Natural Childbirth Options
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?
Traditionally, most of the food is prepared at home. The majority of modern consumers prefer to buy pretreated food which is easily stored and prepared at home. Changes in society, such as more women working away from home, falling birth rate, aging of the population, in combination with familiarity with foreign cultures, influence the modern food supply. Recently, food products with special characteristics, desirable from a nutritional or social point of view, have been developed. These include products containing less saturated and more unsaturated fat, fewer calories, less cholesterol, and more dietary fiber. In general, the food processing industry appears to be willing to gratify the consumer's wishes.
The analyses presented by van Schaik et al. (Chapter 8) illustrate the centrality of investigating patterning to the comparative method. Data were collected for primate species for a wide range of features such as the incidence of infanticide, infant care styles, whether lactation is longer or shorter than gestation, mating patterns during pregnancy, the presence or absence of post-partum oestrus, the development of sex skin, and whether females produce calls related to mating. These data were examined to determine whether the pattern of distribution across species of variants of one feature is associated with that of another - the basic requirement if variables are causally or functionally related. For example, the species in which the mother alone carries the infant do not have post-partum oestrus, whereas most of those which park their infants, or in which carrying is shared with other individuals, do. In Ross and Jones' study (see Chapter 4), patterning is similarly fundamental,...
Setting and implementing health research priorities is a complex and sometimes obscure process. Although the aim should be that the views of all stakeholders are considered, with few exceptions (notably the Childbirth and AIDS advocacy movements), patients and consumers have little input to how research is prioritized, funded and monitored 41 .
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.
Symptoms of MS that have been investigated in some aromatherapy research are anxiety, depression, pain, and insomnia. For anxiety, studies of variable quality indicate that beneficial effects may be obtained with the use of lavender oil, Roman chamomile oil, and neroli (orange) oil. However, no large, well-designed clinical studies have examined this antianxiety effect. Preliminary information suggests that a lower dose of antidepressant medication may be needed by depressed men when the medication is used in combination with aromatherapy using a citrus fragrance. Lavender in bath water does not appear to relieve childbirth-associated pain. Positive and negative results have been obtained in other studies of aromatherapy and pain. Several fragrances, especially lavender, have been evaluated in sleep studies in animals and humans. Some positive results have been reported, but these studies are of variable quality.
As indicated in the preceding section, it is the woman with primary genital HSV infection who is at highest risk of transmitting HSV to her newborn baby during birth. Despite this fact, considerable attention is focused clinically on the woman with a history of genital HSV that preceded her current pregnancy. Prenatal cultures of the vaginal tract do not predict whether a woman with a history of genital HSV will be shedding virus at the time of delivery (27) and as such have no role in the evaluation of such women. There is active debate in the obstetrical community regarding whether, for women with known recurrent HSV disease and active lesions at delivery, the surgical risks of cesarean delivery outweigh the small (
By UGT2B7.107 Morphine was found to undergo significant glucuronidation by the fetus liver. In vitro studies in hepatic microsomes obtained from fetuses (15-27 weeks) indicated that the glucuronidation rates were 10-20 of that observed in adult microsomes.108 In addition, the mean rate of morphine glucuronidation in fetal livers obtained after hysterectomy was twofold higher than that obtained from induced abortion livers, suggesting a possible regulatory mechanism for UGTactivity related to the birth process (Table 4).25 The glucuronidation of morphine in vivo has also been demonstrated in premature neonates as young as 24 weeks of gestation. Studies with other substrates which are mainly or partially glucuronidated by UGT2B7, such as naloxone, an opiate agonist, benzodiazepines, and nonsteroidal antiinflammatory drugs are all suggestive of a reduced glucuronidation ability in neonates compared to adults.109
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 30 min 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...
Weakness of pelvic floor support may result in the descending perineum syndrome. This muscular weakness is reportedly related to injury of the sacral nerves or pudendal nerves or due to damage to the musculature itself during childbirth or chronic straining while defecating. Obstruction to defecation may occur through widening of the anorectal angle, weakening of the perineal body, and a more vertical orientation of the rectum, which are all results of pelvic floor weakness.14 A perineal descent of greater than 4 cm on straining as identified radiograph-
The intrinsic rate of population increase depends on three variables age at first reproduction (AR), birth rate (b) and age at last reproduction (L). Birth rate has an important influence on the rate of population increase, which is illustrated by the examples given of Macaca silenus and Macaca sylvanus the females of which start breeding at about five years of age. However, in Macaca sylvanus, birth rate is higher, leading to a higher intrinsic rate of population increase. Animals that start breeding at an early age also show a higher intrinsic rate of population increase than do those that start breeding later. This has a knock-on effect over the generations, as a female that breeds early produces female infants that also breed early, thus increasing the total number of females that are producing infants. For example, both Macaca sylvanus and Erythrocebus patas breed annually, but E. patas reaches maturity nearly two years before M. sylvanus. Over time, this difference in AR has a...
The possibility of EBV acquisition by neonates during passage through the birth canal has been raised by the results of a study in which cervical shedding of EBV was demonstrated in 5 out of 28 (18 ) seropositive women (13). However, no clear data are available regarding the incidence of perinatal transmission of EBV.
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.
Across primate species, infant mass at birth is a constant proportion of maternal mass, but the relative mass of the neonate (as a proportion of maternal mass) declines with maternal size. Larger species give birth to a proportionately smaller neonate. Within rhesus macaques, larger individual mothers give birth to larger neonates (Bowman and Lee, 1995) and larger mothers appear to be more efficient at sustaining fetal growth as gestation length varies little. However, as found in interspecific comparisons (see also Reiss, 1985), the infants of larger macaque mothers were a relatively lower proportion of their mothers' mass. The patterns are similar between and within species, although with lower slopes, as has been predicted (Kozlowski and Weiner, 1997).
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.
To express the clonal growth model in mathematical terms, the growth kinetics of normal hepatocytes depend on the cell birth rate, a, and death rate, P where N is the number density of normal hepatocytes in the tissue. Initiated cells are produced through mutations in the normal hepatocytes from dieth-ylnitrosamine treatment. This is assumed to be a stochastic process that follows a Poisson distribution. The expected number of initiated cells in a small time step is defined by a function of mutation probability and cell birth rate
Volunteers should be from the community in which they work, even in emergencies. They should work with their elders, leaders and local health staff (health workers and traditional birth attendants). Volunteers should know the traditional beliefs about diseases and know what priority health problems the community wants to solve. They should also know what other groups are doing in their community about priority health problems and know the families and visit them regularly to provide key messages.
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.
One of these parents, Ann, grew up in Hawaii. She became pregnant at fifteen but was able to stay in school because the teen pregnancy rate at my high school was high enough that they had a program to support teen parents and their children. Not long after giving birth to her son, Bane, Ann's own mother left the islands and Ann decided to move in with Bane's father and his family. This Filipino family was large and extended, and few of the members spoke English. Feeling isolated, Ann wrote to her mother pleading for a plane ticket to the mainland. Although Ann imagined she would someday return to Hawaii and marry Bane's father, things didn't work out that way.
The main exception to a general pattern of ignoring interactions between males and infants was of course the study of male care among monogamous primates. It has been known for over 200 years, ever since a zoologist-illustrator named George Edwards decided to watch the behavior of pet marmosets in a London garden, that among certain species of New World monkeys males contributed direct care for infants that equalled or exceeded that given by females (Edwards, 1758). Mothers among marmosets and tamarins typically give birth to twins, as often as twice a year, and to ease the female in her staggering reproductive burden the male carries the infant at all times except when the mother is actually suckling it. It was assumed that monogamy and male confidence of paternity was essential for the evolution of such care (Kleiman, 1977), and at the same time, it was assumed that monogamy among primates must be fairly rare (e.g., see Symons, 1979, or virtually any textbook on physical...
Infancy covers the period from birth through 12 months of age and is divided into two 6-month intervals. The first 6-month interval was not subdivided further because intake is relatively constant during this time. That is, as infants grow they ingest more food however, on a body weight basis their intake remains the same. During the second 6 months of life, growth velocity slows, and thus total daily nutrient needs on a body weight basis may be less than those during the first 6 months of life.
Although maternal poliomyelitis in the first two trimesters can be associated with spontaneous abortion or stillbirth and can predispose to intrauterine growth retardation and premature delivery, poliovirus infection of the fetus was an infrequent occurrence in the prevaccine era (2-7). Maternal poliovirus infection was not linked to an increased incidence of congenital anomalies (8). Neonatal poliomyelitis was a complication of maternal infection, however. Cases presented from birth to 28 days of age, with most cases occurring between days 5 and 21. The incubation period of neonatal poliomyelitis was often shorter (
Because cardiac hypertrophy may be a cause of death if severe, and physiologic in cases of chronic conditioning, the criteria for increased heart weight are important. We usually utilize the tables published from the Mayo Clinic giving the 95 confidence intervals for the height and weight of male and female individuals from birth to 99 years.20,21 We recommend that at least four sections of the left ventricle be examined from the
Infants may be infected in utero through transplacental spread, during labor and delivery through contact with infected blood or secretions in the birth canal, and post-natally through breast-feeding. In countries where women are counseled not to breastfeed, most transmission occurs at the time of delivery. In countries where safe alternatives to breast-feeding are not available for infant nutrition, many infants are infected through breast-feeding. The timing of transmission is defined by the time that HIV-1 is detected in the infant using a standard diagnostic test (20,21). Cord blood should not be used for HIV-1 testing of the infant at birth because of the potential for contamination with maternal blood. If tests that detect the HIV-1 virus, such as an HIV-1 culture or HIV-1 DNA polymerase chain reaction (PCR) assay, are positive within the first 48 hours of life and subsequent tests are also positive, the transmission is considered to have occurred in utero. However, if the HIV-1...
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...
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...
Correlation does not imply causation. There is evidence that the density of the stork population is correlated with the human birth rate. The reason for the relationship is probably that both variables are related to the number of chimney stacks, which are favourite nesting sites for the birds and an indicator of the size of the human population.
Reports of dengue infections have come from Guadeloupe (one mother developed severe thrombocytopenia, giving birth via cesarean section, and the other had preterm labor mothers and infants recovered without complications) and from Thailand (thrombocytopenia with and without hemorrhagic complications) (27-29).
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.
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.
Mastitis is usually caused by the introduction of bacteria from a crack, fissure, or abrasion through the nipple that allows the organism entry into the breast. The source of organisms is almost always the nursing infant's nose and throat other sources include the hands of the mother or birthing personnel and maternal circulating blood. The most common bacterial organism to cause mastitis is Staphylococcus aureus others include beta-hemolytic streptococcus, Escherichia coli, Candida albicans, and rarely, streptococcus. Community-acquired and nosocomial methicillin-resistant S. aureus have also been found to cause mastitis. The actual organism can be cultured from the milk. Common predisposing factors relate to milk stasis and include incomplete or inadequate drainage of a breast duct and alveolus that occurs as a result of missed feedings prolonged delay in infant feeding abrupt weaning of the infant and blocked ducts caused by tight clothing or poor support of pendulous breasts....
Screening for group B streptococcus colonization at 35-37 weeks. All pregnant women should be screened for group B beta-hemolytic streptococcus (GBS) colonization with swabs of both the lower vagina and rectum at 35 to 37 weeks of gestation. The only patients who are excluded from screening are those with GBS bacteriuria earlier in the current pregnancy or those who gave birth to a previous infant with invasive GBS disease. These latter patients are not included in the screening recommendation because they should receive intrapartum antibiotic prophylaxis regardless of the colonization status.
This shrub is native to the Mediterranean and northwestern India. Dried fruits of Vitex agnus-castus seem to be one of the oldest phytomedicines, dating back to the beginning of European civilization. The Greek name of this plant, lygos (pliable branch), hints at its usage in viticulture for staking vines and in livestock farming for pasture fences. The other Greek expression, agonos, meaning chaste and pure, distinguishes it as a feminine plant of goddesses like Hera, Demeter, and Artemis (Diana), a cult plant of womanliness. Agonos is the source of the medieval name agnus-castus (the chaste lamb). The ancient Greek physicians Hippocrates, Theophrastus, and Dioscorides all made reference to it, as did the Greek-Roman historian Pliny The Elder. Both Dioscorides and Pliny reported its use in suppressing the libido. The Greeks' use closely resembled modern practices they recommended it as an aid in healing of external wounds and complaints of the spleen, and for use in child birth. The...
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...
Severe head injuries are often associated with retinal hemorrhage. If the child survives, retinal scarring may result. Retinal hemorrhage can occur naturally from birth trauma, but in these instances, scarring does not occur.6 While retinal hemorrhage is more common in homicides, it can occur in severe accidental head injuries. Retinal hemorrhages are also seen in bleeding disorders, sepsis, vasculopathies, increased intracranial hemorrhage and, rarely, when there is abrupt and severe compression of the chest.7,8 Examples of the last entity are cardiopulmonary resuscitation and the effects of a shoulder harness in a car crash.8
Among adults, epidemiological studies support sexual activity as a route of spread for GBS (8). Mother-to-infant transmission of GBS can occur either prior to birth by the ascending route through ruptured membranes or at the time of delivery by contact with the organism in the birth canal. Less commonly, infants may acquire GBS through
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
The true cause of anterior rectocele is unclear. Childbirth is a known risk factor due to the stretching and distention of the pelvic floor and tearing of the rectovaginal fascia. Prolonged straining during defecation in chronic constipation or in nonrelaxing puborectalis syndrome may also lead to the formation of a rectocele. Both of these events promote widening of the genital hiatus, perineal muscle laxity, and pelvic organ descent, which may subsequently lead to pudendal neuropathy. Postmenopausal status and hysterectomy are also proven to be predisposing factors of rectocele. Rectoceles may present at one or more of three levels and are known as high, middle, and low rectoceles (Fig. 18.2). High rectoceles are usually due to a stretching or disruption of the upper third of the rectovaginal septum, cardinal, or uterosacral ligaments. This type of rectocele is frequently associated with enteroceles of varying degrees that may need simultaneous surgical correction. The middle level...
Prostate cancer continues to be the leading cancer among American men, with 184,500 new cases annually 1 . It has been estimated that 39,200 men died of prostate cancer in the U.S.A. in 1998. This makes prostate cancer the second cause of cancer-related death in men 2, 3 . Furthermore, the probability of developing prostate cancer from birth to death is 20 3 . Treatment selection is dependent on patient age and health, cancer stage and grade, morbidity and mortality of treatment, as well as patient and physician preference. The mainstay for organ-confined disease is either radical surgery or curative radiotherapy 4, 5 . This is only considered an option in the absence of seminal vesicle infiltration (SVI), extension through the prostatic capsule (extracapsular extension, ECE) or metastatic disease. Therefore, the purpose of staging is the possible detection of extraprostatic disease. Clinical staging by digital rectal examination (DRE) and prostate specific antigen (PSA) remains as...
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.
A weakened immune system can be congenital (present from birth), or it may result from an inherited disorder or an infection. It also may occur as a side effect of drug treatment. People with weakened immune systems have difficulty fighting infections that are easily handled by a healthy immune system. When a person's immune system is ineffective, harmful microorganisms can thrive and multiply rapidly, causing life-threatening infections. HIV is transmitted by sexual contact or by direct contact with infected blood or body fluids. HIV can be transmitted from an infected woman to a fetus during pregnancy or to an infant during childbirth or through breast milk. HIV also can be transmitted by sharing needles during intravenous drug use. In the past, some people were infected with HIV through blood transfusions or contaminated blood products. Today, however, all donated blood is routinely screened for HIV, and the blood supply in the United States is safe.
Poorly controlled gestational diabetes is associated with an increase in the incidence of preeclampsia, polyhydramnios, fetal macrosomia, birth trauma, operative delivery, and neonatal hypoglycemia. There is an increased incidence of hyperbilirubinemia, hypocalcemia, and erythremia. Later development of diabetes mellitus in the mother is also more frequent. The prevalence of gestational diabetes is higher in black, Hispanic, Native American, and Asian women than white women. The prevalence of gestational diabetes is 1.4 to 14 percent.
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.
Plotting of data makes it easier to determine whether two variables correlate with each other. For example, the plot of height (ordinate) over age (abscissa) shows that the height increases during the growth years and reaches a plateau at the age of about 17 years. This means that height is related to age in the first phase of life, but is largely independent of age in the second phase. A correlation does not necessarily indicate a causal relationship. A decrease in the birth rate in Alsace-Lorraine, for example, correlated with a decrease in the number or nesting storks for a while.
The most common causes of maternal death in the U.S. are hemorrhage, embolism, hypertensive disease of pregnancy, and infection, approximately in that order. In 1998, there were 281 reported deaths caused by complications of pregnancy, childbirth, and the puerperium.26 This number is lower than the actual number of deaths, as it includes only those reported on the death certificate and assigned to the cause of death. Death complicating an abortion is uncommon.27 In 1998, there were six deaths following legally induced abortions, none from illegal abortion and two from spontaneous abortions.26 All deaths following an abortion should be reported to a medicolegal office. Under most circumstances, such cases should be autopsied, as there is a good probability of civil litigation.
In unwitnessed births outside the hospital in which the infant is brought in with fractures of the skull, the mother may state that the injury was caused by precipitous delivery in the erect position with the infant's head striking the ground. Such an occurrence would, in theory, be more common in a multiparous woman with a large birth canal, a small child, and vigorous labor. Klein, however, felt such fractures to be rare.31 He reported 183 cases of precipitous delivery in women kneeling, sitting, or standing with the infant falling to the ground. Only one child died and there were no instances in which a skull fracture could be detected externally. It must be remembered that when the child is delivered, the umbilical cord is still attached. The cord (average length, 20 in.) will tend to pull the child short, thus preventing the head from hitting the ground with full force.
An infant born to a woman with active cervical infection with C. trachomatis is at risk of acquiring the infection during passage through the infected birth canal. Approximately 50-75 of infants born to infected women become infected at one or more anatomic sites, including the conjunctiva, nasopharynx, rectum, and vagina (Table 1). Overall, the nasopharynx is the most frequently infected site in the infant. Approximately 30-50 of infants born to Chlamydia-positive mothers will develop conjunctivitis (11-14). Studies in the 1980s identified C. trachomatis in 14-46 of infants younger than 1 month of age presenting with conjunctivitis. Chlamydia ophthalmia appears to occur much less frequently now secondary to systematic screening and treatment of pregnant women. The incubation period is 5-14 days after delivery. C. trachomatis is usually not detectable in the eye or nasopharynx immediately after birth unless there has been prolonged rupture of membranes. At least 50 of infants with...
Early deprivation of many kinds (visual, auditory, even emotional) is known to have permanent effects on behavioral development, just as early experiences can have profound affects on neural development. As we saw in Chapter 9, normal vision can never be restored to an adult mammal that has been blind from birth the neural circuitry simply has not developed properly. Human infants who are blind also show delays in various motor skills, a fact that emphasizes the importance of vision as a sensory input for motor development (Levtzion-Korach et al., 2000). Lack of various aspects of education and emotional interactions early in life may also affect the ability to perform later in life because the neural substrates of these behaviors are wired in at particular stages. Thus, although we do not believe that human brains, or those of other animals, emerge as blank slates, it is nevertheless clear that experience shapes and adjusts the nervous system. An argument has been made that the brain...
Combinatorial library design attempts to choose the best set of substituents for a combinatorial synthetic scheme, from all available candidates, to maximize the chances of finding a useful compound such as a drug lead (1). Library design involves operations on virtual combinatorial libraries, which, in turn, are collections of compounds that can be synthesized by a reaction scheme from a set of available reagents (2). By focusing on well-characterized reactions, this approach circumvents a bottleneck in current computational approaches to de novo ligand design the assessment of synthetic accessibility. Possible types of virtual libraries include (i) diverse, (ii) focused, and (iii) complementary libraries. An ideal diverse library is a collection of chemical entities without gaps and redundancies, with an even distribution with regard to a given chemical space. Design of focused libraries involves incorporating a bias into the library, usually based on a similarity metric, docking...
Motoneurons already express low levels of immunoreactivity for clusterin from birth. These levels tend to increase during early postnatal development (Tao, Aldskogius, unpublished observations).3 One-two weeks after injury of motor axons in adult animals, clusterin immunoreactivity and labeling for its mRNA are increased (Fig. 8.2).2,4 This upregulation does not occur uniformly in the population of axotomized motoneurons but predominate in regionally distinct groups. Under the same lesioning conditions in immature rats immu-noreactivity for clusterin appeared to be increased a few days after injury in virtually the entire population of affected motoneurons (Tao, Aldskogius, unpublished observations). These two experimental situations show important differences with respect to neuronal vulnerability. Neonatal injury produces rapid and extensive nerve cell death, but adult injury produces little nerve cell death and that only after a protracted postoperative survival time.
CMV can be transmitted from mother to child transplacentally, during birth, and in the postpartum period via breast milk. Congenital CMV infection rates are directly related to maternal seroprevalence rates. Rates of congenital CMV infection are higher in developing countries and higher for low-income groups in developed countries (7,10,29). The mechanisms for this increased rate of congenital CMV in populations with high seroprevalence rates are not clear. Studies of risk factors for congenital CMV infection have also documented an association between young maternal age and increased rates of congenital CMV infection (30). Preece at al. also found that non-white race and single marital status were independently associated with increased risk of congenital CMV infection (31). Fowler et al. reported an increased risk of congenital CMV infection in women with sexually transmitted diseases, single mothers, and those younger than 20 years (32).
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.
A type of information bias that is of importance in case-control studies is recall bias, which means that cases differ from controls in the recollection of exposure. An example is that after giving birth to a malformed baby, mothers start thinking about potential causes for this malformation during their pregnancy (see Section 126.96.36.199). A way to solve this problem may be the selection of a control group of which the memory has also been activated. In a case-control study on congenital heart disease, for example, a control group can be selected with other congenital diseases. It should be noted that the congenital heart disease studied and the congenital disease in the control group should not have a common determinant.
To eradicate pathogens of various etiologies, it may be wise to use cesarean section (CS) rederivation as a means to end pestilence. This requires a definite commitment with regards to preventing the reintroduction of the various disease agents discussed in this text. This method requires less equipment and resources than embryo transfer. The procedure should be performed as quickly and as safely as possible. The delivery of rats via CS and experiencing a period of less than five minutes of anoxia do not appear to cause changes such as spatial learning deficits compared to vaginal birth controls. In contrast, some alterations from vaginally delivered rats were seen with respect to plasma corticosterone, body weights, and body organ weights during the first 35 days of life.
Why are synapses being assembled and disbanded at the same time, particularly when the pathfinding and mapping mechanisms produce such accurate results The central nervous system is a tissue designed for continuous modification, from birth into adulthood (cf. learning and memory). The addition and loss of synapses may reflect a major goal of development that is, to optimize behavioral performance in a particular environment. One might argue that there is no better time for learning and optimizing performance than during development (see Chapter 10). Therefore, both synapse addition and synapse elimination can improve the specificity of neural connections. The correct complement and strength of synaptic connections should optimize the computational properties of each neuron.
Place during the cycle in which fertilisation occurs, the male rule can be simple if he mated with the female, his paternity is ensured. Field studies on primates with unimale groups suggest that when a newly immigrated male mates with a pregnant female, the probability that he will subsequently commit infanticide is reduced (e.g. blue monkey Fairgrieve, 1995 hanu-man langur Sommer, 1994), although it is not clear how long before birth this mating must take place. Experimental work on rodents confirms these rules (Perrigo and vom Saal, 1994). Where multiple males mate with the female before she gives birth, more complex rules are needed these have not been studied in detail. Unfortunately, there are no data to test the assumption that the degree of unpredictability depends on the need for confusion. However, the concept of unpredictable ovulation also suggests that there should be a good but not perfect correlation between male rank and paternity, with a small proportion of infants...
The age of the patient at the time of sample collection for detection of CMV is of some importance. Neonates who acquire CMV during birth or from breast milk shed virus after 3 weeks of age. Thus, detection of CMV in urine or saliva after 3 weeks of age is not unequivocal proof of CMV acquisition in utero.
TREATMENT In children with congenital Horner's syndrome a history of forceful manipulation of the infant during birth reduces the need for medical work up. In 90 of affected children either trauma or no clearly identifiable cause will be found. However, in 10 an underlying pathology may be uncovered. All cases of acquired Horner's syndrome without a known etiology require extensive evaluation since a high percentage of cases may be associated with a serious underlying condition. In acute cases the eyelid ptosis should be observed. When the ptosis is persistent and visually significant or is of cosmetic concern, surgical correction may be indicated. Since levator function is usually excellent, a conjunctival-Muller's muscle resection or levator aponeurosis advancement procedure will give good results.
As the average human lifespan has increased, a concomitant increase in the incidence of deaths attributed to neurodegenerative disease has occurred.1 According to the National Vital Statistics Report of the US Centers for Disease Control, life expectancy from birth in 2003 was 77.6 years.1 This represents a 0.3-year increase from 2002, which was partially driven by increases in the number of deaths listed as due to AD, the eighth leading cause, and PD, the 14th leading cause. In comparison, the average life expectancy in 1900 was 47.3 years. Thus, with time, the pharmacoeconomic impact of neurodegenerative diseases on society is increasing. At the same time, new drug approvals have decreased, especially in the CNS area, suggesting that as technology has advanced, productivity has fallen. An interesting debate is ongoing that cancer may represent a risk factor in dementia,2 reflecting the yin and yang of cell death therapeutics. In cancer, the task is to enhance cell death, while in...
Deaths complicating cerebral palsy (CP)56 are occasionally seen in a medi-colegal system. Pneumonia or seizures are the typical presenting causes of death. Usually, the only reason the death becomes a medical examiner's case is that it occurred at home. Cerebral palsy is not a single disease, but rather a group of diseases producing non-progressive motor impairment due to lesions or anomalies that arose in the early stages of brain development. Twenty-five percent of afflicted individuals are unable to walk 30 are mentally retarded and 33 have epilepsy. Despite dramatic changes in obstetrical and perinatal care, there has been no decline in CP's prevalence among full term births. In fact, it has increased overall because of the increase in survival of premature infants. The lower the birth weight and the earlier the gestational age, the higher the risk of cerebral palsy. Current medical opinion is that, for the vast majority of children with CP, the injuries are not caused by birth...
Hill and Hurtado examined women's weight as a predictor of fertility. After controlling for age, and whether the previously born child was dead or alive, they found a significant contribution of body weight to predicting time to the next birth. Heavier women had children after a shorter interval than lighter women. Thus, delaying maturation to grow bigger yields greater fertility. Delaying too long cuts into the time available to reproduce, and lowers the probability of surviving from birth until reproduction begins. Fitting real-life parameters to equations summarising this trade-off predicts an optimal age and weight at first birth. The observed Ache age at first birth (17.5 years) fits well with the prediction, but the model predicts maturity at greater weight than observed. Hill and Hurtado then fit Kung weight and mortality data from Howell (1979) (but use the Ache regression of fertility on weight) to the equations and show that observed age at first birth fits the slightly...
Syphilis is a bacterial infection that can be cured by antibiotics, usually penicillin, but that can cause serious problems if left untreated. The disease is much less common today than before the development of penicillin, and safer sex practices to curb HIV transmission also helped reduce the incidence of syphilis. Congenital (from birth) syphilis, which occurs in babies born to mothers with syphilis, is very rare today.
It has become apparent in recent years that cell death is often an active and highly choreographed process of cell suicide, termed apoptosis. During apoptosis, the cell engages a plethora of different pathways that either promote its survival or lead to its demise. A constant crosstalk between these pathways and those that control cell proliferation and other cell activities takes place. This crosstalk is necessary to maintain tissue homeotosis, the mechanism that assures that the cell birth rate is in balance with the death rate. Disruption of this balance is the cause of many diseases, including, of course, cancer. These pathways, the subject of intense research in recents years, are described in unit 7.18.
The setup included the use of a high-speed infrared detection apparatus, the AGA Thermovision 780 System by the AGA Infrared System AB of Sweden. The clinical setup is illustrated in Fig. 3.6. A mirror with a 99.99 reflective rate was placed on an adjustable frame about 1 m above the patient, which would not obstruct the necessary operation of the obstetrician. The image of the patient's body could be received through the mirror by a signal scanner. The scanner was placed in another room and kept in a horizontal position because liquid nitrogen was used to cool its detector. The system combines real-time infrared scanning with thermal measurement capability. The infrared scanner unit converts electromagnetic thermal energy radiated from the abdominal skin into electronic video signals. These signals are amplified and transmitted via an interconnecting cable to a color display monitor where the signals are further amplified. The resultant signal is displayed on a black and white...
Fig. 3.3a, b Congenital atresia of one posterior choana. This congenital deformity may not present until adult life. A total unilateral obstruction from birth may cause suprisingly little trouble to the patient. If, however, the symptoms are marked, the atresia can be treated surgically with removal of the bony obstruction. Fig. 3.3a, b Congenital atresia of one posterior choana. This congenital deformity may not present until adult life. A total unilateral obstruction from birth may cause suprisingly little trouble to the patient. If, however, the symptoms are marked, the atresia can be treated surgically with removal of the bony obstruction.
We also generated random trees with different heights using Evolver in the PAML package We considered the trees with nine and sixteen leaves. The parameters used to generate the trees are 10 for Birth rate, 5 for Death rate, 1 for Sampling fraction, and 0.1, 0.2, 0.5, 1, 2, 5 for height. The height means the sum of the branch lengths from the root to all leaf nodes. For each possible conbination of parameter values, we generated one hundred random trees and estimated the transition probability along each branch using the Jukes-Cantor model. The left panel of Figure 4 shows the average unambiguous reconstruction accuracy for different heights. The right panel of Figure 4 shows the average ambiguous reconstruction accuracy for different heights. In both cases, the solutions output by our greedy algorithms are near optimal. Note also that, for ambiguous reconstruction accuracy, the backward greedy algorithm outperforms the forward greedy algorithm.
Timed pregnant C57Bl6 J (CD45.2 expressing) mice are bred to give birth at approx midnight before the day of anticipated transplantation studies. We find that our colony of C57BL6 J mice give birth 19.5 d after coitus and thus plan on performing the transplant on d 20 after coitus. 1. C57BL6 J (CD45.2 expressing) dams are bred to give birth at midnight of the d of anticipated transplantation studies.
Neonatal thymectomy is used most often to remove mature T cells without removing T cell precursors. Mice from birth to day 3 can be thymectomized for this purpose. Removal of the thymus after day 3 does not alter the influence of the thymus on the development of later T cell-dependent antibody or cellular immune responses.
CLINICAL PRESENTATION The common blue nevus appears as a solitary, smooth surfaced, well-circumscribed oval lesion that is flat to slightly elevated. It is usually less than 1 cm in diameter. Blue nevi vary in color from blue to blue-black and may have a grey or whitish center. They occur most often on the back of the hands, face, and on the buttocks. While they usually occur in the skin, blue nevi can also be seen in the sclera, conjunctiva, and orbit. When present from birth the nevus typically remains unchanged throughout life, but most develop later in life and can show very slow growth.
This can be defined as the deliberate killing of a child within 24 h of its birth. The perpetrator is usually the mother. She delivers the child and kills it. Occasionally, she is assisted by a relative or a friend, but usually neonaticide is an act committed by a single individual with no witnesses. Most of the perpetrators are young and unmarried. Some claim not to have realized they were pregnant until they went into labor. Their goal is either to conceal the fact that they gave birth to a child or to dispose of an unwanted child. determine whether a child was alive include petechiae of the lungs or heart and air in the stomach on radiological examination. Neither of these criteria is valid. Petechiae are nonspecific and can occur from intrauterine stress, and gas in the stomach can be due to labored respiratory efforts as the infant is in transit through the birth canal.
The normal vagina is stabilized and supported on three levels. Superiorly, the vaginal apical endopelvic fascia is attached to the cardinal-uterosacral ligament complex (level I). Laterally, the endopelvic fascia is connected to the arcus tendineus fasciae pelvis (level II). Inferiorly, the lower posterior vagina connects to the perineal body (level III).7 The endopelvic fascia extends between the vaginal apex and the perineal body, comprising the rectovaginal septum (Fig. 19.3). An enterocele or rectocele results from a stretching or actual separation or tear of the rectovagi-nal fascia, leading to a bulging of the posterior vaginal wall noted on examination during a Valsalva maneuver. Trauma from vaginal childbirth
Telogen effluvium is characterized by abrupt, diffuse hair loss. Common causes are childbirth, febrile illnesses, surgery, psychological stress, crash diets, and drug therapy (38). The excessive shedding usually begins 3 to 4 months after the inciting event (39). Anagen effluvium is characterized by widespread or circumscribed loss of anagen hairs from growing follicles. Alopecia due to anagen effluvium is quite obvious because 90 of the hair follicles are in anagen (growing) phase. In contrast with telogen effluvium, loss of anagen hair begins
INTRODUCTION Herpes simplex is caused by a DNA virus that is estimated to infect 60 to 90 of individuals at sometime during their life. Clinically evident infections however are much less common. Involvement of the facial region is predominantly due to type I herpes virus, with the exception of newborns, in whom overwhelming exposure to the type II variety during birth can result in development of typical skin lesions during the first few days of life, often associated with devastating CNS and systemic involvement. Primary herpes occurs in previously uninfected individuals. The chief mode of transmission is by kissing or other forms of intimate contact with an individual who has an active, usually recurrent, herpetic lesion.
Anthrax is a historically important infection, thought to be the fifth and sixth plagues of ancient Egypt, brought by Moses. It was the cause of several disastrous animal plagues in Europe in the eighteenth and nineteenth centuries. In 1877, Robert Koch cultured Bacillus anthracis, the first proof of a microbial agent causing human disease (1). This discovery supported germ theory and gave birth to the science of modern microbiology. Subsequently, Pasteur and Greenfield successfully developed the first vaccine, composed of attenuated B. anthracis (2). Anthrax has been explored as an agent of biological warfare because of its exceptional virulence and capability to create an aerosol of odorless, invisible spores. Its spores could potentially be dispersed over densely populated areas, and generate disease in a multitude of people with high mor
Another common form of brain injury is cerebral palsy. Cerebral palsy is the term used to define a wide range of movement disorders that occur during or shortly after birth. These disorders are caused by an accident (falls or other sudden trauma to the brain), brain infection (bacterial meningitis or viral encephalitis), or medical incidents during childbirth (such as birth asphyxia trauma, when oxygen flow to the brain has been cut off tempo-rarily).16 All of these conditions lead to neuronal death to parts of the brain similar to that experienced with stroke. Unlike stroke, however, the motor effects are quite different. Most often (80 of the time), these children experience what is known as spastic cerebral palsy.7 In spastic cerebral palsy, the muscles are stiffly and permanently contracted, leading to difficulties in performing motor tasks. Other types of cerebral palsy include dyskinetic cerebral palsy, characterized by uncontrolled, slow, writhing movements ataxic cerebral...
Venous air embolism may occur during therapeutic or diagnostic procedures secondary to trauma, during childbirth or abortion, and during oralgenital sex in a pregnant woman when her partner blows air into the vagina. Arterial air embolism occurs secondary to cardiopulmonary bypass, arterial catherization, surgical procedures involving arteries, or injury to the pulmonary veins after chest trauma. One might also incur a paradoxical air embolism, that is, air crossing from the venous to the arterial circulation.
Most of the population was suffering from impoverished nutrition. The rate of anemic students increased from 3.4 to 36.7 during the period of the UN sanctions. In 1993 the incidence of tuberculosis increased fourfold. The prevalence of coronary diseases increased, as well as the mortality from malignant diseases. About 10 patients died waiting for the pacemaker operation. Mortality of patients with renal insufficiency rose by 20 since they could not be put on dialysis. Mortality of diabetic patients doubled, owing to a lack of insulin, and the incidence of the diabetic gangrene increased tenfold. Especially difficult was the situation of the pregnant women and newborn children. In addition to a decreased birth rate, premature births were increasing as well as severe complications during pregnancy. There was an increase of risky pregnancies, of the number of operative interventions and of infants with disturbed psychophysical development. The total mortality rate in Yugoslavia rose by...
The diagnosis of shoulder dystocia is made after delivery of the head. The turtle sign is the retraction of the chin against the perineum or retraction of the head into the birth canal. This sign demonstrates that the shoulder girdle is resisting entry into the pelvic inlet, and possibly impaction of the anterior shoulder.
Acquire about 50 single words, mostly nouns, over the next eight months. As with birds, there is a period of development when communication skills are acquired most efficiently. From 2 to 6 years of age, children learn about eight words per day. One indication of a sensitive period for language development comes from studies of humans who learn to produce and understand a second language. When English-language skills were analyzed in native Korean or Chinese speakers who arrived in the United States as children or adults, the youngest subjects performed best (Johnson and Newport, 1989). A second indication of a sensitive period comes from studies of deaf individuals who were exposed to sign language from birth to one year of age. Those individuals who are exposed to sign language from birth are more skilled than infants who are exposed even as early as 6 months of age (Newport, 1990). Early stages of language acquisition were studied in two infants who were deaf from birth but were...
During simulated defecation, the anal verge should be observed for any patulous opening or rectal prolapse. Patients with constipation may have signs of anal incontinence during physical examination due to progressive neural injury related to chronic straining or an associated neuromuscular lesion due to childbirth. Occasionally, fecal incontinence is suspected only during physical examination or even during physiologic testing. This may occur due to the patient's embarrassment and unwillingness to seek medical therapy or as a subclinical finding.
Another defect resulting from the mutant collagen became evident in the impaired reproductive ability of mutant females. In mammals, the uterine mass changes considerably during pregnancy and postpartum involution.40,41 In mice, the total uterine mass accounted for by collagen accumulation increases up to 20-fold during pregnancy, and after parturition the uterus rapidly recovers from prepregnant size.42 This postpartum involution is accomplished within the first two days after giving birth and involves transcriptional activation of the collagenase gene and increased release of collagenase extracellularly followed by the massive degradation of most of the collagen deposited in the uterus within a few days.40-42 In previously pregnant mutant r r females, degradation of collagen was severely disturbed, leading to the accumulation of nodules in the uterine wall. These nodules consisted of large collagen aggregates, reflecting the impaired collagen degradation during the postpartum period...
Women are even less likely to have symptoms, but they are more likely to experience long-term consequences. In addition to developing PID, a woman with chlamydia can pass the infection to her baby during childbirth, causing pneumonia or conjunctivitis (inflammation of the membrane that covers the white of the eye and lines the inside of the eyelid).