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Parturition - Top 30 Publications

Recovery after Nulliparous Birth: A Detailed Analysis of Pain Analgesia and Recovery of Function.

The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients.

Earwax metabolomics: An innovative pilot metabolic profiling study for assessing metabolic changes in ewes during periparturition period.

Important metabolic changes occur during transition period of late pregnancy and early lactation to meet increasing energy demands of the growing fetus and for milk production. The aim of this investigation is to present an innovative and non-invasive tool using ewe earwax sample analysis to assess the metabolic profile in ewes during late pregnancy and early lactation. In this work, earwax samples were collected from 28 healthy Brazilian Santa Inês ewes divided into 3 sub-groups: 9 non-pregnant ewes, 6 pregnant ewes in the last 30 days of gestation, and 13 lactating ewes ≤ 30 days postpartum. Then, a range of metabolites including volatile organic compounds (VOC), amino acids (AA), and minerals were profiled and quantified in the samples by applying headspace gas chromatography/mass spectrometry, high performance liquid chromatography/tandem mass spectrometry, and inductively coupled plasma-optical emission spectrometry, respectively. As evident in our results, significant changes were observed in the metabolite profile of earwax between the studied groups where a remarkable elevation was detected in the levels of non-esterified fatty acids, alcohols, ketones, and hydroxy urea in the VOC profile of samples obtained from pregnant and lactating ewes. Meanwhile, a significant decrease was detected in the levels of 9 minerals and 14 AA including essential AA (leucine, phenyl alanine, lysine, isoleucine, threonine, valine), conditionally essential AA (arginine, glycine, tyrosine, proline, serine), and a non-essential AA (alanine). Multivariate analysis using robust principal component analysis and hierarchical cluster analysis was successfully applied to discriminate the three study groups using the variations of metabolites in the two stress states (pregnancy and lactation) from the healthy non-stress condition. The innovative developed method was successful in evaluating pre- and post-parturient metabolic changes using earwax and can in the future be applied to recognize markers for diagnosis, prevention, and intervention of pregnancy complications in ewes.

Home is best: Why women in rural Zimbabwe deliver in the community.

Maternal mortality in Zimbabwe has unprecedentedly risen over the last two and half decades although a decline has been noted recently. Many reasons have been advanced for the rising trend, including deliveries without skilled care, in places without appropriate or adequate facilities to handle complications. The recent decline has been attributed to health systems strengthening through a multi-donor pooled funding mechanism. On the other hand, the proportion of community deliveries has also been growing steadily over the years and in this study we investigate why. We used twelve (12) focus group discussions with child-bearing women and eight (8) key informant interviews (KIIs). Four (4) were traditional birth attendants and four (4) were spiritual birth attendants. A thematic approach was used to analyse the data in Ethnography software. The study shows that women prefer community deliveries due to perceived low economic, social and opportunity costs involved; pliant and flexible services offered; and diminishing quality and appeal of institutional maternity services. We conclude that rural women are very economic, logical and rational in making choices on place of delivery. Delivering in the community offers financial, social and opportunity advantages to disenfranchised women, particularly in remote rural areas. We recommend for increased awareness of the dangers of community deliveries; establishment of basic obstetric care facilities in the community and more efficient emergency referral systems. In the long-term, there should be a sustainable improvement of the public health delivery system to make it accessible, affordable and usable by the public.

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

Cerebral palsy is an umbrella term encompassing disorders of movement and posture, attributed to non-progressive disturbances occurring in the developing fetal or infant brain. As there are diverse risk factors and causes, no one strategy will prevent all cerebral palsy. Therefore, there is a need to systematically consider all potentially relevant interventions for their contribution to prevention.

Validation of maternal reported pregnancy and birth characteristics against the Medical Birth Registry of Norway.

Studies using mothers' self-reported information on birth and pregnancy characteristics are common, but the validity of such data is uncertain. We evaluated questionnaire data from the RHINE III study on reproductive health provided by 715 mothers from Bergen, Norway, about their 1629 births between 1967 and 2010, using the Medical Birth Registry of Norway (MBRN) as gold standard. Validity of dichotomous variables (gender, preterm birth [<37 weeks' gestation], postterm birth [>42 weeks' gestation], induction of labour, forceps delivery, vacuum delivery, caesarean section, were assessed by sensitivity, specificity, positive and negative predictive values (PPV and NPV) and Cohen's kappa. Paired t-test, Pearson's correlation coefficient and Bland-Altman plots were used to validate birthweight, stratified by mother's level of education, parity, birth year and child's asthma status. Child's gender and caesarean section showed high degree of validity (kappa = 0.99, sensitivity and specificity 100%). Instrumental delivery and extremely preterm birth showed good agreement with sensitivity 75-92%. Preterm birth and induction of labour showed moderate agreement. Post-term delivery was poorly reported. The validity appeared to be independent of recall time over 45 years, and of the child's asthma status. Maternally reported birth and pregnancy information is feasible and cheap, showed high validity for important birth and pregnancy parameters, and showed similar risk-associations compared to registry data.

Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth?

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives-women's autonomy-plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women's autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women's autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women's education had a strong positive association (odds ratio = 24.11, CI = 9.43-61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women's education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband's education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women's autonomy may be an important mediating factor in this pathway.

Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands.

To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands.

Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study.

Abusive treatment of women during childbirth has been documented in low-resource countries and is a deterrent to facility utilization for delivery. Evidence for interventions to address women's poor experience is scant. We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania.

Understanding and Promoting Birth Satisfaction in New Mothers.

The purpose of this study was to examine the impact of select maternal psychosocial and experiential factors on birth satisfaction of new mothers during early postpartum.

Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey.

The aim of this study was to assess the rural-urban differences in the prevalence and factors associated with non-utilization of healthcare facility for childbirth (home delivery) in Nigeria.

Who delivers where? The effect of obstetric risk on facility delivery in East Africa.

Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk.

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.

Birth cohort studies in China: a review.

With longer than 100-year experience of development, methods used on birth cohort study have been viewed as having important roles in exploring the probable effects of health and environment exposure both prior to and during the pregnancy in the life circle as infants, children, adolescents, adults, and the elderly. However in China, birth cohort studies started late but with rapid development. Recently, some well-known methods on birth cohort studies were established in mainland China, Hong Kong and Taiwan area. This paper presented an overall review on the progress about birth cohort studies and their prospects, in China.

The maternal childbirth experience more than a decade after delivery.

Maternal satisfaction with the birth experience is multidimensional and influenced by many factors, including mode of delivery. To date, few studies have investigated maternal satisfaction outside of the immediate postpartum period.

Peak Bone Mass and Bone Microarchitecture in Adults Born With Low Birth Weight Preterm or at Term: A Cohort Study.

Peak bone mass (PBM) is regarded as the most important determinant of osteoporosis. Growing evidence suggests a role of intrauterine programming in skeletal development. We examined PBM and trabecular bone score (TBS) in adults born preterm with very low birth weight (VLBW) or small for gestational age (SGA) at term compared with term-born controls.

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.

Validation Study of Maternal Recall on Breastfeeding Duration 6 Years After Childbirth.

Breastfeeding duration is an important indicator commonly measured in maternal and child health and nutrition research. Maternal short-term recall for both initiation and duration of breastfeeding has been shown to be valid; however, validity of long-term recall is not well understood. Research aim: This study aims to assess the validity of maternal recall of breastfeeding duration 6 years after childbirth and its association with sociodemographic factors.

Coagulase-Negative Staphylococci in Human Milk From Mothers of Preterm Compared With Term Neonates.

Human milk is the preferred nutrition for neonates and a source of bacteria. Research aim: The authors aimed to characterize the molecular epidemiology and genetic content of staphylococci in the human milk of mothers of preterm and term neonates.

In vivo evidence of significant levator ani muscle stretch on MR images of a live childbirth.

Vaginal childbirth is believed to be a significant risk factor for the development of pelvic floor dysfunction later in life. Previous studies have explored the use of medical imaging and simulations of childbirth to determine the stretch in the levator ani muscle. A report in 2012 has recorded magnetic resonance images of a live childbirth of a 24 year old woman giving birth vaginally for the second time, using a 1.0 Tesla open, high-field scanner. Our objective was to determine the stretch ratios in the levator muscle using these magnetic resonance images of live childbirth.

The Effect of Acupressure Applied to Point LI4 on Perceived Labor Pains.

Controlling labor pain is one of the basic goals for caregivers during the birthing process. There are many pharmacological and nonpharmacological methods that are used for controlling pain and helping the mother to cope with pain and have a favorable labor. The study was planned as a randomized, controlled experimental study to detect the effect of acupressure applied to Point LI4 on perceived labor pains. The study sample comprised 88 pregnant women (44 acupressure group, 44 control group), who complied with the study guidelines, agreed with the conditions of the study, and signed the informed consent. Acupressure was applied to the study group when cervical dilatation reached 4 to 5 cm and again when cervical dilation was 7 to 8 cm. Acupressure was applied to Point LI4 on both the hands at the same time from the beginning to the end of the contraction (16 times). Evaluation with the visual analog scale was made 6 times: when the pregnant woman was first admitted to the hospital, before and after acupressure, and within 2 hours after delivery. The control group received routine care. There were statistically significant differences between the groups in subjective labor pain scores (P < .0001). There was a significant difference between the groups in terms of total duration of labor. As shown from our study, applying acupressure to Point LI4 was found to be effective in decreasing the perception of labor pains and shortening the labor (P < .05). Mothers were pleased with this treatment, but they found it insufficient to control their pain.

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.

Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study.

Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth.

The Role of Hsp70 in the Regulation of Autophagy in Gametogenesis, Pregnancy, and Parturition.

Induction of the 70 kDa heat shock protein (hsp70) and autophagy are two major mechanisms that promote cell homeostasis during the rapid cell growth and differentiation characteristic of reproduction. Hsp70 insures proper assembly, conformation, and intracellular transport of nascent proteins. Autophagy removes from the cytoplasm proteins, other macromolecules, and organelles that are no longer functional or needed and recycles their components for synthesis of new products under nutritionally limiting conditions. Hsp70 inhibits autophagy and so a proper balance between these two processes is essential for optimal germ cell production and survival and pregnancy progression. A marked inhibition in autophagy and a concomitant increase in hsp70 at term is a trigger for parturition. Excessive external or endogenous stress that induces a high level of hsp70 production can lead to a non-physiological inhibition of autophagy, resulting in altered spermatogenesis, premature ovarian failure, and complications of pregnancy including preeclampsia, intrauterine growth restriction, and preterm birth.

Implementation of a Hydrotherapy Protocol to Improve Postpartum Pain Management.

A growing number of women are seeking alternatives to traditional pharmacologic pain management during birth. While there has been an extensive array of nonpharmacologic options developed for labor, there are limited offerings in the postpartum period. The purpose of this quality improvement project was to implement a hydrotherapy protocol in the early postpartum period to improve pain management for women choosing a nonmedicated birth.

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.