Natural Childbirth Options

Bump To Birth

The experience that a woman has during childbirth shapes how the rest of her child-raising experience goes, in many ways. A good birth can have a huge effect on how good you feel about your child, whereas a bad birth can often lead to feelings of sadness or PDST-type symptoms due to the pain and struggle of the birth experience. However, you don't need to worry about that now, because the information in this book gives you ALL of the experience and expert advice that you need in order to have a really amazing birth, that really marked that day as the truly special day that it is. This book teaches you how to use natural, holistic remedies to heal yourself during pregnancy in order to make sure that you feel your best during the whole birth experience. You can also learn everything you need to know about natural birth Everything you need to know to have a great pregnancy and birth is in this guide! Read more...

Bump To Birth Summary


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Prolonged pregnancy and home birth

There is a lack of good quality epidemiological evidence on the outcome of post-term pregnancy when delivery occurs at home. Bastian et al. 26 used multiple methods of case identification and follow-up to assemble a population-based cohort of 7002 home births in Australia. Fifty perinatal deaths occurred, giving a perinatal mortality rate of 7.1 per 1000. Seven of 44 (15 ) of perinatal deaths in women with a known gestational age occurred in women who were42weeks pregnant or more. A study conducted among Native Americans, examining an increase in perinatal mortality in home births attended by mid-wives compared with those attended by doctors identified post-dates pregnancies, breech deliveries and twins as the

Childbirth after a Fourthdegree Tear

There are very few studies evaluating the effect of vaginal birth on women's anal function after a fourth-degree perineal laceration. However, findings from available studies are fairly consistent. A Swiss study reported that women who had one or at least two vaginal deliveries after a fourth-degree perineal laceration developed fecal incontinence more frequently than those who had no subsequent birth 7 25 (28 ) vs. 2 9 (22 ) vs. 0 14, p 0.04 41 . Although the prevalence of anal incontinence was similar 20 52 (38 ) vs. 14 60 (23 ) vs. 10 36 (28 ), p 0.208 , the East Carolina study found that women who had at least two additional vaginal deliveries after a fourth-degree sphincter tear developed severe incontinence more frequently than those who had no or one subsequent delivery 4 36 (11 ) vs. 0 vs. 0, p 0.002 50 . Thus, existing data suggest that vaginal delivery after a fourth-degree perineal laceration

Childbirth after a Thirddegree Tear

Third- and fourth-degree perineal lacerations occur three to seven times more frequently among nulli-paras than multiparas 27, 38, 39 . Consequently, many women who had an anal sphincter tear would want to have more children. Vaginal delivery after an anal sphincter tear has frequently been cited as a major risk factor for developing a new and more severe anal incontinence 8,14, 21, 38 . As we do not know how to effectively repair a torn anal sphincter, and a significant number of failed repairs would develop incontinence, obstetricians are naturally reluctant to subject women who had a prior third- or fourth-degree perineal laceration to the stress of another vaginal birth. In addition, about 7.5-10.5 of women who had a prior third- or fourth-degree perineal laceration would develop a recurrent sphincter tear during subsequent vaginal delivery. These findings have led some investigators to propose that women with a prior third- or fourth-degree tear should have elective cesarean for...


Childbirth may result in damage to the pelvic floor musculature as well as injury to the pudendal and pelvic nerves. The association between increasing parity and urinary incontinence has been reported in several studies. Some authorities have found this relationship to be linear whilst others have demonstrated a threshold at the first delivery and some have shown that increasing age at first delivery is significant. A large Australian study has demonstrated a strong relationship between urinary incontinence and parity in young women (18-23 years) although in middle age (45-50 years) there was only a modest association and this was lost in older women (70-75 years) 20 .

Brief History Of Classical Biochemistry

The period between the 1940s and 1960s gave witness to arguably some of the most significant achievements in biochemistry, which gave birth to biochemical genetics and led to the emergence of molecular biology. In 1941, studying the metabolism of the orange bread mold Neurospora crassa irradiated with X-rays to cause mutations, researchers George Beadle and Edward Tatum demonstrated a 1 1 relationship between a mutation and the absence of a specific enzyme, by identifying mutants defective in specific steps of a metabolic pathway. Assuming that each mutant was defective in a single gene, Beadle and Tatum hypothesized that one gene may contain the genetic information responsible for one enzyme, and that mutants with a defective enzyme carried a defective gene for that enzyme (6). In 1944, building on research from 1928 performed by Frederick Griffith, which demonstrated that heat-killed virulent bacteria contained a transforming principle (agent), which could transform live,...

Who should provide the antenatal care

There is little evidence regarding women's views on who should provide antenatal care. Unfortunately, care is usually provided by a number of different professionals often in different settings. Studies evaluating the impact of continuity of care do not generally separate the antenatal period from labour. The studies consistently show that with fewer caregivers women are better informed and prepared for labour, attend more antenatal classes, have fewer antenatal admissions to hospital and have higher satisfaction rates. Differences in clinical end-points such as Caesarean section rates, post-partum haemorrhage, admission to the neonatal unit and perinatal mortality are generally insignificant 3 . While it would appear advantageous for women to be seen by the same midwife throughout pregnancy and childbirth there are practical and economic considerations that need to be taken into account. Nevertheless, where possible, care should be provided by a small group of professionals.

Effects of Hyperthyroidism on Mother and Child

Congestive heart failure and thyroid storm may also occur and the risk of pre-eclampsia is significantly higher in women with poorly controlled hyperthyroidism and low birth weight may be up to nine times as common. Neonatal hyperthyroidism, prematurity and intra-uterine growth retardation may be observed. A retrospective review documented a 5.6 incidence of fetal death or stillbirth in 249 pregnancies from hyperthyroid mothers and a further 5 fetal and neonatal abnormalities. Women with thyroid hormone resistance who, despite being euthyroid, had high levels of circulating T4 had a significantly increased miscarriage rate compared to euthyroid unaffected couples 30 . However, a recent study of women with subclinical hyperthyroidism, comprising 1.7 of women, showed no significant adverse pregnancy outcomes suggesting that treatment of this condition in pregnancy is not warranted 31 . Nevertheless, there is no doubt that overt clinical and biochemical hyperthy-roidism should...

The Range of Androgen Insensitivity Syndromes

AIS occurs in a range of forms, from complete to mild. Most mutations to the testosterone-binding region, and some other types of mutations, cause complete androgen insensitivity syndrome (CAIS). In this form of the syndrome, the XY person is born phenotypically female, and from birth is raised as a girl. Gender identification (the internal sense of being male or female) is female. Sexual orientation is typically heterosexual, and so most CAIS individuals are attracted to males. At puberty, estrogen production by the adrenal glands causes breasts to develop. However, no pubic or armpit hair develops, since in males and females this is controlled by testosterone, and no menstruation occurs. It is at this point that the condition is usually diagnosed. Once discovered, the testes are usually surgically removed to prevent the possibility of testicular cancer, which is more common in people with CAIS. The woman is infertile, but may be able to enjoy sexual relations if the vagina is long...

Ambulation in the puerperium

It is now well established that early mobilization after childbirth is extremely important. Once the mother has recovered from the physical rigours of her labour, she should be encouraged to mobilize as soon as possible. The physiotherapist has an important role to play in returning the patient to normal health during the puerperium and limb exercises will be particularly important to encourage venous flow in the leg veins of any mother who has been immobilized in bed for any reason. Exercises to the abdominal and pelvic floor muscles are most valuable in restoring normal tone which may have been lost during pregnancy.

Thyroid Synthesis in the Full Term Newborn

During the birth process many changes occur in the function of the thyroid gland in the full-term neonate. The most dramatic change is the abrupt increase in TSH which takes place in the first 30min after parturition which can reach levels of 60-70 mlU l. This increase causes a major stimulation of the thyroid gland with an increase in T4 in the serum by about 50 and a 3- to 4-fold increase in T3 within 24h 36, 37 . Studies in experimental animals have shown that the increase in TSH is a consequence of the relative hypothermia that exists in the environment outside of the uterus. The increase in T3 occurs not only because TSH levels increase but also because of an increase in the action of type I deiodinase during birth. The high levels of reverse T3 (rT3) decrease relatively quickly during the neonatal period. The increase in the action of type II deiodi-nase causes an increase in T3 in the adipose tissue of the neonate which is necessary for thermogenesis and the synthesis of...

System Reconstructive Procedures

The primary cause of cystoceles and rectoceles is a weakened vaginal wall. Factors that contribute to this loss of pelvic muscle tone are repeated pregnancies, especially those spaced close together, congenital weaknesses, and unrepaired childbirth lacerations. Obesity, advanced age, chronic cough, constipation, forceps deliveries, and occupations that involve much standing and lifting are also contributing factors. Lack of estrogen after menopause frequently aggravates the condition.

Transmission and Tissue Tkopism

Based on experimental transmission studies, the major route of FIV transmission is through bites from infected cats. This route of transmission is consistent with the epidemiological studies as well as with the fact that cats shed significant amount of virus in saliva. FIV transmission by ingestion of virus via grooming, as well as presumably when licking bleeding wounds of an infected cat, cannot be excluded, as oral administration of infected blood can result in experimental FIV infection. Sexual transmission has yet to be reported as a natural route of transmission however, FIV infection has been demonstrated by experimental vaginal and rectal inoculation and FIV has been isolated from vaginal swabs and semen of experimentally infected cats. Another route of infection is through virus found in the colostrum milk of infected queens. FIV has been shown to be transmitted to newborn kittens nursed by queens experimentally infected shortly before giving birth. Findings from experimental...

Eriksons Stages Of Psychosocial Development

In addition to this distinction, another important difference was Erikson's concern for psychological development throughout the entire life span, rather than just the years from birth through adolescence. Erikson examined the consequences of early experiences on later life and described the nature of qualitative change during the middle and later years of life.

Transmission and Tissue Tropism

Receptor family that is transiently expressed on activated T cells. FIV cannot use human CD134 as receptor to infect human cells, but can use both feline and human CXCR4, a chemokine receptor, as co-receptor. It has been speculated that CXCR4 can also serve as primary cellular receptor for FIV. Based on experimental transmission studies, the major route of FIV transmission is through bites from infected cats. This transmission route is consistent with the epidemiological studies and with the fact that cats shed significant amounts of virus in saliva. FIV transmission by ingestion of virus via grooming and licking bleeding wounds of an infected cat cannot be excluded, since oral administration of infected blood can cause infection. FIV infection was demonstrated by experimental vaginal and rectal inoculation, and FIV was isolated from vaginal swab and semen of infected cats. Another route of transmission is by ingesting contaminated colostrum milk of infected queens. Experimental...

Discharge And Home Healthcare Guidelines

After the blastocyst implants in the tube, it begins to grow and can cause bleeding into the abdominal cavity. Eventually, the ovum becomes too large, and the tube can rupture, thus causing further bleeding that can lead to shock and maternal death. Ectopic pregnancies occur in approximately 2 in 100 pregnancies and non-European Americans have a 1.4 times increased risk over European Americans. The frequency of ectopic pregnancy has increased fourfold since 1970, owing to the increase in sexually transmitted infections, better diagnostic techiques, increased use of artificial reproductive technology, and the increased use of tubal surgeries to treat infertility. Ectopic pregnancy accounts for 10 of all pregnancy-related deaths and reduces a woman's chance of future pregnancy because of tubal damage approximately one-third of women who experience an ectopic pregnancy subsequently give birth to a live infant. Hemorrhage, peritonitis and infertility are the main complications.

Eligibility Requirements

Head Start and Early Head Start programs serve children from birth to five years of age whose families meet poverty income guidelines based on family size. For example, in 2003, a family of three with an annual income less than 15,260 or a family of four with annual income less than 18,400 qualified. (Alaska and Hawaii had slightly higher values.) In addition, children with disabilities, children from families receiving public assistance such as Temporary Assistance to Needy Families (TANF) and Supplemental Security Income (SSI), and children living in foster care are eligible for Head Start and Early Head Start, regardless of their family's income.

Docosahexaenoic Acid Supply and Conservation

It is of interest how 22 6n-3 is supplied to the developing retina to meet both its requirement and to be conserved in enriched amounts in the membrane. The intestine (Li et al., 1992) and liver (Scott & Bazan, 1989) appear to play an important role. Oral doses of C14 18 3n-3 and C14 22 6n-3 are esterified to triacylglycerols and phospholipids by the intestinal absorptive cells and transported in chylomicrons to the liver (Li et al., 1992). The liver synthesizes 22 6n-3 from 18 3n-3 and can deliver 22 6n-3 to the retina and brain via lipoproteins or albumin (Scott & Bazan, 1989). Phospholipid, triglyceride, and cholesterol esterified with 22 6n-3 are carriers of 22 6n-3 to nervous tissues (Li et al., 1992 Martin et al., 1994 Wang & Anderson, 1993b). Retinal pigment epithelium is actively involved in the preferential uptake of 22 6n-3 from the circulation and subsequently transports this fatty acid to the rod outer segment (Wang & Anderson, 1993a,b). Wang et al. (1992) confirmed that...

Traumatic Brain Injury

Brain injury as a result of birth trauma and congenital and degenerative factors are excluded. school. Consideration of services under this category may be extended to children who have undergone aggressive treatment for neurological conditions (e.g., a brain tumor) that result in impairment. Brain injuries that are congenital, degenerative, or the result of birth trauma are excluded.

Ap Deposition Appears To Be a Necessary but Not Sufficient Factor for the Genesis of AD

APP transgenic mice experience high brain expression of APP from birth and are thus analogous in part to patients with DS. However, the mice reported to date have the additional influence of an FAD-linked missense mutation flanking the Ap region of APP (57,58). Although such animals have high neuronal expression of the APP transgene as well as high levels of soluble Ap within their brains from birth, they develop diffuse and compacted Ap plaques resembling those of AD beginning around 5-7 months (mice normally live to about 2-3 years). During the next several months, the transgenic mice show increasing numbers of Ap deposits, many of which are now Congo redpositive (suggesting that they contain fibrillar amyloid), and electron microscopy clearly reveals filamentous amyloid cores (60). Moreover, after Ap plaques develop, the mice show morphologically and immunocytochemically abnormal neurites intimately associated with the amyloid plaques (57,58,60). Cytoskeletal proteins such as the...

Womens views of induction for postterm pregnancy

Regrettably, randomized trials give little information on women's views of induction versus conservative management. Only one trial assessed maternal satisfaction with induction of labour 75 . These authors showed that satisfaction was related to the eventual outcome of labour and delivery, rather than to the mode of onset of labour. Women's views are likely to be influenced by the local culture, by the attitude of their caregivers and by practical considerations such as the duration of paid maternity leave. Few obstetricians, midwives or childbirth educators are capable of giving women unbiased information about the risks of post-term pregnancy and the benefits and hazards of induction of labour. In a prospective questionnaire study of women's attitudes towards induction of labour for post-term pregnancy Roberts and Young 76 found that, despite a stated obstetric preference for conservative management, only 45 of women at 37 weeks' gestation were agreeable to conservative management...

Comparison of methods of induction of labour

Comparisons of alternative methods are most reliably based on the results of randomized clinical trials. To manage the complexity of several hundred reported randomized trials comparing multiple combinations of 25 methods of labour induction, the Pregnancy and Childbirth Group of the Cochrane Collaboration, in collaboration with the Clinical Effectiveness Support Unit, Royal College of Obstetricians and Gynaecologists, developed a strategy to review well-defined clusters of comparisons in a series of systematic reviews using standardized outcomes and clinical subgroups 9 . For the purposes of this chapter, data comparing PGE2 administered vaginally (as the 'gold standard') with any other method have been extracted from these reviews (Table 23.2).

Induction of labour with previous Caesarean section

In a retrospective study the rates of rupture of a scarred uterus were 2.5 for labours induced with prostaglandins 0.77 for other methods of labour induction and 0.52 for spontaneous labour 13 . The Committee on Obstetric Practice of the American College of Obstetricians and Gynecologists have concluded that the risk of uterine rupture during attempts at vaginal birth after Caesarean section is substantially increased with the use of various prostaglandin agents for the induction of labour, and their use for this purpose is discouraged 14 . On the basis of the evidence above relating to uterine hyperstimulation, extra-amniotic saline infusion (or amniotomy alone when the cervix is favourable) may be the safest options for labour induction following Caesarean section. However, there is no direct evidence to substantiate this assumption.

Detection of Mitotic Cells

There are a number of potential applications for this methodology. It can be used to identify mitotic cells for the estimation of mitotic index (MI) in populations of cells growing exponentially or treated with drugs. It also can be used in stathmokinetic experiments in which the cells are arrested in mitosis and the rate of cell entrance to M ( cell birth rate ), emptying of the G1 compartment, and many other kinetic parameters can be estimated. Furthermore, the immunocytochemical detection of H3-P provides new opportunities for studying the role of H3 phosphorylation in chromatin condensation during mitosis. In particular, it may be helpful in identification of the kinase(s) and or protein phosphatase(s) involved in H3 phosphorylation and dephosphorylation. Since these enzymes are a potential target for development of new antitumor drugs designed to target the G2 to M transition, the possibility of immunocytochemical detection of the activity of one or more of them may be of great...

Phylogeny And Classification

Their trophic diversity and numerical abundance make the Diptera an important component in many ecosystems, both as primary consumers and as a food resource for other organisms. Trophic diversity is reflected in the wide range of larval feeding habits, which encompass nearly every category. In some groups (e.g., asilids, most empidids), larvae and adults belong to the same trophic category in other groups (e.g., simuliids, tachinids) these life stages usually adopt different feeding strategies in still others, feeding can be restricted to only the larvae or adults (e.g., chironomids, hippoboscids, and nycteribiids). The latter comprise primarily the so-called Pupipara, in which the females are hematophagous and do not lay eggs and instead give birth to fully formed larvae (i.e.,viviparous development). In addition to the above-mentioned variety of feeding habits, some groups may feed on multiple food resources during the same life stage (e.g., larvae that can be both saprophagous and...

General principles for the management of diabetic pregnancies

Abnormalities, accelerated fetal growth, late stillbirth, birth trauma, neonatal hypoglycaemia and long-term health problems for the child. Gestational diabetes is associated with those complications attributable to maternal hyperglycaemia arising in the latter half of pregnancy. The principal tenet for the management of all diabetic pregnancies, from the time of conception through to the time of delivery, is to strive for maternal euglycaemia. The need for good glycaemic control is based on evidence implicating hyperglycaemia with maternal and fetal complications, see Table 27.2. Although other maternal metabolic disturbances do occur that may be detrimental to pregnancy, such as changes in lipid metabolism, it is hyperglycaemia, not dyslipidaemia, that is particularly harmful to embryogenesis and it is glucose, not fat, that is the fetal fuel substrate responsible for fetal hyperinsulinaemia and accelerated fetal growth. Monogenetic MODY (Maturity Onset of Diabetes of the Young)....

Lactational amenorrhoea method

Breastfeeding delays the resumption of fertility after childbirth and the length of the delay is related to the frequency and duration of breastfeeding episodes and the timing of the introduction of food other than breast milk (e.g. solids). Prolonged breastfeeding can postpone ovulation, and therefore the risk of pregnancy, for more than a year. A woman who is fully or nearly fully breastfeeding and who remains amenorrhoeic has less than a 2 chance of pregnancy during the first 6 months after childbirth. The lactational amenorrhoea method or LAM is an algorithm which enables a woman to determine whether or not her pattern of infant feeding combined with her pattern of menstruation, confers effective contraception.

Congenital Hip Dysplasia Introduction

Congenital hip dysplasia is related to abnormal hip development. The abnormalities include hip instability, preluxation (shallow acetabulum), subluxation (incomplete dislocation of the hip), and dislocation (femoral head not in contact with the acetabulum). It usually involves one hip, but may involve both. It occurs 6 times more often in females than males. It is usually identified in the newborn period and responds to treatment best if initiated before 2 months of age. Therefore, it is important to examine every infant from birth to 12 months of age. Treatment is dependent on the age of the child and the degree of abnormality, and ranges from application of a reduction device, to traction and casting, to surgical open reduction. Casting and splinting with correction is usually impossible after 6 years of age.

Description Surgical Stomach Esophageal

The most common cause of Mallory-Weiss syndrome is failure of the upper esophageal sphincter to relax during prolonged vomiting. This poor sphincter control is more likely to occur after excessive intake of alcohol. Any event that increases intra-abdominal pressure can also lead to an esophageal tear, such as persistent forceful coughing, trauma, seizure, pushing during childbirth, or a hiatal hernia. Other factors that may predispose a person to Mallory-Weiss syndrome are esophagitis, gastritis, and atrophic gastric mucosa.

Clinical manifestation

Pink-to-violaceous patch, with variable blanching after external pressure present from birth usually located over the head and neck area surface sometimes becomes thickened with a cobblestone-like contour and vascular papules or nodules or pyo-genic granulomas, usually in adulthood skin and underlying soft tissue or bony hypertrophy may occur. Sturge-Weber (encephalofacial or encepha-lotrigeminal angiomatosis) variant vascular malformation involving the upper facial area supplied by ophthalmic branch (CN Vi) of the trigeminal nerve, the ipsilat-eral leptomeninges, and the ipsilateral cerebral cortex more extensive than in isolated nevus flammeus complications include glaucoma, seizures, hemiplegia, mental retardation, cerebral calcifications, sub-dural hemorrhage, and underlying soft tissue hypertrophy

Plantainleaved Everlasting

For women to drink for two weeks after giving birth (H H Smith. 1928), and also a tea from LESSER CAT'S FOOT (Antennaria neodioica) (H H Smith. 1945). African-Americans in the southern states used to steep the leaves with some corn meal, and use the mixture to ease menstrual pains (Puckett). 'Ladies' Tobacco' is a name given to this species (Sanford) (and also to Cat's Foot) 'Indian Tobacco' is another (Grieve. 1931), these names imply that the dried plant must have been smoked as a tobacco substitute, and found to be too mild, if Ladies is to be believed. Love's Test is another name (Bergen. 1899), for this was a plant used in love divinations. A leaf has to be taken by the ends, while the operator thinks of someone of the opposite sex. The leaf then has to be pulled apart. If the down on its underside is drawn out long, much love is indicated. Or both ends may be named, and the one whose end has the longer down on it shows who is the more ardent lover.

Risk Factors for Sphincter Injuries

Episiotomy was at one time believed to be protective to the perineum during childbirth and was used to prevent the occurrence of third- and fourth-degree tears 67 . There is now evidence that episiotomy not only fails to protect the perineum 68 but has been associated with increased tearing and anal sphincter injury 69-72 . Signorello and colleagues 73 studied the relationship between episiotomy and postpartum anal incontinence. They found no protective benefit but found impaired continence. The authors compared women who had episiotomies with women who had an intact perineum and women who spontaneously tore in all comparisons, episiotomy doubled or tripled the risk of incontinence.

Treating Sphincter Injuries The Colorectal Surgeons Role

Women with incontinence due to childbirth present in three categories 49 . First are women who have an injury that was recognized and acutely repaired. Second are those who present with incontinence within the first year after a delivery and a primary sphincter repair. Third are those who present many years from the time of delivery, usually in middle age. The first group, the acute setting and primary repair of injuries, has been discussed. The colorectal surgeon most frequently evaluates and manages the second and third groups of women.

Elective Cesarean after an Anal Sphincter Tear

Although elective cesarean for all births after a third-or fourth-degree perineal laceration has been widely advocated as the method to prevent the occurrence of a new or more severe incontinence, there is very little evidence to support the effectiveness of this prophylactic measure. Elective cesarean has a rather limited protective effect on the anal function. The International Randomized Term Breech Trial found that at 3 months postpartum, only mild flatus incontinence was more prevalent among the planned vaginal delivery than the planned cesarean group (33 58 vs. 20 61, p 0.008) 51 . The prevalence of flatus incontinence (66 616 vs. 59 606, p 0.64), severe flatus incontinence (1 61 vs. 2 58, p 0.481), fecal incontinence (5 619 vs. 9 607, p 0.29), and mild fecal incontinence (2 4 vs. 7 9, p 0.353) were similar between the two groups. The reason for this limited protective effect is that anal incontinence that develops during childbirth occurs primarily during antepartum 52, 53 ....

Surgical Cesarean Section with CC

Postpartum hemorrhage (PPH) is frequently defined as a blood loss of greater than 500 mL after giving birth vaginally or a blood loss of greater than 1000 mL after a cesarean section. Because many women lose at least 500 mL of blood during childbirth and do not experience any symptoms, a more accurate way to define PPH is losing 1 or more of the body weight after delivering a baby (1 mL of blood weighs 1 g). For example, a patient weighing 175 lb, or 80 kg, would need to lose 800 mL of blood to be classified as having a PPH. Greater than a 10 decrease in the prenatal hematocrit is another means used to suggest that PPH has occurred this value needs to be used cautiously because hematocrit is affected by factors other than blood loss, such as dehydration. It is estimated that 2 to 4 of all deliveries end in PPH, and it is a major contributor to maternal morbidity and mortality.

Primary Nursing Diagnosis

Assist the patient who is having natural childbirth in breathing and relaxation techniques. Often, the coach plays a significant role in helping the patient deal with the contractions. The nurse should become involved only when necessary. If a preterm delivery is expected, educate the patient and family on the expected care of the newborn in the neonatal intensive care unit (NICU). If possible, allow the patient to visit the NICU and talk to a neonatologist.

Treatment of infertility

Live-birth rate per cycle started 22 t Live-birth rate per cycle started 28 Pregnancy rate per oocyte recovery 25 * Live-birth rate per oocyte recovery 34 Pregnancy rate per oocyte recovery 26 * Live-birth rate per oocyte recovery 32 Pregnancy rate per cycle 16 * Live-birth rate per cycle 11 Live-birth rate per transfer 50

Other interventions in male factor infertility

Interventions which have been shown to be ineffective include anti-oestrogens (clomifene and tamoxifen), androgens, bromocriptine and kinin enhancing drugs. Antioxidants (Vitamins C and E and glutathione) can improve semen parameters in men, but in the absence of data on more definitive outcomes such as pregnancy or live-birth rates, their use cannot yet be recommended. Mast cell blockers have shown some initial promise in men with severe oligizoospermia (National Collaborating Centre for Women's and Children's Health (NICE) guideline, 2004).

Stereotypies In Animals

Stereotypies can be shown by humans with neurological disorders, by those with some degree of mental illness, and by those in situations where they have little or no control over aspects of their interaction with their environment. People with no illness may show stereotypies when confined in a small cell in prison or when exposed to situations like waiting for an important interview or waiting for their wife to give birth.

Gamete intrafallopian tube transfer

Table 46.3 Live birth rates for assisted reproductive technology (ART) transfer procedures performed among patients who used freshly fertilized embryos from their own eggs, by patient age and selected patient ad treatment factors United States, 2002 Table 46.3 Live birth rates for assisted reproductive technology (ART) transfer procedures performed among patients who used freshly fertilized embryos from their own eggs, by patient age and selected patient ad treatment factors United States, 2002 *P 0.05 chi-square to test for variations in live birth rates across patient and treatment factor categories within each age group. IVF-ET in vitro fertilization with transcervical embryo transfer, and ICSI intra-cytoplasmic sperm injection. ART procedures including GIFT, ZIFT, and a combination of IVF with or without ICSI and either GIFT or ZIFT were not included because each of these accounted for a limited proportion of procedures. *P 0.05 chi-square to test for variations in live birth...

Clinical Features and Pathology

When a persistently infected woman gives birth, she will almost invariably pass on the virus to her infant. HBV normally does not cross the placenta and transmission is believed to occur during or immediately after the birth process. Infants who are infected perinatally have a very high probability ( 90 ) of becoming persistently infected - they are extremely immune tolerant of the virus and the infection may persist even for life. A soluble protein, HBeAg, which is related to the nucleocapsid protein, is secreted from the infected hepatocytes and may cross the placenta and induce tolerance in the foetus. A protein equivalent to HBeAg is made by all of the hepadnaviruses, including the avian viruses.

Payment To The Surrogate

Most people agree that financial compensation should be made to the surrogate for her time and effort in initiating and carrying the pregnancy, her acceptance of the hazards of pregnancy and childbirth, delivering the baby, and her possible loss of employment opportunities. Do not compensate the surrogate for delivering an acceptable product. This means that payment to the surrogate should not be contingent upon her delivering a healthy live-born baby because this would seem to devalue human life and turn surrogacy into a financial baby buying business.

Sex Linked Inheritance

X-linked recessive alleles affect males more often and more severely than females. A male inherits his single X chromosome from his mother. Because a male has only one X chromosome, he expresses every allele on it, including harmful recessive ones. Examples of conditions due to recessive X-linked alleles include Duchenne muscular dystrophy, one form of hemophilia, and red-green colorblindness. These conditions are much more common in males than in females. Female carriers have a 50 percent chance of giving birth to a male child affected by the recessive allele. The genetic status of the father with respect to X-linked conditions is not relevant in this case, because he donates a Y chromosome to his male children.

Medically Indicated Sex Selection

The medical reason for sex selection is to prevent sex-linked genetic disorders, as discussed in Chapter 10. Ideally, the best way to screen for a genetic disorder would be to test for the specific gene that is causing the disorder, but unfortunately, science and technology have not yet reached that point for many diseases. Therefore, the only way to prevent a known sex-linked genetic disorder is to choose to give birth to a baby of the sex that is not affected. For example, if a woman carries the gene for hemophilia, then 50 percent of her sons will have hemophilia, a life-threatening disease. Girls born to this woman will not have the disease, though they could be carriers of hemophilia. To ensure that her children will not have hemophilia, the woman either decides to abort male fetuses or chooses not to transfer male embryos back into her uterus. Of course, this is not ideal, because healthy male embryos may be discarded. Though still a new technology, MicroSort, which helps to...

Environmental Effects on Intelligence

The study of intelligence must take environmental effects into account. The Flynn effect describes a phenomenon that indicates that IQ has increased about 3 points per decade over the last fifty years, with children scoring higher than parents in each generation. This increase has been linked to multiple environmental factors, including better nutrition, increased schooling, higher educational attainment of parents, less childhood disease, more complex environmental stimulation, lower birth rates, and a variety of other factors.

Epidemiology And Transmission

Delivery. 13 Newborn girls can acquire infection from their infected mothers during passage through the birth canal and remain asymptomatic until puberty. Transmission of T. vaginalis in children before and after puberty may be indirect especially in an environment with infected family members. 13

Accessory Glands Of Females

Viviparous insects use accessory glands to provide nourishment directly to developing offspring. Tsetse flies and sheep keds are dipterans that retain single larvae within their reproductive tracts and provide them with nourishment. They give birth to mature larvae ready to pupate. The gland that produces the nourishing secretion, rich in amino acids and lipids, is known as the milk gland. The Pacific beetle roach, Diploptera punctata, is also viviparous and provides its developing embryos with nourishment secreted by the brood sac, an expanded portion of oviduct.

Physiological Actions Of Ovarian Steroid Hormones

Menstrual Physiology

As described above, intraovarian actions of estradiol and progesterone are intimately connected to ovulation and formation of the corpus luteum. In general, extra-ovarian actions of these hormones ensure that the ovum reaches its potential to develop into a new individual. Ovarian steroids act on the reproductive tract to prepare it for fulfilling its role in fertilization, implantation, and development of the embryo, and they induce changes elsewhere that equip the female physically and behavior-ally for conceiving, giving birth, and rearing the child. Although estrogens, perhaps in concert with progesterone, drive females of subprimate species to mate, andro-gens, rather than estrogens, are responsible for libido in humans of either sex. Estrogens and progesterone tend to act in concert and sometimes enhance or antagonize each other's actions. Estrogen secretion usually precedes progesterone secretion and primes the target tissues to respond to progesterone. Estrogens induce the...

Prelabour and labour hormonal and immunological mechanisms

Hormones Initiate Labour

The multitude of biological substances which interact in the control of the human birth process seem to increase almost daily. To catalogue more than 60 such factors might Table 7.1 A far from comprehensive list of substances and categories of substances which are known to participate in the birth process Table 7.1 A far from comprehensive list of substances and categories of substances which are known to participate in the birth process Clinical labour, as opposed to prelabour, is considered to begin with the onset of regular painful uterine contractions. The events of prelabour should have set everything in place for a comparatively short birth process, but not all labours will follow a straightforward course. In its simplest terms, labour consists of the muscle of the uterine corpus progressively stretching the cervix over the fetal head by means of rhythmic contraction and retraction. This process is usefully compared to pulling on a woollen jumper with a tight polo neck, where...

Evaluation of Eyelid Malpositions

Basal Cell Carcinoma Eyelid

The time of onset of the malpositioned lid may be congenital or acquired. In the case of ptosis, a careful birth history will uncover the possible use of forceps during delivery, or the occurrence of other birth trauma. Abnormal eyelids in other family members should alert the observer to the possibility of a familial disorder such as blepharophimosis syndrome or cran-iosynostosis syndrome. The presence of other congenital anatomical deformities or especially neurologic deficiencies may indicate a more serious genetic syndrome, congenital oculomotor nerve palsy, or a central mechanism for the eyelid disorder.

Frequency and timing of antenatal visits

Is uncertainty, an ultrasound scan arranged to exclude breech presentation. If a breech is confirmed, external-cephalic version should be considered. If placenta praevia had been noted at 20 weeks a follow-up scan at 36 weeks is needed. For women who havenot given birth by41 weeks, both a membrane sweep and induction of labour should be discussed and offered.

Aetiology of prolonged pregnancy

Medical Birth Registry data confirm these results and also indicate a tendency for daughters of mothers who deliver post-term to have prolonged pregnancies 12 but overall these factors account for only a small proportion of the overall population attributable risk for post-term pregnancy. Male fetuses may be associated with a higher risk of prolonged pregnancy.

Episiotomy and perineal lacerations

Episiotomy is an intentional surgical incision of the perineum after informed consent with the aim of increasing the soft tissue outlet dimensions to help with childbirth. It is not advocated for every delivery and the rate of epi-siotomy depends on the philosophy and judgement of the caregiver.

Management of puerperium

The morbidity associated with the puerperium is underestimated and an important review (Table 10.2) shows that after childbirth mothers have high levels of post-partum problems. Thirty-one per cent of women felt that they had major problems for up to 8 weeks post-partum. In trying to reduce the impact of this morbidity there are a number of principles which need to be applied in planning post-natal care. These include 1 Continuity of care. An ideal pattern of care is one that offers continuity from the antenatal period through childbirth and into the puerperium involving the smallest team of health professionals with which the mother can identify. Table 10.2 Proportion of mothers having major, intermediate and minor morbidity after childbirth Table 10.2 Proportion of mothers having major, intermediate and minor morbidity after childbirth post-natal facilities which allow rooming in, privacy and the opportunity for close contact play an important part in helping parents to have a good...

Gender Ethnicracial And Life Span Considerations

Epilepsy occurs in all races and ethnicities, and it affects males and females equally. The incidence is approximately 1 in every 100 to 300 persons. Although epilepsy can occur in any age group, usually the onset is before the age of 20. Different age groups have distinct associated causes. In newborns up until 6 months of age, seizures are generally caused by birth trauma or metabolic disturbances, such as hypoxemia, hypoglycemia, and hypocalcemia. In children from 6 months to 5 years of age, etiology is related to febrile episodes or metabolic disturbances such as hyponatremia or hypernatremia, hypoglycemia, or hypocalcemia. In the 5- to 20-year-old group, seizures are primarily idiopathic (50 ). In adults from 20 to 50 years of age, a new onset of seizures is almost exclusively caused by trauma or tumors. In older adults, seizures are generally caused by vascular disease and cardiac dysrhythmias. Ethnicity and race have no known effects on the risk for epilepsy.

Modes of Virus Transmission

'Vertical or transplacental transmission' occurs from mother to fetus prior to or during parturition. Certain retroviruses are vertically transmitted in animals via the integration of viral DNA directly into the DNA of the germline of the fertilized egg. Other viruses are transmitted to the fetus across the placenta yet others are transmitted when the fetus passes through the birth canal. Another vertical transmission route is via colostrum and milk. Vertical transmission of a virus may or may not be associated with 'congenital disease' (i.e., disease that is present at birth) which may be lethal (and the cause of abortion or stillbirth) or the cause of congenital abnormalities. The herpesviruses, especially cytomegaloviruses, and rubella virus cause important congenital diseases in humans, and pestiviruses, such as bovine viral diarrhea virus, in animals.

Suprasphincteric Dysfunction

The IAS is a circular smooth muscle that is responsible for 50-85 of the resting tone 46-48 . Its continuous maximum contraction is due to both intrinsic myogenic and extrinsic autonomic neurogenic properties 48, 49 . With age, resting pressure progressively decreases because of gradual degeneration of the muscular fibres 50 . Primary degeneration of IAS with atrophy was identified by Vaizey et al. in a group of 45 patients (ten men), and this was the only demonstrable cause of passive incontinence 51 . Structural damage of this muscle is often secondary to anorectal trauma or anal surgery. Several studies have shown that IAS injuries occur in up to 35 of women during childbirth, but in these cases, there is usually an associated damage of the EAS 52 .

Medicinal Annonaceae

Foglie Astratte

Abortion and childbirth since very early times. The leaves of Goniothalamus macrophyl-lus Hook. f. & Thoms. are used to abrogate fever, and a decoction of the roots is given as a postpartum remedy and to cause abortion. The roots of Goniothalamus giganteus Hook. f. & Thoms. (Fig. 102) are used to abort and treat colds, and the heated leaves are applied to swellings. A decoction of Goniothalamus scortechinii King is given as a postpartum protective remedy. The roots of Goniothalamus tapis Miq. (Fig. 103) are used as an abortifacient during early months of pregnancy. In Indonesia, an infusion of the roots is used to treat typhoid fever. In Taiwan, the seeds of Goniothalamus amuyon Merr. are used to treat scabies. In the Philippines, the seeds are used to treat rheumatism and tympanites, and the fruit is stomachic. None of the uses mentioned here has been substantiated yet via pharmacological experimentation however, these species are well-known for their phytochemical constituents, as...

Ocular Disease Caused by DNA Viruses

The human herpes viruses are preeminent among DNA viruses in eye disease with at least seven of the eight known human herpes viruses associated with ocular disorders. Herpes simplex virus type 1 (HSV-1) is the most common herpes virus to cause eye disease and herpes simplex keratitis is the most common cause of infectious blindness in the industrialized world. HSV-1 causes self-limited and relatively benign infections of the eyelids, the conjunctiva and the corneal epithelium, but infections of the corneal stroma, uvea and retina may result in chronic or recurrent blinding stromal keratitis, uveitis and retinal necrosis, respectively. Elevation of intraocular pressure due to involvement of the trabecular mesh-work is not uncommon and may help to differentiate herpetic uveitis from noninfectious causes. Post-natally acquired HSV-2 ocular infection, less common than HSV-1, causes disease similar in most respects to HSV-1. Neonatal herpes simplex infection, acquired during transit...

Veterinary Uses Of Plants

It was used on South Uist for something called the dry disease in cows. The roots would be boiled, and the juice given to the cow to drink. They often used TANSY there to treat red water in cows, by boiling the entire plant, putting the juice in a bottle, then pouring it down the cow's throat (Shaw). Bracken has always been said to make the best litter for horses and cattle, and it was cut in huge quantities for the purpose. After a cow had calved, country people used to feed it with SANICLE leaves, to promote the expulsion of the afterbirth, and to stop any bleeding (Drury. 1985). Sanicle is a great wound herb, used for centuries as such. When cattle coughed, they used to be treated by the use of STINKING HELLEBORE. It was done by making a hole in the dewlap with a setter, or thread (hence the name Setter-grass, or Setterwort, given to the plant), and a length of hellebore root inserted to irritate the flesh and keep it running (Grigson. 1955). Or sometimes a few rolled-up leaves...

Chordates Including the Vertebrates

Most mammals have mating seasons, timed to produce young at a favorable season for rearing. Mating is limited by the female, who is receptive to mating only during a brief period in the mating season known as estrus. Old World monkeys and humans have a different cycle, the menstrual cycle. Mammals exhibit three ways of giving birth. Mono-tremes, such as the duck-billed platypus, is a mammal that lays eggs. Animals that lay The third way to give birth is that of the placental mammals, which comprise 94 of all mammals. Gestation in utero is prolonged. The embryo is nourished by a placenta, a membrane structure produced by and surrounding the embryo. The placenta grows thousands of tiny fingerlike projections called villi into the lining of the mother's uterus to absorb nutrients and oxygen from the maternal blood supply without there being an actual exchange of maternal and fetal blood. The fetus is connected to the placenta by the umbilical cord. Once born, the mammal may be more or...

Historical Use of Sodium Hypochlorite

The history of the use of hypochlorite as a disinfectant and antiseptic goes back hundreds of years. It was used for the treatment of wounds and burns even before the revolutionary work of Lister and Koch. Among early uses, the Marquis de la Motte used a hypochlorite solution for the treatment of gangrene in 1732 1 and Paris surgeons used it for the treatment of burns, operative wounds, and ulcers 1 . As noted in the background section, Semmelweis used hypochlorite as an antiseptic hand wash to reduce the very high incidence of puerperal fever (childbed fever) during childbirth in a Vienna hospital. He ensured that his hands, and the hands of his assistants, were washed in a hypochlorite solution. He also insisted that a hypochlorite solution be used on any instruments likely to come in contact with the vaginal canal. While Semmelweis' technique resulted in a drastic decrease in the death rate from puerperal fever, his contemporaries largely ignored his work 1, 2 . Koch reported the...

Frozen embryo replacement cycle

The first pregnancy resulting from a frozen human embryo was in 1985 and since then the use of frozen cycles has increased dramatically. Freezing surplus morphologically normal embryos allows the use of those embryos which otherwise may have been wasted. It therefore gives double benefit from one fresh cycle and significantly adds the cumulative conception rate per cycle when surplus embryos are frozen. Normally embryos are frozen on day 2 after the selected ones have been replaced fresh, but can be frozen anytime from day 1 through to day 5 if excess blastocysts are obtained. The use of day 1 freezing is normally confined to elective freezing of all embryos when there is a high risk of ovarian hyperstimulation syndrome occurring. At day 2 any morphologically normal embryos of suitable quality are selected and through specific cry-opreservation protocols are frozen and stored in liquid nitrogen in specially monitored tanks. The success rates of day 1 and day 2 embryos are cited as...

The Psychoanalytic Model

If the roots of behavior are located in the unconscious, how can they be accessible to study Through a series of historical accidents, Freud was introduced to hypnotism as a method of treatment. This technique, in turn, gave birth to his now-famous method called free association, in which individuals are encouraged to freely associate anything that comes to mind in response to certain words or phrases. Freud believed that such an exposition of underlying needs and fears was the key to understanding a typical behavior. This method is a highly subjective way to collect information, and a large part of the criticism leveled against Freud and many of his followers was directed at this practice. The theory itself, however, is based on abstract and subjective judgments, and the fact that the behaviors under study are not easily amenable to scientific verification has caused controversy for years. However, the richness and diversity that Freud brought to a previously stagnant conception of...

Advantages of breastfeeding

Enteromammary Pathway

One of the most important secondary functions of breastfeeding is to protect the infant against infection. This is particularly important in developing countries where it has been estimated that in each year there are 500 million cases of diarrhoea in infants and children and about 20 million of these are fatal. The extent to which breastfeeding protects against infection in infants in developed countries, however, has been a matter of dispute. In a study from Dundee, Scotland, it was found that babies who had been breastfed for at least 3 months had greatly reduced incidences of vomiting and diarrhoea compared with babies who were either bottlefed from birth or completely weaned within a short time of delivery 18 . This

Incontinence of urine

Women with urinary incontinence 3 months after childbirth still have this 6 years later. Urinary incontinence is more frequently seen following instrumental delivery and least frequently seen after elective Caesarean section. Urinary fistulae are uncommon in obstetric practice today although direct injury from the obstetric forceps may occasionally occur. Complications to the ureter are most commonly seen at a complicated Caesarean section when ureteric injury may either result in a ureteric fistula or ureteric occlusion. Women with this type of urinary problem should not be managed by obstetricians but should be referred to a urological colleague for surgical management.

Syndrome with an Unusual Form of ERG

Supernormal Erg

This unusual combination is illustrated in three of our patients 4 . A 15-year-old girl (case 1), an 11-year-old girl (case 2), and a 32-year-old woman (case 3) had low visual acuity of 0.1-0.4 with moderate to high myopia from birth. The family history was negative in the three patients. Night blindness was detected by dark-adaptation curves with elevation of the final rod thresholds by 1.5-2.3 log units. The visual fields were almost normal except for slight constriction with small and dim targets. The color vision was markedly abnormal, with a scotopic pattern similar to that of rod monochromats. The fundus and fluorescein angiograms are essentially normal (Fig. 2.120), except for bull's-eye maculopathy in case 1 and slight optic atrophy in case 3. We have followed two of these patients for more than 10 years, and the clinical condition has not changed (i.e., it is stationary).

Baiting See Bear Baiting Beak Trimming See Chickens Bear Baiting

Hunters who use baits claim that the baiting method allows them to distinguish species and sex of bears and helps to avoid shooting female bears with cubs. However, a study done by the Colorado Division of Wildlife found that a number of female bears killed over baits were lactating, indicating that the bears had recently given birth to cubs.

Applicability To Humans

A second point is that the diagnosis of an n-3 fatty acid deficiency state in the tissues, especially the brain and retina, can well be approximated by analysis of plasma and red blood cells. This is particularly true if the deficient state occurs during pregnancy and from birth onwards, as has already been demonstrated (Cocchi et al., 1984). DHA in erythrocytes correlated well with the DHA of the cerebral cortex. A third point is that the brain presumably has the capacity to synthesize DHA from precursor forms such as EPA. The presumption of this statement is based on the fact that high plasma and red blood cell concentrations of EPA are not mirrored by similar concentrations in the brain instead, it is DHA that predominates so greatly. The alternative explanation is that EPA was rapidly metabolized once it enters the brain, but there is no evidence to support this particular point. Finally, normal monkeys fed 18 3n-3 from soy oil have a pronounced fall in DHA concentrations from...

Induction of labour for prolonged pregnancy

Obstetricians have responded in various ways to the apparently increased perinatal mortality and morbidity associated with prolonged pregnancy. Management options include induction at term to prevent pregnancies reaching 42 weeks, routine induction at 42 weeks or shortly before and selective induction at 42 weeks in cases identified by tests as being at risk of adverse outcome. Fortunately, the benefits and hazards of some of these strategies have been evaluated in randomized controlled trials. Randomized or quasi-random trials comparing elective induction at term versus expectant management, and elective induction after 41 weeks versus monitoring of post-term pregnancies were identified using the search strategy described by the Cochrane Pregnancy and Childbirth Group and formed the basis of a systematic review of management options in post-term pregnancy 62 . The main outcomes of interest are those already identified in the analysis of post-term pregnancy risks - perinatal...

History of Ideas Surrounding Hunting

Western hunting has always been a characteristically male activity, often regarded as valuable training for the military elite and praised as a prototype of the just war. In the context of 19th-century European imperialism, this tradition gave birth to a third stereotype of the huntsman the colonial White Hunter who dons a pith helmet and leads an army of servile natives on safari to assert his dominion over the conquered territory's land, animals, and people. At the height of Europe's empires in the late 1800s and early 1900s, a love of hunting commonly went hand in hand with imperialist politics, and anti-imperialism was often associated with antihunting sentiment. This link between hunting and the political right has persisted into our own time.

Presymptomatic Treatment In A Gamtd Patient

Blood was taken from the umbilical cord and subsequently every 12 hours until day 5 by heel prick, and was spotted onto filter paper. In the dried blood spot specimens, measurement of GAA, Cr, and creatinine was performed by means of electrospray-ionization tandem mass spectrometry (modified from Bodamer et al., 2001). The results were informative for the diagnosis of GAMT-D in all specimens from birth to day 5 (Figure 4). GAA was already elevated in cord blood. A subsequent increase during the first 24 hours of life was followed by a decline thereafter. However, GAA remained permanently elevated until day 5 by exceeding the 99.5th percentile for healthy newborns. The levels of Cr and creatinine, both

Mechanistic Hypotheses and Comparative Tests

Variation and selection comprise the most important evolutionary processes. For variation, I consider carcinogenic effects that act directly by mutagenesis, defined broadly to include karyotypic and epigenetic change. The different types of heritable change cause different spectra of variation and act at different rates. For selection, I divide mechanisms into three classes mitogens directly increase cellular birth rate, anti-apoptotic agents directly reduce cellular death rate, and selective environment agents favor cell lineages predisposed to develop tumors. Those selective mechanisms may indirectly increase variation. For example, mitogens often increase mutation by raising the rates of DNA replication. Mitogens Increase Cellular Birth Rate

Diagnostic Tools Endoanal Ultrasound

As the use of ultrasound became more popular, it revealed an almost alarming rate of extent of damage to the sphincter following childbirth 24 . In a frequently referenced study by Sultan and colleagues in However, there are several difficulties in the use of ultrasound to evaluate fecal incontinence in women following childbirth. In one study, the prevalence of sphincter defects on ultrasound was 65 in incontinent patients however, sphincter defects were also found in 43 of continent women after childbirth 26 . Sentovich and colleagues reported that even in experienced hands and with a strict protocol of imaging and interpretation, identification of sphincter defect was falsely positive in 5-25 of cases 27 . Study of normal sphincter anatomy has revealed a natural defect anteriorly that has been suggested to complicate the interpretation of ultrasound and result in false positive anterior defects 28 .

Retention with overflow

If it is possible, it is far better to avoid urinary retention by implementing prophylactic measures. The human female bladder, once overdistended, may never contract normally again 244 . When bladder neck surgery for urinary incontinence or radical pelvic surgery for malignant disease is undertaken, adequate postoperative bladder drainage (preferably with a suprapubic catheter) should be employed until normal voiding per urethram has resumed. When epidural anaesthesia is used for surgical procedures or childbirth, an indwelling Foley catheter should be left in situ for at least 6 and probably 12 h after normal sensation to the lower limbs is present. Those women who are known to have inefficient voiding (a low flow rate together with a low maximum voiding pressure) should be taught clean intermittent self-catheterization prior to any surgical intervention for urodynamic stress incontinence.

The Causes of Nondisjunction and Its Frequency in Humans

Nondisjunction is known to occur more frequently in the cells of older individuals. This is illustrated by the fact that older women are more likely to give birth to children affected by an aneuploid condition than are younger women. For instance, the risk of a twenty-year-old mother giving birth to a child with Down syndrome is about one in two thousand, compared to an approximate one in thirty risk in the case of a woman of age forty-five. The precise reason for this is not entirely certain, but a simple explanation could be that the older a cell is, the more loosely controlled are the processes occurring within that cell. This would mean that an older cell undergoing meiosis would be more likely than a younger one to ignore the constraints of the spindle checkpoint and hence give rise to aneuploid cells. SEE ALSO Chromosomal Aberrations Crossing Over Down Syndrome Meiosis.

Preference And Motivation Testing

On the surface, determining the preferences of animals seems like a simple task, but the simplicity is more apparent than real. For example, the preference of pigs* for straw-bedded pens turns out to be remarkably complex. Pigs strongly prefer straw when they are actively foraging they are indifferent to straw when they are using a food or water dispenser and they either select or avoid a bedded floor as a resting area depending on whether the environment is cool or warm. Furthermore, mature sows take a sudden interest in straw when they are building a nest just before giving birth. To characterize the animals' preferences, we need a comprehensive study that asks how this preference varies with the animal's age, reproductive state, and ongoing behavior and with fluctuations in the environment.

Sphincteric Risk Factors Obstetric Events

The overwhelming risk factor was childbirth (91 ), with at least one vaginal delivery reported as complicated (notably perineal trauma, and the use of forceps) in 78 . The median age of onset of symptoms in those women who ascribed their symptoms to childbirth was 26 years less than that of those in whom obstetric factors were the only risk but in whom no association had been made with subsequent symptoms and in whom the median time lag before symptom onset was 18.5 (range 2-55) years, although there was no difference in symptom duration before presentation between the ascribers and nonascribers. Notwithstanding the limitations of retrospective study (the practicalities of a prospective long-term study, given the time lag to symptom onset amongst many factors, means that such a study has never been performed), there is now clear recognition, supported by a considerable body of evidence, that obstetric trauma is, by far, the major risk factor for the development of acquired faecal...

Some Explanations For Variations In Size

The size of female insects often determines their fecundity, which may be manifested in giving birth to many small offspring or a smaller number of large ones. To be able to produce many large offspring, which may be adaptive for survival in a harsh environment, the female herself must be large. The importance of size for female fecundity can often be seen in the sexual dimorphism of insect species, in which males typically are much smaller than females.

Life Span and the Aging Process

The aging process causes many changes, both visible and invisible. In humans, these changes take several forms. In the first two decades of life, from birth to adulthood, aging involves physical growth and maturation and intellectual development. These changes are fairly noticeable and relatively swift compared to the rest of the life span. After reaching physical maturity, humans begin to show subtle signs of physical aging that grow more pronounced over time. Long-term exposure to sunlight and the outdoors may begin to toughen the skin and produce wrinkles on the face and body. The senses change Sight, hearing, taste, and smell become less acute. Gradual changes in the eye cause many older adults to need glasses to read. Hair begins to thin and turn gray. Individuals with less active lifestyles often begin to gain weight, particularly around the waist and hips. Beginning in their 40s (or, rarely, in their late 30s), many women experience menopause, which marks the end of...

Pathophysiological and Behavioral Aspects

Further studies investigating pathophysiological mechanisms of FI is of crucial importance because progress will have an impact on both diagnostic and therapeutic strategies. Due to the possible multifactorial origin of FI and the existence of different clinical presentations, basic research into the influence played by each of the numerous factors involved in continence control can be of help 2 . Future studies must consider that the traditional assumption that women younger than 65 years of age are at maximum risk of FI because of obstetric trauma to anal sphincters or pudendal neuropathy is not true 3 . Prevalence of FI in men has been certainly underestimated. Also, other causative factors, different than those secondary to childbirth, have to be of primary interest, these being neuropathies (diabetes, multiple sclerosis, Parkinson's disease, spinal cord injury, systemic sclerosis, myotonic dystrophy, amyloidosis) and conditions related to idiopathic FI. Moreover, conditions...

Breast Cancer and Its Treatment

Breast cancer is the leading type of new cancer among women. The ACS estimated that 211,300 new cases of invasive breast cancer would occur among women and 1300 among men in the United States in 2003 (ACS 2004). New cases of breast cancer represented one third of 658,800 cases for all cancers in women, greater than the 12 of new cases of lung cancer among women. The incidence of breast cancer among white women increased at about 4.5 in the 1980s but has risen more slowly in the 1990s. The cumulative probability of developing breast cancer increases as a function of age. Lifetime chances for women from birth to age 39 are 1 in 228 for those aged 40 to 59, they rise to 1 in 24, and they increase to 1 in 4 for those aged 60 to 79. All women, from birth to death, have a 1 in 8 chance of developing breast cancer (ACS 2004).

Clinical Description

In symptomatic individuals, certain clinical manifestations are common. In women, menorrhagia is frequently reported and there is an increased risk of bleeding after childbirth. 9 Epistaxis may occur, whereas petechiae and bruising are rather unusual. 9 Bleeding can be excessive and frequently manifests postoperatively, in particular after surgical procedures involving tissues with high fibrinolytic activity such as dental extractions, tonsillec-tomies, prostatectomies, or urinary tract operations. For other surgical interventions such as appendectomies, orthopedic operations, cholecystectomies, or hysterectomies, the risk of severe bleeding is less pronounced. 10 Sometimes the first bleeding episode is observed after circumcision. 9 Bleeding can be immediate, 9 but typically, it is protracted or presents as persistent oozing after surgery. 10

Management of unexplained recurrent miscarriage

A significant number of couples investigated for recurrent miscarriage will have no cause identified to account for their pregnancy losses. While this is a frustrating situation for both patient and clinician, the prospective live-birth rate of women who are aPL negative is good 32 . The main determinants of future pregnancy outcome are the maternal age and the number of previous miscarriages she has had (Figs 13.4 and 13.5). A woman less than 38 years of age who has had less than five consecutive first trimester miscarriages and who is aPL negative has a 65 chance of her next pregnancy being successful with supportive care alone. While the scientific basis for the benefit of supportive care in early pregnancy remains to be elucidated, it is possible that elevated stress hormones (e.g. cathecholamines and cortisol) may be able to reduce fetal vascularization and oxygen supply and thereby induce miscarriage.

Pregnancy and Breastfeeding

Babies born at low weights (less than 5.5 pounds) have a greater likelihood for development of health problems. Mothers-to-be can help prevent this from occurring by eating the well-rounded diet that women their age would ideally eat, as well as achieving an appropriate weight for their height. Women who are 15 percent or more underweight present a special risk for a difficult pregnancy and childbirth.

Noncoding Triplet Repeat Disorders

DM is a multisystem disorder with highly variable phenotypes and anticipation. Rigidity of muscles after contraction (tonic spasms), muscle weakness, and progressive muscle wasting characterize adult-onset DM. Developmental abnormalities, mental handicap, and respiratory distress are often evident in more severe forms. DM is caused by an expanded CTG triplet repeat in the 3' untranslated region of the protein kinase gene DMPK. The CTG expansion may disrupt DMPK transcription, causing loss of function. CTG expansions may also cause loss of function in two genes flanking DMPK the DM locus-associated home-odomain protein (DMAHP) and gene 59 (also known as DMWD). The CTG expanded transcript could also gain toxic function by interfering with normal processing of various RNAs. Congenital myotonic dystrophy occurs from birth in infants whose mothers have DM, often a case so mild it is never diagnosed. Due to anticipation, the child is much more severely affected than...

Positive and Negative Eugenics

Galton identified positive and negative eugenics as the two basic methods to improve humanity. Positive eugenics used education, tax incentives, and childbirth stipends to encourage procreation among fit people. Education would convince fit parents to have more children, out of a desire to increase the common good. Lower taxes on larger families and the provision of a small birth payment for each eugenic child would provide further inducements. Conversely, eugenically educated but unfit people would selflessly forgo procreation, to prevent the propagation of their hereditary taint. Believing that neither altruism nor self-interest would be enough to control the unfit, however, many eugenicists also advocated negative eugenics.

The Oligodendrocyte As A Target Of Inflammatory Damage

Glutamate-mediated damage of oligodendrocytes could be of physiological importance in a variety of settings. One dramatic example of oligodendrocyte death in which these pathways have been invoked is that of the ischemic injury occurring in birth trauma, which can be associated with periventricular leukomalacia and cerebral palsy 61 . It also must be considered whether glutamate contributes to the demyelination seen in multiple sclerosis and other inflammatory disorders of the CNS, particularly as it has been observed that glutamate levels are increased in the CNS of patients with demyelinating disorders, with levels correlating with disease severity 62,63 . In this context, it is of potential interest that chronic infusion of kainate (an AMPA receptor agonist) into white matter tracts is associated with the generation of lesions that have many of the characteristics of multiple sclerosis lesions, including extensive regions of demyelination with plaque formation, massive

Epithelial Permeability and Secretory Immunity

In fetal life, murine gut epithelial cells are sensitive to microbial factors such as LPS (endotoxin) because they express intracellularly a PRR for this MAMP, namely TLR4 91 . Exposure to LPS in the vaginal tract during birth activates the neonatal gut epithelium via TLR4 and temporarily upregulates microRNA-146a, which leads to degradation of the TLR signaling molecule IL-1R-associated kinase 1 (IRAK1). Such translational repression of IRAK1 protects the epithelium from microbiota-induced damage during transition from a sterile environment 92, 115 . In remarkable contrast, epithelial tolerance to the commensal bacteria does not occur in mice delivered by cesar-ean section 91 . These experimental observations may be related to the fact that children delivered by cesarean section appear particularly prone to develop food allergy if they have a genetic predisposition for atopy 116, 117 .

Gastrointestinal disorders

Required if the amniotic sac has broken and for gastroschi-sis immediate management is to wrap the abdominal contents in a plastic wrapper taking care not to twist the bowel and disrupt its vascular supply. This should help prevent hypovalaemia due to fluid loss from the exposed bowel. A large bore nasogastric tube is passed and the baby's circulatory status constantly assessed. Hypovalaemia or excessive nasogastric output should be treated with 20 ml kg 0.9 sodium chloride bolus intravenous infusions. The risk of hypothermia is high unless good thermal management is present from birth. Primary repair is not always possible if the abdominal cavity is not large enough to accommodate all the contents a silo made of sterile prosthetic material is attached to the abdominal wall and the contents gradually reduced over 7-10 days. Outcomes are worse for those requiring silo treatment as infected complications are high. The long-term outcome for most with exopmhalos is determined by the...

Transmission and Epidemiology

PVs are frequently transferred from mother to child during birth. So far, however, there is no evidence for efficient establishment of infections with high-risk HPV types toward anogenital carcinogenesis by this infection route. It is very possible, however, that the relatively high fraction of juvenile patients affected by laryngeal papillomatosis have acquired their HPV-6 and HPV-11 infections from their mothers.

Mechanisms of Faecal Incontinence in Diabetes

Feacal Incontinence Types

Women with poor glycaemic control tend to give birth to large babies and are more likely to experience long and difficult labours and require assisted delivery with forceps or ventouse 51 . Inevitably, such women are more liable to suffer from obstetric complications, such as traumatic disruption of the anal sphincter or weakness of the pelvic floor, leading to chronic stretching of the pudendal nerve.

Role of Epidural Anesthesia

Regional anesthesia for the relief of labor pain has become more popular over the past 20 years. Some studies suggest that epidural analgesia, by enabling relaxation of the pelvic floor, leads to greater control of delivery of the fetal head and consequently fewer perineal lacerations 39 , but prolongation of the second stage of labor may also increase the incidence of pudendal nerve damage 40,41 . Robinson et al. 42 recently examined the relationship between epidural analgesia and perineal damage and found that the rate of significant perineal injury was higher with epidural analgesia (16.1 ) than with increased use of operative intervention.

Invited Commentary

Anal endosonography has revolutionized the treatment of fecal incontinence. In the early 1990s, research appeared that documented the normal anal sphincter complex and its components 1-3 . Mapping out the normal appearance of the internal and external sphincters allowed actual visualization of defects in the anal sphincter. Prior to this, patients with fecal incontinence (mostly women) were evaluated with physical exam, anal physiology, and needle electromyelogram (EMG) 4-6 . This limited evaluation was not precise, and probably many sphincter defects (usually as a result of childbirth) were missed 7 . Prior to anal endosonography, patients with fecal incontinence that manifested years after the injury were labeled as having idiopathic fecal incontinence. Whereas this category still exists, anal endosonography allows precise anatomical delineation in an effort to tailor treatment for the individual patient. The most common repair of the sphincter muscle is the overlapping anterior...

Impact Of Dietary Essential Fatty Acids On Neuronal Cell Composition And Function

By feeding nutritionally adequate diets, dietary intake of 18 2n-6, 18 3n-3, or the proportion of 18 2n-6 to 18 3n-3, particularly during development, has been shown to influence the content of long-chain polyunsaturated fatty acids in membrane lipids by changing the composition of the whole brain, oligodendrocytes, myelin, astrocytes mitochondrial, microsomal, and synaptosomal membrane (Bourre et al., 1984 Foot et al., 1982 Lamptey & Walker, 1976 Tahin et al., 1981). Feeding diets with a 18 2n-6 to 18 3n-3 fatty acid ratio between 4 1 and 7 1 to rats from birth to 1, 2, 3, and 6 wk of

Description Medical Coagulation Disorders

Acute ITP affects children of both sexes between the ages of 2 and 9 years. Almost 50 of those children recover in 1 month, and 93 recover completely by 1 year. More than 80 of acute ITP patients recover, regardless of treatment, but 10 to 20 progress to chronic ITP. ITP can also occur during pregnancy, and 5 to 20 of the neonates born to these mothers will have severe thrombocytopenia and are at risk of intracranial hemorrhage during vaginal birth. Chronic ITP occurs mainly between the ages of 20 and 50 years and affects women almost three times as often as men. There are no known racial and ethnic considerations.

Unexplained infertility

A single randomized trial (Goverde et al. 2000) showed that pregnancy rates in women treated by IUI alone were comparable to those in women treated by SO IUI or IVF. A much larger multicentre American trial (Guzick et al. 1999) found SO IUI to be more effective than IUI alone in terms of live-birth rates (OR 1.7,95 CI 1.2-2.6) but associated with an appreciably higher risk of multiple pregnancy. IUI in an unstimu-lated cycle thus offers the safer option, while SO IUI may enhance success rates at the cost of a higher multiple pregnancy rate.

Effects of growth hormone and insulinlike growth factor 1 deficiency on ageing and longevity

In contrast to growth and development, ageing is a progressive process orchestrated by decreasing synthesis and secretion of numerous factors and hormones among them growth hormone (GH) and its anabolic effector hormone, insulin-like growth factor 1 (IGF1). Therefore, ageing is often compared with growth hormone deficiency (GHD) (Toogood & Shalet 1998). This assumption is based on the evidence that pituitary GH secretion and serum IGF1 concentrations decline with increasing age (Gil-Ad et al 1984, Arvat et al 2000), reaching low levels in late adulthood, and have similarities to changes of body appearance, composition and function (Carroll et al 1998, Toogood & Shalet 1998) (Table 1). These findings led to trials of GH treatment in elderly people (Rudman et al 1990). The finding that GH increased lean body mass, decreased adiposity and improved apparent skin changes gave birth to an

Meiotic Nondisjunction And Down Syndrome

Meiosis I (MI) involve reductional division, in which the duplicated sister chromatids stay attached and the paired homologs segregate (disjoin) to opposite poles. In meiosis II (MII), the sister chromatids undergo centromeric separation and segregate as in normal mitotic division. In the human female fetus, oocytes undergo DNA replication and genetic recombination and then remain arrested in meiotic prophase I (diplotene stage) for up to several decades until initiation of oocyte maturation and ovulation in the sexually mature adult female (90). Nondisjunction can occur between homologs in anaphase of MI during oocyte maturation or can occur between sister chromatids in MII at the time of conception (91,92). It is important to note that the actual nondisjunction event does not occur when the mother is a fetus, but occurs during oocyte maturation in the adult female or at the time of conception (90,93). The risk of maternal nondisjunction increases exponentially after the age of 30...

Homocysteine And The Child

Wong et al. (80) studied 35 women who had given birth to a child with orofacial clefts and 56 controls. Both fasting and after load, plasma ho-mocysteine values were significantly higher in the study group than in the control group (OR 5.3.8 95 , CI 1.1 - 24.2). The median concentrations of serum and red cell folate were significantly higher in mothers of cases compared to the mothers of controls.

Choline And Brain Development

Choline availability during embryogenesis and perinatal development are especially important for brain development. There are two sensitive periods in rat brain development during which treatment with choline (about 1 mmol d administered to the mother during a critical period during pregnancy, or 300 mg kg administered subcutaneously 2 wk after after birth) produces long-lasting enhancement of spatial memory that is lifelong (28-36). The first critical period occurs during embryonic d 12-17 (rats give birth on d 21) and the second occurs during postnatal days 16-30. Choline supplementation during these critical periods elicits a major improvement in memory performance at all stages of training on a 12-arm radial maze. The two sensitive periods for memory responsiveness to supplemental cho-line correlate with the formation of cholinergic neurons (neurogenesis prenatal) and with the formation of nerve-nerve connections (synaptogenesis prenatal and postnatal) in the hippocampus and basal...

Pregnancy And Childbirth

Pregnancy And Childbirth

If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?

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