Central concepts in the midwife-woman relationship

The relationship between the midwife and the woman is essential for a positive experience for woman during childbearing period, i.e. pregnancy, childbirth and the first postpartum phase. Thereby, the aim of this study was to delineate central concepts in the midwife-woman relationship, in normal as well as high-risk situations. A secondary analysis was performed on original texts from eight Swedish qualitative studies, all with a phenomenological or phenomenological-hermeneutic approach. Six pairs of concepts were elucidated; each one describing one aspect from the woman's perspective and one responsive aspect from the midwife. The pairs of concepts are: surrender-availability, trust-mediation of trust, participation-mutuality, loneliness-confirmation, differenceness-support uniqueness and creation of meaning-support meaningfulness. Disciplinary concepts about the midwife-woman relationship have evolved that are essential for care in both normal and high-risk contexts, and we suggest that they should be implemented as a guide for midwifery care.

Experiences of children treating functional bladder disturbances on schooldays

OBJECTIVE

After clinical urotherapeutic guidance, schoolchildren suffering from functional bladder disturbances are expected to manage treatment at school. To comply with treatment instructions the children have to visit the toilet at least every 3 h, find the sitting position facilitating relaxation of the pelvic floor, and then empty the bladder as completely as possible. They often blame failing to comply on their experiences of the school toilet. We describe the experiences of children treating functional bladder disturbances on schooldays.

METHOD

The study consisted of open-ended interviews of 20 schoolchildren aged 8-14 years undergoing treatment for functional bladder disturbances, and qualitative content analysis was performed.

RESULTS

Conflicting rules, a risky toilet environment and uncertainty concerning social support at school were experienced. The children had difficulty in reconciling treatment compliance with their psychological needs. They used various tricks to avoid disclosing their bladder disturbances and enabling postponement of toilet visits. Most children gave their psychological needs priority over carrying out treatment.

CONCLUSION

The physical and social school environment was not adapted to these children's needs.

Characterization of divergent and atypical canine coronaviruses from Sweden

Field canine coronaviruses (CCVs) identified during a series of outbreaks of gastroenteritis in Swedish dogs were subjected to genetic analysis involving the open reading frame 1b (ORF1b) and the membrane (M) and spike (S) protein genes. Four field viruses originating from the Stockholm region presented identical sequences and segregated separately from other CCVs characterized so far and from GOT/05, the variant recovered in Western Sweden. A recombinant origin of the fifth virus identified in the Stockholm region is suggested. In addition, the five viruses originating from the same geographical area displayed atypical 5′ S gene sequences.

Development of a microarray for studying porcine cytokine production in blood mononuclear cells and intestinal biopsies

A microarray for demonstration of a limited number of porcine cytokines was initiated. Polymerase chain reaction (PCR) products were synthesized for four house-keeping genes, cyclophilin, beta-actin, hypoxanthine phosphoribosyltransferase (HPRT) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and the following cytokines: interleukin (IL)-1beta, IL-4, IL-6, IL-8, IL-10, IL-12 p35, IL-12 p40, IL-18, interferon (IFN)-alpha, IFN-beta, IFN-gamma, tumour necrosis factor (TNF)-alpha, macrophage inhibition factor (MIF) and granulocyte/macrophage colony-stimulating factor (GM-CSF). Cytokine production was induced by incubation of porcine peripheral blood mononuclear cells (PBMC) with Concanavalin A (ConA) or oligodeoxynucleotide (ODN) 2216. RNA was isolated after 6 or 24 h from stimulated cells or unstimulated control cells and from intestinal biopsies. Cytokine expression was analysed using a 3-DNA Array 350(TM) labelling kit from Genisphere. Data were normalized using external control genes and analysed with the genepix pro 5.0 software. All the cytokines could be induced in PBMC and expressed on the array and the cytokines IL-6 and IFN-alpha were also analysed at protein level. All but one cytokine were expressed in samples from intestinal biopsies. Densitometric analyses of PCR products of the house-keeping genes were performed to validate the results from the microarray. Thus, this microarray will enable analyses of the cytokine profile during local and systemic infections in the pig.

Early random capillary glucose level screening and multidisciplinary antenatal teamwork to improve outcome in gestational diabetes mellitus

BACKGROUND

This study describes maternal and neonatal characteristics and delivery outcome in women with gestational diabetes mellitus [GDM], compared to a control group.

METHODS

A retrospective observational study of 719 women with GDM was undertaken in a Swedish urban district. All other parturients at the same hospital served as the control group. GDM was diagnosed using random capillary glucose levels at fixed intervals, beginning early in pregnancy. An oral glucose tolerance test was performed at glucose levels>or=7.0 mmol/l (127.8 mg/dl). Data was analysed according to glucose levels at diagnosis, ie, mild or severe GDM.

RESULTS

GDM was diagnosed in 2.28% of the women who were older and had higher Body Mass Index [BMI]. A high proportion was of non-Nordic origin (44.5%); they had severe GDM more often (49.1%) than the Nordic group (33.1%). The GDM-mild group had less complications and abnormalities, compared to the GDM-severe group, although both groups differed from the control group in this respect. Delivery was spontaneous in 70.2% of GDM-mild, 65.7% of GDM-severe and 81.0% of the control group. LGA (+2 SD) was found in 4.8, 10.5 and 3.2%, respectively.

CONCLUSION

Early non-fasting random universal screening and multidisciplinary antenatal teamwork intervention seems to be favourable, with low rates of excessive fetal growth, instrumental vaginal delivery and caesarean section.

Feeling Good in Daily Life: From the Point of View of Boys With Posterior Urethral Valves

PURPOSE

We determined what is important to feel good in daily life when living with a long-term illness that requires daily treatment routines.

MATERIALS AND METHODS

Seven boys between 6 and 16 years old who were born with posterior urethral valves narrated their experiences with daily life. They were on clean intermittent catheterization, had impaired renal function and 2 had undergone transplantation.

RESULTS

Being involved in decisions about themselves was important, as was having their own doctor and nurse. Friends were important. Clean intermittent catheterization was something that worried them in relation to friends and made them feel uncertain about how they would react to it. The boys accepted the catheterization procedure as something that had to be done but they needed strategies to be able to comply. A single event, such as no available toilet, was enough to interrupt treatment.

CONCLUSIONS

In these boys prescribed treatment was a surprisingly small part of their lives. The clean intermittent catheterization routine was sometimes experienced as an obstacle in company with friends. The new challenge might be to achieve compliance with the treatment routine in daily life in a long-term perspective.

SYBR Green real-time reverse transcription-polymerase chain reaction assay for the generic detection of coronaviruses

Coronaviruses are etiologic agents of respiratory and enteric diseases in humans and in animals. In this study, a one-step real-time reverse transcription-polymerase chain reaction (RT-PCR) assay based on SYBR Green chemistry and degenerate primers was developed for the generic detection of coronaviruses. The primers, designed in the open reading frame 1b, enabled the detection of 32 animal coronaviruses including strains of canine coronavirus, feline coronavirus, transmissible gastroenteritis virus (TGEV), bovine coronavirus (BCoV), murine hepatitis virus (MHV) and infectious bronchitis virus (IBV). A specific amplification was also observed with the human coronaviruses (HCoV) HCoV-NL63, HCoV-OC43, HCoV-229E and severe acute respiratory syndrome coronavirus (SARS-CoV). The real-time RT-PCR detected down to 10 cRNA copies from TGEV, BCoV, SARS-CoV and IBV. In addition, the assay exhibited a high sensitivity and specificity on clinical samples from different animal species. The developed assay represents a potential tool for laboratory diagnostics and for detecting still uncharacterized coronaviruses.

Tactile massage and severe nausea and vomiting during pregnancy - women's experiences

Nausea and vomiting during pregnancy is a condition with an obscure aetiology. The treatment is symptomatic but there is a lack of alternative treatments. Tactile massage is known to give relaxation and increased well-being in connection with different illnesses, but has never been studied on women with severe nausea and vomiting during pregnancy (SNVP). The aim of this study was to describe hospitalized women's experiences of SNVP and of tactile massage. A phenomenological method was used. Ten hospitalized women with SNVP were included. Each woman was given tactile massage on three separate occasions. After the final massage an open interview was used covering both the experience of severe nausea and vomiting, and of tactile massage. The findings revealed an essential meaning summarizing the experience: to obtain a relieving moment of rest and access to the whole body when nausea rules life. When nausea is experienced as controlling a woman's life, tactile massage is experienced as promoting relaxation and gives her an opportunity to regain access to her body. The findings suggest that tactile massage is a good alternative and complement to traditional treatment of SNVP.

Learning curve for add-on stereotactic core needle breast biopsy

PURPOSE

To evaluate the learning curve for an add-on 14 G stereotactic core needle biopsy (SCNB).

MATERIAL AND METHODS

A total of 231 non-palpable breast lesions that had undergone add-on SCNB were evaluated in this prospective study. Five radiologists performed their first three biopsies under supervision. Subsequent, independently performed, biopsies were also evaluated. The samples were collected in three different containers: the first sample in container A, the second and third samples in container B, and subsequent samples in container C (available for four radiologists from the first biopsy on). Technically successful biopsies and false-negative rate in three container combinations (A, A+B, A+B+C) were reported as a function of operator experience.

RESULTS

Technically unsuccessful biopsies occurred significantly more often in microcalcifications than in masses (14.9% versus 3.8%; P=0.04). For microcalcifications, the rate of successful biopsies was 75% (18/24) for the first 5 biopsies and 87.8% (79/90) for the subsequent biopsies (P=0.335); rates for the masses were 95.7% (22/23) and 96.3% (79/82) (P=1.0), respectively. A tendency was noted for the false-negative rate to be higher for the first five biopsies in three container combinations than in subsequent cases.

CONCLUSION

Our results support the existence of a learning curve, especially in the biopsy of microcalcifications. More than three mentor-guided biopsies are needed.

Mothers' experiences of having their newborn child in a neonatal intensive care unit

BACKGROUND

From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU.

AIM

The aim of this study was to describe mothers' experiences when their full-term newborn child was cared for in a NICU during the postpartum maternity care period.

METHOD

A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience.

RESULTS

The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers' experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU.

Swedish women's experiences of doula support during childbirth

OBJECTIVE

to describe women's experiences of having a doula present during childbirth.

DESIGN AND SETTING

a qualitative study with a phenomenological approach in two large Swedish cities. Data were collected via open-ended taped interviews 1-2 months after childbirth. The analysis of the text of transcripts included search for meaning units sorted into clusters for a final expression of the essential structure of the phenomenon.

DATA

interviews from 10 women aged between 25 and 35 years, both primiparous and multiparous.

FINDINGS

women's needs during childbirth were described in a metaphor, as a puzzle consisting of different pieces where the doula was the necessary missing piece. She was a mainstay functioning as an experienced adviser, an affirmative person, a mediator, a guarantor, a fixer and as an accessible presence.

KEY CONCLUSION

for these women, the doula fulfilled important needs. The roles of the midwife and the doula differ, yet some of the evolved doula supportive functions are also essential in the midwife's care. When a birthing woman has chosen a doula, the challenge for the midwife is to support her in collaboration with the doula and the partner if present. More research is needed in order to determine whether the presence of a doula for the midwife is an asset or a hindrance, and to find the essential prerequisites for midwife-doula collaboration to be possible.

First Report of Xylella fastidiosa in Oklahoma

In Oklahoma, during the late summer of 2004, an elm tree (Ulmus americanus L.) located in the Oklahoma Botanical Gardens near Stillwater showed symptoms of marginal leaf scorch bordered by a yellow band between necrotic and green tissues, indicating possible Xylella fastidiosa infection. Three leaves from the symptomatic tree and one leaf from an asymptomatic nearby elm were sampled. DNA was extracted with the Extract-N-Amp kit (Sigma, St. Louis, MO). Samples were tested for X. fastidiosa using real-time polymerase chain reaction (PCR) with Xylella genus specific primers XfF1/XfR2 and dual-labeled TaqMan probe XfP2 (2). Infected oleander from California was used as a positive control. All three samples from symptomatic leaves and the positive control were PCR positive, and the sample from the asymptomatic tree was PCR negative. Attempts to culture an isolate of the bacteria from petioles and branch tissues on PD3 and PW, media selective for X. fastidiosa, failed. For more detailed molecular characterization of the putative pathogen, DNA from additional symptomatic petioles from the same tree was isolated using the cetyltrimethylammoniumbromide (CTAB) extraction. X. fastidiosa specific primers BBXFOUTF1 (5'-AAGCGCCTCCGTGAGTTATC-3') and BBXFOUTR1 (5'-CCTTCACGCATATCATCACC-3') were used to PCR amplify the gyrB gene. The amplification product was recovered after gel electrophoresis with QIAquick gel extraction kit (Qiagen, Valencia, CA) and was subjected to automated sequencing (Oklahoma State University Recombinant DNA/Protein Resource Facility). BLASTN alignment (1) of the obtained 381 bp sequence revealed 100% identity with the gyrB gene from elm (GenBank Accession No. AF534966) and mulberry (GenBank Accession No. AF534965) isolates of X. fastidiosa. During 2005, petiole samples from the tree were collected and serological diagnosis was confirmed using enzyme-linked immunosorbent assay (Agdia, Inc., Elkhart, IN). Some strains of X. fastidiosa have very wide host ranges and many of the hosts may be asymptomatic. Therefore, the economic importance and implications of the detection of X. fastidiosa in the state of Oklahoma remain to be determined. To our knowledge, this is the first report of X. fastidiosa in Oklahoma. References: (1) S. F. Altschul et al. J. Mol. Biol. 215:403, 1990. (2) N. W. Schaad et al. Phytopathology 92:721, 2002.

Same systems, different outcomes--comparing the implementation of computerized physician order entry in two Dutch hospitals

OBJECTIVES

To compare the outcome of the implementation of computerized physician order entry (CPOE) systems in two Dutch hospitals.

METHODS

Qualitative research methods, including interviews in both hospitals, observations of system in use, observations of staff meetings and document analysis were used to understand the implementation of CPOE. The transcribed texts and implementation documents were analyzed for relevant concepts. The transcripts and field notes were analyzed using a heuristic success and failure model with medical work as the primary focus.

RESULTS

Occasions that determined the outcome of the implementation were classified according to factors that may influence the success or failure of implementing systems.

CONCLUSIONS

The themes and patterns that emerged from the data helped validate the concept of medical work as the primary focus of our analysis model; in addition the concept of a support base necessary to accept changes in medical work that result from introducing CPOE may help to understand the different implementation outcomes.

152 SURVIVAL OF BIOPSIED DAY 15 BOVINE CONCEPTI RE-TRANSFERRED TO SYNCHRONIZED RECIPIENT HEIFERS

In cattle, a significant proportion of in vitro-produced (IVP) blastocysts do not result in viable pregnancies after transfer to recipient surrogates. Betteridge et al. (1980 J. Reprod. Fert. 59, 205–216) showed that it was possible after superovulation to recover elongated bovine embryos up to Day 17, transfer them into synchronized recipient cows, and have them develop further. We investigated the feasibility of recovering cattle embryos at Day 15, taking a sample of the trophoblast and transferring the embryos into recipients afterward for further development. The biopsied material could be used later to evaluate gene expression and correlate the profile retrospectively with developmental potential. With this approach, a larger amount of material is available for study and only embryos surviving to the elongation stage would be examined. In our experience, 30–40% of transferred blastocysts do not develop to the elongation stage. In three separate experiments, IVP embryos were generated using abattoir derived oocytes and cultured in SOF-aa supplemented with BSA (Thompson et al. 2000 J. Reprod. Fert. 118, 47–55). Six graded Day 7 (Day 0 = day of IVF) blastocysts were transferred into synchronized recipient heifers (n = 10 for each experiment). At Day 15 of gestation, concepti were flushed from the uteri after slaughter with EmCare Flush (ICPbio, Ltd., Suckland, New Zealand) containing 25 mg/mL kanamycin sulfate and then put into EmCare Hold. Conceptus lengths were measured and a proportion of those >30 mm long were cut off (5–15 mm) at one end and the trophoblast kept for future analysis. Pairs of cut or uncut (control) concepti were loaded into 0.25-mL embryo transfer straws. Each pair was transferred nonsurgically into recipients synchronized at Days 15 (Expt. 1, n = 17) or 13 (Expts. 2 and 3, n = 16 and 17, respectively) of the estrous cycle. The time between embryo flush and transfer to a recipient was noted. At Day 30, embryo survival was assessed at slaughter and compared using the Fisher's exact and chi-square. Day 15 conceptus lengths varied between 1 and 140 mm. The time between flush and transfer varied between 13 and 126 min and did not affect the ability of the concepti to subsequently establish pregnancies. Transfer to an earlier uterine environment did not significantly improve embryo survival. The proportion of embryos recovered at Day 30 was not affected by the biopsy. Up to 10 mm can be removed from 40–10 mm concepti without effect on subsequent survival. However, the overall survival post-Day 15 transfer is still too low for practical application. Table 1.

Cellular composition and interferon-gamma expression of the local inflammatory response in feline infectious peritonitis (FIP)

Feline infectious peritonitis (FIP) is one of the most important viral diseases of cats. International studies estimate that approximately 80% of all purebred cats are infected with the causative agent, feline coronavirus (FCoV). Out of these, 5-12% develop clinical symptoms of FIP. The pathogenesis of the disease is complex with many unresolved issues relating to the role of the immune system. The aim of the present study was to determine the proportions of various inflammatory cell types in FIP lesions by using a panel of cat specific, thoroughly validated, monoclonal antibodies. In addition, the expression of interferon-gamma within the inflammatory lesions was examined by RT-PCR. Our results confirm the mixed nature of the inflammatory reaction in FIP, involving B cells and plasma cells as well as CD4+ and CD8+ T cells. However, one cell type stands out as being the key element in both the "wet" and "dry" forms of FIP: the macrophage. Upregulation of IFN-gamma expression within the inflammatory lesions suggests a local activation of macrophages, which might result in increased viral replication.

Women's experiences of childlessness 2 years after the end of in vitro fertilization treatment

Approximately 15% of all couples in the reproductive age are involuntarily childless. Many of these couples consult medical experts for diagnosis and treatment but not all of them achieve the results. This paper describes a study of women's experiences of childlessness 2 years after the end of in vitro fertilization (IVF) treatment, which represents the end of infertility treatment in Swedish society. Giorgi's method, based on Husserl's phenomenology with the lifeworld theory, was used. The participants were eight women treated at the Clinic of Reproductive Medicine, Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Göteborg, Sweden. Data were generated from transcriptions of taped interviews. Five constituents emerged from the analysis: (i) childlessness is a central issue in life, (ii) IVF is a positive and important part of life, (iii) contact with other people is not an important issue, (iv) the hope of achieving pregnancy still exists and (v) attempts to identify other central issues in life. The essence of all constituents is 'life-grief' and expresses the grief of being childless, of not reproducing, and being unable to confirm one's relationship through parenthood. The result is important in professional caring and presents a challenge to all midwives, nurses, physicians and other staff who are involved in the care of involuntarily childless women.

Experimental reproduction of postweaning multisystemic wasting syndrome (PMWS) in pigs in Sweden and Denmark with a Swedish isolate of porcine circovirus type 2

An experimental model using 3-day-old snatch-farrowed colostrum-deprived piglets co-infected with porcine circovirus type 2 (PCV2) and porcine parvovirus (PPV) is at present one of the best methods to study factors affecting development of postweaning multisystemic wasting syndrome (PMWS). A Swedish isolate of PCV2 (S-PCV2) retrieved in 1993 from a healthy pig has been used in this model to reproduce PMWS in pigs from Northern Ireland. This virus has been present in the Swedish pig population for at least a decade without causing any known PMWS disease problems, despite its potential pathogenicity. The reasons for this are unknown, but could be related to genetics, absence of triggers for PCV2 upregulation (infectious agent and/or management forms) within Swedish pig husbandry. In order to confirm the pathogenicity of S-PCV2, Swedish and Danish pigs were experimentally infected with this isolate according to the established model. Swedish pigs were also infected with a reference isolate of PCV2 (PCV2-1010) to compare the severity of disease caused by the two isolates in Swedish pigs. Both Danish and Swedish pigs developed PMWS after the experimental infection with S-PCV2. Antibodies to PCV2 developed later and reached lower levels in serum from pigs infected with S-PCV2 than in pigs inoculated with PCV2-1010. In general, pigs infected with S-PCV2 showed more severe clinical signs of disease than pigs infected with PCV2-1010, but pigs from all PCV2-inoculated groups displayed gross and histological lesions consistent with PMWS. All pigs inoculated with PPV, alone or in combination with PCV2, displayed interleukin-10 responses in serum while only pigs infected with PPV in combination with PCV2 showed interferon-alpha in serum on repeated occasions. Thus, the pathogenicity of S-PCV2 was confirmed and a role for cytokines in the etiology of PMWS was indicated.

Recurrences after immediate reconstruction in breast cancer

AIM

To determine the incidence of and reasons for recurrences after immediate breast reconstruction in breast cancer patients.

MATERIAL AND METHODS

The data of 79 patients undergoing immediate breast reconstruction between 1998 and 2001 in Kuopio University Hospital were re-examined from both the local cancer register and the patient charts at the end of year 2003.

RESULTS

There were five local recurrences (6.3%), one regional recurrence (1.2%), and three cases (3.8%) presented bone and/or visceral metastases. All recurrences except one (primary tumor noninvasive) appeared within the first two years after primary therapy. Young age and increasing size of the tumour were risk factors for distant or logoregional metastases.

CONCLUSION

Immediate breast reconstruction is a safe procedure in breast cancer patients, but a multidisciplinary team is needed for careful patient selection.

The surgical and oncological safety of immediate breast reconstruction

AIM

The aim of our study was to (1) examine the incidence of surgical complications, (2) determine the incidence of loco-regional recurrences and (3) examine the safety of saving the nipple-areola-complex after immediate breast reconstructions in breast cancer.

METHODS

Sixty-six immediate breast reconstructions were performed. Wide local excision (WLE), skin sparing mastectomy and subcutaneous mastectomy (SCM) were performed to 12, 20 and 34 patients, respectively. In all patients with WLE the reconstruction was performed with the latissimus dorsi (LD) miniflap. In other patients reconstructions were done with a free TRAM-flap (n=26) LD-flap (n=27) or with a prosthesis only (n=1).

RESULTS

Major flap necrosis developed in four patients. Local recurrence rate was 8.3% in the group where nipple-areola-complex was removed and 7.1% in the group where nipple-areola-complex was saved. Metastases were found in 12.5 and 0%, respectively.

CONCLUSION

SCM compared to skin sparing mastectomy may lead to an enhanced risk of immediate surgical complications, but does not threat the oncological safety. Saving the nipple-areola-complex in immediate breast reconstructions is possible in early breast cancer, if the tumour is not in the central part of the breast.

A midwifery model of care for childbearing women at high risk: genuine caring in caring for the genuine

According to this paper's synthesis of research, three constituents of ideal midwifery care emerge. First, a dignity-protective action takes place in a midwife's caring relationship with a childbearing woman at high risk and includes mutuality, trust, ongoing dialogue, enduring presence, and shared responsibility. Secondly, the midwife's embodied knowledge is based on genuineness to oneself and consists of theoretical, practical, intuitive, and reflective knowledge. Finally, nurse-midwives have a special responsibility to balance the natural and medical perspectives in the care of childbearing women at high risk, especially by promoting the woman's inborn capacity to be a mother and to give birth in a natural manner. This midwifery model of care is labeled "Genuine Caring in Caring for the Genuine." Here, the word genuine expresses the nature of midwifery care, as well as the nature of each pregnant woman being cared for as a unique individual.

Pregnancy and diabetes: how women handle the challenges

In order to optimize the possibilities for the birth of a healthy child, pregnant women with type 1 diabetes mellitus (type 1 DM) work hard to achieve normoglycemia. In the research presented here, pregnant, diabetic women's experiences of dealing with life circumstances are summarized as a construct of duality: "to master or to be enslaved." The overall experience of challenges and managing is understood to depend on the individual woman's identity, attitude, and resources including health professionals and social environment. Health professionals in antenatal care have a special responsibility to give care that not only optimizes the biological possibility for a healthy child to be born but also supports the woman with type 1 DM to master the situation and, thus, promote her health, well-being, and motherhood.

54 COMPOSITION OF ALLANTOIC FLUID IN CATTLE PREGNANT WITH AI-, IVP-, OR NUCLEAR TRANSFER-GENERATED EMBRYOS

Abnormal placentation, pregnancy failure, and hydroallantois are associated with somatic cell nuclear transfer (SCNT) in cattle. Identification of diagnostic markers for abnormal placentation in early gestation would permit therapeutic intervention. Ultrasonography and transvaginal sampling of amniotic and/or allantoic (fetal) fluid enables regular monitoring of fetal health. We report on the composition of serial samples of fetal fluid from individual cows between Days 70–130 of gestation and the potential of steroid and electrolyte composition as an early diagnostic marker for the subsequent occurrence of hydroallantois in SCNT pregnancies in cattle. On Day 70, pregnancy rates were 50% and 60% for cows or heifers implanted with single in vitro-fertilized (IVP, 20/40) or SCNT (25/42) embryos, respectively, and 67% for pregnancies generated by artificial insemination (AI, 12/18). Resulting fetuses were either clones (SCNT) or offspring (IVP/AI) of a donor Holstein bull. Fetal fluids, sampled using ultrasound-guided transvaginal puncture, were collected on Days 70, 100, and 130 of gestation (n = 12 and 139 for amniotic and allantoic samples, respectively). Placental and fetal morphological data were collected following slaughter between Days 135–163 of gestation (n = 14, 20, and 10 for SCNT, IVP, and AI groups, respectively). Fetal fluids were analyzed for progesterone, estrone sulphate, sodium, chloride, potassium, creatinine, urea, calcium, magnesium and phosphate. Pregnancy outcomes for the SCNT group were retrospectively classified as: Fail 100 (pregnancies failing between Days 70–99; n = 6); Fail 130 (failing between Days 100–129; n = 5); Hydrops (greater than 10 L combined amniotic and allantoic fluid at postmortem between Days 135–163; n = 8) and SCNT Pregnant 150 (pregnant between Days 135–163; n = 6). IVP and AI pregnancies were classified as IVP or AI Pregnant 150. Fluid composition was analyzed by ANOVA on log-transformed data. On Day 70, allantoic progesterone and estrone sulphate concentrations were significantly higher (P < 0.05) for the SCNT cows compared to the IVP/AI Pregnant 150 cows. On Day 70, allantoic potassium, chloride, creatinine, and urea concentrations were significantly higher (P < 0.05) for the SCNT Hydrops cows compared to the IVP/AI Pregnant 150 cows. In addition, Day 70 allantoic creatinine and urea concentrations were significantly higher (P < 0.05) for the SCNT Hydrops cows compared to other SCNT groups. By Day 100, allantoic chloride, creatinine, and urea concentrations in SCNT Hydrops cows were significantly lower (P < 0.05) than in IVP/AI Pregnant 150 groups. We conclude that elevated Day 70 allantoic urea and creatinine concentrations are potential early diagnostic markers predicting hydroallantois in recipient cattle carrying SCNT fetuses. Further investigation of these markers in other somatic donor cell lines used for nuclear transfer is warranted to determine their general utility.