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PubMed1986

Cardiac myosin light and heavy chain isotypes in tetralogy of Fallot.

Myosin isotype composition was examined in ventricular infundibular muscle from 40 patients with tetralogy of Fallot, aged from 7 months to 38 years. Results were compared with normal samples of ventricular infundibulum from subjects in the same age range, from 18-20 week old fetuses to 6 month old neonates, and from 43-81 year old adults. Myosin light chain isotypes were examined by one dimensional and two dimensional gel electrophoresis and quantified densitometrically. Heavy chain isotypes were examined by electrophoresis of whole heavy chains and peptide mapping after limited proteolytic digestion with chymotrypsin. At mid-gestation in normal tissues, only ventricular light chain 2 was present but light chain 1 consisted almost equally of atrial and ventricular isotypes. Amounts of atrial light chain 1 declined towards birth and disappeared during the first year after birth, gradually being replaced by ventricular light chain 1. Relative amounts of total light chains 1 and 2 remained equal. In tetralogy of Fallot atrial light chain 1 expression did not cease neonatally with mean values of 11.8% of total light chain 1 present between 7 months and 2 years, decreasing to 1.7% at 6.5-12 years and then increasing again to 3.4% in adults. A value of 34% atrial light chain 1 was present in one subject. As in normal subjects, equimolar amounts of total light chains 1 and 2 were retained. No evidence of new light chain isotypes was found in tetralogy of Fallot. Heavy chain expression was constant in normal infundibulum with only beta-heavy chain (V3 isozyme) present in the fetus, neonate, and adult.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Histopathology of the interactions between alveolar bone and impacted dental germs in osteopetrotic op/op rats.

Osteopetrosis, a general increase in bone density, is well-known as an autosomal recessive disease in several mammalian species. Compared with normal littermates, the osteopetrotic rats suffered from a complete failure of tooth eruption. Histologic and microradiographic studies show that the molars and the incisors developed a progressive ankylosis, the bone invades the germs and finally dissociates them. As early as the first days after birth, the incisors and the first molars are affected by the osteopetrotic process while the second and the third molars remain untouched. The periodontal membrane of the incisors is rapidly invaded by the osteopetrotic bone trabeculae. After the eleventh day, the process reached all molars. The germs were overlaid by an occlusal unresorbed bone. The formation of the gebernacular canal appeared to be independent of the prefunctional eruption.

Alveolar Process↗
PubMed1977

Copper metabolism in pregnant and pospartum rat and pups.

A detailed study was made of copper metabolism in rats during and after pregnancy and in the fetuses and pups up to the age of 6 wk. Maternal ceruloplasmin levels increase only briefly at the beginning of the third (and last) week of pregnancy. They then decrease to normal levels at term and decrease markedly in the early postpartum period. Bilary excretion of copper and 67Cu almost stops at term and remains decreased for 2 wk. In spite of this, there is no increase in hepatic copper levels. Except for a 1- to 2-day period shortly after delivery, maternal rats have a positive copper balance if lacteal elimination of copper is ignored. Levels of copper in milk drop at about the fourth day postpartum. Fetal hepatic copper levels are already above adult levels, but the concentration almost doubles during the first week after birth; it decreases to adult levels by 6 wk of age. Ceruloplasmin levels, which are found to be very low in the pups at birth, increase sharply in the first 24 h and quickly achieve adult levels. Large quantitative differences also occur between the pups and adults in concentrations of copper in the brain and kidney. Qualitative differences, measured with 67Cu, are most notable when the neonatal liver is compared with the adult liver.

Animals↗
PubMed2005

Longer postpartum hospitalization options--who stays, who leaves, what changes?

BACKGROUND: This paper examines the practice implications of a policy initiative, namely, offering women in Ontario Canada up to a 60-hour postpartum in-hospital stay following an uncomplicated vaginal delivery. This change was initiated out of concern for the effects of 'early' discharge on the health of mothers and their infants. We examined who was offered and who accepted extended stays, to determine what factors were associated with the offer and acceptance of this option, and the impact that these decisions had on post-discharge health status and service utilization of mothers and infants. METHODS: The data reported here came from two related studies of health outcomes and service utilization of mothers and infants. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care managers and providers at each site. For both studies, samples were drawn from the same five purposefully selected hospitals. Further analysis compared postpartum health outcomes and post discharge service utilization of women and infants before and after the practice change. RESULTS: Average length of stay (LOS) increased marginally. There was a significant reduction in stays of <24 hours. The offer of up to a 60-hour LOS was dependent upon the hospital site, having a family physician, and maternal ethnicity. Acceptance of a 60-hour LOS was more likely if the baby had a post-delivery medical problem, it was the woman's first live birth, the mother identified two or more unmet learning needs in hospital, or the mother was unsure about her own readiness for discharge. Mother and infant health status in the first 4 weeks after discharge were unchanged following introduction of the extended stay option. Infant service use also was unchanged but rate of maternal readmission to hospital increased and mothers' use of community physicians and emergency rooms decreased. CONCLUSION: This research demonstrates that this policy change was selectively implemented depending upon both institutional and maternal factors. LOS marginally increased overall with a significant decrease in <24-hour stays. Neither health outcomes nor service utilization changed for infants. Women's health outcomes remained unchanged but service utilization patterns changed.

Journal Article↗
PubMed1995

A perspective on vesicoureteral reflux.

Prevention of UTI appears to be the most important way to avoid the serious complications of vesicoureteral reflux, which then requires early recognition, ideally prior to bacterial invasion. With early evaluation of children noted to have dilated collecting systems in utero and the screening of siblings and offspring of those with reflux, this prevention becomes possible. This screening should be performed in the first weeks to months after birth, before the first UTI. The choice of management appears to be less important than control of infection, because the results of both medical and surgical management are equal; however, because mild-to-moderate (grades I-III) reflux is likely to resolve, it seems appropriate to pursue an aggressive nonsurgical course in these patients, at least until some minimally invasive, safe interventional treatment becomes available. If reflux remains severe (grades IV and V) beyond 24 to 48 months of age, surgical intervention appears appropriate because resolution is unlikely, assuming, of course, that an experienced surgeon performs the procedure. As was evident from the European branch of the IRS, renal scarring occurred most frequently in the few patients who had ureteral obstruction after failed surgical correction. In those who continued to have mild reflux beyond 5 to 7 years of age, a trial of medication is justifiable. If infection occurs during that time and reflux persists, correction should be considered for those with clinical or scan-documented pyelonephritis. Patients who have reflux plus bacteriuria present a special problem because it is unclear whether their risks are increased. Finally, we must forewarn all our female patients with UTI in childhood that they are at risk for bacilluria during pregnancy and may require prophylaxis regardless of the state of their reflux at that time.

Algorithms↗
PubMed1996

Prevention of preterm birth. Role of daily telephone contact.

OBJECTIVE: To compare the effectiveness of routine management of patients at high risk for preterm delivery to the effectiveness of routine management in combination with daily telephone nursing contact. STUDY DESIGN: The control group, 1 (n = 21), had education and frequent prenatal visits and cervical examinations. The study group, 2 (n = 21), had education, frequent prenatal visits and cervical examination, and daily telephone contact. Group 3 (n = 22) received education but refused to participate. RESULTS: There were no significant differences (SD) between groups in race, smoking, age, multiple gestation, visits, diagnosis of premature labor, mean days gained after diagnosis of premature labor, tocolytic use or bed rest. There was also no SD in preterm birth rate, mode of delivery, number of maternal or neonatal hospital days, mean neonatal weight or gestational age at delivery between groups. While not reducing the overall incidence of preterm birth, this management for all groups resulted in a more advanced gestational age at the time of delivery (mean change = 7.5 weeks, P < .0001) when compared to the patient's first preterm birth. CONCLUSION: This study indicated that daily contact, while providing reassurance and support, did not change the outcome when the study group was compared to women managed similarly but without daily contact.

Adolescent↗
PubMed1996

Determinants of preterm delivery in low-risk pregnancies. The RADIUS Study Group.

From 14,948 low-risk singleton pregnancies, we calculated incidence, risk ratios, and attributable risks for characteristics associated with spontaneous and medically induced preterm delivery. There were 754 women who gave birth prior to 37 weeks of gestation (50.4/1000 deliveries). The greatest fraction of the incidence of prematurity among low-risk pregnancies was due to unknown factors associated with carrying a first live birth, regardless of preterm delivery mechanism (i.e., spontaneous labor, PROM, medical intervention), with population-attributable risk percents (PAR%) ranging from 16.0 to 30.5%. Other than nulliparity, male sex of the fetus accounted for the greatest fraction of spontaneous labor-induced prematurity incidence (PAR% = 13.6%), and maternal age greater than 30 years or a positive urine culture accounted for the greatest fraction of PROM-induced prematurity incidence (PAR% = 7.9 and 6.7, respectively). All other risk factors for either preterm labor or PROM accounted for less than 5% of the incidence. Three characteristics explained a large fraction of medically induced prematurity: women over 150 pounds at the onset of pregnancy (PAR% = 23.8), a > or = 2+ prenatal urine protein (PAR% = 18.7%), and cigarette smoking during the first trimester (PAR% = 8.6). Our results suggest known risk factors may explain only a small fraction of spontaneous preterm delivery incidence in low-risk pregnancies.

Adolescent↗
PubMed1984

Clinical significance of fetal heart rate patterns during labor. VIII. Breech presentations.

The fetal heart rate (FHR) tracings of 302 consecutive breech presentations were analyzed to assess their potential value in clinical practice. There were 274 singleton births, 27 first twins and 1 triplet. Ten percent of the gestations were greater than or equal to 42 weeks, and 26% were less than or equal to 36 weeks. Infants premature by weight (less than 2,500 gm) made up 32%. Only 33.3% had no decelerations, and 63.0% had variable or variable-late decelerations. The latter group had a significantly higher incidence of depressed neonates and neonatal deaths. When accelerations were present, there were significantly fewer depressed infants and neonatal deaths. Overall the perinatal mortality (PNM) was 7.9%; for premature infants it was 27%, postterm 3% and term 1%. There was a 31% incidence of cesarean section. The PNM, when analyzed according to route of delivery, was no different for the very-low-birth-weight, low-birth-weight and term infants. Weight-specific mortality accounted for the apparent difference among the very-low-birth-weight infants. The high incidence and pathophysiology of cord compression (for first- and second-stage labor) may explain the higher incidence of depression in breeches as compared to cephalics. FHR monitoring should be done throughout delivery in order for the physicians to intervene on time when fetal distress is imminent.

Birth Weight↗
PubMedDate not supplied

Early discharge of Alberta mothers post-delivery and the relationship to potentially preventable newborn readmissions.

OBJECTIVE: To determine whether early maternal discharge increases newborn readmission rates. METHODS: Singleton vaginal deliveries weighing at least 2500 grams were extracted from April 1, 1997 to March 31, 2000 Alberta hospital abstracts and linked to records of birth. Potentially preventable readmissions were for dehydration, jaundice, feeding problems, inadequate weight gain, and social reasons. RESULTS: The most common reason for readmission is jaundice (74%). In order of importance, influencing factors were: length of gestation, Aboriginal treaty status, first live birth, delivering in region of residence, number of deliveries done in the hospital, newborn sex, maternal smoking, birthweight, previous abortions, and delivering in nearest hospital. Post-delivery length of stay was associated with readmissions in the first 6 days post discharge (25% greater in those < 27 hours compared to those > 48 hours) but not in the first 28 days post discharge. CONCLUSION: Early maternal discharge is a minor determinant of potentially preventable newborn readmissions.

Adolescent↗
PubMed1994

Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births.

PURPOSE: To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies. METHODS: The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates. We fit a negative binomial regression model to determine the effects of various factors on the number of prenatal care visits during second pregnancy. RESULTS: The number of prenatal care visits during the first pregnancy, poor first birth outcome, interval between first and second pregnancy, and care provided by health department staff during first pregnancy were all positively associated with number of prenatal care visits during second pregnancy when controlling for gestation age of second birth. Other independent variables in the model included maternal age, education, black race, and being unmarried at the time of second birth. CONCLUSIONS: Because prenatal care is important for healthy mothers and babies, adolescents should be encouraged to seek prenatal care early in the first pregnancy. This could be an important time to implement interventions aimed at increasing prenatal care utilization in this and subsequent pregnancies.

Adolescent↗
PubMed1993

First- and second-trimester hemoglobin levels. Relation to birth weight and gestational age.

The computerized records of 3074 women who were delivered during the period 1987-1990 were analysed. We studied possible relations of birth weight and gestational age to maternal first- and second-trimester hemoglobin levels. Birth weight and gestational age were taken as outcome variables in a multiple stepwise regression analysis, including factors that might interact with hemoglobin levels. A strong independent inverse correlation between the lowest second-trimester hemoglobin and birth weight was observed. First-trimester hemoglobin levels explained little with regard to birth weight, but had a small negative correlation to gestational age. For gestational age < 259 days we found a strong positive correlation between the first- to second-trimester decrease in hemoglobin and birth weight.

Birth Weight↗
PubMed2006

Predictors of persistent smoking and quitting among women smokers.

This study examined predictors of persistent tobacco smoking and smoking cessation in a longitudinal study of women's health. The sample consisted of 575 women, with an average age of 34 years at baseline. Follow-up occurred some 13 years later. Two models of smoking behavior were examined, the first identifying correlates of daily smoking at baseline and the second identifying predictors of subsequent quitting at follow-up among those smoking at baseline. Poor maternal education, being young at birth of first child, high level of anxiety, having a partner who smoked, and high tea/coffee consumption were all associated with smoking at baseline. Being a young mother and number of cigarettes smoked at baseline predicted subsequent persistent smoking while high levels of anxiety significantly predicted subsequent quitting.

Adult↗
PubMed1996

'Wrongful conception', 'wrongful birth' and 'wrongful life': the first South African cases.

Internationally case law has developed in regard to actions which in due course were given the following labels. "Wrongful pregnancy" or "wrongful conception" for cases where a healthy but unwanted child is born, following negligent contraceptive advice by a doctor or a negligent sterilization or abortion procedure, and the parents claim damages; "wrongful birth" where such a claim is brought by the parents of an abnormal or disabled child; "wrongful life" where a claim is brought by or on behalf of the abnormal or disabled child itself. The first judgments in South Africa were handed down during the past seven years and are discussed in this article.

Abortion, Induced↗
PubMed1993

On the appearance of islet associated autoimmunity in offspring of diabetic mothers: a prospective study from birth.

For the first time the incidence of insulin autoantibodies and islet cell antibodies were evaluated in a prospective study from birth. Consecutive neonates (168) from mothers with Type 1 (insulin-dependent) diabetes mellitus (n = 113) and gestational diabetes (n = 55) were included at birth. To date, follow-up sera were obtained from 90 of 168 mother-child-pairs 9 months postpartum and from 39 of 168, 2 years postpartum. At birth, there was a strong correlation between the presence of antibodies in the cord blood of neonates and in maternal circulation [Type 1 diabetic mothers: 20% islet cell antibodies > or = 20 JDF-U (detection threshold of our islet cell antibody assay), 74% insulin antibodies > 49 nU/ml (upper limit of normal range in sera of healthy control subjects aged 0.5 to 46 years); neonates: 21% islet cell antibodies > or = 20 JDF-U, 76% insulin antibodies > 49 nU/ml; gestational diabetic mothers: 11% islet cell antibodies > or = 20 JDF-U, 18% insulin antibodies > 49 nU/ml; neonates: 13% islet cell antibodies > or = 20 JDF-U, 55% insulin antibodies > 49 nU/ml]. This supports transplacental passage of insulin antibodies and islet cell antibodies from diabetic mothers to their offspring. During follow-up, the majority of children lost antibody-positivity after birth. A few offspring, however, exhibited or developed antibodies consistently, whereby insulin autoantibodies preceded islet cell antibodies in each case (antibody-positivity: 9 months: 0% islet cell antibody positive, 3.3% insulin autoantibody positive; 2 years: 2.6% islet cell antibody positive, 7.7% insulin autoantibody positive).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Son preference and child replacement in Bangladesh: a new look at the child survival hypothesis.

Birth history data from women in the 1975-76 Bangladesh Fertility Survey were used to search for intentions to replace dead children. The median intervals between successive births of orders (i) and (i + 1) were not shorter when some siblings of orders below (i) had died. Nor was the median duration between the death of a child and the first posthumous birth shorter when the dead child was a boy or when it was survived by fewer than two brothers. The median intervals were generally shorter when the mother lived in an urban rather than a rural area but this difference was attributable only to the shorter duration of breast-feeding by urban women. These results disputed the notions that the timing of births was deliberately quicker to replace a dead child, that attempts at replacement were sex-selective, or that child replacement intentions were stronger in urban than in rural populations.

Adult↗
PubMedDate not supplied

[Pregnancy-associated symphysis damage from the orthopedic viewpoint--studies of changes of the pubic symphysis in pregnancy, labor and post partum].

AIM: Is the sonographic measurement of the symphysis pubis enough to enable a prognosis of the occurrence of symphyseal pain during pregnancy and birth? METHOD: First of all, a simplified definition of symphyseal pain was categorized in order to make the classification more easy. The symphyseal widths of 171 pregnant women were measured during pregnancy and after birth. Our control group consisted of 25 non-pregnant women. 15 of the 171 patients suffered from symphyseal pain; however, 156 of the 171 did not. Additionally, we measured the intrapartal symphyseal width in 11 of the women. RESULTS: The average symphyseal width of non-pregnant women was 4.07 mm (s = 0.79; n = 25). Pre- and postpartally we measured 6.32 mm (s = 1.71; variation of 3 to 16 mm) in pregnant asymptomatic women. A significant increase in width was recorded in the 15 women with pain in the symphysis: the symphyseal width was 10.62 mm (s = 2.37; Variation from 6.7 to 15.25 mm). Intrapartally the symphyseal width varied between 5.8 and 1.2 mm. CONCLUSION: Ultrasound measurement of the symphyseal width shows around 4 mm in non-pregnant women. Asymptomatic pregnant women have an average width of 6.3 mm. The majority of pregnant women with 9.5 mm or more have symphyseal pain. If that is the case then conservative treatment is usually sufficient to cure this complaint.

Adolescent↗