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July 15, 2008, 10:40 PM CT

Caesarean section: no consensus on best technique

Caesarean section: no consensus on best technique
Despite the routine delivery of babies by caesarean section, there is no consensus among medical practitioners on which is the best operating method to use. In a systematic review published in The Cochrane Library, scientists call for further studies to establish the safest method for both mother and infant.

"Caesarean section is a very common operation, yet there is a lack of high quality information available to inform best practice," says researcher Simon Gates of the Clinical Trials Unit at the University of Warwick.

Techniques used during caesarean section operations depend largely on the preferences of individual surgeons. Their personal preference can affect the length of the operation, amount of blood lost, risk of infection and the level of pain experienced by a woman following surgery.

The review includes 15 trials that together involved 3,972 women. Eventhough results from several of these trials suggest that single layer closure of the uterus after delivery reduces blood loss and operation times in comparison to double layer closure, there was no information on other important outcomes such as infection and subsequent complications. The scientists found only very limited data on incision techniques and instruments, as well as methods used to close the uterus. They were therefore unable to make recommendations as to the most appropriate surgical procedure.........

Posted by: Emily      Read more         Source


July 9, 2008, 7:30 PM CT

Predicting birthweights in obese mothers

Predicting birthweights in obese mothers
Scientists have found what they believe to be the most accurate way of predicting the birth-weight of babies born to the growing number of obese mothers, as per a research studyin the UK-based journal Ultrasound in Obstetrics and Gynecology

Experts from the University of Rochester Strong Memorial Hospital in Rochester, New York, USA, have recorded accurate results in more than nine out of ten cases using the gestation-adjusted projection method (GAP).

The GAP method uses a range of ultrasound measurements, taken when the mother is 34 to 36 weeks pregnant, and a mathematical formula to determine whether the baby is larger than the average size of babies for its gestational age. This data is then used to predict the final birth weight.

GAP is very useful when a pregnant woman is obese, as this often makes it difficult for medical staff to obtain a clear ultrasound image of her baby. This is especially true at the end stages of pregnancies, when most birth weight measurements are obtained, so doing this earlier in the pregnancy is a distinct advantage. Prior research carried out at the University of Rochester has already shown GAP to be accurate when used on diabetic and non-diabetic patients.

"Obesity is a risk factor for almost all complications correlation to pregnancy" explains Dr Loralei Thornburg from the Division of Maternal Fetal Medicine at the University. "It is especially important to identify high birth-weight babies over 4,000 grams (just under nine pounds) as these are linked to higher complication rates for mothers and babies.........

Posted by: Emily      Read more         Source


July 7, 2008, 9:34 PM CT

Pregnancy and risk of heart attack

Pregnancy and risk of heart attack
Eventhough acute myocardial infarction (AMI) is rare in women of child-bearing age, pregnancy can increase a woman's risk of heart attack 3- to 4-fold, as per a research studyreported in the July 15, 2008, issue of the Journal of the American College of Cardiology Since women today may delay having children until during the later part of life, and advances in reproductive medicine enable older women to conceive, the occurrence of AMI linked to pregnancy is expected to increase.

The study, authored by Arie Roth, M.D., Tel Aviv University in Israel, and Uri Elkayam, M.D., University of Southern California (USC), is a follow up to their initial report released in 1995. The report is based on a review of 103 women with pregnancy-related AMI in the last decade and outlines key recommendations for the diagnosis and therapy of this condition in pregnant women that also considers the health and safety of the developing baby.

"It's extremely important that physicians who take care of women during pregnancy and after delivery be aware of the occasional occurrence of AMI in pregnancy and not overlook symptoms in these young patients," said Dr. Elkayam, who is a professor of Medicine and Obstetrics and Gynecology at USC. "Eventhough a number of of the standard principles for diagnosing and treating AMI in non-pregnant patients also apply to pregnant women, two patients need to be treatedthe mother and her babyand the health status of both should play a major role in the selection of diagnostic and therapeutic strategies".........

Posted by: Emily      Read more         Source


July 3, 2008, 8:55 PM CT

Disclosing violence to primary care or obestetrics

Disclosing violence to primary care or obestetrics
Scientists from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) observed that patients who disclose intimate partner violence (IPV) to their clinicians of any type did not experience serious harm. However, those who disclosed IPV in a primary care or obstetrics/gynecology setting received the most benefit. The findings, which appear in the Biomedical Central Public Health Journal, also conclude that disclosures made in an emergency department setting were more problematic from the patient's point of view.

Scientists studied 27 IPV survivors recruited through community support programs in Massachusetts. The participants were given in-depth interviews to ascertain types of medical encounters relating to abuse, with encounters described as either single interactions or continued contact over a period of time.

Participants described disclosure of IPV to medical personnel. They also reported episodes in which they were asked about or treated for an IPV related problem in which they did not disclose. The scientists determined the medical specialty in which the encounters occurred, and limited their focus to emergency department, obstetrical/gynecological care, and primary care. The scientists also labeled whether harms occurred as a result of any disclosure as well as the perceived helpfulness (beneficial or not).........

Posted by: JoAnn      Read more         Source


July 1, 2008, 9:29 PM CT

Find ways to predict IVF success

Find ways to predict IVF success
Scientists at the Stanford University School of Medicine have identified a method that can predict with 70 percent accuracy whether a woman undergoing in vitro fertilization therapy will become pregnant. This information may someday help the tens of thousands of couples who want to undergo IVF each year, and their doctors, decide on their course of action.

The new method involves using four factors to determine a woman's chance of becoming pregnant from an IVF cycle. These variables may prove "critical in counseling patients, improving therapy, and ultimately in developing. more customized therapys," the authors wrote in a paper that will appear in the July 2 issue of Public Library of Science-ONE

The research was led by Mylene Yao, MD, assistant professor of obstetrics and gynecology, whose work focuses on early embryo development.

IVF is a therapy given to boost the chances for women to get pregnant. During IVF, a woman is given drugs to stimulate ovulation, and her eggs are removed from the ovaries. The eggs are then combined with sperm in a culture dish in a laboratory.

A typical IVF cycle produces five to 12 embryos, and doctors aim to transfer the "best quality" one or two into a woman's uterus. Doctors use a variety of criteria to identify which embryos are most likely to result in a live birth, including how the embryo looks and whether the embryo has hit certain milestones, such as having reached the eight-cell stage by its third day of existence.........

Posted by: Emily      Read more         Source


June 18, 2008, 9:08 PM CT

Caesarean sections associated with risk of asthma

Caesarean sections associated with risk of asthma
Babies born by Caesarean section have a 50 % increased risk of developing asthma in comparison to babies born naturally. Emergency Caesarean sections increase the risk even further. This is shown in a new study based on data from 1.7 million births registered at the Medical Birth Registry at the Norwegian Institute of Public Health.

The goal of the study was to investigate the possible link between being born by Caesarean section and later development of asthma.

Summarised results from the study:.
  • In comparison to children born in the natural way (i.e. spontaneously and vaginally), children born by Caesarean section had an approximately 50 % increased risk of developing asthma.
  • Children born vaginally, but with assistance from vacuum or forceps, had a 20 % increased risk of asthma.
  • For children born between 1988 and 1998, planned Caesarean section was linked to an approximately 40 % increased risk of asthma while emergency Caesarean section was linked to a 60 % increased risk.
.

Why do Caesarean sections give an increased risk of asthma?

- We found a moderately strong association between birth by Caesarean section and asthma in childhood, says doctor and research fellow Mette Christophersen TollÄnes, who works for both the Norwegian Institute of Public Health and the Department of Public Health and Primary Health Care at the University of Bergen, Norway.........

Posted by: Emily      Read more         Source


June 16, 2008, 10:09 PM CT

Abortion drug's off-label use may have led to deaths

Abortion drug's off-label use may have led to deaths
University of Michigan researcher David Aronoff, M.D., uses an oxygen-free "glove box" to study Clostridium sordellii bacteria. These bacteria normally don't cause serious infection, but overwhelmed the immune systems of several women taking the drug misoprostol.

Credit: Scott Galvin-U-M Photo Services

Preliminary U-M studies indicate that oral use of RU-486's companion drug misoprostol is safe, but vaginal use may undermine body's immune responses.

The off-label use of a drug given with RU-486 to terminate a pregnancy may be responsible for a handful of rare, fatal infections seen in women taking the drugs since 2000, a study by University of Michigan researchers suggests.

The drug misoprostol is FDA-approved to be taken by mouth along with RU-486 to end a pregnancy. But a number of women have received the drug vaginally as part of the two-drug combination, a method of delivery not reviewed by the FDA.

In animal and cell culture studies, the U-M scientists observed that misoprostol, when given directly in the reproductive tract, suppresses key immune responses and can allow a normally non-threatening bacterium, Clostridium sordellii, to gain the upper hand and cause deadly infection. When absorbed through the stomach, however, the drug did not compromise immune defenses or cause illness.

The study, which appears today online ahead of print in the Journal of Immunology, also has implications for understanding dangerous infections that occur during pregnancy.

"Infections after medicine abortions are rare, and Clostridium infections after abortion are exceedingly rare," says David Aronoff, M.D., an infectious disease specialist who led the U-M study.........

Posted by: Emily      Read more         Source


June 16, 2008, 9:19 PM CT

Complex Changes in the Brain's Vascular System Occur after Menopause

Complex Changes in the Brain's Vascular System Occur after Menopause
A number of women experience menopausal changes in their body including hot flashes, moodiness and fatigue, but the changes they don't notice can be more dangerous. In a new study, scientists at the University of Missouri have discovered significant changes in the brain's vascular system when the ovaries stop producing estrogen. MU researchers predict that currently used estrogen-based hormone therapies may complicate this process and may do more harm than good in postmenopausal women.

"Before menopause, women are much more protected from certain conditions such as heart disease and stroke, but these vascular changes might explain why women lose this protection after menopause," said Olga Glinskii, research assistant professor of medical pharmacology and physiology in MU's School of Medicine and lead author of the study. "Because the body eventually will naturally adapt to the loss of estrogen, we advise extreme caution when using estrogen-based treatment in postmenopausal women".

In their study, MU scientists removed the ovaries of pigs, which have a reproductive cycle similar to humans, to create postmenopausal conditions. Two months after the ovaries were removed, they observed dramatic differences in the brain's vascular system. There was a huge loss of micro vessels, and blood vessels became "leaky".........

Posted by: JoAnn      Read more         Source


June 16, 2008, 9:16 PM CT

Hot flashes underreported and linked to forgetfulness

Hot flashes underreported and linked to forgetfulness
Women in midlife underreport the number of hot flashes that they experience by more than 40 percent, and these hot flashes are associated with poor verbal memory, as per a research studyby scientists at the University of Illinois at Chicago.

The study is published online and will appear in the September/recent issue of the journal Menopause

It is the first study to explore the relationship between objectively measured hot flashes and memory performance.

Memory complaints are common at midlife, and prior research indicates that about 40 percent of midlife women report forgetfulness.

Many studies have looked at the relationship between menopausal symptoms (vasomotor symptoms, hot flashes and sleep disturbances that accompany hot flashes) and memory complaints and found no relationship between subjective, or self-reported, hot flashes and objective performance on memory tests in women.

These findings have left a number of to assume that there is no relationship between menopausal symptoms and memory dysfunction in women, said Maki.

"The problem is that the physiology of hot flashes and the science of hot flashes is more complex than we previously understood," she said.

The scientists enrolled 29 midlife women with moderate to severe hot flashes in an observational study. The women wore monitors that measured changes in skin conductance during a hot flash. Both subjective and objective hot flashes were recorded during a 24-hour period. The average number of objective hot flashes was 19.5 per day.........

Posted by: Janet      Read more         Source


June 9, 2008, 8:27 PM CT

Mother's obesity and newborn deaths

Mother's obesity and newborn deaths
Hamisu Salihu, MD, PhD
maternal obesity appears to have no impact on the early survival of infants born to white women, the situation is different for black women, scientists report in the June 2008 issue of the journal Obstetrics & Gynecology.

Infants of obese black mothers had a higher risk of death in the first 27 days following birth than newborns of obese white mothers, the scientists found. Furthermore, this black disadvantage in neonatal infant mortality widened with an increase in the body mass index (BMI).

"Even if the infant of an obese black woman survives pregnancy, labor and delivery, that baby is at greater risk of dying than a baby born to an obese white woman," said the study's lead author Hamisu Salihu, MD, PhD, associate professor of epidemiology at the USF College of Public Health.

The scientists analyzed more than 1.4 million births recorded from Missouri's vital records database, covering the period 1978 through 1997. The database linked black and white mother-infant pairs. Among all women, the likelihood of neonatal death (up to 27 days following death) and early neonatal death (up to six days following death) was 20 percent greater than for nonobese women, the researcher found.

Further analysis revealed that the higher risk of neonatal deaths among newborns of obese mothers was confined to blacks only. The rate of neonatal deaths increased significantly with rising BMIs of black women (ranging from 50 to 100-percent increments). However, the offspring of obese white mothers, regardless of the severity of maternal obesity, had no greater risk of neonatal death than the newborns of nonobese women.........

Posted by: Emily      Read more         Source



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Did you know?
The addition of testosterone to hormone therapy in women after menopause enhances their sexual function. However, it may also reduce HDL cholesterol (the "good" cholesterol) in women, according to a systematic review of current evidence."If the reduction in HDL had been associated with an increase in triglycerides [fatty acids] or LDL cholesterol it would be of great concern," said Dr. Susan Davis, professor of medicine at Monash University, Melbourne, Australia, and study co-author "However, as an isolated finding the significance is difficult to interpret." She added, "Testosterone has not been found to alter other coronary heart disease risk factors.".

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