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Background: Amniotic fluid volume (AFV) is a vital sign of fetal well-being. Maternal plasma volume expansion has been demonstrated to have a role in relieving oligohydramnios. Maternal venous fluid infusion, maternal hydration and maternal water immersion can influence both maternal plasma volume and amniotic fluid volume. A previous study showed that water immersion during the third-trimester of pregnancy is able to maintain higher amniotic fluid index (AFI) levels. Objectives: The present study is aimed at exploring the acute shifts in amniotic fluid index (AFI), maternal haematocrit (Ht) and haemoglobin (Hb) levels, maternal plasma volume and plasma and urine osmolality during deep water immersion and it is aimed at evaluating the relationship between amniotic fluid and maternal plasma changes in healthy singleton pregnancies. Methods: 23 volunteers with low-risk singleton pregnancy were recruited. Ultrasound evaluation of the amniotic fluid index (AFI) was provided and urine samples were received before and after 50 minutes of maternal water immersion in deep (200 cm.) thermo-neutral (29°±1°C) water, performing a swimming-program for pregnant women. Before water immersion (0, basal) plasma sample was collected through venous catheter positioned in the cubital vein; plasma sample was collected at 10° minute (1st sample) and at 45°. minute (2nd sample) of water immersion. Urine specific gravity, haematocrit and haemoglobin levels, plasma glucose, sodium, potassium, albumin, total protein and blood urea nitrogen were determined in all samples. Plasma volume change, plasma osmolality as well as percentage (%x) changes of biochemical analytes were calculated from the obtained data. Statistical analysis with paired t-test and correlation Pearson's test; significance from p=0,05. Results: 428 sonographic measurements of deepest amniotic pocket and 552 biochemical evaluations were performed. Complete data from 20 healthy pregnant women were statistically analysed. AFI increased from mm. 150,5±37,5 (mean±SD) to mm. 182,2±38,2 (p< 0,0001) after 50 minutes water immersion period. Sodium slightly raised in the first 10 minutes from 140,3±3,7 to 141,8±4,5 (mEq/L) (p= 0,05). Haematocrit, haemoglobin, glucose, blood urea nitrogen and albumin decreased in the first 10 minutes and remained lower to the end of the water immersion period. Haematocrit: (basal - first - second sample) 34,4±2,3 - 33,5±2,8 - 33,1±2,4 (p=0,002); haemoglobin (g/dL): 11,8±0,8 - 11,5±1,0 - 11,3±0,7 (p= 0,002); glucose (mg/dL): 82,9±13,1 - 73,0±10,3 - 66,8±7,8 (p<0,001); blood urea nitrogen (mg/dL): 19,1±4,6 - 18,4±4,9 - 17,8±5,2 (p=0,02); albumin (g/dL): 3,52±0,2 - 3,4±3,1 - 3,4±3,0 (p=0,01). Potassium level, plasma osmolality and total protein didn't alter during water immersion. Estimated maternal plasma volume raised from basal 2833,9±340,2 mL to 2869,7±338,6 (p=0,009) and 2889,8±331,9 (p=0,002) after 50' water immersion, with a 106,3±8,2% shift in plasma volume estimated by haematocrit and haemoglobin values. The amount of %AFI changes was significantly correlated to the %Ht changes (r= -0,44; p=0,05), to the %Hb changes (r= -0,52; p=0,01) and to the %plasma volume changes (r=0,54; p=0,01). Conclusion: This study agrees with previous papers to state the rapid increase in plasma volume during maternal acute hydration and water immersion. Modulation in intramembranous absorption could be hypothesized to be the link between maternal plasma volume changes and amniotic fluid volume. Studies demonstrated that low maternal plasma volume expansion and high haematocrit and haemoglobin levels can be used to predict and monitor women at risk for preeclampsia. So, later immersion could be a harmless, available and pleasant way to prevent dehydration and low plasma volume expansion during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Osteopathy is present in a large number of hospitals in Italy, firstly in pediatric departments. It is mainly deals with musculo-skeletal imbalances, but osteopathy states to have a role in improving general health. Few studies about safety and efficacy of osteopathic manipulative treatment (OMT) in Obstetrics have been produced. Objectives: Our long-term study, of which this report is a preliminary communication, is aimed at investigating the effects of OMT during the third trimester of pregnancy on labour and delivery and on the peri-partum parameters of fetal well-being and it is aimed at verifying the prognostic value of a diagnostic dynamic test. Methods: From July 2015, our cross-sectional and analytical controlled study enrolled women, with low-risk singleton pregnancy, referring to the hospitals of the Second District of Liguria (Savona and Pietra Ligure - Italy). The OMT and the diagnostic test were performed at the obstetrics-osteopathic practice of the hospitals, approved by the local Healthcare Director. Nulliparous patients who agreed to submit to OMT were treated at the beginning, mid and late (36-38 weeks) third trimester of pregnancy; patients who were not interested in OMT entered the control group. The values of the transverse diameter of the Michaelis' sacral rhomboid area (PSIS) in changing three different positions (1- vertical kneeling position; 2- hand-to-knee position; 3- kneeling squat position) and their differences were the diagnostic predictive tool. Results: Obstetrical outcomes considered for this study are: normal deliveries (ND), operative deliveries (OD: kiwi and/or >3 Kristeller manouvres), cesarean sections (CS), pharmacological inductions of labour for pregnancy beyond the term, demands for analgesia, use of oxytocin in the first stage of labour, episiotomy rate, presence of meconium-stained fluid, neonatal APGAR score, PROM. Statistical analysis of clinical outcomes: chi-square test and risk ratio (RR) with 95% confidence interval (95%CI). Apgar score was analyzed by Mann-Whitney U test. T-test and area under the ROC curve (θ value) for the transverse sacral diameter were done. Significance from p= 0.05. The low-risk nulliparae in labour were in total 327: 166 for the OMT group and 161 for the control group. The deliveries were between October 2015 and December 2016. It was shown to be significant (OMT vs control): an overall lower rate of dystocia (CS+OD: 19/166 - 11.4% vs 47/161 - 29.1%: p=0.00006; RR 0.39 and 95%CI 0.24-0.63), a lower CS rate during labour (7.8% vs 13.1%: p = 0.05; RR 0.52 and 95%CI 0.27-1.003), a lower OD rate (3.6% vs 16.1%: p=0.00006, RR 0.21 and 95%CI 0.08-0.49) and a lower use of episiotomy (9.8% vs 22.8%: p=0.002; RR 0.42 and 95%CI 0.24- 0.75). Amniotic fluid was less frequently meconium-stained (13.2% vs 23.6%: p = 0.01; RR 0.56 and 95%CI 0.34-0.91). The rate of pregnancy beyond the term, treated with pharmacological induction, was not significantly different (13.2% vs. 19.2%: p = 0.1) but in the OMT group CS+OD was less effective frequency (18.1% vs 54.8%: p = 0.008; RR 0.33 and 95%CI 0.12-0.85). The transverse diameter of Michaelis' losanga adapts in changing positions: 364 triplets of data (ND= 283; CS+OP: 81) are summarized as follow. ND PSIS1: mm. 125,5±13,8 and CS+OD PSIS1: mm. 127,7±16,9 (t-test and ROC: not significant - ns). ND PSIS2: mm. 133,1±14,1 and CS+OD PSIS2: mm. 130,1±17,6 (t-test and ROC: ns). ND PSIS3: mm. 132,9±15,1 and CS+OD PSIS3: mm. 127,7±18,1 (t-test and ROC: ns). ND PSIS2-1: mm. 8,3±3,8 and CS+OD PSIS2-1: mm. 2,5±2,1 (t-test p 0,000 ; ROC θ value: 0, and 95%CI 0,92-0,97). ND PSIS3-1: mm. 7,3±5,9; CS+OD PSIS3-1: mm. 1,1±4,3 (t-test p 0,000 ; ROC θ value: 0,81 and 95%CI 0,76-0,86 ). ND PSIS2-3: mm. 1,1±4,8; CS+OD PSIS2-3: mm. 1,4±3,7 (t-test and ROC: ns). A PSIS2-1 (difference between hand-to-knee position and vertical position) cut-off value of 3,0 mm. shows a True Positive Rate: 0,98; a True Negative Rate: 0,81; False Positive Rate 0,18; False Negative Rate: 0,01. Conclusion: Preliminary data from our experience confirm that osteopathic treatment during the third trimester of pregnancy is safe for both mother and baby, OMT seems to be able to support birth physiology and reduce dystocia. These outcomes potentially result in fewer days of hospitalization and a reduction in risk factors for maternal and neonatal disease. Osteopathy seems also to support midwives and obstetricians in the diagnosis of dystocia by its dynamic approach to external pelvimetry. WHO recommends collaboration and integration between traditional and conventional approaches in medicine. Midwives and osteopaths together could improve the quality of childbirth and delivery, thus affecting the well-being of the infants in the short and long term as well as women's health. [ABSTRACT FROM AUTHOR]

Background. Preeclampsia has been associated with maternal haemodynamic dysfunction and hypolumbarlordosis. These conditions are matched with lumbar spine stiffness, which can be treated with vertebral manipulations. It has been shown that vertebral manipulations have an effect on the autonomous nervous system and on vasomotor arterial tone. The vertebral segment most prone to complications is the lumbosacral tract, which is the level of the pelvic vasomotor centre in the osteopathic literature. It is well known that preeclampsia is accompanied by an impaired uterine arterial impedance. Objective. The purpose of this randomized pilot study is to verify in healthy non-pregnant Volunteers the effectiveness on uterine haemo-dynamics of two different types of vertebral manipulations directed on the lumbosacral area. Methods. Consecutive patients aged 22-44 years, with ovulation and regular menstrual periods, without any pelvic disorder, any oral contraception, any hormonal or metabolic-related pathologies, were recruited. They were randomly inserted into four groups. Group A: L5-S1 inhibition technique (patient lying prone; technique: bilateral steady and firm pressure in the space between the transverse process of the fifth lumbar vertebra and the sacrum, for 90 seconds). Group B: Bilateral stimulation of the sacral base (patient lying prone; the sacral base is pushed anteriorly while the ilium laterally by high-velocity-low-amplitude manual technique, for 60 times, 1 time/sec.). Group C: sham (perception of the space opening at the L5-S1 level, on the rhythm of the diaphragmatic respiration, for 90-120 seconds). Group D: no treatment (trans-abdominal pelvic ultrasound exam, for 90 seconds). The study was performed during the peri-ovulatory days of each woman: the uterine flow is relatively stable, for any age and parity. Colour and pulsed doppler imaging was done before and after the technique, within a maximum of 15 minutes. Assessments were performed using a trans-vaginal transducer by a single experienced operator in ultrasound, to avoid interobserver variability. According to the usual technique, three similar consecutive waveforms of the uterine artery flow, detected at the level of the internal cervical os, were obtained: the average of the maximum velocity (Vmax) and of the pulsatility index (PI) were calculated automatically by the sonographic device. Statistical analysis for verifying the normal distribution of the data; variance analysis to evaluate the percentage difference between Vmax and PI; paired t-test to calculate the effect of the techniques. Statistical significance returned from a p<0.05. Results. A total 158 uterine arteries were analysed: 40 in the group A; 38 in the group B (2 dropped out for poor doppler waveform quality); 40 in the group C and 40 in the group D. The analysis within the groups showed a significant variation in peripheral resistance (PI) decreasing in group A (from 2,42±0,9 to 1,98±0,6; p = 0,0006) and increasing in group B (from 2,17±0,6 to 2,5±0,7; p <0.0001). No difference for groups C (2,13±0,61 – 2,12±0,6) and D (1,9±0,46 – 1,9±0,48). No significance for the absolute Vmax value; while the percentage change of Vmax between the first and the second detection was significantly higher (121,9%) for group B over all groups (respectively: group A = 98,02%, group C = 103,8% ; Group D = 98,7%). Conclusion. The measurement of the uterine artery flow is a key tool in clinical diagnosis and prognosis for placental dysfunctions. Spine manipulations had been demonstrated to have a cardiovascular effect at cervical and thoracic level. This first pilot study shows statistically significant effects in the pelvic area of different spine manipulation techniques. Effects on the peripheral impedance of the uterine arteries are: decreasing the PI by the inhibition technique and increasing the vascular resistance with the stimulation technique. Appropriate techniques could be useful to prevent pathological obstetrics condition and to treat abnormal menstrual bleeding, but it demands further research to detect long-term effects of the techniques and their effectiveness in disease conditions. [ABSTRACT FROM AUTHOR]

Background: Genetic factors have been associated with efavirenz (EFV) plasma concentrations in different populations. In this study, we investigated the effects of CYP2B6 516G>T (rs3745274), CYP2B6 c.485-18C>T (rs4803419), CAR c.540C>T (rs2307424), CAR c.152-1089T>C (rs3003596), and smoking status in a cohort of Serbian patients with HIV., Methods: Patients with HIV positive, all whites, were recruited from the HIV/AIDS Center at the Infectious and Tropical Diseases Hospital, University of Belgrade Teaching Hospital, Belgrade, Serbia. Mid dose (10-14 hours after dose) EFV plasma concentration was determined using a validated liquid chromatography/tandem mass spectrometry method. Genotyping for CYP2B6 516G>T (rs3745274), CYP2B6 c.485-18C>T (rs4803419), CAR c.540C>T (rs2307424), and CAR c.152-1089T>C (rs3003596) was conducted using allelic discrimination real-time polymerase chain reaction assay. One-way analysis of variance, Mann-Whitney test, Pearson or Spearman correlation, and multiple linear regression were used for data analysis., Results: Minor allele frequencies were similar to frequencies reported in other European populations. The overall mean (95% confidence interval) plasma EFV concentration was 2800 ng/mL (2460-3140). Significant differences between patients based on CYP2B6 516G>T (rs3745274) genotypes were observed: GG (n = 60), 2320 (range, 2160-2480) ng/mL; GT (n = 30), 3230 (range, 2790-3670) ng/mL; and TT (n = 2), 10,700 (range, 6170-15,300) ng/mL (P = 2.0 × 10). In multivariate linear regression analysis, CYP2B6 516G>T (rs3745274) [β = 1770 (1230 to 2310) ng/mL, P < 0.0001] and smoking status [β = -464 (-1250 to -43.3) ng/mL, P = 0.038] were independently associated with plasma EFV concentrations., Conclusions: The effects of CYP2B6 516G>T (rs3745274) and smoking status on EFV plasma concentration in the Serbian population have been established for the first time.