or not," said Buhimschi. "By identifying these protein biomarkers we gained further insight into the mechanisms related to the development of PE."

"This can lead to earlier diagnosis and treatment of PE and can help prevent unnecessary pre-term deliveries," Buhimschi added.

Nervous fathers can be a 'pain' during childbirth

Thu, 26 Jan 2006 16:34:37 PST

( from http://www.rxpgnews.com ) Anxious men pass on their fears to mothers giving birth by Caesarean section, says a study that suggests that early preparation can help reassure both partners about the procedure.

Researchers from University of Bath and Imperial College London studied 65 women scheduled for an elective Caesarean at the Chelsea and Westminster Hospital here and found that anxious men passed on their fears to mothers, the online edition of Daily Mail reported.

This increased the pain women experienced after the operation, which in turn could affect their immediate recovery and factors such as breastfeeding and parent-child bonding, it said.

The researchers questioned the women during their regular antenatal check-ups.

The women and their birth partners were questioned before, during and after the delivery about their fears, expectations and experiences.

The women were also assessed for their pain levels at different stages of the procedure and immediately afterwards.

The study, published in the journal Psychosomatic Medicine, suggested fathers should be prepared for the Caesarean, both at antenatal classes and before the operation, to help reassure them.

This could then help reduce the pain experienced by the mother and improve the birth experience - for both the mother and father.

Stress could cause death of male foetus

Wed, 25 Jan 2006 14:13:37 PST

( from http://www.rxpgnews.com ) Stress during a disaster particularly after natural calamities like earthquakes and severe famine can cause the death of weaker male foetus but those that survive may live longer than the average, says a study.

It is known that fewer boys tend to be born during times of hardship, such as a natural disaster. Male foetuses and embryos are weaker than those of females and are less likely to survive.

Researchers at the University of California examined data on Swedish births from 1751 to 1912 and found why the proportion of newborn boys often dips sharply during times of stress, reported the online edition of BBC News.

Mothers' bodies under stress have less tolerance for unhealthy embryos and foetuses and thus spontaneously abort offspring that would have been otherwise carried to birth, they said.

Writing in Proceedings of the National Academy of Sciences of the US, researchers concluded aborting boys may be a way to maximise the odds of survival of the bloodline.

According to them, only weak foetuses were selectively targeted by the mother's body, giving more robust males every opportunity to thrive.

They argued that actively culling weak male foetuses might increase the overall chance that a woman's genetic line will survive down the generations, as weak individuals were more likely to produce fewer offspring.

However Allan Pacey, an expert in andrology at the University of Sheffield says: "There must also be other mechanisms at play to manipulate the sex ratio in other situations.

"After the last World War there was a dramatic increase in the number of boys born and this theory cannot explain how that was achieved. It's a very complex area of biology," he said.

Normal delivery better for sex life - study

Thu, 19 Jan 2006 15:37:37 PST

( from http://www.rxpgnews.com ) Women who give birth naturally may have better sex life than those who opt for caesarean birth, says a study that warns both prospective mothers and healthcare professionals to think again.

There is a widespread belief among the public and some doctors that women who give birth surgically will experience fewer sexual problems than those who have normal delivery.

But the study of almost 500 first-time mothers in Britain by Brunel University and St George's Healthcare NHS Trust in London challenges that protecting sexual function is among the benefits of a surgical birth, reported the online edition of Daily Mail.

Some women believe that having a caesarean birth will help protect their sex life after they have their baby. But the researchers say women opting for caesarean delivery do not get additional benefits compared to vaginal delivery.

"They would gain relatively little additional benefit from this mode of birth, and could be denying herself a possible vaginal delivery, which is generally assumed to be safer than caesarean section", the researchers said.

The study, published in the journal Birth, has however found that in the long term there is no difference in sexual health between the two groups.

The researchers said they hoped the study would dispel myths about caesarean births and help give women the best information before they make a decision.

"Since consideration of post-natal sexual health may be a factor in driving the current high caesarean section rates, this important message needs to be clearly delivered to both prospective mothers and their healthcare professionals," the researchers said.

Why, throughout the world, more boys are born?

Mon, 19 Dec 2005 15:32:38 PST

( from http://www.rxpgnews.com ) The longer it takes to get pregnant, the more chance there is of having a boy, finds a study in this weeks BMJ.

Dutch researchers analysed data for 5,283 women who gave birth to single babies between July 2001 and July 2003.

Among the 498 women who took longer than 12 months to get pregnant, the probability of male offspring was nearly 58%, whereas the proportion of male births among the 4,785 women with shorter times to pregnancy was 51%.

The authors calculate that, for couples conceiving naturally, each additional year of trying to get pregnant is associated with a nearly 4% higher expected probability of delivering a male baby, even after adjusting for factors such as age, smoking status, alcohol use, and variability of the menstrual cycle.

In contrast, sex of the offspring of couples who had received medical help in getting pregnant did not show any relation with time to pregnancy.

These findings support the idea that, in viscous fluids, sperms bearing the Y (male) chromosome swim faster than those bearing the X (female) chromosome, say the authors. Women whose cervical mucus is relatively viscous would not only have more difficulties conceiving naturally, but also have a higher probability of male offspring if they do get pregnant.

Furthermore, the findings may explain why, throughout the world, more boys than girls are born (105 boys to 100 girls in most countries), despite the fact that human semen holds equal amounts of X bearing and Y bearing sperms.

Prepregnancy Weight Increasing, may mean more complications

Sat, 17 Dec 2005 15:52:38 PST

( from http://www.rxpgnews.com ) A growing number of women are overweight or obese when they become pregnant, a condition that is risky to both mother and baby, a new study conducted by researchers at the University at Buffalo has shown.

An analysis of the prepregnancy body mass index of more than 79,000 women in eight counties of Western New York who became pregnant between 1999 and 2003 found that the number of women who were overweight when they became pregnant increased by 11 percent and the number who were obese increased by 8 percent over that time period.

There was a corresponding decrease in the percentage of women who were normal weight or underweight in the prepregnancy period over those five years, results showed. The shift applied regardless of age, ethnicity (black or white), education level, type of insurance, previous live births, urbanization status, median family income and smoking status.

The study appears in the current (Dec. 2005) issue of the American Journal of Obstetrics and Gynecology.

The results are thought to apply to the population-at-large because they are consistent with findings in at least three previous papers and because of the large sample size.

"Cumulatively, 40.5 percent of all patients had prepregnancy BMIs in the overweight and obese categories in 2003 compared with 37.1 percent in 1999," said John Yeh, M.D., lead author who is professor and chair of the Department of Gynecology-Obstetrics, UB School of Medicine and Biomedical Sciences. "This represents a relative 9.2 percent increase over five years of the study.

"This increase in obesity is important to the obstetrician and the patient because obesity can be a high-risk situation in a pregnant woman," said Yeh. "Obese patients who become pregnant are at increased risk of developing gestational diabetes, pregnancy-related hypertension, preeclampsia, neonatal death and labor complications."

The researchers analyzed data from the Western New York Perinatal Data System, which contains information on more than 200 demographic, obstetric, medical and other items on each delivery occurring in the 17 hospitals in the region with obstetric services.

A breakdown of data showed that 75 percent of the women were between the ages of 20 and 34; 80 percent were white, 55 percent had more than a high school education and 58 percent had HMOs as their insurance carrier.

It was the first live birth for 39 percent of the women, 64 percent lived in urban areas and 80 percent were non-smokers.

While half of the total number of women had a body mass index in the normal range, more than a quarter were obese when they became pregnant. Over five years the percentage of women with a normal BMI dropped from 50.8 percent in 1999 to 49.2 percent in 2003.

During the same time period, the number of overweight women increased from 13.2 percent to 14.6 percent, and the number of obese women increased from 25.1 percent to 25.9 percent.

Preeclampsia poses a serious health threat to the overweight or obese mother, and if not treated properly can result in death of both mother and baby. Preeclampsia causes blood vessels to constrict, resulting in high blood pressure and a decrease in blood flow that can affect many organs, including the liver and kidneys. Less blood flows to the placenta, which can result in poor fetal growth, decreased amniotic fluid and separation of the placenta from the uterine wall before delivery.

Gestational diabetes, while less serious, is an increase in blood sugar during pregnancy that returns to normal after delivery but increases the mother's risk of developing Type 2 diabetes later in life.

Yeh noted that many women gain additional weight during pregnancy, and these pounds often stay with them after the baby is born. "This increases a woman's risk of obesity-related morbidity in the future," he said.

Childbirth not linked to urinary incontinence

Fri, 02 Dec 2005 18:58:38 PST

( from http://www.rxpgnews.com ) Postmenopausal women who have given birth vaginally do not appear to suffer from urinary incontinence at higher rates than their sisters who have never given birth, according to a University of Rochester Medical Center study published in the December Obstetrics and Gynecology journal.

The study results are contrary to conventional thinking that vaginal delivery will result in urinary incontinence later in life. In fact, elective caesarean sections are now being performed for the sole purpose of preventing future incontinence, the authors report, even though the scientific literature is inconsistent on this link.

In the current study, lead author Gunhilde Buchsbaum, M.D., compared 143 pairs of biological, postmenopausal sisters from western New York and northern Vermont. The sisters completed a comprehensive questionnaire about their symptoms of pelvic floor disorders, and 101 pairs underwent a clinical evaluation.

The results: 49.7 percent of the women who had given birth reported some degree of urinary incontinence compared to 47.6 percent of the women who had never given birth. The difference is not statistically significant. Instead, an underlying genetic predisposition seemed to play the largest role in determining risk. The results showed that in 63 percent of the sisters, if one experienced urinary incontinence the other sister also did.

"The family history and genetic predisposition is something that definitely needs to be explored further," said Buchsbaum, an associate professor of obstetrics and gynecology at the University of Rochester. "If we can find a clear genetic link, it would have great implications for the direction of basic research, treatment approaches, risk management and potential prophylactic interventions."

Down Syndrome now Detectable at 11 Weeks

Thu, 10 Nov 2005 20:01:38 PST

( from http://www.rxpgnews.com ) A new study from Columbia University Medical Center researchers at NewYork-Presbyterian Hospital/Columbia of more than 38,000 pregnant women at 15 U.S. centers demonstrates the high accuracy of non-invasive screening for Down syndrome (also known as trisomy 21) in the first trimester of pregnancy, at 11 weeks. The findings are a significant advantage over the current standard screening, a blood test performed in the second trimester of pregnancy. Published this week in the New England Journal of Medicine (Nov. 10, 2005 issue), the study is known as the FASTER trial (First and Second Trimester Evaluation of Risk). It was funded by a $13 million grant from the National Institutes of Health and the National Institute of Child Health and Human Development one of the largest ever grants for an obstetrical study.

The new screening approach uses a blood test that analyzes the level of a protein and hormone in the mother's blood, combined with an ultrasound or sonogram picture of the thickness of skin on the back of the baby's neck (known as the nuchal translucency or NT). Results are available within five days, often before starting the second trimester of pregnancy. This combination approach determines the odds that the baby might have Down syndrome, allowing pregnant women the option of prenatal diagnosis for Down syndrome and other chromosomal abnormalities within the first trimester or pregnancy. The researchers found higher detection 87 percent in the first trimester compared to the best second trimester screening method 81 percent detection. Results with this new combination screening approach in the first trimester are a significant advantage over the current standard screening test.

First-trimester screening was performed on 38,167 patients; 117 were found to have a fetus with Down syndrome. If a positive result was found via screening, the woman was given the option to have the finding confirmed with a diagnostic exam: chorionic villus sampling (CVS) or amniocentesis. Both tests carry risks of complication leading to miscarriage.

Down syndrome is one of the leading causes of mental retardation and birth defects, found in one in 660 pregnancies. Persons with this condition have distinct physical features and commonly have certain birth defects and medical problems. Any woman can have a baby with Down syndrome, regardless of her age, race, health, economic status or family history. For this reason, most pregnant women undergo testing to determine their potential to have a baby with this syndrome.

"These results will undoubtedly change national practice all pregnant women should have the option of early screening for Down syndrome in their first trimester," said Mary E. D'Alton, M.D., principal investigator of the study. She is Chair of the Department of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, and Chief of Obstetrics and Gynecology at NewYork-Presbyterian Hospital/Columbia. "Down syndrome screenings based on either maternal age alone, or an ultrasound or sonogram alone, are no longer justified protocols."

Dr. D'Alton and the research team believe that the new screening method should only be administered by qualified, trained physicians. Dr. D'Alton and other experts working with the Society of Maternal Fetal Medicine have recently formed the Maternal Fetal Medicine Foundation to facilitate physician training and quality review for the screening. So far 1,600 physicians and sonographers nationwide have undergone training, and more are scheduled. Information about the training and quality review program can be found at http://www.MFMF.org.

Women seeking this early screening should seek healthcare professionals with appropriate ultrasound training and who participate in ongoing quality monitoring programs. Programs should provide sufficient information and resources for counseling regarding the different screening options and limitations of these tests. Additionally, the services should provide access to an appropriate diagnostic test when the screening test is positive.

"This study was a wonderfully collaborative effort between researchers, including four leading Obstetrics and Gynecology centers in New York City. This incredible achievement would not have been possible without the hard work of the 15 centers that comprised the FASTER Research Consortium and the 38,167 women who participated in this clinical trial," said Dr. D'Alton.

The term 'Down's syndrome' was first used in 1961 by the editor of The Lancet. Of the inborn disorders that affect intellectual capacity, Down syndrome is the most prevalent and best studied

Effect of sublingual misoprostol on severe postpartum haemorrhage

Thu, 06 Oct 2005 15:30:38 PST

( from http://www.rxpgnews.com ) A relatively cheap and easy to use drug could save the lives of thousands of women in the developing world, according to a study in recent BMJ.

Postpartum haemorrhage (excessive blood loss after childbirth) is the leading cause of maternal death in Africa. Several drugs reduce blood loss, but in poor areas they are often inaccessible, too expensive, and too difficult to use.

The study took place in Guinea-Bissau, West Africa, where maternal death is more than 8 per 1000 live births. Immediately after delivery, 330 women received misoprostol tablets and 331 received placebo (dummy pills).

Significantly fewer women in the misoprostol group experienced severe blood loss.

In rural Guinea-Bissau, 75% of women give birth at home, and worldwide only about 50% of women give birth in health facilities. So strategies are needed to increase the safety of deliveries attended by unskilled birth attendants, say the authors.

Our trial suggests that misoprostol would play an important part in such a strategy to reduce complications of delivery and maternal mortality, they conclude.

Recurrence of pre-eclampsia across generations

Mon, 19 Sep 2005 16:28:38 PST

( from http://www.rxpgnews.com ) Genes from both the mother and father can trigger pre-eclampsia, finds a study published online by the BMJ.

Pre-eclampsia is a serious condition where abnormally high blood pressure and other disturbances develop in the second half of pregnancy. It occurs in 3-5% of pregnancies and is dangerous for both mother and child.

Researchers in Norway used birth registry data to study whether men and women who are born after pre-eclamptic pregnancies pass on this risk to the next generation, compared with those who had no family history of pre-eclampsia.

They found that daughters of women who had pre-eclampsia during pregnancy had more than twice the risk of pre-eclampsia themselves compared with other women. Men born after a pregnancy complicated by pre-eclampsia also had a moderately increased risk of fathering a pre-eclamptic pregnancy.

These associations were stronger for the more severe types of pre-eclampsia.

Sisters of affected men or women, but who were not themselves born after a pre-eclampic pregnancy, also had an increased risk. However, for brothers, the risk of fathering a pre-eclamptic pregnancy was similar to that in men with no family history.

This suggests that maternal susceptibility can pass from mother to daughter but not from mother to son, write the authors.

These results support the theory that both the mothers and the fathers genes contribute to the risk of pre-eclampsia, say the authors. The risk through affected mothers is higher because they carry their mothers susceptibility genes and also transmit independent genetic risk factors to their unborn child. The risk through affected fathers is lower because fathers transmit only fetal risk genes.

Recurrence of pre-eclampsia across generations

Mon, 19 Sep 2005 16:28:38 PST

Methoxychlor (MXC) may reduce female fertility

Tue, 13 Sep 2005 04:24:38 PST

( from http://www.rxpgnews.com ) The researchers found that MXC, which was manufactured as a safer replacement for the now-banned DDT, alters the estrogen-regulated gene Hoxa10 in the reproductive tract and reduces the ability of the uterus to support embryo implantation. The researchers used mice and then human cell lines to confirm their findings.

MXC is a man-made pesticide used to kill flies, mosquitoes, cockroaches and other insects, and is applied directly to food crops, livestock, home gardens and pets. It is one of a large number of chemicals that can mimic the action of hormones and in some instances interfere with endocrine function.

Some of these endocrine disruptors bind estrogen receptors and adversely affect reproductive tract development, which is heavily influenced by estrogen. MXC and other chemicals like DDT have been shown in other studies to induce abnormalities in tissue development and function in the female reproductive tract.

"MXC has an adverse effect on these mice similar to that of DES, a synthetic estrogen," said senior author Hugh S. Taylor, M.D., associate professor in the Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "Female offspring of women exposed to DES were more likely to have an abnormally shaped cervix, were more prone to cancer of the vagina, miscarriages, early labor and other complications."

Folic acid link with low birth weight

Tue, 06 Sep 2005 00:05:38 PST

( from http://www.rxpgnews.com ) Mothers-to-be with lower levels of the vitamin folate in their body during early pregnancy are more likely to have babies with lower, or less healthy, birth weights, a study has revealed.

Conversely, researchers from the University of Newcastle upon Tyne, UK, who examined nearly 1,000 women and their newborn babies, found that higher levels of folate (found in some vegetables, fruits and cereals, and also known as vitamin B9, or folic acid) were linked with increased birth weights.

Expectant mothers who smoked were more likely to have lower levels of folate in their blood, which might explain why women who smoke often have lighter babies.

The health benefits of folic acid for babies are already known but this is the first time that folate levels commonly seen in UK mothers in early pregnancy have been linked with birth weight. The study is published in the British Journal of Nutrition.

Seven per cent of all babies born are low birth weight (less than 2.4kg or 5.5lbs) and they have a 50 per cent chance of having a severely disabling condition as a result of being too light. Healthy birth weights are a marker for good health in infancy and later life.

Researchers say that current NHS policy is to advise women to take folic acid at their first pregnancy check-up but this means that many mothers-to-be miss out on taking the vitamin in the crucial, early stages of gestation.

They also say the findings have implications for health promotion policies, adding weight to arguments in favour of fortifying everyday foods like bread and cereals with folic acid.

For the study, Dr Caroline Relton (pictured above, with baby Nell Reckitt), of Newcastle Universitys School of Clinical Medical Sciences, and colleagues studied 998 expectant mothers attending a hospital in North West England (West Cumberland Hospital, Whitehaven, Cumbria) and their newborn babies.

The team analysed blood samples that the women gave during their routine antenatal visits in early pregnancy (averaging 11.5 weeks gestation) and recorded the amount of folate in their red blood cells these cells show activity over the previous three months. They gathered lifestyle information, such as smoking habits, from a questionnaire, and also recorded the weight of each baby when born.

Medical evidence suggests that folic acid influences birth weight because it is an essential nutrient for growth and gene expression in the foetus. Smoking is likely to reduce a womens folate levels because it is a significant source of oxidative stress and may alter the ability of the cell to metabolise and ultimately store the vitamin.

The best way to increase folic acid levels is by taking supplements but it is also advisable to eat folate-rich foods like green vegetables (broccoli, spinach), citrus fruits (oranges, grapefruits) or wholemeal products like bread or cereals. The current recommended intake is 200 micrograms per day and women are advised to take an additional 400 micrograms a day before conception and during the first 12 weeks of pregnancy.

Dr Relton said: Folic acid is highly important in preventing birth defects which affect a small number of pregnancies. This study suggests that it is also important in every pregnancy to help the developing baby reach a healthy birth weight. However, many women are missing this critical window in the first few weeks of gestation during which their baby really needs folic acid to grow and develop.

The evidence from this study strengthens the argument for fortifying everyday foods like bread and cereals with folic acid. For example, in the United States, all wheat products have been fortified since 1998, with the intention of reaching women of childbearing age.

Fortifying a range of foods promises to be a more effective solution than a campaign to encourage women to take folic acid supplements. Our previous research shows younger women and those from deprived backgrounds are less likely to take these supplements, and although some cereals are currently fortified in the UK, they tend to be the more expensive, brand-name products.

The research was funded by the Westlakes Research Institute and the Minnie Henderson Trust.

Meconium aspiration syndrome rsik not reduced by amnioinfusion

Sun, 04 Sep 2005 07:12:38 PST

( from http://www.rxpgnews.com ) An international randomized trial, funded by the Canadian Institutes of Health Research (CIHR), has revealed that amnioinfusion, the infusion of saline into the uterus, does not reduce the risk of meconium aspiration syndrome (MAS), as previously believed. The study, which is led by Dr. William Fraser from the Department of Obstetrics and Gynaecolgy of the Université de Montréal and the Maternal-Child Health Centre associated with Ste-Justine's Hospital, is published in today's issue of The New England Journal of Medicine.

"Dr. Fraser and his colleagues have made an extremely important contribution to our knowledge about the possible prevention of MAS, a rare but very serious neonatal lung condition," said Dr. Michael Kramer, Scientific Director of the CIHR Institute of Human Development, Child and Youth Health. "The rigorous study methods and international scope of this randomized trial (56 study sites in 13 countries) provides very strong evidence against the use of amnioinfusion, and the results are likely to have a major impact on childbirth practices around the world."

Meconium aspiration syndrome (also referred to as meconium aspiration) occurs when a newborn inhales a mixture of meconium and amniotic fluid during labor and delivery. Meconium is the material that fills the fetal intestinal tract during pregnancy and is formed from ingested amniotic fluid and dead intestinal cells. Although it is sterile, inhaled meconium is highly irritating to the lung when the infant takes its first breaths. It can cause a partial or complete blockage of the baby's airways when exhaling, making it difficult to breathe.

Meconium alters the amniotic fluid, reducing antibacterial activity and subsequently increasing the risk of perinatal bacterial infection. Aspiration induces 3 major pulmonary effects, which are airway obstruction, surfactant dysfunction, and chemical pneumonitis. Meconium-stained amniotic fluid occurs in 7 to 22% of term deliveries. In anywhere from 2% to more than a third of these deliveries, MAS can occur.

One of the techniques used to reduce its risk is amnioinfusion. This technique involves infusing saline, via insertion of a catheter in the uterine cervix, into the amniotic cavity of women in labour who show heavy meconium. Amnioinfusion is intended to reduce the risk of MAS by diluting the meconium.

Women were eligible for this randomized trial, after the fetal membranes ruptured and thick, opaque, meconium-stained (greenish colour) amniotic fluid was identified. In this trial, amnioinfusion was not effective in reducing the risk of meconium aspiration syndrome.

"Amnioinfusion has been used in the prevention of meconium aspiration syndrome, or MAS, for the past 15 years. Prior to our study, information about the effectiveness of the intervention was based on small studies carried out in single centers," said Dr. Fraser. "Our research is the first large study that has a sufficient sample size to answer the question as to whether the technique is effective to prevent MAS. We showed that it is not effective in this context. This trial did not examine amniofusion in other contexts. Thorough, large scale studies are needed before drawing conclusions on the potential role of amnioinfusion for other indications."

Dr. Fraser worked with collaborators in Canada, France (Dr. François Goffinet, from INSERM Unité149 and Maternité de Port-Royal), as well as with researchers from Argentina, Belgium, Brazil, Ireland, Mexico, Portugal, South Africa, Switzerland, Tunisia, the United Kingdom and Uruguay.

Trichostatin A (TSA) could aid premature labour

Tue, 14 Jun 2005 03:15:38 PST

( from http://www.rxpgnews.com ) An anti-cancer drug could potentially be the first effective treatment for the many thousands of premature births that occur worldwide each year, scientific tests have found.

The drug, which has been used to treat types of cancer including breast, bowel and lung, has been found in the laboratory to control levels of a hormone receptor protein in the womb which is linked with giving birth.

The findings, from a research team at the University of Newcastle upon Tyne, should bring hope to the women who see their premature babies die or suffer from physical or mental disability as a result of being born too early.

The research, funded by the charity Action Medical Research, is published today in the Journal of Clinical Endocrinology and Metabolism.

In the UK each year, around 10 per cent, or 60,000, pregnancies end with premature births of less than 37 weeks gestation, which is the highest rate in Western Europe and costs the NHS millions of pounds. The problem is worse in the developing world.

Drugs currently used to treat women who give birth prematurely are relatively ineffective, and often have dangerous side effects, such as heart problems in mother and baby.

The research team examined the effect that the anti-cancer drug Trichostatin A better known as TSA had on the levels of receptors on human smooth muscle cells of the womb, or uterus, that are affected by the pregnancy hormone, hCG (Human chorionic gonadotrophin).

During pregnancy, the placenta releases large amounts of hCG. This activates the CG/LH receptors on the muscle cells of the womb to produce a muscle relaxant, which in turn prevents contractions and keeps the uterus in a relaxed state. It is known that decreases in hCG receptor levels may lead to contractions in the womb and labour.

Women whose babies are born prematurely experience an acute drop in the numbers of the CG/LH receptors and are thus less responsive to the hCG hormone. Laboratory tests carried out by the Newcastle University team found that TSA is able to increase numbers of the CG/LH receptors in uterine smooth muscle cells.

The researchers are now seeking funding for clinical trials to assess whether TSA would work in women who are due to give birth prematurely, or in those who are at high risk of having a premature baby.

Research team leader, Dr Nick Europe-Finner, of Newcastle University's School of Surgical and Reproductive Sciences, said: "Many people think that that premature births are no longer a problem and would be astonished to know that, even in a sophisticated, developed nation like the UK, there are still around 10 per cent of births which are classed as premature.

"It's particularly frustrating for doctors and mothers alike that there is still no effective treatment, despite the fact that many premature babies die or have physical or mental conditions that may affect them for the rest of their lives.

"Our laboratory tests show that the drug TSA is able to fool uterine muscle cells and suggest it could be a potential new therapeutic agent in preventing premature birth from occurring. We now need to take the research a step further and test it in a clinical setting, although funding for this would be required."

Mr Andrew Loughney , consultant obstetrician at the Royal Victoria Infirmary in Newcastle upon Tyne, said: "This is a very exciting area of research because it may lead to the development of new, more effective ways of preventing premature birth.

"Premature birth is a huge problem in the UK. In the hospital where I work, the Royal Victoria Infirmary in Newcastle upon Tyne, we find ourselves looking after women in premature labour day in and day out without having any really effective treatments to offer.

"There are two challenges ahead. The first will be to see whether the drug has a clear clinical effect in reducing contractions in the womb. The second will be to ensure that the new treatment has no adverse effects for the mother or the baby."

Routine procedure during childbirth provides no benefits

Sat, 07 May 2005 19:22:38 PST

( from http://www.rxpgnews.com ) According to a systematic review of existing studies, to appear in the May 4 issue of the Journal of the American Medical Association, the surgical procedure known as an episiotomy, performed in up to 35 percent of U.S. vaginal births, usually provides no benefits.

Moreover, the researchers found that, in some cases, routine use of episiotomy causes more harm to mothers than avoiding its use. An episiotomy is an incision made at the vaginal opening during a birth. The intent, in most cases, is to mitigate the severity of the spontaneous tearing that sometimes occurs during childbirth and to facilitate proper anatomic repair. The procedure also may be performed in cases when the baby's safety is threatened and delivery needs to take place quickly. This study addressed routine use only, not emergencies.

In routine births, women without episiotomy were found to have less pain with faster resolution, and no greater or lesser risk of wound healing complications. In addition, the evidence showed that episiotomy did not protect women against urinary or fecal incontinence or pelvic organ prolapse in the first three months to five years following delivery.

"The literature we reviewed suggests that the outcomes with spontaneous tears, if they happen, are better than with episiotomy," said Dr. Katherine Hartmann, the lead author of the JAMA article. She noted that women are more likely to suffer the most severe types of tears, from the vagina into the rectum, when they have an episiotomy.

A key message from such findings, she added, is that a mother-to-be should talk to her doctor about her wishes regarding episiotomy during her prenatal care because it will be too late to have an informed discussion in the delivery room.

"You're in charge of what happens to you in your care. Your best bet to reach a clear understanding with your doctor about what this aspect of your birth will be like is to talk about it in advance."

Hartmann is assistant professor of obstetrics and gynecology in the University of North Carolina at Chapel Hill's School of Medicine and of epidemiology in UNC's School of Public Health. She also directs UNC's Center for Women's Health Research.

The JAMA article is based on work by a team of researchers from the RTI International-UNC Evidence-based Practice Center (EPC) working under contract to the Agency for Healthcare Research and Quality. The full evidence report, led by co-author Dr. Meera Viswanathan, senior health analyst at the RTI International, also concludes that any possible benefits of the procedure do not outweigh the fact that many women would have had less injury without the surgical incision.

The studies reviewed were consistent in demonstrating that routine episiotomy provided no benefit over restrictive episiotomy in terms of the severity of laceration, pain and pain medication use, the researchers said. Episiotomy also provided no benefit in terms of preventing problems such as fecal and urinary incontinence, or in reducing impaired sexual function. In fact, women who had an episiotomy were more likely later to have pain during intercourse than women who did not have the procedure.

The researchers concluded that the evidence does not support the benefits traditionally ascribed to routine episiotomy.

"In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision," they wrote.

Dr. John Thorp Jr., co-author of the article and a professor in UNC's department of obstetrics and gynecology and deputy director of the Center for Women's Health Research, has studied episiotomy for almost two decades.

"In most cases, episiotomy doesn't do any good, and it can harm women," Thorp said. "Why would one want a surgical procedure that's worthless?"

The rationale used to justify routine episiotomy, Thorp added, is that performing an episiotomy prevents more serious injury to the mother. It had been thought that a deliberate incision would heal more quickly and with fewer complications than a spontaneous tear, and that a woman who has an episiotomy would be less likely to have pelvic floor problems, such as fecal or urinary incontinence or impaired sexual function, later on.

By the 1930s, the procedure had become common in obstetrical practice. The procedure remains common today, occurring in more than 1 million of the roughly 4.2 million births nationwide each year. Among first-time mothers, 70 percent to 80 percent have an episiotomy, Thorp said.

However, studies published as early as 1983 began to question whether routine episiotomy actually provided the benefits credited to it. Thorp himself began to investigate the wisdom of routine episiotomy in the late 1980s.

"This is embedded in modern obstetrics," Thorp said, adding that episiotomy was introduced as part of the same movement in which the hospital, rather than the home, became the place where most babies are born. "Episiotomy was part of that package."

Other aspects of that "package," such as frequent use of general anesthesia and routine use of forceps during delivery, have since fallen out of favor due to advances in scientific understanding. However, Thorp said, many clinicians in practice today, who were trained to perform routine episiotomies as a standard of care, are reluctant to change.

Prenatal sonography has no effect on the Intellectual Capacity

Thu, 14 Apr 2005 16:17:38 PST

( from http://www.rxpgnews.com ) Fears have been expressed that sonography can lead to diminished intellectual capacity, explains Helle Kieler, research scientist at Karolinska Institutet.

Previous epidemiological studies have shown that young men who had been exposed to in utero ultrasonic scans are more likely than other young men to be left handed; and that there is a correlation between left-handedness and reduced intellectual capacity in children born after a complicated pregnancy.

The new study, which is to be published on 13 April in the scientific journal Epidemiology, is based on data from approximately 180,000 boys born in the 1970s, when routine ultrasonic examinations of foetal development were first introduced in Sweden. Almost 20 years later, the young men were given intelligence tests on signing up for their military service. When researchers compared the boys who had been scanned with those that had not, it transpired that intellectual capacity was lower in those who were exposed to ultrasound in during gestation. The differences, however, were small and other influences on the results could not be ruled out.

To control for such (unquantified) factors, the scientists then conducted a smaller-scale analysis of brothers. This enabled them to confirm that there was nothing to suggest that the brother who had been exposed to in utero ultrasonic radiation was intellectually inferior to the one who had not.

The results are reassuring in terms of the risk that routine prenatal sonography has lasting effects on the development of the foetal brain, says Ms Kieler. It is important to remember, however, that the study reflects the effects of how ultrasound was used in the 1970s. Scanning procedures have changed since then, and children born today have generally been exposed to more ultrasonic radiation than those included in the study.

Study supports use of aspirin in treating pregnancy disorder

Wed, 23 Mar 2005 00:11:38 PST

( from http://www.rxpgnews.com ) A new study led by Queens University researcher Colin Funk provides indirect support for the use of low-dose aspirin therapy in preventing and treating pre-eclampsia a pregnancy disorder that is often harmful to both mother and fetus.

This treatment strategy is controversial, since it has been associated with complications such as thrombosis (blood clotting) and problems with labour. However, the new study shows that the rationale for low-dose aspirin therapy to prevent or delay pre-eclampsia without compromising reproductive function, or increasing the possibility of thrombosis, is definitely a feasible therapeutic strategy, says Dr. Funk.

The study results are published on-line in the
international Journal of Clinical Investigation.

Recently appointed as Canada Research Chair in Molecular, Cellular and Physiological Medicine, Dr. Funk is an expert in the study of molecules that function in almost every bodily system. The production of prostaglandins is blocked by taking aspirin.

Other members of the research team are from the University of Pennsylvania, where Dr. Funk was on faculty before coming to Queens through a Canadian Institutes of Health Research (CIHR) program.

Pre-eclampsia, which strikes five to 10 per cent of all pregnancies, is characterized by high blood pressure in the mother, and is one of the leading causes of baby and maternal deaths in developing countries. It is believed that the development of new treatments for pre-eclampsia and the early identification and management of this risk in both groups may prevent the onset of long-term heart disease.

In the current study, the research team created a model that mimics low-dose aspirin therapy in mice. They found that the uterine and ovarian environments were altered only slightly, and the mice experienced normal induction of labour, normal litter size, and development of offspring.

This new mouse model will have significant value in studying the implications of low dose aspirin in several pathological conditions, such as pre-eclampsia, thrombosis, and inflammatory disorders, says Dr. Funk. Were hopeful that our model will lead the way to further treatment options for these debilitating conditions.

Birthing a new model of aspirin therapy in preeclampsia

Fri, 18 Mar 2005 23:02:38 PST

( from http://www.rxpgnews.com ) Preeclampsia is a hypertensive disorder that occurs during pregnancy and can be detrimental to the health of the developing fetus and the mother. Low-dose aspirin therapy has been used to treat preeclampsia, but this strategy is controversial some researchers believe that it prevents preeclampsia while others find it increases related complications.

In a study appearing online on March 17, in advance of the April 1 print edition of the Journal of Clinical Investigation, Colin Funk and colleagues from the University of Pennsylvania describe a new mouse model that mimics the effects of low dose aspirin to explore how such therapy would impact blood clotting and reproductive functions.

The mice generated have reduced levels of prostaglandin H synthase 1 (PGHS1), a platelet protein that contributes to the heart-healthy effects of aspirin therapy. The authors find that these mice had the expected decreased platelet aggregation, inhibition of thrombosis, and impaired inflammatory responses typically seen with aspirin therapy. However, the uterine and ovarian environments were altered only slightly and allowed for normal induction of labor, normal litter size and similar development of offspring.

This new mouse model will have significant value in studying the role of low dose aspirin in several pathological conditions, such as preeclampsia, thrombosis and inflammation. The results suggest that low-dose aspirin treatment may prevent preeclampsia without compromising reproductive function.

Acupuncture Relieves Pelvic Girdle Pain during Pregnancy

Fri, 18 Mar 2005 15:44:38 PST

( from http://www.rxpgnews.com ) Acupuncture and strengthening exercises help relieve pelvic girdle pain during pregnancy and are effective complements to standard treatment, finds a study published online by the BMJ today.

Pelvic girdle pain is a common complaint among pregnant women worldwide, but no cure exists.

Researchers in Sweden identified 386 pregnant women with pelvic girdle pain. Women were randomly divided into three groups; one received standard treatment (a pelvic belt and a home exercise programme), another received standard treatment plus acupuncture, and the third received standard treatment plus stabilising exercises to improve mobility and strength.

Pain levels were recorded every morning and evening using a recognised scale and all women were assessed by an independent examiner at the end of the treatment period.

After treatment, both the acupuncture group and the stabilising exercise group had less pain than the standard group in the morning and in the evening. Reduction of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group.

Acupuncture or stabilising exercises as an adjunct to standard treatment offers clear clinical advantages over standard treatment alone for reduction of pain in pregnant women with pelvic girdle pain, say the authors.

Acupuncture was superior to stabilising exercises in this study, they conclude.

Preimplantation Sex Selection Popular Among Infertile Women

Fri, 11 Mar 2005 16:05:38 PST

( from http://www.rxpgnews.com ) A new survey says a significant number of women being treated for infertility would choose the sex of their next child if given the option -- and those as yet childless would choose baby girls and boys in approximately equal numbers.

"We found that 41 percent of patients surveyed would use preimplantation sex selection if it were offered to them at no cost," said Dr. Tarun Jain, assistant professor of reproductive endocrinology and infertility at UIC and lead author of a study in the March issue of Fertility and Sterility.

Two techniques currently available in the United States, sperm separation and preimplantation genetic diagnosis, make sex selection possible. But the procedures are usually reserved for the prevention of sex-linked genetic disorders in children and are not widely used for nonmedical purposes.

"Sex selection is a topic that's almost taboo for physicians to talk about. Yet it's important to understand patient interest in nonmedical sex selection and adequately address the ethical and social implications before the cat is out of the bag," said Jain. "Prior to this study, there has been no data to indicate what the demand might be."

Researchers conducted a survey of female patients at a hospital-based infertility clinic to determine the demand and preferences for nonmedical sex selection. They also looked at the type of sex selection method patients would choose.

Of the 561 survey respondents, 229 would want to select the sex of their future child. Among the women who would choose, 45 percent did not have any children and 48 percent had children of all the same sex.

Half of the women who wanted sex selection at no cost would still choose to select the sex of their next child if they had to bear the cost.

Sex selection is not without controversy. Some believe it may lead to imbalances in society's sex ratio and contribute to gender stereotyping and discrimination. The practice has been banned in the United Kingdom.

"One of the fears is that sex selection will drive patients toward a certain sex," said Jain. "And the presumption is a preference for boys. But our study did not show that. In fact, in patients who did not have children there was no greater desire for boys over girls."

The researchers also determined that women with only daughters wanted to select a male child, and women with only sons wanted to select a female child.

Non-white racial groups had a stronger preference for sex selection, according to the study.

Women who were older, not religious, willing to pay for sex selection, had more living children, had only sons, or had a diagnosis of male infertility were more likely to want a daughter.

Based on these recent findings, the researchers suggest that it may be important for clinics, and perhaps society, to determine what is an acceptable use of nonmedical sex selection.

The President's Commission on Bioethics has identified sex selection as a topic of concern. The Commission briefly addressed the issue in their 2004 report, "Reproduction and Responsibility: The Regulation of New Biotechnologies."

The American College of Obstetricians and Gynecologists and the International Federation of Gynecology and Obstetrics are opposed to sex selection for nonmedical reasons.

In contrast, the American Society of Reproductive Medicine has stated that preconception sex selection for nonmedical reasons is acceptable to provide a family with a child of a different sex than an existing child -- known as family balancing -- provided the methods are safe and effective.

The tricky part for physicians will be determining if families want to choose the sex of their child for family balancing or for other reasons, Jain said.

"As the techniques gain more popularity, physicians will have to decide if they will offer the procedure to patients with and without children," he said.

The study also found that 55 percent of women would choose sperm separation, 41 percent would choose preimplantation genetic diagnosis, and 4 percent would choose neither method for sex selection.

UKOSS - World first for study of rare disorders of pregnancy and childbirth

Thu, 03 Mar 2005 17:32:38 PST

( from http://www.rxpgnews.com ) Rare disorders of pregnancy are such that most practising midwives and obstetricians will see fewer than one case in a year. Some are so infrequent that health professionals may see only one case in a working lifetime, making it difficult to build up sufficient individual expertise to be confident as to the appropriate clinical management.

However, if the number of women who suffer from these conditions are added together, it is clear that rare disorders actually cause a significant burden to women, their families and carers, the health professionals and health systems that care for them.

Studying these disorders also poses problems because we do not have the appropriate information to make decisions about treatment. Nor do we have sufficient information to enable us to plan services appropriately. Neither can we explain with any confidence to a woman with one of these conditions how the disease may affect her and her baby. There is clearly a need therefore, to develop a system that allows the study of the epidemiology and management of these rare conditions without imposing a significant reporting burden on the staff who care for affected women. UKOSS provides such a system.

A Novel Approach to Identify Patients at Risk for Preterm Delivery

Thu, 10 Feb 2005 17:10:38 PST

( from http://www.rxpgnews.com ) For the first time, researchers have successfully profiled the amniotic fluid metabolome (the sum of all metabolic processes occurring in the amniotic fluid), in order to identify which women who have experienced preterm labor are also at risk for delivering a premature baby. With nearly one in eight babies in the U.S. born prematurely every year, and the problem of premature birth increasing, the need for tools that can identify preterm delivery risk has never been greater, experts say.

"We studied the amniotic fluid of three groups of patients â those with preterm labor who delivered at term, those with intra-amniotic inflammation who had both preterm labor and delivery, and those with no sign of inflammation who still had preterm labor and delivery," said Roberto Romero, M.D., lead study author and SMFM member. "We discovered that by using metabolic profiling, 96 percent of the time we could correctly identify the patients as belonging to the appropriate clinical group.

"A second study, in a different set of patients with a larger sample size, has already confirmed the effectiveness of our method. Until now, we have never had a way to predict the course of preterm labor with such accuracy. Metabolomic profiling has given us that tool," Dr. Romero said.

"Prematurity is a common, serious, and growing problem in this country," said Nancy S. Green, M.D., medical director of the March of Dimes. "More research to identify and address the risk factors for prematurity are needed if we are to reverse this trend. The innovative nature of this study has earned it our annual award for the best research paper on prematurity."

Least forceful way to deliver a baby whose shoulders are stuck in the birth canal

Mon, 03 Jan 2005 18:40:38 PST

( from http://www.rxpgnews.com ) Johns Hopkins researchers, using a novel birthing simulator designed by biomedical engineering faculty, staff and students at the University, have identified what may be the least forceful way to deliver a baby whose shoulders are stuck in the birth canal.

Shoulder dystocia, in which the baby's shoulders won't move past the mother's bony pelvis during delivery, occurs in about 5 percent of births. Of these, up to a quarter of deliveries may result in an injury to the baby's brachial plexus, the nerves that control movement and sensation in the arm. As many as 10 percent of infants may sustain some permanent damage.

An obstetrician can perform one of several maneuvers to manipulate the position of either the mother or the baby when shoulder dystocia occurs. The Hopkins researchers found that turning the baby so its spine faces the mother's belly (a technique known as anterior Rubin's maneuver) requires less force than either turning the baby so its spine faces the mother's spine, or moving the mother's legs back to try to reduce the force of the baby's shoulders against the mother's pelvis.

These results are reported in the Jan. 4 issue of the American Journal of Obstetrics and Gynecology.

"Every obstetrician is likely to face this circumstance at some point in his or her career, and the longer the baby remains stuck, the higher the risk that the baby will suffocate," says Edith D. Gurewitsch, M.D., lead author of the study and an assistant professor of gynecology and obstetrics. "While further studies are necessary before we can make definitive recommendations on the use of one procedure over another, our initial lab results demonstrate that we can measure what is happening to the baby during birth, and that we can alter our techniques to create a safer environment for delivery - a goal shared by every obstetrician."

For the study, Gurewitsch performed 30 mock deliveries using a complex birthing device designed by Hopkins faculty, staff and students to simulate shoulder dystocia. It consists of several parts: a maternal model with a three-dimensional bony pelvis, a fetal model, a force-sensing glove, and a computer-based data acquisition system.

The maternal model - composed of pleather "skin," carpet foam, foam sealer and other components - features a birth canal, a mock uterus connected to a pneumatic pump to simulate the natural pattern of uterine contractions and force from a mother's pushing, and flexible legs that can be moved to rotate the pelvis.

The fetal model consists of a cloth mannequin outfitted with a joystick device, a spring and wooden dowels representing the cervical vertebrae. Additional elements measure neck extension, rotation and stretching of the brachial plexus nerves during delivery.

To deliver the "baby" during the study, Gurewitsch wore a force-sensing glove. The custom, nylon-lycra glove has pockets sewn into it to house force-sensors, which were used to measure the traction she used in delivery. Wires emanating from the sensors connected to a computer-based data-acquisition system that stored and processed the data.

Gurewitsch performed 10 deliveries by turning the baby so its spine faced the mother's belly, 10 deliveries by turning the baby so its spine faced the mother's spine, and 10 deliveries by moving the mother's legs back.

The first maneuver was associated with the least amount of force, at 6.5 pounds, to the baby's head necessary to achieve delivery. The other techniques applied 8.5 pounds and 16 pounds, respectively. The first maneuver also produced the least amount of stretching on the baby's brachial plexus nerves, at 2.9 millimeters. The other techniques caused the nerves to stretch by 6.9 millimeters and 7.3 millimeters, respectively.

Researchers calculated that turning the baby created as much as 2 centimeters of extra space between the baby's shoulders and the mother's pubic bone, whereas raising the mother's legs produced only 1 centimeter of extra space.

"Since complicated deliveries comprise a small percentage of vaginal births, clinicians in training often do not have adequate exposure to these types of deliveries," says Robert H. Allen, Ph.D., senior author of the study and a senior engineering lecturer at Hopkins. "Our device provides an opportunity to simulate birth complications and allow clinicians to practice resolving them. Using this birthing simulator as a research tool, we may be able to glean new insights into complicated births and develop new ways to resolve them."

The device won top prize in a student design competition held in September during the international meeting of the Institute of Electrical and Electronics Engineers' Engineering in Medicine and Biology Society in San Francisco. The inventors, including Gurewitsch, Allen and Paul Gilka, manager of the laboratory that housed the work, have filed a provisional patent on the simulator.

In continuing work with the laboratory model, Gurewitsch and Allen plan to have other doctors train on the simulator to develop a better sense of how much force they apply to babies during delivery.

No level of alcohol consumption during pregnancy has been determined safe

Mon, 27 Dec 2004 23:22:38 PST

( from http://www.rxpgnews.com ) To determine the alcohol consumption patterns among all women of childbearing age, including those who are pregnant or might become pregnant, CDC analyzed data for women aged 18--44 years from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) survey.

The results of that analysis indicated that approximately 10% of pregnant women used alcohol, and approximately 2% engaged in binge drinking or frequent use of alcohol. The results further indicated that more than half of women who did not use birth control (and therefore might become pregnant) reported alcohol use and 12.4% reported binge drinking. Women who are pregnant or who might become pregnant should abstain from alcohol use.

CDC monitors the prevalence of alcohol use among women of childbearing age through BRFSS. In 2002, with the inclusion of a family planning module in the BRFSS survey, information became available to assess the alcohol consumption patterns among pregnant women and also among women who might become pregnant. BRFSS is a monthly, state-based, random-digit--dialed telephone survey of the U.S. civilian, noninstitutionalized population aged >18 years in all 50 states, the District of Columbia, and three U.S. territories.

In 2002, the median state/area response rate was 58.3% (range: 42.2%--82.6%). For 2002, a total of 64,181 women aged 18--44 years were included as the general population of childbearing-aged women. Participants were asked about their use of alcohol during the 30 days preceding the interview.

Alcohol usage questions included the number of days per week or month the respondents had at least one drink, the average number of drinks consumed on a drinking day, the number of times the respondents had five or more drinks per occasion, and the number of times they drove when they had "perhaps too much to drink." The following alcohol consumption patterns were assessed: any use (at least one drink on one occasion), binge drinking (five or more drinks on one occasion), and frequent drinking (seven or more drinks in a week or binge drinking).

In addition, women were asked whether they or their partners were doing anything to prevent pregnancy. Reasons were collected from women who responded that they or their sex partners were not doing anything to prevent pregnancy.

For this analysis, 4,404 women who might become pregnant were defined as those who were not using any type of birth control and provided one of the following reasons: wanted a pregnancy (52.4%), did not care whether pregnancy occurred (19.1%), did not think they would become pregnant (14.3%), did not want to use birth control (5.7%), feared the side effects of birth control (4.2%), thought they were too old to become pregnant (1.8%), could not pay for birth control (1.3%), or had lapsed in use of a method (1.2%).

Excluded from this defined category were women who were not sexually active, had a same-sex partner, had no sex partner, had undergone sterilization or hysterectomy, were postpartum breastfeeding, were currently pregnant, had other unspecified reasons for not using birth control, or did not provide any reason. Prevalences for alcohol consumption patterns were calculated for women who were pregnant, those who might become pregnant, and women of childbearing age overall.

A total of 2,689 women reported that they were pregnant. Because of the limited number of pregnant women available in the 2002 BRFSS sample population, additional analyses were performed by focusing only on the demographic characteristics of women who might become pregnant and who engaged in binge drinking. To obtain appropriate statistics, weighted data analyses were performed to reflect general population estimates, and standard errors were calculated by using statistical analysis software.

The 2,689 women who reported that they were pregnant and the 4,404 women who might become pregnant represented population-weighted estimates of 4.7% and 7.6%, respectively. Among those who reported not using birth control, 52.4% said that they wanted to become pregnant.

The prevalence of binge drinking was 12.4%, both for childbearing-aged women overall and for those who might become pregnant, and 1.9% for pregnant women. The prevalence of frequent drinking was 13.2% for childbearing-aged women overall, 13.1% for women who might become pregnant, and 1.9% for pregnant women. The prevalence of any use of alcohol was 52.6% for the childbearing-aged population overall, 54.9% for women who might become pregnant, and 10.1% for pregnant women.

Binge drinking prevalences for childbearing-aged women overall varied among participating states, ranging from 21.6% in Wisconsin (95% confidence interval [CI] = 18.8%--24.8%) to 5.4% in Kentucky (CI = 3.8%--7.5%

Safety of childbirth after C-section examined

Thu, 16 Dec 2004 18:09:38 PST

( from http://www.rxpgnews.com ) The most definitive study to date of women who had previously undergone cesarean-section deliveries, but who later chose an attempt at vaginal delivery for subsequent births, shows that serious complications are possible, but that the absolute risk of these occurring is very small.

The multicenter study was sponsored by the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network a part of the National Institutes of Health.

"This study is significant in addressing an issue that continuously receives debate in obstetrics," said Mark Landon, vice chairman of obstetrics and gynecology at The Ohio State University Medical Center and principal investigator for the four-year study. "Until now, the information comparing a trial of labor and an elective repeat operation has been inadequate to counsel women concerning their options for childbirth following prior cesarean delivery."

Researchers at 19 academic medical centers joined forces to complete the research, which included cases between 1999 and 2002. Of the approximately 46,000 women in the study with a prior cesarean delivery, one in three, or about 16,000, underwent elective, repeat cesarean delivery without labor. Another 18,000 attempted "vaginal birth after cesarean section," (VBAC), while approximately 12,000 women had other maternal or fetal indications for a repeat cesarean delivery.

The study demonstrated that, when compared to elective repeat cesarean delivery, women attempting VBAC are at increased risk for maternal morbidity and serious obstetric complications, such as uterine rupture, endometritis, transfusion, or newborn hypoxic ischemic encephalopathy (newborn brain injury due to lack of oxygen).

About 39 percent of the women chose to attempt a vaginal delivery in spite of their previous cesarean section. Of these, 73 percent succeeded in this "trial of labor" and delivered vaginally. Symptomatic uterine rupture - one of the major risks in such situations - occurred in less than 1 percent (124 women or 0.7 percent) of these cases.

The study also confirmed that an increased risk of uterine rupture accompanied labor induction, which was evident regardless of the method of induction employed.

Among infants whose mothers chose this "trial of labor," the frequency of hypoxic ischemic encephalopathy (HIE) another serious complication--was increased. While only 12 cases of HIE occurred with "trial of labor" cases, there were no cases among women who had elected to have a repeat cesarean delivery. Seven of 12 cases of HIE, including two neonatal deaths, followed uterine rupture. Maternal morbidity, endometritis and blood transfusion were all more likely among women who chose VBAC than among those who chose repeat cesarean delivery.

"While the magnitude of these risks for serious complications is small, women who have had a previous cesarean section and who are considering choices for childbirth should be aware of the level of risk involved," said Landon. "Overall the risk for a serious newborn complication is approximately 1 in 2000 trials of labor. At this level of risk, many women will continue to opt for an attempted VBAC. The benefits of this approach would be faster recovery, shorter hospital stay and avoiding the risks of major surgery."

In the United States, the overall rate of cesarean delivery has risen dramatically, from 5 percent in 1970 to more than five times that (27 percent) in 2003. During the last 25 years, as repeat cesarean birth became the leading reason for abdominal delivery, studies detailed the relative safety of VBAC and suggested increasing the VBAC rate would be crucial to lowering the overall rate of cesarean delivery. The rate of VBAC in the United States increased 10-fold, from 3 percent in 1981 to 31 percent in 1998, Landon said.

But the safety and appropriateness of widespread adoption of VBAC has been challenged. Landon said there has been an apparent rise in reported uterine rupture among pregnant women, with associated maternal and perinatal risk. More reports have appeared in the literature, but actually the rupture rate has been fairly constant: 0.5 1.0 percent of trials of labor. The rate of VBAC fell by more than half to 10.6 percent in 2003. In addition, liability concerns have led physicians and hospitals to limit VBAC as an option, Landon said.

In past studies of VBAC and cesarean sections, the magnitude of risks has remained uncertain; the terminology and definitions for uterine rupture have varied significantly; and the lack of direct evidence about benefits and risks has made it difficult for physicians to provide appropriate counseling. The picture has been anything but clear.

"There are important distinctions in this study," Landon noted.

"Existing data until now has largely come from retrospective studies, utilizing birth certificate data which is often unreliable. This study was prospective in gathering data by trained nursing personnel and underwent central renew by the investigators for cases of uterine rupture. This is particularly important with respect to the fetal outcomes associated with uterine rupture. It is important to share this new data with women regarding childbirth choices."

Second cesarean section is safer than normal delivery

Thu, 16 Dec 2004 16:06:38 PST

( from http://www.rxpgnews.com ) For a pregnant woman who already has had one cesarean delivery, an attempt at vaginal delivery is more dangerous for the baby than a second cesarean section, according to a research study at 19 academic health centers, including Wake Forest University Baptist Medical Center.

The study, published in today's New England Journal of Medicine, showed that vaginal birth after a cesarean section (VBAC) also is more dangerous for the mother, leading to the increased possibility of a ruptured uterus and such complications such as endometritis infection of the uterus and the need for transfusions.

"This information is relevant for counseling women about their choices after a cesarean section," said the researchers, who included Margaret A. Harper, M.D., of Wake Forest Baptist. The 19 academic health centers all belong to the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development.

The issue is important because of the debate about the overuse of cesarean sections, which reached 26 percent of all births in 2002. The U.S. Public Health Service has been seeking a reduction in the rate of cesareans to 15 percent; and had set a goal that 37 percent of women who previously had had a cesarean section to try normal or vaginal delivery for the next child.

"This study shows that the risk of adverse perinatal outcomes is increased with a trial of labor after a prior cesarean delivery but also confirms that the risk is still very small," said Harper, associate professor of obstetrics and gynecology. "Therefore, the members of the network conducting this study recommend thorough counseling of women interested in VBAC, but have not recommended abandoning VBAC."

She said that an important issue is the number of future pregnancies desired. "The risks of complications before and during delivery increase with increasing numbers of cesarean operations," she said. The lead author is Mark B. Landon, M.D., of Ohio State University. For the study the researchers monitored all pregnant women at the 19 centers during a four-year period who had had a cesarean section and were carrying a single child 45,988 women in all. Of those, 17,898, or 38.9 percent, elected to try normal delivery, and 15,801, or 34.4 percent, elected a second cesarean. Of the rest, 9,011 had medical reasons to have a second cesarean, and 3,276 were already in labor when they arrived at the hospital.

The results showed that the rate of uterine rupture was seven per 1,000 among the mothers who were attempting vaginal delivery, compared with no uterine ruptures among the women who chose a second cesarean. Endometritis developed in 2.9 percent of the women who chose normal delivery, compared to 1.8 percent of the women who elected a second cesarean; of the women who elected normal delivery, 1.7 percent required a transfusion, compared to 1 percent of those in the cesarean group.

The researchers said the results indicate that in about one in 2,000 cases, the baby would be affected adversely during or after the attempt at normal delivery. The researchers said the risk "is quantitatively small but greater than that associated with elective repeated cesarean delivery."

The researchers found that one complication of birth insufficient oxygen supply to the brain that can lead to acute brain injury "was significantly greater among the infants of women who underwent a trial of labor" than among the infants of women who elected a second cesarean. "The rate was eight per 10,000 in the attempted vaginal delivery group and no cases in the elective repeat cesarean delivery group," Harper said.

The researchers noted, "It has generally been accepted that vaginal delivery is associated with lower maternal morbidity and mortality rates than is cesarean section." But the instances of infection or inflammation of the wall of the uterus and the increased rate of transfusion mitigate that advantage.

"During the past 25 years, as the number of repeated cesarean sections grew, vaginal birth after cesarean section was increasingly recommended in clinical-management guidelines, prompting a rise in the use of this approach in the United States from 3 percent of deliveries after a cesarean section in 1981 to 31 percent in 1998."

Increasing concern about the risk of uterine rupture and the health of both the mother and the baby led to a sharp decline in VBAC to 12.7 percent in 2002. The new study was aimed at providing scientific evidence on which approach was better.