mercredi 22 septembre 2010
The Final Stretch: Range of Normal Perineal Changes During Second Stage Labor in First Vaginal Birth
The Final Stretch: Range of Normal Perineal Changes During Second Stage Labor in First Vaginal Birth: "Purpose: The aim of this descriptive, observational study is to identify the range of perineal changes during second stage labor and associated perineal outcomes. Background: Many women fear pelvic floor damage as a consequence of vaginal birth despite limited evidence of a causal link between vaginal birth and pelvic floor damage. Documentation of the process of perineal stretch, which is presumably when damage would occur, is absent from the literature. Methods: Eighteen nulliparas were observed during second stage labor. Documentation of position, pushing, time of vertex being visible, crowning, rate of distention, color changes and blanching was noted with each push. Descriptive statistics were calculated. Results: Second stage length ranged 15-281 minutes (mean 94). Ratio of time the vertex was visible to a sustained crown was 0% to 75% of the total time in second stage. The ratio of time spent with the vertex in a sustained crown ranged from 3% to 48% of second stage duration. Despite variance in duration of stretch, longer duration did not correlate with perineal trauma. Blanching, duration of active pushing, and rate of distension were associated with increased risk of trauma. Conclusions: A wide range of “normal” perineal changes during second stage was documented that do not lead to lacerations. Future studies should identify opportunities to prevent perineal trauma beyond focusing duration of perineal stretching."
Men Suffer from Prenatal and Postpartum Depression, Too; Rates Correlate with Maternal Depression
Men Suffer from Prenatal and Postpartum Depression, Too; Rates Correlate with Maternal Depression: "Paternal depression has often taken a back seat to the studies of maternal and postpartum depression despite recognition that depression among fathers negatively affects family life. Although the primary focus of our care as midwives and women's health clinicians is directed at women and mothers, we view our work as that which promotes and strengthens families; however, “family” is defined by women in our care. Although depression among fathers is not well understood and the literature on this topic is emerging, Paulson and Bazemore wanted to describe what is known about paternal depression and its association with maternal depression using techniques of metaanalysis. The primary outcome for this study was described as a point prevalence rate, defined by the authors as cases of depression divided by the number of study participants. The rate of depression among female partners was a secondary outcome."
Comfort Measures for Childbirth
Comfort Measures for Childbirth: "Penny Simkin introduces her DVD by stating that her intent is to demonstrate techniques to help laboring women cope with their pain and hence alleviate the concept of suffering. Simkin gives a brief overview of her belief in the 3Rs—Relaxation, Rhythm, and Ritual—and their role in pain management, along with a supportive partner, and a little luck! The organization of the remainder of the DVD is clear and logical, with four distinct sections: 1) basic relaxation and rhythmic breathing; 2) comfort measures, devices, and positions; 3) techniques for back pain and labor progression; and 4) positions and techniques for squatting and birth. Simkin begins each section with a brief introduction. Videos and photographs of actual labors demonstrate the techniques being used. This DVD replaces Simkin's 1995 video of the same name. The DVD is both extended and enhanced, with a seemingly daunting running time of 91 minutes. However, the user-friendly menu allows the viewer to access each section or even each position or technique individually."
jeudi 12 août 2010
The long path to pregnancy: early experience with dual anonymous gamete donation in a European in vitro fertilisation referral centre
The long path to pregnancy: early experience with dual anonymous gamete donation in a European in vitro fertilisation referral centre: "Background:
This investigation describes features of patients undergoing in vitro fertilisation (IVF) and embryo transfer (ET) where both gametes were obtained from anonymous donors. Methods: Gamete unsuitability or loss was confirmed in both members of seven otherwise healthy couples presenting for reproductive endocrinology consultation over a 12-month interval in Ireland. IVF was undertaken with fresh oocytes provided by anonymous donors in Ukraine; frozen sperm (anonymous donor) was obtained from a licensed tissue establishment. For recipients, saline-enhanced sonography was used to assess intrauterine contour with endometrial preparation via transdermal estrogen. Results: Among commissioning couples, mean+/-SD female and male age was 41.9+/-3.7 and 44.6+/-3.5yrs, respectively. During this period, female age for non dual anonymous gamete donation IVF patients was 37.9+/-3yrs (p<0.001). Infertility duration was [greater than or equal to]3yrs for couples enrolling in dual gamete donation, and each had [greater than or equal to]2 prior failed fertility treatments using native oocytes. All seven recipient couples proceeded to embryo transfer, although one patient had two transfers. Clinical pregnancy was achieved for 5/7 (71.4%) patients. Non-transferred cryopreserved embryos were available for all seven couples. Conclusions: Mean age of females undergoing dual anonymous donor gamete donation with IVF is significantly higher than the background IVF patient population. Even when neither partner is able to contribute any gametes for IVF, the clinical pregnancy rate per transfer can be satisfactory if both anonymous egg and sperm donation are used concurrently. Our report emphasises the role of pre-treatment counselling in dual anonymous gamete donation, and presents a coordinated screening and treatment approach in IVF where this option may be contemplated."
This investigation describes features of patients undergoing in vitro fertilisation (IVF) and embryo transfer (ET) where both gametes were obtained from anonymous donors. Methods: Gamete unsuitability or loss was confirmed in both members of seven otherwise healthy couples presenting for reproductive endocrinology consultation over a 12-month interval in Ireland. IVF was undertaken with fresh oocytes provided by anonymous donors in Ukraine; frozen sperm (anonymous donor) was obtained from a licensed tissue establishment. For recipients, saline-enhanced sonography was used to assess intrauterine contour with endometrial preparation via transdermal estrogen. Results: Among commissioning couples, mean+/-SD female and male age was 41.9+/-3.7 and 44.6+/-3.5yrs, respectively. During this period, female age for non dual anonymous gamete donation IVF patients was 37.9+/-3yrs (p<0.001). Infertility duration was [greater than or equal to]3yrs for couples enrolling in dual gamete donation, and each had [greater than or equal to]2 prior failed fertility treatments using native oocytes. All seven recipient couples proceeded to embryo transfer, although one patient had two transfers. Clinical pregnancy was achieved for 5/7 (71.4%) patients. Non-transferred cryopreserved embryos were available for all seven couples. Conclusions: Mean age of females undergoing dual anonymous donor gamete donation with IVF is significantly higher than the background IVF patient population. Even when neither partner is able to contribute any gametes for IVF, the clinical pregnancy rate per transfer can be satisfactory if both anonymous egg and sperm donation are used concurrently. Our report emphasises the role of pre-treatment counselling in dual anonymous gamete donation, and presents a coordinated screening and treatment approach in IVF where this option may be contemplated."
mercredi 11 août 2010
A randomized controlled study investigating the necessity of routine cervical dilatation during elective cesarean section
A randomized controlled study investigating the necessity of routine cervical dilatation during elective cesarean section: "
Abstract
Objective
To investigate if it was necessary to dilate the cervix routinely during elective cesarean section and to determine the effects
of this traditional maneuver on maternal morbidity.
of this traditional maneuver on maternal morbidity.
Methods
A total of 150 patients meeting eligibility criteria were enrolled in this prospective, randomized controlled study. Patients
were allocated randomly into cervical dilatation group or non-dilated group. In the cervical dilatation group, the surgeon
performed cervical dilatation by inserting a double-gloved index finger into the cervical canal of the patients after extraction
of placenta and membranes. Endometrial cavity thickness of the patients at postoperative 24 h, development of postoperative
febrile–infectious morbidity and postoperative hemoglobin levels were evaluated and compared between the groups.
were allocated randomly into cervical dilatation group or non-dilated group. In the cervical dilatation group, the surgeon
performed cervical dilatation by inserting a double-gloved index finger into the cervical canal of the patients after extraction
of placenta and membranes. Endometrial cavity thickness of the patients at postoperative 24 h, development of postoperative
febrile–infectious morbidity and postoperative hemoglobin levels were evaluated and compared between the groups.
Results
The two groups were comparable with regard to demographic and clinical properties. Mean postoperative endometrial cavity thickness
of the dilated group was significantly less than the non-dilated group (6.87 ± 2.50, 9.51 ± 3.35 respectively, p < 0.0001). The level of hemoglobin reduction was comparable between the groups (p = 0.37). Febrile morbidity was seen in one patient in the dilated group. Endometritis or wound infection was not encountered
in either group during the puerperium.
of the dilated group was significantly less than the non-dilated group (6.87 ± 2.50, 9.51 ± 3.35 respectively, p < 0.0001). The level of hemoglobin reduction was comparable between the groups (p = 0.37). Febrile morbidity was seen in one patient in the dilated group. Endometritis or wound infection was not encountered
in either group during the puerperium.
Conclusions
Cervical dilatation seems to be an unnecessary intervention during the cesarean section.
- Content Type Journal Article
- DOI 10.1007/s00404-010-1608-9
- Authors
- Miğraci Tosun, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Mehmet Sakinci, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Handan Çelik, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Burcu Torumtay, Aksaray Şambaz Vehbi Ekecik Maternity Hospital Aksaray Turkey
- Eren Yazici, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Tayfun Alper, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Erdal Malatyalioğlu, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Journal Archives of Gynecology and Obstetrics
- Online ISSN 1432-0711
- Print ISSN 0932-0067
dimanche 1 août 2010
Stress périnatal et développement neuropsychologique
Stress périnatal et développement neuropsychologique: "
Résumé
Depuis deux décennies, la recherche expérimentale s’est efforcée de modéliser le stress périnatal et ses conséquences cliniques
et biologiques. En laboratoire, l’effet du stress s’apparente à celui d’une programmation développementale et peut rendre
compte de la survenue ultérieure de pathologies neuropsychologiques. Si un tel niveau de preuve n’est pas établi en clinique
humaine, plusieurs observations suggèrent l’intervention modulatrice du stress périnatal dans le développement à court et
long terme de l’enfant, ainsi qu’une vulnérabilité accrue aux troubles psychopathologiques. Après avoir rappelé les principaux
modèles, cette revue présente quelques stratégies cliniques intégrant la gestion du stress dans l’objectif d’en limiter le
retentissement.
et biologiques. En laboratoire, l’effet du stress s’apparente à celui d’une programmation développementale et peut rendre
compte de la survenue ultérieure de pathologies neuropsychologiques. Si un tel niveau de preuve n’est pas établi en clinique
humaine, plusieurs observations suggèrent l’intervention modulatrice du stress périnatal dans le développement à court et
long terme de l’enfant, ainsi qu’une vulnérabilité accrue aux troubles psychopathologiques. Après avoir rappelé les principaux
modèles, cette revue présente quelques stratégies cliniques intégrant la gestion du stress dans l’objectif d’en limiter le
retentissement.
- Content Type Journal Article
- Category Article De Synthèse / Review Article
- DOI 10.1007/s12611-010-0072-x
- Authors
- G. Cambonie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- A. Rideau, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- M. Bienfait, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- O. Pidoux, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- R.-M. Toubin, CHU de Montpellier Médecine psychologique pour enfants et adolescents, clinique Peyre-Plantade Montpellier France
- J.-C. Picaud, hôpital de la Croix-Rousse, CHU de Lyon Service de néonatologie Lyon France
- G. Barbanel, université de Montpellier-II, institut Max-Mousseron des biomolécules de Montpellier Laboratoire stress oxydant et neuroprotection bâtiment 24, 3e étage, place Eugène-Bataillon-cc 2400 F-34095 Montpellier cedex 5 France
- Journal Revue de médecine périnatale
- Online ISSN 1965-0841
- Print ISSN 1965-0833
TheLancet: New issue of The Lancet online. Home birth Editorial proving controversial! http://bit.ly/cITaNr
TheLancet: New issue of The Lancet online. Home birth Editorial proving controversial! http://bit.ly/cITaNr: "TheLancet: New issue of The Lancet online. Home birth Editorial proving controversial!
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61165-8/fulltext
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery (currently contributing a third of all births, with nine out of ten women who have a caesarean going on to have repeated caesareans). This is because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits. This July, however, the American College of Obstetricians and Gynecologists (ACOG) issued a new caesarean guideline specifically aimed at putting more emphasis on respecting women's wishes to have a vaginal birth after one or two previous caesarean sections, or when expecting twins.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home. These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location. The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK's Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis published in the American Journal of Obstetrics & Gynecology provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations (USA, Canada, Australia, Sweden, the Netherlands, and Switzerland). The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies, even though it is not without risks—a recent study from Scotland showed that rates of neonatal death are higher in hospitals when births occur outside normal working hours. Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61165-8/fulltext
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery (currently contributing a third of all births, with nine out of ten women who have a caesarean going on to have repeated caesareans). This is because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits. This July, however, the American College of Obstetricians and Gynecologists (ACOG) issued a new caesarean guideline specifically aimed at putting more emphasis on respecting women's wishes to have a vaginal birth after one or two previous caesarean sections, or when expecting twins.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home. These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location. The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK's Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis published in the American Journal of Obstetrics & Gynecology provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations (USA, Canada, Australia, Sweden, the Netherlands, and Switzerland). The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies, even though it is not without risks—a recent study from Scotland showed that rates of neonatal death are higher in hospitals when births occur outside normal working hours. Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.
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