Search

Aim Cerebellar hypoplasia, particularly, trisomy 18, represents a chromosomal abnormality. However, morphological assessment of the fetal cerebellum is yet to be established. The purpose of this study was to produce reference values for the fetal transverse cerebellar diameter (TCD), anteroposterior cerebellar diameter (APCD) and the ratio of APCD to TCD (APCD/TCD ratio) in normal fetuses, compared with cases of trisomy 18. Methods This retrospective study included 266 normal singleton pregnancies resulting in term delivery at our institution from 2012–2013. Patients had received ultrasound examinations in the second trimester. TCD and APCD measurements were performed and then APCD/TCD ratio was calculated. Consequently, three cases of trisomy 18 were compared with reference values. Results Gestational age correlated with TCD (rs = 0.766, P

Objective To assess whether prolonged second stage of labour influences the gestational age at the subsequent delivery. Methods We performed a retrospective cohort study Clinical information was retrieved from the McGill Obstetrical and Neonatal Database for the period of January 2001 to February 2008. We evaluated primiparous women with term singleton pregnancies who reached the second stage of labour. Women were divided into two groups, according to the duration of the second stage: delivery after more than three hours of full cervical dilatation, or delivery within three hours The primary outcome measured was the incidence of spontaneous preterm births at the subsequent delivery. Results Among 1818 women whose records were available for analysis, 416 women (22.9%) had a prolonged second stage of labour in their first delivery. Women with a prolonged second stage in their first delivery did not deliver prematurely more often in the successive delivery than those women whose second stage was not prolonged (rate of preterm birth 4.3% in the prolonged second stage group and 5.5% in the normal second stage group; P =0.3). Conclusion In our population of primiparous women with a singleton term delivery, a prolonged second stage of labour lasting more than three hours was not associated with preterm birth at their subsequent delivery.

Separation between amniotic and chorionic membranes is a normal sonographic finding before 14th weeks of gestation. As pregnancy progresses, these membranes fuse and chorionic cavity becomes obliterated. Chorioamniotic membrane separation may occur spontaneously or as a complication of invasive intrauterine procedures. Following invasive fetal intervention, resulting in a condition referred to as chorioamniotic membrane separation (CMS) and it is reported to be associated with adverse perinatal fetal outcomes. Here we present a case of CMS that had occurred after a second trimester amniocentesis and resulted with the delivery of a term healthy baby. Complete post-interventional CMS may complicate pregnancy progression. Although there are no established guidelines to follow, close follow-up may CMS can be managed to be a morbid, rather than mortal condition.

To evaluate if gestational age (GA), mode of delivery and abdominal wall closure method influence outcomes in uncomplicated gastroschisis (GTC). Retrospective review of NICU admissions for gastroschisis, August 2008–July 2016. Primary outcomes were: time to start enteral feeds (on-EF), time to discontinue parenteral nutrition (off-PN), and length of stay (LOS). A total of 200 patients with GTC were admitted to our NICU. Patients initially operated elsewhere (n = 13) were excluded. Patients with medical/surgical complications (n = 62) were analyzed separately. The study included 125 cases of uncomplicated GTC. There were no statistically significant differences in the outcomes of patients born late preterm (34 0/7–36 6/7; n = 70) and term (n = 40): on-EF 19 (5–54) versus 17 (7–34) days (p = 0.29), off-PN 32 (12–101) versus 30 (16–52) days (p = 0.46) and LOS 40 (18–137) versus 37 (21–67) days (p = 0.29), respectively. Patients born before 34 weeks GA (n = 15) had significantly longer on-EF, off-PN and LOS times compared to late preterm patients: 26 (12–50) days (p = 0.01), 41 (20–105) days (p = 0.04) and 62 (34–150) days (p

The analysis of uterine EMG (electrohysterogram?EHG) records may help solve the problem of predicting pre-term labor. We investigated the adaptive autoregressive (AAR) method to estimate the EHG signal spectrograms and sample entropy, to separate and classify sets of term and pre-term delivery records, using the Term-Preterm EHG Database. The database contains four sets of records divided according to the time of delivery (term or pre-term:??37 or?37 weeks of gestation, respectively) and according to the time of recording (early or later: before or after the 26th week of gestation, respectively). Using the AAR method the term and pre-term delivery records recorded early can be separated (p?=?0.002), as well as all term and pre-term delivery records (p?

Background: Despite the advances in prenatal care and improving health indicators, preterm delivery and resultant infant mortality rate are still considerable. Emerged financial, social, mental and emotional damages could result in mental and behavioral disabilities for mothers as well as children. Although spontaneous preterm labor is well known as a multifactorial issue, yet poor nutrition is assumed as a strong related factor. Objective: To identify the role of dietary habits on preterm delivery prevalence in Iran, this study was conducted on pregnant women with preterm and term delivery. Methods: In this retrospective case-control study, 70 women with preterm labor and 70 women with term labor were compared in terms of their dietary habits. Women who met the inclusion criteria and referred to two hospitals in North-East of Iran were selected using purposive convenience sampling method and completed 163-item food frequency and dietary habits questionnaire. Results: This study showed that dietary habits of women with preterm labor are more unfavorable compared to women with term labor (P = 0.023). Generally, dietary habit of more than half of the women with preterm labor, in this study, was assessed unfavorable. In terms of different food groups, daily intake of vegetables was significantly lower in women with preterm labor (P = 0.02). Consumption of dairy products was also lower in women with preterm labor than women with term labor which was significant (P = 0.05). Conclusion: To prevent adverse outcomes of preterm delivery more attention regarding nutritional planning for pregnant women seems to be essential.

Background: Ectopic pregnancy is the commonest gynecological emergencies. If not treated timely, threatens the life but also places major morbidity on future fertility. This study performed to determine the future pregnancy outcomes following surgical management of ectopic pregnancy and factors influencing the outcome. Methods: Prospective observational study conducted at Tertiary Hospital. Records of patients with ectopic pregnancy between 2005 to 2010 traced, interviewed about fertility outcomes and the risk factors using a structured questionnaire. Patients followed for 3 years from index ectopic pregnancy. The main outcome measure was the occurrence of intrauterine pregnancy or ectopic pregnancy at 3 years of follow-up after the index ectopic pregnancy. Results: 64 patients with primary ectopic formed the basis of the study. 84.37% of patients undergone radical surgery (salpingectomy) and 15.62% forming the conservative group (Salpingotomy/milking) were included. In 3 years follow up, 40% of conservative group and 59% of radical group had intrauterine pregnancy. 30% in conservative group and 46% of radical group had term delivery. 20% of conservative group and 18.51% in radical group had repeated ectopic. Incidence of term delivery in patients with the past history of sub fertility was 25% and without subfertility 46%. 17% with tubal pathology and 63% with normal tube had term pregnancy. 37% aged more than 30 years and 44.64% aged less than 30 years had term pregnancy. Conclusions: Subfertility, tubal pathology and age will influence on future fertility outcome following ectopic pregnancy. Radical or conservative surgery does not have influence on future pregnancy outcome.

With increased clinical use of antibodies, long-term delivery strategies are needed to decrease injection frequency and improve health outcomes. A three-component drug-delivery system was developed for competitive affinity release of a streptavidin-antibody conjugate from agarose-desthiobiotin hydrogels via controlled dissolution of sparingly soluble biotin derivatives. The antibody conjugate was localized in the hydrogel through streptavidin-desthiobiotin complexation. Dissolution of sparingly soluble biotin derivatives disrupts streptavidin-desthiobiotin complexation for controlled release of the antibody conjugate. Release was tuned by altering the total biotin derivative concentration without further hydrogel or antibody modification. First-order tunable release of bioactive Avastin, a therapeutic anti-VEGF antibody, was demonstrated from a non-cytotoxic system for over 100 days.

Stillbirth is one of the most distressing complications of pregnancy and still occurs far too frequently. The rate of stillbirth has been decreasing worldwide but room for improvement remains even in high-income countries. Risk factors for stillbirth have been identified in an effort to detect those women at increased risk. However, risk factors are non-specific and do not identify most stillbirths. Strategies employed to screen the general population such as assessment of fetal activity, fetal growth screening and biomarkers have also been used to identify increased risk for stillbirth. As with clinical risk factors, these methods are non-specific. Interventions to prevent stillbirth include antenatal testing of high-risk women, ultrasonographic assessments of fetal growth and Doppler velocimetry as well as iatrogenic preterm or term delivery. Additional research into the role of these interventions and better identification of those at high risk for stillbirth will help to achieve further stillbirth reduction.

Background: Preterm labor is defined as labor occurring prior to 37 weeks which .There are different factors which can lead to preterm labor including maternal causes, chorioamnionitis, cervical insufficiency and others. Because there is no satisfactory clinical method fop prediction of preterm labor, so it is important to look for some probable predicting markers by para clinical investigation. Objectives: The main goal of this study is evaluation of relationship of intra-amniotic sludge in ultrasound exam and preterm delivery. Methods: In a cohort study included 84 pregnant women in 18 - 32 weeks of gestational age referred to Islamic Azad university of mashhad hospitals in 2015. Cervical length measurement and intra-amniotic sludge were examined by transvaginal probe. Depending on sludge density the cases were divided to three groups: no amniotic sludge, light sludge and dense sludge. According to gestational age at delivery time the women were classified into two groups: term (delivery after 37 weeks) and preterm (delivery before 37 weeks). Results: The prevalence of preterm delivery was 14/3%. The frequencies of term delivery in mothers with dense, light and no sludge were 78/6%, 82/1% and 96/4 % respectively, and for preterm delivery they were 21/4%, 17/9% and 3/6% respectively. But there was no statistically significant relationship between term and preterm delivery and type of sludge. Neonatal weight in mothers with sludge, was significantly lower than mothers without sludge. Conclusions: There is no statistically significant relationship between preterm delivery and type of sludge.

Interstitial, angular and rudimentary horn pregnancies have all been referred to as cornual pregnancies despite definite diagnostic criteria. Angular pregnancies can be followed up expectantly under close surveillance while interstitial and rudimentary horn pregnancies are terminated by medical or surgical methods. This study aimed to assess accuracy of ultrasound in the diagnosis of ‘cornual pregnancy’ and evaluate management. Data pertaining to clinical features, ultrasound findings and treatment modalities of the aforementioned conditions between January 2002 and December 2015 at a tertiary perinatal centre were retrieved from the medical records. The ultrasound images and surgical videos were reviewed by the authors. Of 62 cases, 35 were interstitial, 26 were angular/eccentric intrauterine, and 1 was a rudimentary horn pregnancy. The accuracy of ultrasonography in the diagnosis of interstitial and angular pregnancies was 71.0 and 46.8%, respectively. Medical management was successful in 33.3% of interstitial pregnancies. Fifteen women with interstitial pregnancy had subsequent pregnancies and nine (75.0%) were Caesarean deliveries. Rupture and recurrence rates of interstitial pregnancy were 34.2 and 2.9%, respectively. The rudimentary horn pregnancy was managed by laparoscopic excision followed by a subsequent term delivery. This study identified frequent occurrences of imprecise nomenclature that resulted in mismanagement of a few potentially viable angular pregnancies. It is imperative for clinicians and sonologists to use unambiguous nomenclature and avoid the term ‘cornual pregnancy’ altogether.

Commentary on: Wong LF, Wilkes J, Korgenski K, et al. Risk factors associated with preterm birth after a prior term delivery. BJOG 2016;123:1772–8.[OpenUrl][1] The aetiology of spontaneous preterm birth remains, despite many publications on the subject, largely indefinite.1 Studies focus on identification of risk factors for preterm birth in order to develop tailor-made care. Risk factor identification might however also provide clues in unravelling the pathophysiological processes leading … [1]: {openurl}?query=rft.jtitle%253DBJOG%26rft.volume%253D123%26rft.spage%253D1772%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx

Objectives To investigate whether, in pregnancies complicated by spontaneous preterm delivery, fetal fraction of cell-free DNA (cfDNA) in maternal plasma at 11–13 weeks' gestation is altered and if this measurement could be useful in the prediction of preterm delivery. Methods Fetal fraction of cfDNA was measured at 10 + 0 to 13 + 6 weeks' gestation in 3169 pregnancies, 3066 (96.7%) that delivered at ≥ 37 weeks and 103 (3.3%) with spontaneous delivery at

Proteins are effective biotherapeutics with applications in diverse ailments. Despite being specific and potent, their full clinical potential has not yet been realized. This can be attributed to short half-lives, complex structures, poor in vivo stability, low permeability, frequent parenteral administrations and poor adherence to treatment in chronic diseases. A sustained release system, providing controlled release of proteins, may overcome many of these limitations.This review focuses on recent development in approaches, especially polymer-based formulations, which can provide therapeutic levels of proteins over extended periods. Advances in particulate, gel-based formulations and novel approaches for extended protein delivery are discussed. Emphasis is placed on dosage form, method of preparation, mechanism of release and stability of biotherapeutics.Substantial advancements have been made in the field of extended protein delivery via various polymer-based formulations over last decade despite the unique delivery-related challenges posed by protein biologics. A number of injectable sustained-release formulations have reached market. However, therapeutic application of proteins is still hampered by delivery-related issues. A large number of protein molecules are under clinical trials, and hence, there is an urgent need to develop new methods to deliver these highly potent biologics.

During last years, a role of genetic factors in maturation of innate immunity functions was actively studied. It is known, that some SNP in TLR9 and TLR2 genes are known to be associated with development of infection in pregnancy. However, interrelations of various TLR-mediated anti-infectious mechanisms with genetic factors in pregnant women were poorly studied. The aim of present study was to evaluate associations between the following SNPs: Arg677Trp, Arg753Gln of TLR2 gene, A2848G SNP of TLR9 gene, and frequencies of pre-term birth complicated by infections in Russian population of Moscow City. SNPs Arg677Trp, Arg753Gln in TLR2 gene have been studied in a clinical material by means of PCR-RFLP analysis, using AciI restrictase. A2848G polymorphic marker in TLR9 gene was assessed by real-time PCR, employing TaqMan probes. It has been shown, that Arg allele of Arg753Gln TLR2 gene was associated with urogenital infections. When studying A2848G polymorphism in TLR9 gene, the A Allele was associated with normal delivery, thus assuming the A2848G polymorphic marker as a protective one.

We report a robotic-assisted, ultrasound-guided abdominal cerclage placement during pregnancy that resulted in term delivery, and review the current literature with respect to the efficacy of robotic-assisted transabdominal cerclage (RoboTAC) placement. The patient was a 25-year-old gravida 5 para 0-0-4-0 with cervical insufficiency who failed McDonald cerclage placement in two prior pregnancies, and presented at 13 weeks with a shortened (1.66 cm) cervical length. Placement of abdominal cerclage with robotic assistance under ultrasound guidance was performed at a teaching hospital. The main outcome measure was feasibility of RoboTAC placement in a gravid uterus under ultrasound guidance, and delivery of an infant ≥34 weeks of gestation with neonatal survival. Abdominal cerclage was safely and successfully placed at 13 weeks with robotic assistance. The patient had an otherwise uncomplicated antenatal course and was delivered via primary cesarean section at 38 weeks. Robotic-assisted abdominal cerclage can be considered for patients who require abdominal cerclage placement by skilled robotic surgeons.

This case study will consider the case of Mrs White, who has been anonymised in accordance with the Health and Care Professions Council (HCPC) Standards of Conduct, Performance and Ethics ( HCPC, 2012 ). A brief clinical overview would show that Mrs White was a 34-year-old multipara who underwent a planned lower segment caesarean section (LSCS) for placental insufficiency of unknown cause during the 36th week of her second pregnancy. This was found to be due to placental infarction and considered to be due to previous placental abruption. This was causing failure of the foetus to thrive and, therefore, was an indication for LSCS ( de Souza Rugolo et al, 2011 ). Her first pregnancy was an uneventful vaginal term delivery. She was otherwise fit and well and had no significant medical history.

Quadriceps weakness is a notable problem following knee damage. Research has shown effectiveness of TENS in improving Quadriceps weakness associated with arthrogenic muscle inhibition. However, these studies were not focused upon short term delivery of TENS, nor did they examine the potential mechanism(s). The present study examined the effect of 25–30 s of TENS upon weakness induced temporarily by a prolonged vibration. Subjects performed eccentric MVCs under 2 conditions (TENS and no-TENS). First, MVC was measured at baseline. For the TENS condition, TENS was applied to each subject’s knee joint during a second MVC measurement after vibration. For no-TENS condition, TENS was not applied during the 2 nd MVC measurement. MVC between pre-and post-vibration stimulation were compared across the 2 conditions. The results showed that MVC and EMG of TENS-condition was larger than that of no-TENS condition. Our results suggest that TENS could partially restore α-motoneuron activation, despite the induced dysfunctional γ-loop. These results suggest that mechanisms independent of the γ-loop such as a direct facilitation of the QF α-motoneuron pool by a long latency spinal-reflex and/or supraspinal mechanisms appear more likely to be responsible. The findings provide further support for utilizing TENS, even when γ-loop dysfunction is present following joint damage.

Background: The benefits of feeding human milk to infants, even in prematurity, have been well documented. Well-organized donor milk processing has made the milk bank a good source of nutrition for premature or sick infants if their own mother’s milk is not sufficient or suitable. The Taipei City Hospital Milk Bank was established in 2005 and is the first nonprofit human milk bank to operate in Taiwan. Methods: The milk bank has adopted standards of practice laid down by the Human Milk Banking Association of North America and United Kingdom Association for Milk Banking. The clinical characteristics of the eligible milk donors, the recipients, and the donor milk were reviewed retrospectively. Results: In the past 6 years, 816 eligible donors donated a total or 13,900 L (mean 17.03 L/ donor) of breast milk. The mean age of these donors was 31.3 years, and 79.7% of them had college education. Most had term delivery (91.2%), with mean birth weight of their babies being 3120 g; 68.9% of the donors were primiparas. A total of 551 infants had received bank milk, with these indications: prematurity (65.4%), malabsorption (7.6%), feeding intolerance (7.2%), maternal illness (5.1%) and post-surgery (4.6%). The pass rate of raw donor milk was around 72.1%. The most common reasons to discard raw milk were Gram-negative rods contamination (72.8%) and � 10 4 colony-forming units/mL of coagulase-negative Staphylococcus (62.3%). Only 0.63% of donor milk post pasteurization showed bacterial growth. Conclusion: Proper management and operation of a human milk bank can support breastfeeding, and provide a safe alternative to artificial formula for feeding preterm or ill infants in Taiwan. Sustainability of the milk bank needs more propagation and financial support by health authorities.

Contains fulltext : 118390.pdf (Publisher’s version ) (Closed access) Bone morphogenetic proteins (BMPs) are the most potent osteoinductive growth factors. However, a delivery system is essential to take advantage of the osteoinductive effect of BMPs. The purpose of this study was to develop a sustained delivery system for recombinant human bone morphogenetic protein-2 (BMP-2). We covalently attached heparin to a cross-linked collagen type I coated tricalciumphosphate/hydroxyapatite (TCP/HA) bone substitute and subsequently loaded it with BMP-2. To systematically evaluate the contribution of each component with respect to the binding and release of BMP-2, six constructs were prepared and characterized: TCP/HA, TCP/HA with collagen (TCP/HACol), and TCP/HA with collagen and heparin (TCP/HAColHep) with and without BMP-2 (B). More BMP-2 bound to the TCP/HAColHep + B (92.9 +/- 4.8 ng BMP-2/mg granule) granules as compared to the TCP/HACol + B (69.0 +/- 9.6 ng BMP-2/mg granule) and TCP/HA + B granules (62.9 +/- 5.4 ng BMP-2/mg granule). No difference in release pattern was found between the TCP/HA + B and TCP/HACol + B granules. Up to day 14, BMP-2 was still bound to the TCP/HAColHep + B granules, whereas most BMP had been released from TCP/HACol + B and TCP/HA + B granules at that time. After 21 days most BMP-2 also had been released from the TCP/HAColHep + B granules. The local and sustained delivery system for BMP-2 developed in this study may be useful as a carrier for BMP-2 and could possibly enhance bone regeneration efficacy for the treatment of large bone defects.

Background: Preterm delivery is a major cause of mortality in infants. The prevalence of preterm delivery is rising over time. Psychological disorders have been associated with preterm delivery. In this study, we aimed to compare the frequency of psychological disorders among women with spontaneous preterm versus term delivery. Methods: In this cross- sectional study, psychological disorders in 60 women, who experienced spontaneous term delivery and in 60 women who had spontaneous preterm delivery (gestational age of less than 37 weeks) were examined , using symptom checklist-90-revised questionnaire (SCL-90-R) in Akbarabadi teaching hospital during 2014. The question scales were compared between the two groups, using Chi 2 test and independent t- test. Results: The mean age of the participants was 23.58 ± 4.26, and 23.90 ± 4.71 in preterm-delivery and term-delivery groups, respectively (P value = 0.22). The mean score of Symptom checklist-90-revised questionnaire (SCL-90-R) was 102.21 (± 35.81) in women with preterm delivery, and it was 59.14 ± 22.17 in women with term delivery, which was significantly different (P value < 0.001). In addition, the total score and the score for all the subscales of psychological disorder were higher in women with preterm delivery (P value < 0.001). Conclusions: Psychological disorders in pregnancy are associated with an increased risk of preterm delivery. Therefore, future studies should focus on finding ways to lower psychological disorders in late pregnancy.

Endogenous endophthalmitis during pregnancy is a rare condition with few reports of such infections in the peri- and post-partum period. We reviewed the literature on endogenous endophthalmitis in pregnancy and also report a series of four patients who presented to our institution from January 2011 to September 2011. We retrospectively reviewed four patients who developed endogenous endophthalmitis either during pregnancy (two patients) or in the post-partum period (two patients--one after abortion and one after normal term delivery). Presenting visual acuity ranged from finger counting at 3 m to no perception of light. Positive cultures included Bacillus mycoides (vitreous) and Klebsiella pneumoniae (urine). Vitrectomy was performed in three patients. In one patient, the vision improved to 20/20. On reviewing the literature and our experience we concluded that endogenous endophthalmitis related to pregnancy is a rare entity with visual prognosis generally being poor. Fluoroquinolones are best avoided. Cephalosporins and amphotericin B are generally the preferred drugs.

Approximately 1 in 10 babies in the U.S. is born premature or preterm. Inadequate understanding of the psychoneuroendocrine immune mechanisms that facilitate length of gestation and initiate parturition contributes to our inability to intervene effectively to prevent preterm labor. Hair cortisol serves as a practical measure of long-term retrospective cortisol activity. This study used descriptive, correlation, and between-group comparison analysis. We compared hair cortisol and perceived stress scores (PSS) in mothers who delivered preterm (n = 22) and mothers who delivered term (n = 30). The mean gestational age at the time of preterm delivery was 31.45(4.2) weeks and at the time of term delivery was 39.45(1.1) weeks. Cortisol was significantly different between term and preterm in the third trimester (t = 2.16, df = 48, p = 0.04) and trending towards significance in the second trimester (dt = 1.88, df = 48, p = 0.06). PSS were significantly different between term and preterm (t = −2.96, df = 50, p = 0.05). Our data did not provide any support that the rate of change in cortisol levels was greater in the preterm delivery group. There appears to be a blunted, flattened pattern of cortisol levels across the gestation in the women who delivered preterm and diminished HPA responsiveness in mechanisms that promote preterm labor. Future studies are needed to further evaluate best strategies for measuring the mechanisms of allostatic load during pregnancy, along with psychoneuroendocrine and immune triggers and placental responses that lead to premature birth.

Background Shoulder dystocia is an obstetric emergency which occurs in 0.2–3% of all births ACOG Committee on Practice Bulletins-Obstetrics and The American College of Obstetrician and Gynecologists (2002) . Symphysiotomy is a treatment option reserved primarily for developing countries where mortality rates of Cesarean delivery are 1–2% Monjok et al. (2013) . Case A G3P2002 with a history of two prior vaginal deliveries had a term delivery complicated by a severe shoulder dystocia. She underwent emergent symphysiotomy at an outside institution, with delivery of a dead macrosomic infant. She was transferred to our tertiary care center for further care. Conclusion Symphysiotomy is rarely performed in the United States. We submit our postoperative management to add to the literature of this rarely performed obstetric intervention. Precis Symphysiotomy for severe shoulder dystocia is rarely utilized in the United States. We describe a case of symphysiotomy done for severe shoulder dystocia at an outside institution, and the patient's subsequent care at our institution.

Background and purpose Various new delivery systems for recombinant human bone morphogenetic protein-2 (rhBMP-2) have been introduced to improve its efficacy in osteogenesis. Of these, we have previously developed heparin-conjugated PLGA nanospheres (HCPN) as a long-term delivery system for BMP-2. In vitro studies have shown that the BMP-2 long-term delivery system enhances the level of bone formation. However, the long-term effects of BMP-2 on spinal fusion have not been assessed. Therefore, we now tested the hypothesis that the long-term delivery of BMP-2 using HCPN improves spinal fusion compared to short-term delivery in a rabbit fusion model. Methods 24 adult New Zealand White rabbits underwent posterolateral fusion (6 animals in 4 groups). The autograft group received an autologous iliac chip bone graft as a positive control. The BMP-2-PN group received rhBMP-2 (20 μg per implant) and PLGA nanospheres (PN) suspended in fibrin gel, and served as a short-term release group. The HCPN group received HCPN suspended in fibrin gel without BMP-2 as a negative control. The BMP-2-HCPN group received rhBMP-2 (20 μg per implant)-bound HCPN suspended in fibrin gel and served as a long-term release group. All animals were killed 12 weeks after surgery. Manual palpation, axial tensile tests, radiography, and histological evaluations were then performed. Results The spinal fusion rate and Young's modulus of the fusion mass were better in the BMP-2 long-term delivery group than in the short-term delivery group at an equivalent dose. However, the outcome of the long-term delivery was inferior to that of the autograft group. Interpretation The HCPN system showed potential as an effective carrier that might improve the osteogenic efficacy of BMP-2 for spinal fusion.

Aim: Primary elective cesarean sections are being carried out in considerable numbers in both developed and developing countries; however, little information is available concerning differences in maternal physiological responses associated with the mode of delivery. The aim of the present study was to compare the changes in the maternal complement and contact systems between delivery by cesarean section and vaginal delivery at term. Methods: Maternal levels of complement 3 (C3), complement 4 (C4) and coagulation factor XII (FXII) were measured during primary elective cesarean (n = 70) and vaginal (n = 140) deliveries. Results: The C3, C4 and FXII levels decreased significantly during delivery by cesarean section and remained low for two hours. By contrast, C3 levels, but not C4 levels, increased temporally during normal term delivery and FXII levels decreased two hours later. Conclusions: The changes in maternal C3, C4 and FXII levels during cesarean section were very different from those during delivery at term, suggesting that the maternal complement and contact systems respond differently.

Background: Exercise during pregnancy has minimal risks and has been shown to benefit most women, including reduction in cesarean section rates, appropriate maternal and fetal weight gain managing gestational diabetes as well as preventing and treating antenatal depression. There are, however, multiple factors that may influence an expectant mother’s decision to engage in physical activity, including concerns for potentially harming the baby or the pregnancy. We designed a study to determine whether or not a prior pregnancy loss or pre-term delivery would increase an expectant mother’s concern about exercise during a current pregnancy.Methods: Our prospective survey study consisted of 572 obstetric patients, 173 (30.2%) had a history of prior pregnancy loss or pre-term delivery (PPLPT) compared to 399 (69.8%) with no history of a prior pregnancy loss (NPL).Results: Logistic regression modeling was performed, including the following variables: history of abortion, miscarriage, or pregnancy loss, age, pre-pregnancy BMI, typical weekly pre-pregnancy exercise minutes, physical wellbeing and emotional wellbeing. Patients in the PPLPT group were more likely to express a fear of hurting the baby as a barrier to exercise during pregnancy, with an adjusted odds ratio of 2.358 (95% CI 1.111-3.852, p

Background: To evaluate the improvement of the term delivery rate after uterine surgery in various uterine malformations. Methods: 170 patients were eligible for the present retrospective case series study. Data were weighted for the number of pregnancies observed (n = 218) after surgical intervention, stratified to the number of previous abortions (at least 2) and type of malformation. Results: Before surgery, the overall term delivery rate was 5.5%. After surgery, the overall term delivery rate was 59% (absolute benefit increase, ABI, was 54.5) and correlated with the number of previous abortions (69.7% ABI = 64.2, 56.5% ABI = 51 and 26.3% ABI = 20.8 for 2, 3–4 and >4 abortions, respectively; p = 0.0008, log-rank test). Data stratified according to uterine malformations yielded the following term delivery rate: 66.7% for T-shaped uterus, 62.8% for septum/partial septum and 55.6% for arcuate uterus (NS, log-rank test). The number of previous abortions and maternal age also affected the term delivery rate. Their effect upon the term delivery rate, expressed as an odds ratio, was 1.73 (95% CI: 1.20–2.49) and 1.11 (95% CI: 1.05–1.18), respectively. Conclusion: The term delivery rate was about 10-fold higher after surgery. T-shaped uterus surgery yielded the best term delivery rate.

Spontaneous preterm delivery (sPTD) is associated with an increased risk of CVD later in life, but causes of this phenomenon are not well understood. The aim of this study was to assess vascular function over time in women who experience sPTD compared to term delivery controls. We performed a

AIM: The main objective of this study was to evaluate the association between prematurity and the time to achieve full enteral feeding in newborns with gastroschisis. The second objective was to analyze the associations between length of hospital stay and time to achieve full enteral feeding with mode of delivery, birth weight and surgical procedure. METHODS: The medical records of newborns with gastroschisis treated between 1997 and 2007 were reviewed. Two groups were considered: those delivered before 37 weeks (group A) and those delivered after 37 weeks (group B). The variables of gestational age, mode of delivery, birth weight, time to achieve full enteral feeding, length of hospital stay and surgical approach were analyzed and compared between groups. RESULTS: Forty-one patients were studied. In Group A, there were 14 patients with a mean birth weight (BW) of 2300 g (range=1680-3000) and a mean gestational age (GA) of 36 weeks (range=34-36). In group B, there were 24 patients with a mean BW of 2700 g (range=1500-3550) and a mean GA of 38 weeks (range=37-39). The mean time to achieve full enteral feeding was 30.1±6.7 days in group A and 17.0±2.5 days in group B (p=0.09) with an OR of 0.82 and a 95% CI of 0.20-3.23 after adjustment for sepsis and BW. No statistical difference was found between low BW (

Refractive findings are reported in a follow-up study comprising 88 children aged 7-10 years, who were submitted to regular control for retinopathy of prematurity (ROP) in the first months after their pre-term delivery 1982-84 (mean birthweight 1467 g, mean gestational age 31 weeks). The refractive range was -13 to +6.75 D. In four subjects with fully-blown ROP both eyes were left blind and dysmorphic. Twenty-four had had ROP with regression; myopia of prematurity (MOP) appeared in six (25%). At follow-up the myopia frequency in the remaining 60 without ROP was 5%. Out of the 9 subjects with uni- or bilateral myopia of prematurity three had no evidence of early ROP. With a median corrected acuity of 0.5 only, the eyes with MOP had a lower corrected visual score than in the rest of the material (median monocular acuity 0.9). The latter value is even a little lower than what was previously reported in full-terms of a similar age (median acuity above 1.0). Obviously, as a sequel to the pre-term delivery we are dealing not only with early myopia in some subjects; further, the potential for developing full vision appears influenced and reduced. This applies to the total group of ex-prematures, but in particular it is valid for myopia of prematurity.

Hintergrund Ob durch Pravention und Gesundheitsforderung Kosten im Gesundheitswesen eingespart werden konnen, ist unter Gesundheitswissenschaftlern und Gesundheitsokonomen weiterhin strittig [2, 6, 7]. Und sicher ist es unmoglich, fur das gesamte Gesundheitswesen bzw. fur das Spektrum aller Krankheiten und Indikationsgebiete wissenschaftlich belastbare Kosteneinsparungspotentiale zu berechnen oder auch nur nachvollziehbar zu schatzen. Der Logik nach ist ein mogliches Kosteneinsparungspotenzial bei definierten Krankheiten von einer ganzen Reihe von Faktoren abhangig. Dazu gehoren u. a.: der epidemiologische Wissensstand zu den moglichen Ursachen von Krankheiten, gemessen in der Regel durch Assoziationsmase zwischen Risikofaktoren und protektiven Faktoren und Krankheit (Odds-Ratio, relatives Risiko), die Pravalenz sowohl von Krankheit als auch von Risiko- und protektiven Faktoren in der Bevolkerung, die Intervenierbarkeit der epidemiologisch gesicherten Risikofaktoren und protektiven Faktoren, die Stabilitat der Interventionseffekte in der Zeit, die Evidenz aus experimentellen Interventionsstudien zur Wirksamkeit und Wirtschaftlichkeit; die Akzeptanz und Inanspruchnahme territoriumsubergreifender Interventionen durch die Bevolkerung und die Effekte auf die Krankheitsinzidenzen mit steigendem Alter und steigender Lebenserwartung der Bevolkerung. Belegen die hier benannten Punkte einerseits die Unmoglichkeit einer globalen Schatzung praventiver Kosteneinsparungspotenziale, so zeigen sie andererseits auch die methodischen Schwierigkeiten auf, mit dem entsprechende Versuche konfrontiert sind, die sich nur auf ein chronisches und ggf. pravenierbares Krankheitsbild (z. B. Krankheiten des Herz-Kreislauf-Systems) richten. Der Geburtshilfe wird in den Gesundheitswissenschaften relativ selten Aufmerksamkeit geschenkt. Dies gilt selbst fur die Frauenforschung und „gender studies“. Dabei liegen hier in Bezug auf Fruhgeburten erhebliche praventive Potenziale wie auch Moglichkeiten der Kostensenkung vor. Diese werden im folgenden Artikel vorgestellt.

In pregnant women, brucellosis may have different clinical aspects, but there are no specific signs of the disease and in all cases the maternal and fetal prognosis may be involved. We report two cases of brucellosis-infected pregnant women. In the first, the diagnosis and the treatment were early and the evolution was favorable with term delivery of a healthy newborn. In the second the pregnancy was complicated by a premature delivery at 32 weeks of gestation. On the occasion of these two observations, we made a literature review to clarify the clinical features of this infection during pregnancy as well as its therapy specificities.

OBJECTIVE To estimate the natural history of funneling in the second trimester by transvaginal ultrasonograms and whether funneling increases the risk of spontaneous birth. METHODS Secondary analysis of a blinded, multi-center observational study of women with at least one prior spontaneous preterm birth at 16.0-31.9 weeks who subsequently carried singleton gestations. Cervical length, funneling (membrane prolapse greater than or equal to 5 mm), funnel shape, and dynamic changes were recorded at 16-18 weeks, and then every 2 weeks until 23.9 weeks. Managing obstetricians were blinded to the ultrasonography results. The primary outcome was gestational age at delivery. RESULTS Five hundred ninety scans were performed in 183 women, of which 60 (33%) had funneling observed on at least one of the serial evaluations. These 60 women delivered at an earlier gestational age at delivery than the 123 women without funneling (31.7+/-7.9 weeks compared with 36.9+/-4.4 weeks; P

The normal mechanical functioning of an intact chorioamnion (CA) membrane is essential to successful human reproduction. The amnion and the chorion, separately and together as the bilayer chorioamnion, serve barrier and container functions throughout gestation, and these two important roles are required from conception to birth. The event associated with the "breaking of waters" is a landmark event in labor and delivery. Mechanical rupture of the CA membrane is part of the natural sequence of term delivery, but has serious implications when rupture occurs prior to term; preterm premature rupture of the CA membrane (PPROM) is associated with one-third of premature births. The current manuscript reviews PPROM from a clinical, anatomical, and mechanical perspective with a special focus on the clinically relevant fracture properties of these membranes. Emphasis is given to the link between membrane structure and properties at macroscopic and microscopic length scales. Because it has been demonstrated that the mechanical properties of prematurely failed membranes are not different from membranes of the same gestational age that have remained intact, membrane failure is a local process that must be explored in terms of local changes in structure and properties of isolated portions of the membrane. Future diagnostic techniques aimed at detection of changes in membrane structure (including thickness) and altered mechanical stiffness or strength may allow for prefailure diagnosis of membrane weak spots, thus opening the door for potential intervention and treatment techniques for preterm membrane rupture.

Introduction. Human milk proteins are maximally adapted to physiological needs of a neonate. Thus, depending on the speed of the neonatal growth and development, the content of milk proteins changes, both in quantity and quality. Objective. The study was conducted in order to determine variations of total protein concentrations in milk in the first and third lactation week in lactating mothers of term and preterm neonates. Also, we analyzed the influence of the mode of delivery, neonatal Apgar score and parity on the concentration of human milk proteins in both lactation phases. Method. The study aims were evaluated on the sample of 48 women, of whom 33 were mothers of term neonates and 15 of neonates born between the 34th to 37th gestational weeks. Total protein level of the lactation milk from the middle phase was determined using the standard laboratory method (Lowry et al., 1951), and the obtained differences were analyzed by t-test. Results. Total protein concentration in term colostrum was 17.60-45.17 g/l (X=24.71?5.19), while in preterm colostrum it was 28.39-73.30 g/l (X=39.17?11.08). The total protein level of mature milk in women who had term delivery was 11.90-22.11 g/l (X=16.39?2.96), while in women who had preterm delivery it was 14.50-44.19 g/l (X=23.25?8.96). The obtained results indicated that total protein concentration in women who had preterm delivery was significantly higher than that of women who had term delivery, both in the colostral and mature phase of lactation. (p

Prediction of preterm labor is of great importance to reduce neonatal death. Analysis of electrohysterogram (EHG) could be considered as a proper tool for this aim. In this paper, the statistical and non-linear features have been extracted from EHG signals and then Support Vector machine (SVM) has been applied for classification between term and preterm labor. The dataset of this research consists of 26 records from term delivery (duration of pregnancy ≥37 weeks) and 26 records from pre-term delivery (duration of pregnancy

Long-term contraceptive delivery devices have been shown to be beneficial to delay or stop childbearing. This work presents a novel biodegradable polymeric implant to deliver a contraceptive agent up to one year. The implant is an injectable device, designed and fabricated using biodegradable polymers with varying molecular weights, hydrophilicity/hydrophobicity, and degradation rates specifically formulated to ensure proper daily therapeutic dosage. Implantable via intra-muscular injection, the use of a novel polymer composition allows for customization of the drug delivery system and provides a flexible, yet sturdy implant that degrades as a unit, avoiding troublesome fragmenting and implant retrieval surgery post-treatment. The implant is designed to remain intact throughout the therapeutic release phase, and thereby allow for easier, intact retrieval of the implant should the patient wish to terminate contraception and get pregnant. The hybrid polymer architecture creates an economically-efficient implant system, overcoming the shortcomings of daily use methods and eliminating the need for surgical procedure removal, granting the patient contraceptive effectiveness up to a year.

Perinatal brain damage has a diverse and complex aetiology. Over the past decades, much progress has been made in this research field. In this article, I offer a discussion of seven dimensions of aetiological perinatal brain damage research: (1) hypoxia-ischaemia vs. inflammation; (2) "classic" vs. "remote" intrauterine infection; (3) focal vs. diffuse white matter damage; (4) maternal vs. foetal inflammatory response; (5) clinical vs. experimental data; (6) bacterial vs. viral infection; and (7) preterm vs. term delivery. Despite these complexities, it is hoped that obstetricians, neonatologists, and neuropaediatricians will agree on a perinatal neuroprotective strategy in the near future.

A 30 year old woman presented 12 days after embryo transfer with lower abdominal pain and orange vaginal discharge. She was diagnosed to have pyometra. A conservative management with drainage of the pyometra was followed by an uneventful pregnancy and term delivery. Conservative management in a case of pregnancy with pyometra needs close supervision to ensure maternal and fetal well being.

The advantages of breast feeding to both the mother and infant are well recognised. However, breast feeding problems are common in the immediate period following delivery. This paper describes the management of an infant who was admitted to a Neonatal Unit with dehydration and his subsequent breastfeeding management.

The purpose of this study was to determine whether differences are seen in calculation of fetal weight using 5-mm sagittal, 3-mm coronal, and 8-mm axial MRI acquisitions compared with term birth weight and contemporaneous sonography.Fetal volume measurements were obtained from MRI acquisitions as follows: 5-mm sagittal (2 acquisitions), 3-mm coronal (2 acquisitions), and 8-mm axial (1 acquisition). A 90-sec single-shot fast spin-echo sequence was used. MRI and sonographic studies for fetal weight estimates were performed within 3 hr of term delivery. MRI calculation was based on the equation 0.12 + 1.031 x fetal volume (fetal area x slice thickness) (mL) = MRI fetal weight (kg). The sonographic fetal weight estimate was calculated using the Hadlock formula. MRI and sonographic calculations were compared with birth weight. Concordance coefficient analysis was performed.Thirty-five retrospective fetal calculations were performed. Concordance coefficients, gram weight means and standard deviations (mean +/- SD) between birth weight and MRI acquisitions were as follows: 8-mm axial, 0.91 (3,554 +/- 431 g); 3-mm coronal, 0.84 (3,752 +/- 578 g); and 5-mm sagittal, 0.83 (3,685 +/- 567 g), compared with 0.78 (3,518 +/- 332 g) for sonography. The MRI axial concordance coefficient was significantly different from that of the sonographic estimates (p = 0.05). MRI axial concordance coefficient was not statistically different from that of the MRI coronal concordance coefficient (p = 0.22) or the MRI sagittal concordance coefficient (p = 0.19).Calculated weights from a 90-sec single-shot fast spin-echo sequence MR acquisition with 8-mm-thick slices in the axial plane at term are better than sonographic estimates.

Problem: Macrophage colony-stimulating factor (M-CSF) promotes placental growth and maintenance. M-CSF also regulates trophoblast invasion into the placental bed. We evaluated whether M-CSF levels in amniotic fluid during labor contributing to subsequent delivery differed from those before the onset of labor in normal pregnancies. Method of study: This study enrolled 48 Japanese women experiencing normal pregnancies with single fetuses who had no infection. Of these pregnancies, 24 were women during labor: 22 led to subsequent term delivery (labors); two had premature delivery. The other 24 were women without labor underwent cesarean section (controls). These two groups (22 labors and 24 controls) were compared. The average gestational age at entry was 38 weeks of gestation. The women's ages and gestational ages did not differ significantly between the two groups. Amniotic fluid was collected and the M-CSF levels were compared between two groups. The M-CSF level was determined by the sandwich enzyme-linked immunosorbent assay (ELISA) method. Results: The levels of M-CSF in amniotic fluid did not differ significantly between the women during labor and those without labor. Conclusions: M-CSF in amniotic fluid may not contribute to the onset of labor in term pregnancy and/or labor resulting in subsequent delivery may not induce the production and secretion of M-CSF into amniotic cavity.

Choriocarcinoma is an aggressive tumor of gestational trophoblastic neoplasia (GTN) (Milenkovic et al. 2013). It can complicate any form of pregnancy including normal term delivery, ectopic pregnan...