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Cesarean delivery is an abdominal surgical procedure performed for child delivery when the vaginal route is not feasible or desired due to maternal/fetal indications. All childbirth facilities should be able to safely perform a cesarean, which is not the current reality. For planned cesarean delivery, the facility must be prepared for the patient. In contrast, for unplanned arrivals at the facility, FIGO's Prep‐for‐Labor triage method allows rapid decision‐making on whether cesarean delivery can be safely performed on site or whether transfer to an advanced care center is needed. A checklist of staff/tools for safe on‐site cesarean delivery is provided to enable timely decision‐making. Maternal complications following cesarean are three‐fold higher than vaginal delivery. To prevent nonmedically indicated cesarean by favoring vaginal delivery, up‐to‐date safe and effective guidance is provided, defining labor, second stage length, and status before an arrested labor is confirmed. Whether cesarean delivery is planned or emergency, the Misgav Ladach simplified procedure is proposed as it is suitable for both low‐ and high‐risk cases, including twins, thereby reducing both operative morbidity and postoperative recovery. A trial of labor after first cesarean (TOLAC) should be pursued when feasible, for which the indications, contraindications, safeguards, and steps of safe labor induction are delineated. Implementation of these good practice recommendations will improve childbirth by reducing excessive nonindicated cesareans, while precisely defining the resources and postoperative care required for safe performance on site. Enabling safe childbirth by cesarean and TOLAC, even at sites with low rates currently, will significantly improve maternal and fetal outcomes. Synopsis: Cesarean delivery rates remain high. FIGO's Prep‐for Labor triage method defines site suitability, staff/tools, indications, methods, and how to minimize risks. Redefining labor arrest and trial of labor after cesarean reduces rates. [ABSTRACT FROM AUTHOR]

Childbirth is an intense event in which decisions may need to be made in seconds to guarantee the health of both mother and newborn. Despite health systems and care approaches varying widely according to real-life scenarios, availability of facilities, beliefs, resources, staff, and geography, among others, optimal outcomes should be ensured worldwide. Triaging low-risk pregnancies from high-risk pregnancies is the first step to ensure proper allocation of resources. From this need, we developed FIGO's Prep-For-Labor triage methods, a series of 2-minute labor and delivery bundles of care, with special regard given to low-and middle-income countries and rural settings. Around 80% of women, once properly triaged, can pursue vaginal delivery with minimal intervention, while those at risk can either be managed on site or transferred promptly to an advanced care site. FIGO's bundles of care and good practice recommendations for labor and delivery and immediate newborn triage cover four clinical scenarios: (1) preterm labor; (2) induced or spontaneous labor at term; (3) cesarean delivery; and (4) newborn care. From rapid triage of the mother (low vs high risk) to the list of required equipment, description of skilled staff, and coordination of resources, the recommendations for care are introduced across these four areas in this overview article. Implementing the proposed management steps described in each summary can improve maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Worldwide, health systems and care approaches vary widely due to local reality, distance to facilities, cultural norms, resources, staff availability, geography, and politics. Consequently, globally maternal–newborn dyad care and outcomes are highly variable, leading to approximately 800 maternal deaths daily with a 100‐fold difference among high‐ and low‐resource countries. Irrespective of where care is received, maternal safety and wellbeing should be preserved. Despite ongoing efforts, however, this is not the case. Large gaps exist between spending and clinical outcomes. Segmented health care, coupled with poor planning and inadequate resource distribution, results in failure to provide essential life‐saving treatment. The proposed solution is a regional integrated care model from midwife to advanced level III/IV care and the newborn unit, achieved through effective coordination by site, staff, and clinicians. This model has been successfully implemented in high‐ to low‐resource countries in the past 20 years. In the large diverse population of the United States, constructive steps have been implemented to reduce high maternal mortality in black and rural communities. The COVID‐19 pandemic demonstrates the feasibility of rapid resources coordination to provide effective advanced care. The proposed integration of resources will have a major positive impact on the maternal–newborn dyad. Fragmented‐care resource‐independent policies put the maternal–newborn dyad at high risk. Integration of healthcare resources even in low‐income countries can improve global dyad outcomes. [ABSTRACT FROM AUTHOR]

Persistent mating‐induced endometritis (PMIE) is a significant cause of mare infertility hence its treatment would advance the management of susceptible mares. Preimplantation factor (PIF) is secreted by viable embryos, including human, mouse and cattle, and is essential for maternal immune‐tolerance without immune‐suppression by modulating inflammation. This preliminary study aimed to test whether PIF exerts inflammatory‐modulating properties upon equine endometrium challenged with Escherichia coli‐derived lipopolysaccharide (LPS) using endometrial explant culture. Follicular (n = 3), luteal (n = 4), anoestrous (n = 4) and transitional (n = 4) stage endometrial explants were established and cultured in triplicate in either serum‐free medium alone (control) or medium with; 50 or 100 nmol/L synthetic PIF (sPIF); 3 μg/mL LPS; LPS and 50 or 100 nmol/L sPIF; or scrambled PIF (PIFscr; same amino acid composition arranged in a different order). Media samples were collected at 24 and 72 h, representing acute and chronic inflammatory response. Radioimmunoassay determined Prostaglandin F2α (PGF2α) as an inflammatory marker. The only significant observation was the abrogation of PGF2α response to LPS challenge by 100 nmol/L PIF for follicular stage tissue, 24 h after treatment. Further studies are therefore, warranted to realise PIF potential in managing PMIE. Preimplantation factor modulates acute inflammatory responses of equine endometrium. [ABSTRACT FROM AUTHOR]

A typical autoimmune neuro-inflammatory disease ( NID), multiple sclerosis ( MS), is more prevalent in women than in men. Majority of patients with MS are of child-bearing age; therefore, occurrence in pregnancy is common. Herein, we review proposed disease mechanisms and suggest therapeutic interventions, focusing on the remarkable pregnancy-induced protection against MS - insofar considered as best, albeit temporary therapy for such harsh NID. Current drugs used for MS therapy in pregnancy are described. Role of non-pregnancy-specific agents considered involved in amelioration of disease is also presented. This review highlights pregnancy-derived neuro-protective agents, proposing that unique pregnancy-induced immune-protective environment is because of the conceptus and its direct action. The essential role of pre-implantation factor ( PIF) in pregnancy is delineated. Finally, PIF immune-modulatory effects and efficacy in chronic model of neuro-inflammation to reduce inflammation and paralysis coupled with neural regeneration is presented. Overall, we postulate that this embryo-derived-compound holds great promise to improve MS and possibly neuro-inflammation in general. [ABSTRACT FROM AUTHOR]

Background: The crestal core elevation (CCE) technique is reportedly a less invasive procedure than the lateral window elevation technique. We retrospectively evaluated long-term outcomes of CCE procedures over an 11 -year time period. Methods: Core preparations were made after extractions of 57 upper molars in 45 patients. Extraction sites were drilled with a calibrated trephine bur to an estimated distance of 1 mm from the sinus membrane. The trephined interradicular bone and underlying sinus membrane were imploded into the sinus. The surgical crater and residual extraction socket were filled with deproteinized bovine bone mineral or freeze-dried bone allograft, stabilized, and protected with an absorbable collagen membrane and fully covered with coronally positioned flaps. Implants were placed 4 months later. Success was defined if ≥9 mm available bone height was available. Where the available bone height varied between 7 and 9 mm, implant placement was complemented using the bone-added osteotome sinus floor elevation technique; those sites were defined as a "partial success." Results: The CCE technique was successful in 31 (68.9%) out of 45 sites, and partially successful in six (13.3%) out of 45 sites. Eight sites failed (17.8%). Surgical failures were caused by core detachment resulting in large tears of the sinus membrane. Implants placed in successful sites presented a 100% survival rate during the study duration. Conclusions: CCE implemented simultaneously with molar extractions provided therapeutic benefits and clinical limitations. The subsequent implant placement using CCE revealed an excellent survival rate in the study population evaluated. [ABSTRACT FROM AUTHOR]

Pregnancy is a unique immune state in which both mother and embryo/fetus tolerate and interact with one another through term, without interfering with the mother's native immunity. When the embryo is viable, it initiates maternal immune tolerance (IT)—but not immune suppression. The balance is complex: some immune disorders are ameliorated during pregnancy, despite the presence of an “inflammatory” environment. We have identified a pregnancy viability biomarker—preimplantation factor (PIF)—secreted only by viable embryos, which helps to initiate this maternal tolerance and uterine receptivity. Using anti-PIF antibodies, we have detected PIF in the fetus and placenta. Beyond enhancing uterine receptivity locally, PIF has also been detected in maternal circulation, and may promote peripheral tolerance. In the fetus, PIF may help avoid a “graft-versus-host”-type reaction PIF exhibits unique potent immune-modulatory effects and its synthetic analogue has been shown to exert significant protection in diverse immune scenarios. Nontoxic, low-dose, short-term PIF administration has led to long-term effects in preclinical models of multiple sclerosis (MS), juvenile diabetes mellitus (JDM), and graft-versus-host disease (GVHD), in a manner enabling its translation into a clinical setting. Further investigation of this compound is warranted. [ABSTRACT FROM AUTHOR]

Offers information on the phases of fertilization. Immunosuppressive activity of the follicular fluid that surrounds the egg cells; Maternal immune reaction during egg and sperm-head fusion; Differentiation of embryonic cell during blastocyst and trophoblast polarization.

The effect of cadmium (Cd) as CdCl2 on some placental enzyme activities were studied after explants had been incubated with the salt for 6 or 24 hr. The results indicated that, for both incubation periods, Cd at low doses had a stimulatory effect on aryl hydrocarbon hydroxylase (AHH) (a phase I enzyme) and on quinone reductase and catecholamine-O-methyltransferase (COMT) (both phase II enzymes). This effect was dose- and time-dependent. Only the activities of AHH and COMT showed a biphasic response, (i.e., increases at the lower dose levels and decreases with the higher ones), whereas that of quinone reductase continually increased with all the dose levels of the metal administered. Glucose-6-phosphate dehydrogenase (G-6-PD) activity was found to be inhibited at all the dose levels of Cd tested, the effect also being time- and dose-dependent. In conclusion, it appears that the use of placental explants can serve as a valuable means for studying the toxic effects of certain xenobiotics, as reflected in the activity of various important enzymes. [ABSTRACT FROM AUTHOR]

The effect of HgCl2 on human term placental aryl hydrocarbon hydroxylase (AHH), quinone reductase (QR), catecholamine-O-methyltransferase (COMT), and glucose-6-phosphate dehydrogenase (G-6-PD) enzyme activities was studied after incubation of placental explants with the salt for either a 6 or 24 hr period. Mercury (Hg) increased the activities of AHH, QR and COMT, but decreased that of G-6-PD. The increases in enzyme activities, as well as the decrease in G-6-PD activity observed were in all cases time- and dose-dependent. The data suggest that Hg exerts an enhancing effect on the activity of placental phase I enzyme (AHH) and phase II enzymes (QR and COMT). This enhancement may be due to increased de novo synthesis, elimination of some suppressing agent(s), or the decreased breakdown of enzyme protein. Also, the inhibitory effect of Hg on G-6-PD activity appears to indicate that this enzyme is appreciably more sensitive to Hg than the other three enzymes. These findings may imply increased cellular resistance to Hg toxicity. The altered state of activity may also be used as a tool for monitoring exposure to this metal. [ABSTRACT FROM AUTHOR]

Deals with the integration of the Society for Investigation of Early Pregnancy (SIEP) with the American Society for Reproductive Immunology. Information on the sated mission of SIEP; Objective of SIEP on joining the publication of the "American Journal of Reproductive Immunology"; Condition of the study of reproductive immunology.