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Parturition - Top 30 Publications

Effect of season of birth on cord blood IgE and IgE at birth: A systematic review and meta-analysis.

Elevated cord blood IgE is important on the pathway to allergic disease. The association between season of birth and infant cord blood IgE is not well-established. Study findings differ on which birth season is associated with higher cord blood IgE risk and its magnitude. We conducted a systematic review and meta-analysis of studies on season of birth and cord blood IgE.

Hospital-Level Variation in Postpartum Readmissions.

Zika Virus: Obstetric and Pediatric Anesthesia Considerations.

As of November 2016, the Florida Department of Health (FDH) and the Centers for Disease Control and Prevention have confirmed more than 4000 travel-related Zika virus (ZIKV) infections in the United States with >700 of those in Florida. There have been 139 cases of locally acquired infection, all occurring in Miami, Florida. Within the US territories (eg, Puerto Rico, US Virgin Islands), >30,000 cases of ZIKV infection have been reported. The projected number of individuals at risk for ZIKV infection in the Caribbean and Latin America approximates 5 million. Similar to Dengue and Chikungunya viruses, ZIKV is spread to humans by infected Aedes aegypti mosquitoes, through travel-associated local transmission, via sexual contact, and through blood transfusions. South Florida is an epicenter for ZIKV infection in the United States and the year-round warm climate along with an abundance of mosquito vectors that can harbor the flavivirus raise health care concerns. ZIKV infection is generally mild with clinical manifestations of fever, rash, conjunctivitis, and arthralgia. Of greatest concern, however, is growing evidence for the relationship between ZIKV infection of pregnant women and increased incidence of abnormal pregnancies and congenital abnormalities in the newborn, now medically termed ZIKA Congenital Syndrome. Federal health officials are observing 899 confirmed Zika-positive pregnancies and the FDH is currently monitoring 110 pregnant women with evidence of Zika infection. The University of Miami/Jackson Memorial Hospital is uniquely positioned just north of downtown Miami and within the vicinity of Liberty City, Little Haiti, and Miami Beach, which are currently "hot spots" for Zika virus exposure and transmissions. As the FDH works fervently to prevent a Zika epidemic in the region, health care providers at the University of Miami and Jackson Memorial Hospital prepare for the clinical spectrum of ZIKV effects as well as the safe perioperative care of the parturients and their affected newborns. In an effort to meet anesthetic preparedness for the care of potential Zika-positive patients and perinatal management of babies born with ZIKA Congenital Syndrome, this review highlights the interim guidelines from the Centers for Disease Control and Prevention and also suggest anesthetic implications and recommendations. In addition, this article reviews guidance for the evaluation and anesthetic management of infants with congenital ZIKV infection. To better manage the perioperative care of affected newborns, this article also reviews the comparative anesthetic implications of babies born with related congenital malformations.

Assessment and support during early labour for improving birth outcomes.

The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date.

Dimorphism in the Size and Shape of the Birth Canal Across Anthropoid Primates.

It has long been noted that the human female birth canal is well adapted to giving birth to large-brained neonates. However, several species of nonhuman primates give birth to large-headed neonates compared to the maternal birth canal. The presence of such large cephalopelvic proportions in nonhuman primates presents the question of whether dimorphism in the birth canals of these other species is related to obstetric demand, as such dimorphism is presumed to be in humans. In this study, the hypothesis that either the presence or magnitude of dimorphism in the birth canal is related to large cephalopelvic proportions among anthropoid primates is directly tested. This study shows that birth canal dimorphism is common among anthropoids regardless of cephalopelvic proportions, but taxa with large cephalopelvic proportions have a higher magnitude of dimorphism than those that give birth to relatively small-headed neonates. Furthermore, humans have exceptionally high levels of dimorphism that cannot be explained based on our large cephalopelvic proportions alone. Anat Rec, 300:870-889, 2017. © 2017 Wiley Periodicals, Inc.

Neonatal Shoulder Width Suggests a Semirotational, Oblique Birth Mechanism in Australopithecus afarensis.

Birth mechanics in early hominins are often reconstructed based on cephalopelvic proportions, with little attention paid to neonatal shoulders. Here, we find that neonatal biacromial breadth can be estimated from adult clavicular length (R(2) = 0.80) in primates. Using this relationship and clavicular length from adult Australopithecus afarensis, we estimate biacromial breadth in neonatal australopiths. Combined with neonatal head dimensions, we reconstruct birth in A. afarensis (A.L. 288-1 or Lucy) and find that the most likely mechanism of birth in this early hominin was a semi-rotational oblique birth in which the head engaged and passed through the inlet transversely, but then rotated so that the head and shoulders remained perpendicular and progressed through the midplane and outlet oblique to the main axis of the female pelvis. Any other mechanism of birth, including asynclitic birth, would have resulted in either the head or the shoulders orthogonal to the short anteroposterior dimension of the A.L. 288-1 pelvis, making birth untenable. There is a tight fit between the infant and all planes of the birth canal, perhaps suggesting a difficult labor in australopiths. However, the rotational birth mechanism of large-brained humans today was likely not characteristic of A. afarensis. Thus, the evolution of rotational birth, usually associated with encephalization, may have occurred in two stages: the first appeared with the origin of the australopiths with their platypelloid pelves adapted for bipedalism and their broad-shouldered neonates; the second which resulted in the modern mechanism of rotational birth may be associated with increasing brain size in the genus Homo. Anat Rec, 300:890-899, 2017. © 2017 Wiley Periodicals, Inc.

Mechanical Constraints on the Hominin Pelvis and the "Obstetrical Dilemma".

The "obstetrical dilemma" posits that increases in birth canal dimensions during hominin evolution were constrained by mechanical factors associated with bipedal gait. This model has recently been challenged, in part on the basis of experimental data showing little association between pelvic and proximal femoral dimensions and locomotor costs among human experimental subjects. However, complete rejection of the model is premature, for two reasons: (1) it is difficult to extrapolate experimental results to naturalistic conditions and the much more varied body form and possibly locomotor style of early hominins. Relative pelvic breadth and femoral neck length in both australopiths and early Homo are at or beyond the limits observed among modern humans, and there is evidence that australopiths may have used an altered form of bipedal gait. (2) Other mechanical factors in addition to locomotor cost are important when assessing pelvic and proximal femoral morphology. Increasing biacetabular breadth increases the joint reaction force (JRF) on the femoral head. Increasing femoral neck length may reduce hip JRF, but also increases stress and fracture risk in the femoral neck. Increasing both biacetabular breadth and femoral neck length also increases mediolateral bending stress in the proximal femoral shaft, necessitating substantial buttressing of the diaphysis. Thus, there are mechanical consequences beyond simply locomotor costs that must be considered when evaluating variation in pelvic and femoral morphology among past and extant hominins. Anat Rec, 300:946-955, 2017. © 2017 Wiley Periodicals, Inc.

Determinant factors of home delivery among women in Northern Ethiopia: a case control study.

Maternal mortality remains a major challenge to health systems worldwide. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop potentially life-threatening complications. Home delivery in this context can be acutely threatening, particularly in developing countries where emergency care and transportation are less available. This study identifies factors associated with home delivery in Tanqua-Abergele District, Tigray, northern Ethiopia.

Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis.

Tocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short-term and long-term adverse effects on mother and baby. We performed a systematic review and meta-analysis to determine the global prevalence of tocophobia in pregnancy.

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Antenatal care reduces maternal and perinatal mortality and morbidity through the detection and treatment of some conditions, but its coverage is less than optimal within certain populations. Supply kits for maternal health were designed to overcome barriers present when providing care during pregnancy and childbirth particularly to women from underserved population.We conducted a mixed-methods systematic review on the use of supply kits. This manuscript presents the findings from qualitative studies that reported barriers, facilitators, and user's recommendation in the adoption and implementation of any type of kit designed to be used during pregnancy or childbirth.This review included eight studies, and seven were implemented in developing countries. Most studies assessed the implementation of clean delivery kits to be used during labour and delivery, and contributed to gain insights into factors that may hinder or foster the use of kits.Clean delivery kits were conceived to cope with barriers related mainly to access. The most important barrier identified were those related to the socio-cultural and the lack of knowledge dimension such as who held the decision-making authority in the household, as well as popular beliefs behind the idea that birth preparation could bring bad luck, may prevent clients from adhering to their use. In addition, financial constraints and limited understanding of the instructions of use were accessibility barriers found. On the other hand, once used, clean delivery kits for maternal health were accepted by women and health workers. Convenience, hygienic components, and avoidance of delays in receiving care were viewed as satisfactory features.Supply kits are mostly affordable and easily deployable. Increasing awareness among the population about the offered kits and providing information on their benefits emerges as a critical step to foster use in settings where kits are available. Implementation of this strategy requires low complexity resources and could make the use of kits an accepted alternative to increase the use of evidence-based interventions and thus improve quality of care during pregnancy, childbirth and neonatal period mainly at the community level in low income countries and remote areas with low access.

Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery.

Pelvimetry assesses the size of a woman's pelvis aiming to predict whether she will be able to give birth vaginally or not. This can be done by clinical examination, or by conventional X-rays, computerised tomography (CT) scanning, or magnetic resonance imaging (MRI).

Predictors of preference for caesarean delivery among pregnant women in Beijing.

Objective To evaluate factors associated with preference for caesarean or vaginal delivery among pregnant Chinese nulliparous and parous women. Methods In this cross-sectional study, a self-administered questionnaire was used to collect information on sociodemographic characteristics, preference/reasons for delivery mode, and knowledge of delivery complications. Results Of the 450 participants, 85 (18.9%) reported a preference for caesarean section (CS) pre-partum. Compared with women who would prefer a vaginal delivery, nulliparous women who preferred CS were more likely to be: ≥35 years; have no medical insurance; have had two or more pregnancies; have access to only one source of information about birthing options; knowledge of the complications of vaginal delivery and think doctors have no right to decide the type of delivery. For parous women who preferred CS, they were more likely to have had a previous caesarean delivery and live outside Beijing. Conclusions From this study conducted at a large, maternity centre in Beijing, the proportion of pregnant women with preference pre-partum for CS was moderate and their reasons were varied.

Committee Opinion No. 697: Planned Home Birth.

In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Committee Opinion No 697 Summary: Planned Home Birth.

In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Oxidative stress in newborns by different modes of delivery.

The aim of our study is to investigate the impact of the type of delivery - vaginal vs. cesarean section on oxidative damage determined as the lipid peroxidation (15-F2t-isoprostane (15-F2t-IsoP) in the cord blood of newborns and venous blood from mothers in two localities with different levels of air pollution: Ceske Budejovice (CB), a locality with a clean air, and Karvina, a locality with high air pollution.

Effects of childbirth on podocyturia in women with normotensive, uncomplicated pregnancies.

Changes in hemodynamics and blood pressure occur shortly before and after childbirth regardless of the mode of delivery. This study aimed to test the hypothesis that parturition induces a temporal increase in podocyturia monitored by podocyte-specific protein podocin mRNA expression levels (Pod-mRNA). A total of 105 urine specimens, consisting of 43 and 62 from 18 and 20 otherwise healthy women with vaginal delivery (VD) and elective cesarean delivery (ECS), respectively, were studied. Determination of urine protein and creatinine (Cr) concentrations and quantitative analyses of Pod-mRNA, nephrin mRNA (Nep-mRNA), synaptopodin mRNA (Syn-mRNA), and aquaporin 2 mRNA expression were performed using RT-PCR in pelleted urine samples. Levels of mRNA expression were corrected by urine Cr concentration. Podocyturia increased significantly, concomitant with a significantly decreased Nep:Pod-mRNA ratio (NPR) in the urine, collected immediately before or after childbirth regardless of the delivery mode compared with urine collected before commencement of labor or on postpartum day 3 or later. Podocyturia was significantly negatively correlated with NPR [correlation coefficient (r) = -0.614/-0.750 for VD/ECS women, respectively], as well as the Syn:Pod-mRNA ratio. Systolic blood pressure exceeded 140 mmHg during labor in 50% of VD women, and mean arterial pressure was significantly positively correlated with podocyturia during labor in VD women (r = 0.733). Thus parturition induces a transient increase in urine podocytes with reduced Nep- and Syn-mRNA expressions. Glomerular podocytes with reduced Nep- and Syn-mRNA levels were suggested to be likely to detach from the glomerular basement membrane around childbirth.

"Is the doctor God to punish me?!" An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia.

Disrespectful and abusive treatment during childbirth is a violation of women's right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, there is a lack of in-depth research exploring single mothers' encounters at the maternal healthcare facilities, especially in Tunisia. In Tunisia, single mothers are particularly vulnerable due to their social stigmatization and socio-economic marginalization. This study examines the self-perceptions and childbirth experiences of single mothers at the public healthcare facilities in Tunisia.

Dairy cows with prolonged calving seek additional isolation.

In modern calving facilities, dairy cows either calve in a group pen or are moved to a separate individual pen when calving is imminent. In practice, cows are often moved too close to calving, which poses a health risk to cow and calf. Thus, a need exists for new calving facility designs and management practices that better align with the motivations of the cow. This study examined dairy cow preferences for individual calving pens by offering 3 different levels of isolation (tall and narrow, low and wide, and tall and wide) by analyzing the association between precalving behavior, choice of degree of isolation, and the progress of calving. The hypotheses were that cows would prefer the highest level of isolation when giving birth, and that calving in a high level of isolation would be associated with less restlessness and a shorter calving duration. Contrary to these hypotheses, no specific preference between degrees of isolation or difference in calving behavior in the different calving pens was found. However, cows experiencing a longer calving duration chose to calve in the most secluded calving pen (tall and wide). These results cannot determine cause and effect, but may suggest that interactions between motivation for isolation seeking and calving behavior exist.

Early postpartum administration of equine chorionic gonadotropin to dairy cows calved during the hot season: Effects on fertility after first artificial insemination.

Heat stress reduces fertility of high-producing dairy cows, and early administration of equine chorionic gonadotropin (eCG) may improve it. Here, 401 heat-stressed, high-producing dairy cows on a single commercial farm were given eCG (500 UI, n = 214) or saline (n = 187) on days 11-17 after calving, and the effects on fertility after the first artificial insemination (AI) were assessed. On post-partum day 96.34 ± 9.88, all cows were inseminated after a "double short Cosynch" synchronization protocol. Ovarian activity and uterine status were checked by ultrasound on the day of eCG administration and every 7 days thereafter for a total of 3 weeks; checks were also performed during synchronization, and 7 days after AI. On post-partum day 30, cytobrush uterine cytology was performed to check for subclinical endometritis. Pregnancy status was checked on days 30 and 60 after AI. The eCG and control groups did not differ significantly in terms of average lactations per cow (2.33 ± 1.34), days in milk at first AI (96.33 ± 9.88), average milk yield at AI (41.38 ± 7.74 L), or the particular inseminator or bull used for AI. The eCG and control groups showed increasing ovarian activity with time, with approximately 75% of cows in both groups showing a corpus luteum at the beginning of the synchronization protocol. On post-partum day 30, 17.4% of eCG cows and 22.9% of control cows showed subclinical endometritis. Cows treated with eCG showed a tendency toward lower hyperecogenic intraluminal content (16.8 vs. 21.4%, P = 0.15), but ovarian activity during the synchronization protocol was similar between eCG and control groups, with 91% of animals in both groups showing luteolysis after prostaglandin application and 88% showing ovulation after the last administration of gonadotropin-releasing hormone. Fertility was similar between the two groups at both time points after AI (30 days, 34.9 vs. 31.8%; 60 days, 30.6 vs. 28.5%; P > 0.2). These results suggest that early postpartum eCG administration does not improve fertility of heat-stressed dairy cows as long as 60 days after AI. Other strategies may be more effective at mitigating the ability of post-partum heat stress to reduce fertility of high-producing dairy cows.

The effect of litter size, parity and farrowing duration on placenta expulsion and retention in sows.

The hypothesis was that a prolonged parturition impairs placenta expulsion and can lead to retained placentas in sows. Furthermore, we hypothesized that application of oxytocin around the time of expulsion of the first placental part improves placenta expulsion. We recorded 142 parturitions of 101 Yorkshire x Large White sows. We determined parity, gestation length, number of liveborn and stillborn piglets, farrowing duration (time between first and last piglet) and the outcome variables: number of expelled placental parts, placenta expulsion duration (time between first and last placental part), first placental part expulsion (time between last piglet and first placental part) and last placental part expulsion (time between last piglet and last placental part). The relationship between farrowing duration and each of the outcome variables was investigated using four distinct multivariable models. Use of oxytocin (used in 44 out of 142 parturitions) increased number of expelled placental parts (3.8 ± 0.2 vs. 2.9 ± 0.3; P = 0.035), decreased the placenta expulsion duration (172 ± 44 vs. 328 ± 26 min; P = 0.011) and time of last placental part expulsion (148 ± 48 vs. 300 ± 24 min; P = 0.025). If oxytocin was not used, farrowing duration obeyed a quadratic relationship with the number of expelled placental parts (P = 0.001), placenta expulsion duration (P = 0.002) and time of last placental part expulsion (P = 0.024). If oxytocin was used, number of expelled placental parts was positively associated with number of liveborn piglets (β = 0.2 ± 0.1; P = 0.002) and affected by parity. 5th parity sows expelled more placental parts (4.3 ± 0.4) than 4th (3.2 ± 0.3; P = 0.024) and 3rd parity sows (2.7 ± 0.4; P = 0.008). Furthermore, placenta expulsion duration was positively associated with number of liveborn piglets (β = 18 ± 8 min; P = 0.025). First placental part expulsion was negatively correlated with farrowing duration (β = 0.3 ± 0.1; P = 0.001). Sows that experienced total (no expulsion of placental parts; n = 4) and partial retained placentas (no expulsion of placental parts after birth of the last piglet; n = 4) had longer farrowing durations (1009 ± 275 and 734 ± 136 min) than sows with no retained placentas (369 ± 202 min; P = 0.021 and P = 0.004). The results show that a prolonged parturition impaired and oxytocin improved placenta expulsion in sows. Furthermore, retained placentas occurred in 3-6% of the sows and was correlated with a prolonged parturition.

What accounts for the association between late preterm births and risk of asthma?

Although results of many studies have indicated an increased risk of asthma in former late preterm (LPT) infants, most of these studies did not fully address covariate imbalance.

Oxytocin treatment does not change cardiovascular parameters, hematology and plasma electrolytes in parturient horse mares.

In mares, foaling is associated with changes in hematology, plasma electrolytes, blood pressure and heart rate and it has been hypothesized that these are induced by oxytocin. To test this hypothesis, mares (n = 8-14/group) were treated with oxytocin (OT; 20 I.U.) or saline (CON) at 1 h (test A) and 12 h after foaling (test B) and during first postpartum diestrus (test C). Heart rate, heart rate variability (HRV), atrioventricular blocks, salivary cortisol concentration, blood pressure, plasma electrolytes and blood count were determined. Heart rate decreased from test A to C (P < 0.001) but at no time differed between groups. The HRV, blood pressure and occurrence of atrioventricular blocks did not change in response to oxytocin. Cortisol concentration decreased from test A to C (P < 0.001). Oxytocin induced a cortisol release in test B (time x treatment P < 0.001, time x test P < 0.001). Plasma sodium and chloride concentrations decreased from test A to C (P < 0.001) but did not differ between groups. In test A, potassium concentration increased in CON but not OT mares (time P < 0.01, time x test P < 0.01, time x treatment P < 0.05). Polymorphnuclear cell (PMN) numbers in blood decreased from test A to C (P < 0.001) while lymphocytes increased (P < 0.05). At no time PMN and lymphocytes differed between groups. Oxytocin treatment had no effect on skin temperature. In conclusion, except for a limited effect on cortisol release, oxytocin was without effect and the hypothesis of oxytocin-induced alterations in cardiac parameters, plasma electrolytes and hematology of foaling mares was not verified.

Essential newborn care after home delivery in Nepal.

Postnatal care of the newborn is essential in order to reduce neonatal mortality. Nepal has made great efforts to improve maternal and child health by focusing on accessibility and outreach over the past decades. This study aims to examine trends, over the past decade, in levels and equity of facility delivery rates and the provision of newborn care after home delivery in Nepal.

Paternal Depression Symptoms During Pregnancy and After Childbirth Among Participants in the Growing Up in New Zealand Study.

Antenatal and postnatal depression are known to be common and associated with poor outcomes for women and their children. There is little evidence on depression symptoms among men during the perinatal period.

Factors of influence and social correlates of parturition in captive Campbell's monkeys: Case study and breeding data.

How nonhuman primates deal with birth, at the moment of delivery, and during the following days, remains poorly explored because of the unpredictability of this event, particularly for forest-dwelling arboreal species. Available studies highlight intra- and interspecific variation which suggest flexibility of the timing of delivery, of behavior associated with labor contractions and parturition, and the social context and ambient noise surrounding delivery. Here, we present the findings of a two-decade survey of reproduction in a population of captive Campbell's monkeys. Analysis of 34 births (with a female-biased sex ratio) showed that deliveries occurred systematically at night and more frequently during week-ends and in fall (September-November). This suggests the existence of both circadian and infradian biological rhythms. We present the first detailed description of a birth for this species and its short-term social consequences. In line with previous findings for other monkeys and apes, labor (estimated by unusual stretching postures) and parturition were rapid, and delivery occurred in a clear social and vocal context. During the following days, the new mother became the center of attention of for young (kin and non-kin) females and rose through the hierarchy. We discuss socio-ecological factors, notably captivity conditions and the high degree of tolerance in the species' social system, and confirm the existence of both "rigidity" and "flexibility" in the primates' adaptive reproductive strategies.

Hospital Variations in Unexpected Complications Among Term Newborns.

To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida.

Consequences of delivery at home in a woman without prenatal care.

This is a case report of a 39-year-old multigravida woman without allopathic prenatal care who, after three previous caesarean sections, attempted to deliver her fourth child at home with the help of a direct entry midwife. During labour, fetal movement and fetal heart tones became undetectable, at which time the patient was referred by the midwife to the hospital. The patient was diagnosed with uterine rupture, bladder rupture and fetal demise; she was rushed to emergency surgery. The patient's lack of allopathic prenatal care, attempt of vaginal birth after three previous caesarean sections, coupled with her desire for delivery at home, led to her complicated course. The patient related that she was never made aware that attempting a home birth after three prior caesarean sections put her at increased risk for complications, and she was also unaware that midwives could have varying levels of training.

Shelter type and birth number influence the birth and death sites of lambs and ewe movement around lambing time.

A significant number of lambs born each yr in Australia die within 72 h of birth. Periods of high wind, combined with rain and low temperatures, can lead to marked increases in the level of mortality. Under these weather conditions mortality levels may be reduced with the provision of shelter, provided it is utilized by lambs. This study used GPS collars to determine the use of shelter by ewes and lambs, to compare the movement of ewes with twin lambs across 2 types of shelter (hedgerows and shrubs), while also comparing ewes with single and twin lambs in a single shelter type (hedgerows). Additionally, the birth sites of 364 lambs and death sites of 252 lambs were recorded across the 3 shelter type and litter size combinations (Twins in shrubs, Twins in hedgerows, Singles in hedgerows) plus an unsheltered group (Singles in unsheltered). A higher (P < 0.001) than randomly expected percentage of ewes lambed in the areas closest to both shelter types; in the shrub shelter 42% of ewes lambed within 2.5 m of shrub rows compared to an expected 11% based on the proportion of the paddock this area constituted. Despite the higher than expected percentage of ewes lambing close to the shelter rows, ewes in both twin lamb shelter types avoided the areas close to the shelter before and after lambing (Hedgerows-2.5 m; Shrubs- 6.25 m) and single bearing ewes showed no preference for or against these areas. With a high proportion of twin bearing ewes lambing close to the shelter, a design that reduces the potential for ewe and offspring separation while providing good shelter will offer the greatest potential reduction in newborn twin lamb mortality arising from exposure.

Selective versus routine use of episiotomy for vaginal birth.

Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures.

Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta-analysis.

There remains no consensus on the best timing of deinfibulation in women with type III female genital mutilation (FGM).