Prevalence of developmental dysplasia of the hip in preterm infants with maternal risk factors

PURPOSE

The aim of this study was to determine the prevalence of developmental dysplasia of the hip (DDH) in preterm infants with maternal risk factors.

METHODS

A prospective review of the medical records and ultrasound (US) scans of all preterm infants at one tertiary-care children's hospital was completed to identify all premature infants without any infantile risk factors at a particular time frame. We consecutively evaluated 421 babies (842 hips) who satisfied the criteria for inclusion. Hip US images were classified according to Graf.

RESULTS

Overall, one hip was diagnosed as DDH (Graf type 2c). Female infants had significantly lower alpha angles (70.2 ± 6.6 and 71.4 ± 4.4 for females and males, respectively) (P = 0.033). There was no correlation between oligohydramnios and alpha and beta angles and hip sides (P = 0.345 and P = 0.789 for left and right hips, respectively). US examination of the infants revealed no differences between the alpha and beta angles of the hips and birth weight and age at gestation. Although it was statistically not significant, US evaluation of left hips among singletons demonstrated one immature hip (P = 0.864) and that of right hips demonstrated one immature hip for both singletons and twins (P = 0.904).

CONCLUSIONS

Prematurity with or without maternal risk factors does not have an effect on DDH.

Timing and variability of postpartum sleep in relation to daytime performance

Postpartum women have highly disturbed sleep, also known as sleep fragmentation. Fragmentation extends their total sleep period, also disrupting sleep timing. A stable and earlier sleep period among non-postpartum populations is related to better performance, physical health, and mental health. However, sleep timing has not been examined among postpartum women who are also vulnerable to daytime impairment. The study objective was to examine how the timing and regularity of sleep during the early postpartum period are related to daytime functioning across postpartum weeks 2-13. In this field-based study, 71 primiparous women wore an actigraph, a small wrist-worn device that monitors sleep and sleep timing, for the 12-week study period. Mothers self-administered a 5-min psychomotor vigilance test (PVT) each morning to evaluate the number of >500ms response lapses. They also completed a Morningness-Eveningness scale at the beginning of the study to identify chronotype. After controlling for maternal age, earlier sleep timing was associated with significantly fewer PVT lapses at postpartum weeks 9,12; a more stable sleep midpoint was associated with significantly fewer PVT lapses at postpartum weeks 2,5-13. Earlier sleep midpoints were related to more stable sleep midpoints at postpartum week 2 and a morning-type chronotype. An earlier sleep midpoint was also associated with a reduced slope of worsening PVT lapses across weeks. Across the first 12 postpartum weeks, women with earlier or more stable sleep periods had less daytime impairment than women with later or more variable sleep midpoints. Postpartum women with earlier sleep midpoints also showed less severe decrements in performance across time, which has been attributed to cumulative impacts of sleep disturbance. These data suggest that the sleep period, in addition to sleep duration and fragmentation, should be more closely examined, particularly among vulnerable women, as it may affect the neurobehavioral performance of new mothers.

A maternal vaccine against group B Streptococcus: past, present, and future

Group B Streptococcus (GBS) is a major cause of morbidity and mortality among neonates. Though there have been tremendous advances in prevention of invasive neonatal GBS disease through prophylactic antibiotic treatment of pregnant women, the incidence of neonatal disease has not changed significantly over the past several years. Vaccination of pregnant women is an important strategy that has the potential to improve further on existing protocols. In this review, we explore the history of the design of maternal GBS vaccines. We also discuss how recent applications of genomics and immunology to vaccine design promise to further enhance our ability to develop more effective vaccines against this important disease.

Maternal, perinatal and long-term outcomes after assisted reproductive techniques (ART): implications for clinical practice

The use of assisted reproductive techniques (ART) is on the rise throughout the world and the number of babies born as a result of ART has reached an estimated total of 5 million since the world's first, Louise Brown, was born in 1978. Data from many prospective and retrospective studies have suggested increased risks of adverse maternal, perinatal and long-term outcomes after ART compared to natural conception. Recent research suggests that underlying maternal factors rather than ART methods themselves play a significant role in causing such outcomes. Couples attempting ART need to be provided with accurate and reliable information on risks of adverse reproductive outcomes and reassured that absolute risks appear small. Clinicians need to remain vigilant about increased risk of pregnancy complications and formulate a plan of care for the woman, from periconception to the puerperium, which aims to prevent or minimise maternal and perinatal morbidity. This review attempts to summarise the available data on reproductive outcomes after ART and provide guidance to the obstetricians and primary care physicians about management of ART pregnancies.

Identification of the zebrafish maternal and paternal transcriptomes

Transcription is an essential component of basic cellular and developmental processes. However, early embryonic development occurs in the absence of transcription and instead relies upon maternal mRNAs and proteins deposited in the egg during oocyte maturation. Although the early zebrafish embryo is competent to transcribe exogenous DNA, factors present in the embryo maintain genomic DNA in a state that is incompatible with transcription. The cell cycles of the early embryo titrate out these factors, leading to zygotic transcription initiation, presumably in response to a change in genomic DNA chromatin structure to a state that supports transcription. To understand the molecular mechanisms controlling this maternal to zygotic transition, it is important to distinguish between the maternal and zygotic transcriptomes during this period. Here we use exome sequencing and RNA-seq to achieve such discrimination and in doing so have identified the first zygotic genes to be expressed in the embryo. Our work revealed different profiles of maternal mRNA post-transcriptional regulation prior to zygotic transcription initiation. Finally, we demonstrate that maternal mRNAs are required for different modes of zygotic transcription initiation, which is not simply dependent on the titration of factors that maintain genomic DNA in a transcriptionally incompetent state.

The effect of maternal thyroid disorders (hypothyroidism and hyperthyroidism) during pregnancy and lactation on skin development in wistar rat newborns

OBJECTIVE(S)

Previous studies have shown that thyroid hormones are necessary for normal development of many organs and because of the importance of skin as the largest and the most important organ in human body protection in spite of external environment, the study of thyroid hormones effects on skin development is considerable. In this survey we have tried to study the effects of maternal hypothyroidism on skin development in fetus during pregnancy and lactation by immunohistochemistry technique.

MATERIALS AND METHODS

Rats were divided into 4 groups, hypothyroids, hyperthyroids, hypothyroids are treated with levothyroxin and a control group. The rat mothers were exposed to PTU with 50 mg/lit dosage and levothyroxin with 1 mg/lit dosage and PTU and levothyroxin simultaneously and with the same dosage respectively in hypothyroid, hyperthyroid and treated hypothyroids with levothyroxin groups. After 14 days, blood sample was taken from mothers, and if thyroid hormones level had change well, mating was allowed. After pregnancy and delivery, 1th day dorsal skin (as the sample for pregnancy assay) and 10th day skin (as for lactation assay) was used for immunohystochemical and morphometric studies.

RESULTS

In this study it was observed that maternal hypothyroidism during pregnancy and lactation causes significant increase in laminin expression, in most areas of skin, and maternal hyperthyroidism during pregnancy and lactation causes significant decrease in laminin expression. Also significant decrease was observed in hair follicles number and epidermis thickness in hypothyroidism groups.

CONCLUSION

This study showed maternal hypothyroidism causes significant decrease in epidermis thickness and hair follicles number and it causes less hair in fetus. Also maternal hypothyroidism causes large changes in laminin expression in different parts of skin. At the same time,maternal hyperthyroidism causes opposite results. In fact, thyroid hormones regulate laminin expression negatively which means increase in thyroid hormone level, decreases laminin expression. So changes in thyroid hormones level can influence skin development significantly.

Birth outcome in patients presenting for hospital delivery in the second stage of labour

BACKGROUND

Even though women in labour are expected to be managed in the hospital under the care of an Obstetrician, a subset of women, who actually plan to have hospital delivery spent greater part of their labour at home without any medical assistance and only present to the labour room at full cervical dilatation.

AIM AND OBJECTIVES

To compare the maternal and neonatal outcome in patients that present in the second stage of labour and those that present in the active phase of labour before full cervical dilatation.

PATIENTS AND METHODS

This was a prospective case - control study comparing the maternal and neonatal outcomes of women who planned hospital delivery but presented to the labour ward of the University of Maiduguri Teaching Hospital at full cervical dilatation, following an unsupervised first stage at home. For each case, the next two patients that presented for delivery in the active phase of labour were used as controls. The study was conducted between 1st January 2013 to 31st December 2013 and only booked and low risk pregnancies were recruited. Independent sample t-test was used to compare continuous variables. For categorical data, Pearson's chi-square or Fisher's exact test was utilized for comparisons. A P value less than 0.05 was considered significant

RESULTS

The incidence of home labour was 11.54% (335/2902). The mean age, gestational age at delivery and birth weights were comparable in the 2 groups with p values of 0.724, 0.787 and 0.618 respectively. However, the parity and the estimated blood loss were significantly higher in the Home labour group compared to the Hospital labour group. Interventions such as augmentation of labour, episiotomy and caesarean delivery were higher among those that laboured in the hospital compared to those that laboured at home. However, post partum haemorrhage occurred in 6.3% of the Home labour group compared to 0.94% of the Hospital labour group and the differences were statistically significant. The neonatal outcomes were similar in the two groups.

CONCLUSION

Our finding showed that women that present for hospital delivery in the second stage of labour have increased risk of post partum haemorrhage but the risk of labour augmentation, episiotomy and caesarean delivery is lowered. We advocate that women should be encouraged to present to the labour ward early in labour to avoid hasty delivery and risk post partum haemorrhage.

Perinatal Outcome in Pregnancies with Extreme Preterm Premature Rupture of Membranes (Mid-Trimester PROM)

OBJECTIVES

Preterm premature rupture of membranes (PPROM) is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM.

METHODS

A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study.

RESULTS

Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 (55%) survived, 7 (16%) died within 24 hours of birth, 9 (20%) were miscarried, and 4 (9%) were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 (46%), respiratory distress syndrome in 19 (79%), sepsis in 12 (50%), and low birth weight in 11 (46%). The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes.

CONCLUSION

Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counselling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals.

Maternal perceptions of antenatal care provision at a tertiary level hospital, riyadh

OBJECTIVE

Report maternal perceptions of antenatal care provision and identify deficiencies in the current model of care provision.

METHODS

A survey was conducted to record maternal views about quality of antenatal consultations provided at a tertiary level hospital. Trained nurses and female health workers interviewed the patients attending antenatal visits during the month of July 2009. A standard questionnaire was use to enter the responses. Data were entered into the statistical package for social sciences (SPSS) for appropriate statistical analysis of the results. Data analysis generated two groups. One group had up to 4 antenatal visits and the other group had more than 4 visits.

RESULTS

Responses were obtained for 244 patients. Chi-square test was applied for the comparison of variables between the two groups. Significantly higher number of women preferred to follow the 4 visit care plan (n=118/244 vs. n=103/244, respectively; p=0.004). Patient satisfaction was also significantly higher among women in the 4 visit group (n=112/244 vs. n=90/244; p=0.04). More than 50% of patients said that they did not receive any information about the process of labor, breast-feeding or contraception.

CONCLUSION

Women included in the study did not want frequent visits to antenatal clinic. Efforts should be made to provide information about labor, breast-feeding and contraception.

Characteristics of hypertensive disorders in twin versus singleton pregnancies

OBJECTIVE

To determine the characteristics of hypertensive disorders of pregnancy in twin compared with singleton pregnancies.

STUDY DESIGN

Analysis of a prospectively recorded database of 4976 hypertensive pregnancies.

MAIN OUTCOME MEASURES

Comparison of progression to pre-eclampsia and maternal and neonatal outcomes.

RESULTS

There were 3942 singleton and 214 twin pregnancies. De novo hypertension in twin pregnancy was diagnosed earlier (p<0.001). In singleton pregnancies with de novo hypertension (n=3161), 60% had an initial diagnosis of gestational hypertension (GH) and 40% had pre-eclampsia (PE). In twin pregnancies with de novo hypertension (n=199), 35% of women were initially diagnosed with GH and 65% with PE (p<0.001). At delivery, 46% of the singletons had GH and 54% had PE, compared with twin pregnancies where 23% had GH and 77 % had PE (p<0.001). The progression from GH to PE for twins was twice that of singleton pregnancies (p<0.001). There were 781 singleton and 15 twin pregnancies with chronic hypertension (CH). Twin pregnancies complicated by CH were more likely to progress to PE than singletons (p<0.01). The gestation at delivery was earlier for twin pregnancies (p<0.001) and there were more twins that were smaller for gestational age (p<0.001). There were no differences in maternal outcomes.

CONCLUSION

Women carrying twins with de novo hypertension are more likely to present earlier, have initial PE and to subsequently progress from GH to PE. Neonatal outcomes are worse in such pregnancies.

The Architecture of a Software System for Supporting Community-based Primary Health Care with Mobile Technology: The Mobile Technology for Community Health (MoTeCH) Initiative in Ghana

THIS PAPER DESCRIBES THE SOFTWARE ARCHITECTURE OF A SYSTEM DESIGNED IN RESPONSE TO THE HEALTH DEVELOPMENT POTENTIAL OF TWO CONCOMITANT TRENDS IN POOR COUNTRIES: i) The rapid expansion of community health worker deployment, now estimated to involve over a million workers in Africa and Asia, and ii) the global proliferation of mobile technology coverage and use. Known as the Mobile Technology for Community Health (MoTeCH) Initiative, our system adapts and integrates existing software applications for mobile data collection, electronic medical records, and interactive voice response to bridge health information gaps in rural Africa. MoTeCH calculates the upcoming schedule of care for each client and, when care is due, notifies the client and community health workers responsible for that client. MoTeCH also automates the aggregation of health status and health service delivery information for routine reports. The paper concludes with a summary of lessons learned and future system development needs.

Echocardiographic assessment of cardiovascular hemodynamics in preeclampsia

OBJECTIVE

To assess maternal cardiovascular function using echocardiography in normal and preeclamptic women in the third trimester of pregnancy.

METHODS

40 subjects, 20 with preeclampsia and 20 normotensive controls with >34 weeks gestation and singleton pregnancy were recruited. Baseline characteristics, maternal and fetal outcome were studied with systolic and diastolic parameters on echocardiography.

RESULTS

The following parameters were higher in preeclamptic subjects as compared to normotensive controls-mean cardiac output (66.85 ± 4.56 ml/min vs. 56.1 ± 1.77 ml/min); mean LV diastolic mass (131.15 ± 16.85 vs. 104.90 ± 23.17 g); systolic mass (88.5 ± 7.34 vs. 83.33 ± 23.84 g); total vascular resistance (1396.85 ± 150.2 vs. 1204.5 ± 71.182 dyne, s cm(5)). Women with preeclampsia delivered smaller babies (2410 ± 426.16 g) as compared to normotensive controls (2895 ± 276.20 g). Student 't' test was used as a test of significance.

CONCLUSION

Women with preeclampsia have significant systolic and diastolic dysfunction compared to normotensive controls. Blood pressure monitoring alone is insufficient to identify effectively, risk of cardiovascular complications in these subjects.

Maternal perspectives of prenatal sonogram in a north-eastern population in Nigeria

Limited information exists on maternal perspectives of prenatal sonogram in north-eastern Nigeria. This study was aimed at documenting the views and expectations of pregnant women concerning prenatal sonogram as well as their level of awareness of its purpose, limitations and safety in a predominantly Moslem society. A survey was carried out on a convenience sample of 150 patients referred from ante-natal clinics for prenatal sonogram, by administering semi-structured questionnaires. The results show that 61.3% of the women had prenatal sonogram, with little or no information about the purpose, capabilities and limitations of the procedure. 24.7% had neither formal western nor Islamic educational background that may have influenced their perceptions. Most of the women (81.3%) were sponsored by either government or their husbands, 72.7% perceived sonogram to be affordable and 63.4% viewed sonographic results as reliable. The perceived main reasons for having a prenatal sonogram were to determine the expected date of delivery and foetal well-being, and to obtain reassurance of maternal health. Sex determination and number of foetuses were the least considered reasons. The study indicates that providing pregnant women with adequate information and sensitising them to the purpose and limitations of sonograms is necessary to guarantee its rational utilisation. Improving patient care, enhancing the skill of sonographers and providing more facilities would improve the services and patients' perspectives of prenatal sonography.