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March 6, 2007, 4:05 PM CT

Musculoskeletal Care During Pregnancy

Musculoskeletal Care During Pregnancy
Despite the high prevalence of musculoskeletal pain during pregnancy, few women in underserved populations receive therapy for their low back pain, as per a February 2007 study in the Journal of Manipulative and Physiological Therapeutics (JMPT). Moreover, scientists observed that pain in a prior pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies.

As per Clayton Skaggs, DC, the study's chief author, 85 percent of women surveyed reported that they had not received therapy for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained.

"Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, particularly in underserved populations," Dr. Skaggs said. "As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or therapy".

Scientists surveyed more than 600 women at a clinic that serves predominantly an uninsured, underinsured or Medicaid-insured population. Surveys were offered to all obstetrical patients and were designed to collect information about pregnancy-related pain and quality of life issues. Of those women who responded to the survey, two-thirds reported back pain and nearly half of all women reported pain at two or more locations, including pelvic pain and mid-back pain.........

Posted by: Emily      Read more         Source

March 1, 2007, 9:54 PM CT

Steroid Use Fails To Boost Pregnancy Rates

Steroid Use Fails To Boost Pregnancy Rates Image courtesy of
There is no clear benefit from a hormone usually prescribed to enhance the effectiveness of infertility therapys, as per a new review of studies.

The steroid hormones called glucocorticoids have potent effects on the bodys inflammatory and immune responses, so a number of fertility specialists prescribe them in hopes of making the lining of the uterus more receptive to embryo implantation. But lead review author Carolien Boomsma says that routine practice should stop.

This meta-analysis shows that empirical use of glucocorticoids is not supported by evidence from studies, she said. Moreover, we dont know enough about the possible adverse effects of glucocorticoids in early pregnancy. Therefore, at present, glucocorticoids should not be prescribed in this way, said Boomsma, a researcher at the University Medical Centre Utrecht in the Netherlands.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The review compares success rates between would-be mothers who took glucocorticoids around the time of embryo implantation and those who did not. All of the women underwent one of two types of assisted reproductive technology. In vitro fertilization (IVF) involves removing mature eggs from a womans ovary, mixing them with sperm in the laboratory, and placing the embryos in the womans reproductive tract. Intracytoplasmic sperm injection (ICSI) is another in vitro fertilization practice where a single sperm is injected directly into a harvested egg.........

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February 26, 2007, 8:51 PM CT

Menstrual Cycle And The Female Brain

Menstrual Cycle And The Female Brain
What influence does the variation in estrogen level have on the activation of the female brain? Using functional Magnetic Resonance Imaging, Jean-Claude Dreher, a researcher at the Cognitive Neuroscience Center (CNRS/Universit Lyon 1), in collaboration with an American team from the National Institute of Mental Health (Bethesda, Maryland) directed by Karen Berman, has identified, for the first time, the neural networks involved in processing reward-related functions modulated by female gonadal steroid hormones. This result, which was published online on January 29, 2007 on the PNAS website, is an important step in better comprehension of certain psychiatric and neurological pathologies.

The human brain has a recompense system that predicts different types of reward (food, money, drugs). The normal functioning of this system plays a fundamental role in a number of cognitive processes such as motivation and learning. This reward system, composed of dopaminergic neurons1 situated in the mesencephalon (a very deep region of the brain) and their projection sites2, is crucial for neural coding of rewards. Its dysfunction can result in disorders such as addictions and is also implicated in various psychiatric and neurological pathologies, such as Parkinson's disease and schizophrenic disorders. A number of studies on animals prove that the dopaminergic3 system is sensitive to gonadal steroid hormones (estrogen, progesterone). For example, female rats self-administer cocaine (a drug that acts on the dopamine system) in higher doses after estrogens have been administered to them. The influence of gonadal steroid hormones on the activation of the reward system remained to be studied in humans. A better knowledge of this influence should make for better understanding of the differences between men and women, especially as observed in the prevalence of certain psychiatric pathologies and in vulnerability to drugs, (for which the dopaminergic system plays an important role.) It is known, for example, that the female response to cocaine is greater in the follicular phase of the menstrual cycle4 than in the luteal phase5.Moreover, schizophrenia tends to appear later in women than in men.........

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February 23, 2007, 5:02 AM CT

Aspirin For Conception And Healthy Pregnancy

Aspirin For Conception And Healthy Pregnancy
Scientists at the University at Buffalo and the University of Utah are beginning a clinical trial to test whether aspirin can improve a woman's chances of becoming pregnant and of maintaining a pregnancy to term.

UB's portion of the study is funded by a $2.8 million grant from the National Institute of Child Health and Development.

The trial is aimed at women who have miscarried a pregnancy in the past year.

"In women who have had their first miscarriage, the reasons for losing that pregnancy are in a number of instances unknown," said Jean Wactawski-Wende, Ph.D., UB associate professor of social and preventive medicine and principal investigator of the UB clinical center.

"These women generally are advised to try to get pregnant again, but health-care providers can offer limited assistance on any specific actions to take to improve their next pregnancy outcome," she noted. "If aspirin can help some women become pregnant or maintain a health pregnancy, it will be a critically important finding.

"Aspirin is available, inexpensive and has very few side effects," she added. "We're hopeful that this trial could produce an important finding".

Statistics show that in the United States, 10-15 percent of couples trying to become pregnant are not able to conceive, 15-31 percent of pregnancies that do occur end in miscarriage, and 8-15 percent of pregnancies that continue beyond 20 weeks end in premature birth, putting these infants at risk for increased health problems.........

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February 11, 2007, 9:28 PM CT

Protecting Women's Mood Under Stress

Protecting Women's Mood Under Stress
German scientists have found additional evidence that the stress hormone cortisol can have positive effects in certain situations. Eventhough chronic stress, which brings long-term elevations of cortisol in the bloodstream, can weaken the immune system and induce depression, this new study adds to mounting evidence that cortisol given near in time to a physical or psychological stress may lessen the stressor's emotional impact. Psychology experts are particularly interested in what this means for preventing and treating post-traumatic stress disorder. The findings are reported in the recent issue of Behavioral Neuroscience, which is published by the American Psychological Association (APA).

Psychology experts Serkan Het, MSc, and Oliver Wolf, PhD, of the University of Bielefeld, enlisted 44 healthy women for a double-blind study, in which neither scientists or participants knew the condition to which the women were assigned. One hour before a psychosocial stress test, participants were given either a 30 mg. dose of oral cortisol or a placebo. That 30 mg. dose is considered high, translating to a severe stressor. Experimenters tracked participant mood through self report, and measured their cortisol levels with a simple swab check of their saliva, before and after the psychosocial stress test.........

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February 9, 2007, 4:46 AM CT

New smear test policy puts young women at risk

New smear test policy puts young women at risk
Last month, the BMJ reported a fall in the number of young women attending smear tests. Now, two senior doctors warn that a new policy not to screen women aged 20-24 may be a factor in falling coverage and could increase the risk of cancer developing in young women.

Prevalence of carcinoma in situ (a precursor to cancer known as CIN3) has increased in women aged 20-24, write consultants Amanda Herbert and John Smith. This new policy will add more than 3000 women with untreated CIN3 to the larger numbers failing to accept their invitations later on, they warn.

The authors accept that CIN may regress, that invasive cervical cancer (ICC) is rare in women under 25, and that screening does little to reduce its incidence in such young women. However, they argue that ICC can develop within a couple of years of missed cell analysis, failure to investigate cell abnormalities, or incomplete therapy, emphasising the importance of treating high-grade CIN when it is found.

Screening in the UK has been highly successful and, since 1988, incidence and mortality have fallen by more than 40% despite increased risk of disease. This has been achieved by treating high-grade CIN, especially CIN3, in young women, say the authors. The peak prevalence of CIN3 is in women aged 25-29 amongst whom the fall in coverage has been greatest.........

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February 9, 2007, 4:40 AM CT

Abortion -- where do we draw the line?

Abortion -- where do we draw the line?
The 40th anniversary in October this year of the passing of the UK Abortion Act is certain to be marked by attempts to reopen the debate about lowering the upper limit for legal terminations. In a special report in this weeks BMJ, journalist Jonathan Gornall examines current arguments for reform.

Any challenge to the upper limit of 24 weeks poses big questions about viability, infant suffering, and the capabilities of neonatal care, writes Gornall and the danger is that this vital debate is taking place increasingly on emotional rather than scientific grounds.

The ProLife Alliance can take much of the credit for having put abortion back on the public and political agenda over the past decade. The organisation was set up in 1996 as a political party to show the reality of abortion and was also behind the ultimately failed attempt in 2003 by Joanna Jepson, a trainee vicar, to have police prosecute two doctors over the late abortion of a fetus with a cleft lip and palate.

Now the alliance has turned its attention away from pictures of dead babies to 4D ultrasound images of live ones in the womb.

The technique was pioneered by Stuart Campbell, head of obstetrics and gynaecology at St Georges Hospital, London, who is convinced that his 4D images have undermined the validity of the current time limit for abortion.........

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February 9, 2007, 4:25 AM CT

Benchmark fetal surgery study

Benchmark fetal surgery study
It's one of the biggest controversies in fetal surgery and the cause of heated debate among surgeons and maternal-fetal medicine physicians around the world: What's the best way to treat twin-twin transfusion syndrome (TTTS), one of the most common conditions requiring fetal surgery and the leading cause of mortality in twins?

The benchmark, NIH-funded study on TTTS, conducted at 17 centers in the United States, will be presented February 9 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, and it won't likely resolve the question of which is the best procedure. The study, led by Timothy Crombleholme, M.D., director of the Fetal Care Center of Cincinnati, shows that the question isn't which surgical procedure is better, it's when the procedure is done.

Dr. Crombleholme issued a clarion call to fetal care specialists around the world. "The earlier in gestation TTTS is diagnosed, the more severe the syndrome tends to be," says Dr. Crombleholme, who is also a pediatric surgeon at Cincinnati Children's Hospital Medical Center. "We have to shift attention to diagnosing this earlier in the progression of the syndrome and being more aggressive about intervention. We can't conclude that one treatment is better than another, but it's apparent that we're going to compromise survival if therapy isn't initiated before it gets to be severe".........

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February 9, 2007, 4:23 AM CT

African-American mothers more likely to deliver prematurely

African-American mothers more likely to deliver prematurely
African-American women are three times more likely to deliver babies three to 17 weeks prematurely than Caucasian women, as per a review of Missouri birth statistics by scientists at Washington University School of Medicine in St. Louis.

In addition, African-American women are more likely to deliver babies prematurely in subsequent pregnancies.

The scientists analyzed data from the Missouri Department of Health's maternally linked database of all births in Missouri between 1989 and 1997, adjusting for such variables as socioeconomic status, education level, cigarette smoking and maternal medical conditions such as diabetes, high blood pressure and eclampsia. Full-term birth is considered to be between 37 weeks and 42 weeks of gestation.

Results of the analysis appear in the recent issue of the American Journal of Obstetrics and Gynecology.

The data showed that 8.8 percent of births to African-American women were between 20 weeks and 34 weeks gestation, or nearly three times the 2.95 percent of premature births to Caucasian women. In addition, African-American women were nearly four times as likely to deliver babies between 20 weeks and 28 weeks gestation than Caucasian women.

African-American women also were nearly 5.5 times more likely to have recurrent preterm births than Caucasian women.........

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February 7, 2007, 8:20 PM CT

Helping women with PCOS achieve pregnancy

Helping women with PCOS achieve pregnancy
Metformin, a drug used to treat diabetes and once thought to have great promise in overcoming the infertility linked to polycystic ovary syndrome (PCOS), is less effective than the standard fertility drug therapy, clomiphene, as per scientists from the University of Pennsylvania School of Medicine and the National Institutes of Health Reproductive Medicine research network. This is the largest, most comprehensive effort yet to compare the two drugs in helping PCOS patients achieve successful pregnancy. The findings are reported in the February 8th, 2007 issue of the New England Journal (NEJM).

"With this study, my colleagues and I recommend and support the use of clomiphene alone and NOT in combination with Metformin as a first-line treatment for infertility in women with PCOS," said Christos Coutifaris, MD, PhD, Director of the Division of Reproductive Endocrinology and Infertility and the principal investigator from Penn. "These results emphasize the need to test any new application rigorously, no matter how promising it may seem initially."

As per the study authors, women who took metformin ovulated more that the women who were given the standard therapy. Similarly, women in the combination treatment group ovulated more frequently than did the women in either the clomiphene-alone or the metformin-alone groups. However, as the current study revealed, an increase in ovulation did not result in more successful pregnancies and deliveries for either the metformin alone, or combination group.........

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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.". Archives of obgyn news blog

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