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Bump To Birth

The experience that a woman has during childbirth shapes how the rest of her child-raising experience goes, in many ways. A good birth can have a huge effect on how good you feel about your child, whereas a bad birth can often lead to feelings of sadness or PDST-type symptoms due to the pain and struggle of the birth experience. However, you don't need to worry about that now, because the information in this book gives you ALL of the experience and expert advice that you need in order to have a really amazing birth, that really marked that day as the truly special day that it is. This book teaches you how to use natural, holistic remedies to heal yourself during pregnancy in order to make sure that you feel your best during the whole birth experience. You can also learn everything you need to know about natural birth Everything you need to know to have a great pregnancy and birth is in this guide! Read more here...

Bump To Birth Summary


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Birth Trauma

Birth Trauma Newborn

Birth trauma refers to those injuries sustained during labor and delivery. Despite skilled and competent obstetric care, some may be unavoidable. Factors predisposing infants to injury include macrosomia, prematurity, cephalopelvic disproportion, dystocia, prolonged labor, and abnormal presentation. In 1988, birth injuries ranked eight as major causes of neonatal mortality and caused 4.6 deaths per 100,000 live births. The clinician who cares for newborn infants must be familiar with the conditions caused by birth injury. Injuries are known to occur to the soft tissues, head, eyes, ears, vocal cords, neck and shoulder, spine and spinal cord, intra-abdominal organs, extremities, and genitalia. Although many are mild and self limited, others are serious and potentially lethal. Figure 4.1. Severe molding of die head following an occipitoposterior presentation. The mobile skull bones and brain deform to comply with pressure in die birth canal. Note the flattened forehead and long occiput....

Predisposing Conditions

Recovered twice as often from these infants, gram-positive and gram-negative anaerobes were equally represented in those episodes. All four infants with Bacteroides spp., bacteremia not associated with gastrointestinal disease had congenital pneumonia. Three were born to mothers who did not have chorioaminoitis, but had premature rupture of membranes for less than 24 hours before birth. These infants may have aspirated organisms colonizing the birth canal or acquired infection in utero from mothers with subclinical infection (7). In contrast, three infants with congenital pneumonia born to mothers with apparent intrauterine infection had gram-positive anaerobic bacteremia.

Conjunctivitis And Dacryocystitis Conjunctivitis

The conjunctiva of newborns acquires facultative and anaerobic bacteria during birth primarily from the mother's cervical flora during passage through the birth canal (14). The role of anaerobes in neonatal conjunctivitis was investigated by obtaining conjunctival cultures from 35 babies prior to silver nitrate application and 48 hours later (19). On initial culture, 46 facultative bacteria, and 27 anaerobes were recovered. The organisms isolated in almost all of these cases were present also in the mother's cervical cultures and in the baby's gastric aspirates, taken concomitantly. Clostridium spp. were recovered from two infants who developed conjunctivitis (14,19).

Peutz Jeghers Syndrome

Body have been reported in approximately 10 of patients with this syndrome. Pigmentation of the face, lips, and oral cavity, present from birth, is a hallmark of this syndrome. Interestingly, the facial pigmentation fades later in life, although the intraoral mucosal pigmentation persists. No specific oral treatment is necessary.

Descriptive Epidemiology of ARM

One of the problems in ARM epidemiology is that the lesion may be hidden among other multiple anomalies in syndromes, some of which are life threatening. The ARM may then not be properly identified and classified. By way of example, a South American study of more than 1 million births in 11 countries 78 identified 121 (8.5 ) of 1,428 babies with multiple anomalies that included anal, renal and genital anomalies. Three or more VACTERL associations were seen in 21 of these cases (17.4 ) . A second group are encountered as part of a complex group of multiple anomalies, which include exomphalos and the OEIS complex, bladder exstrophy and colonic anomalies among others. Cuschieri 29 reported a high incidence of exomphalos, half of which were associated with cloacal exstrophy. In one study urinary tract anomalies were identified in 42.5 , skeletal in 26 and the cardiovascular system in 18.5 16 . ARM have also been reported in association with malrotation 79 , and with Pallister-Hall 80 ,...

Bacteroides fragilis Group

Bacteroides Fragilis Group

B. fragilis can be recovered from infectious processes in the newborn. The newborn infant is at risk of developing these infections when born to a mother with amnionitis, experienced premature rupture of membranes, or acquire the infection during the newborn's passage through the birth canal, where B. fragilis is part of the normal flora (62). B. fragilis was recovered from newborns with aspiration pneumonia (63), bacteremia (11), omphalitis (64), and subcutaneous abscesses and occipital osteomylitis following fetal monitoring (65). Bilophila wadsworthia and Centipeda periodontii are new genuses and species found in abdominal and endodontic infections respectedly (66).

Current national standards and guidelines

In 1999, the Royal Colleges of Midwives and Obstetricians and Gynaecologists published Towards Safer Childbirth - Minimum Standards for the Organisation of Labour Wards, setting out recommendations for organisational aspects of maternity services and risk management (due for revision 2007).

Management options

However rapidly delivery can be achieved, every effort should be made to relieve the occlusion of the umbilical cord by manually lifting the presenting part off the cord. This can be difficult, and may be helped by maintaining a steep head-down tilt until delivery is imminent. Rapid transfer of the patient in this position, especially with a midwife supporting the fetus with her hand inside the birth canal, can be very fraught indeed. Instillation of saline into the bladder via a catheter has been claimed to assist this manoeuvre.

Problems during pregnancy

E.g. anaemia may become more pronounced mild cytotoxic-induced cardiomyopathy may become more severe. Finally, there may be direct effects of the malignancy or its treatment on the uterus and birth canal, e.g. cervical surgery and scarring, perineal scarring and abdominal adhesions.

Puerperal Or Childbed Fever

During the second half of the eighteenth century, the population of Europe began a steep increase, unprecedented in extent, duration, and permanence. The eighteenth century, a period of particular interest to philosophers, political scientists, demographers, and historians of medicine, has been called the age of enlightenment and revolution. Within this context of social and intellectual change, medical men first made significant inroads into the traditionally female domain of childbirth. Epidemics of the previously rare and sporadic disease known as puerperal or childbed fever apparently became more common during this period, especially in the lying-in hospitals that accommodated poor women in cities and towns throughout Europe. The death of new mothers was of special interest to social reformers and physicians like Johann Peter Frank (1745-1821), who believed that the greatest wealth of the state should be measured in terms of the number, health, and productivity of its subjects....

The World Takes Note Of The Accomplishment

Past criticism of the use of dogs in their ballistic rocket programme had made the Soviets sensitive to this issue, making it understandable why they were not eager to immediately set the record straight. On occasion, they had been careful to hold press conferences after successful launches to show that the dogs had survived and were in good health. When space dogs gave birth, mother and pups would often be put on display as well. Twice in October, the New York Times had reported about articles that had appeared in Soviet publications detailing the recovery of dogs from rocket flights using parachutes. So the idea that the Sputnik 2 dog would be recovered from space seemed a real possibility to concerned readers.

Publicising space flights

Meanwhile, back in the USSR, Belka and Strelka returned to a hero's welcome in Moscow. After an interview on Radio Moscow, they were whisked off to a press conference at the Academy of Sciences, during which dog trainer Oleg Gazenko held the dogs aloft in a gesture of triumph. In November of that year, Strelka gave birth to a litter of puppies, one of which would play its own role in international diplomacy. Following a meeting at a Vienna summit conference, Soviet premier Nikita Khrushchev gave one of Strelka's pups to the U.S. First Lady, Jacqueline Kennedy. The dog, named Pushinka (Fluffy) would grow up in the Kennedy White House. Before the dog could be accepted, however, and reflecting the deep suspicions of those Cold War times, army experts thoroughly searched and X-rayed the little dog to check for any implanted bugs or a possible doomsday device.

National Institutes of Health 19521953

We left Bethesda in the month of May 1953. We went by train from Washington D.C. to New York where the parents of my friend Jonathan Wittenberg generously had invited us to stay for some days in the top flat of their charming house in Greenwich Village, downtown New York. We enjoyed being tourists in this metropolis and it was nice having some time off together. Vacation was not at the agenda of The Enzyme Section. We had a pleasant voyage to Gothenburg, Sweden, on board the liner Gripsholm of the Svenska Amerikalinien. After a short journey by train to Copenhagen we had a happy reunion with our families. A few weeks later, my wife gave birth on Midsummer Day to our second son (Lars Klenow).

Estimated Exposure Risks

Heterosexually acquired HIV infections in the UK, including those among pregnant women, and the numbers of new HIV diagnoses reflect the focus of the pandemic in sub-Saharan African countries with close links to the UK. In England, Wales and Northern Ireland, of the HIV-infected heterosexual patients receiving care in 2003 (and for whom ethnicity was reported), 70 per cent were black-African. Over two-fifths of the HIV-infected heterosexuals receiving care reside and are treated outside London most of these are black-African. Among women who were born in sub-Saharan Africa and who subsequently gave birth in the UK, an estimated one in 42 were HIV-infected in 2003. However, the transmission of HIV from mother to child in the UK has been reduced greatly since the universal offer and recommendation of HIV testing in pregnancy was introduced. Despite this, undiagnosed HIV infection and late diagnosis of longstanding HIV infection continue to be a feature of the treatment histories of...

Managing Work While Nurturing Relationships

The trouble started after I gave birth to our son three years ago he's our second kid. We wanted two kids and they're both a lot of fun. But they're also a lot of work, and he's an especially lively handful. Since he started walking and getting into things, it has been a real struggle for me at home. My husband helps a lot and my mother-in-law provides day care for him when I work. That's all good, but the two kids together exhaust me. And then two months ago I got promoted to be nurse manager for our ICU. That's been a disaster. I can't keep up with all the work of scheduling staff, ordering supplies, and attending meetings. It's worse than it ever was for me when I was doing just direct patient care. I can't go on this way.

Should Everyone Be Tested

As recently as 1974, a leading medical text described CF as not only one of the most common disorders of childhood, but also one of the most enigmatic. Even its name reflects the mystery. The term cystic fibrosis was coined more than 60 years ago to describe the scarring found in the pancreas at autopsy, yet the far more devastating effects are on the lungs, in which the ravages of recurrent, serious pneumonia are evident at a glance. Most strange is the protean nature of the disease. Some children are severely ill from birth, others become ill only gradually over four or five years, and a few are quite well until young adulthood. Most patients have both lung disease and severe gastrointestinal problems, but some are burdened only with comparatively mild lung disease. One fact emerges from this back-of-the-envelope analysis. Until the unit cost of DNA testing drops by a factor of 2-5, it is unlikely that we will see a significant effort to screen millions of young Americans to...

Anatomy and Physiology

Hemorrhoids are cushions of vascular tissue that are present from birth and are therefore considered normal anatomy. Internal hemorrhoids arise from the superior hemorrhoidal vascular plexus cephalad to the dentate line and are covered by mucosa. External hemorrhoids are dilations of the inferior hemorrhoidal plexus. Located below the dentate line, they are covered with anoderm and perianal skin. Because these plexuses communicate, a combination of external and internal hemorrhoid (mixed hemorrhoids, Figure 92-1) is often seen.

Familial dysautonomia Riley Day

A rare, autosomal recessive neurological disease associated with gastrointestinal dysfunction, presenting from birth, and usually occurring in Jewish children ofAshkenazi descent.Although most of the nervous system is involved, the autonomic and peripheral neuronal elements are of most concern to the anaesthetist.A decrease in sympathetic, parasympathetic and sensory neurones, a decrease in synthesis of norepinephrine (noradrenaline) (but with a normal adrenal medulla), and a sensitivity to exogenous catecholamines, have been shown. There is an increased risk of sudden death. Emotional lability is common but the IQ is normal. Patients may present for fundoplication, gastrostomy, or orthopaedic procedures.

Congenital Ossicular Abnormalities

A child may have a conductive hearing loss present from birth, with no middle ear effusion or retraction to explain it. Juvenile otosclerosis is possible, but this is extremely rare. The only other possibility is a congenital malformation of the middle ear ossicles. Some middle ear malformations readily stand out, with distorted TM landmarks or accompany-

Development of Islet Autoantibodies in Early Life

A number of large-scale prospective studies have been established with the intention of following the natural history of autoantibody responses to islet-cell autoantigens in early life. These studies have also tried to identify factors important for the initiation of islet autoimmunity and to estimate the risk for later development of diabetes of individuals in whom islet autoantibodies are detected. Three major studies are established. The BABYDIAB Study 121 was started in 1989 and is a multi-center study in Germany following offspring of diabetic parents from birth. In the US, the Diabetes Autoimmunity Study in the Young (DAISY) based in Denver 122 has, since 1993, followed young (< 4 years), first-degree relatives of diabetic patients, as well as children with no family history of diabetes, who were identified at birth as having high- or moderate-risk diabetes-susceptibility HLA-DQ genotypes. Thirdly, the Type 1 Diabetes Prediction and Prevention (DIPP) study follows children in...

Primary Lactase Deficiency

Congenital lactase deficiency is an extremely rare autosomal recessive disorder, described in some families in Finland. The gene for this disorder has been located on chromosome 2, in the vicinity of the lactase gene (Jarvela et al, 1998). Affected infants have diarrhea from birth, and have been reported to have hypercalcemia and nephrocalcinosis. This disorder was fatal before the development of lactose-free infant formulas. In premature infants, when born at 28 to 32 weeks gestation, lactase activity is normally low. However, most of these children (when otherwise healthy) do not have symptoms of diarrhea from lactose intolerance, because SCFAs (from bacterial fermentation of unabsorbed lactose) will be absorbed by the colonic mucosa.

Intermittent schedules of reinforcement

Attention deficit hyperactivity disorder (ADHD) was associated with increased response rates on FI performance in 7- to 12-year-old boys, as well as a bursting pattern of response produced by a run of closely spaced responses separated by a short pause 25 . This pattern was also observed in 3-year-old monkeys exposed to lead from birth (Figure 6.1) 18 . Children with ADHD also responded more in the extinction (TO) portion of the schedule, as did lead-exposed monkeys. FI performance predicted poorer performance on a test of impulsivity in normal children 26, 27 children with high response rates and shorter post-reinforcement pause times

Sensory Dysfunction Possible Contribution To Cognitive Effects

Documented higher auditory thresholds across a range of frequencies as a function of blood lead levels, including blood lead concentrations below 10 g dl 97 . Monkeys exposed to lead from birth, with blood lead concentrations of 30 g dl at the time of testing, exhibited impaired detection of pure tones at 13 years of age, with the pattern of impairment being somewhat idiosyncratic 98 . A number of elec-trophysiological studies in animals demonstrated impairment at various parts of the auditory pathway in monkeys and other animals related to lead exposure 99-103 , although electrophysiological changes have not been universally observed 104 .

In Vitro Fertilization

There are a number of different ovarian-stimulation protocols namely (1) human menopausal gonadotropin (hMG) or FSH, with or without clomiphene citrate, which was typically used in the early 1980s (2) the long, short, ultrashort, and microdose flare protocols using gonadotro-pin-releasing hormone (GnRH) agonists and hMG or FSH, which have gained widespread acceptance since the long protocol was first described in the mid-1980s and, more recently, (3) protocols using hMG or FSH followed by the addition of newer GnRH antagonists. The highest pregnancy and live-birth rates reported in all age groups and for all causes of infertility have been with the long protocol, which induces pituitary desensitization with GnRH agonist followed by ovarian stimulation with hMG or FSH and which is the most widely used protocol today (7). The results of IVF today exceed spontaneous pregnancy rates in healthy fertile couples in many IVF clinics, although the success declines quite significantly with age....

Respiratory Adaptations

It is an old misconception that a neonate must be spanked to stimulate it to breathe. During birth, CO2 accumulates in the baby's blood and strongly stimulates the respiratory chemoreceptors. Unless the infant is depressed by overse-dation of the mother, it normally begins breathing spontaneously. It requires a great effort, however, to take the first

Brachial plexus injuries

Excessive downward traction on the upper limb during birth can result in injury to the C5 and C6 roots. This results in paralysis of the deltoid, the short muscles of the shoulder, brachialis and biceps. The combined effect is that the arm hangs down by the side with the forearm pronated and the palm facing backwards. This has been termed the 'waiter's tip' position.

Conclusions and Future

The trend is now for less invasive techniques and the industry have redirected their efforts towards the development of minimally invasive approaches. This economical and technological input will give birth to new high tech instruments. New ideas arise from our daily practice and a critical and constructive spirit will contribute to reduce the morbidity linked to our still incomplete understanding of pain and disability.

Future Avenues Of Investigation

Several unresolved questions exist concerning the use of metformin in PCOS, and these may serve as future investigative directions, including (a) the efficacy of metformin in large-scale trials in increasing clinical pregnancy, live-birth rates, and its effects in multiparity (b) ovulation induction with combination therapy of metformin and gonadotropins (c) prospective studies of metformin in decreasing EPL (d) whether metformin enhances the quality of eggs retrieved for in vitro fertilization (e) whether measurable biological factor(s) exist that can be used to predict response to insulin sensitizers (f) the effects of metformin on birth defects, pre-eclampsia, and gestational diabetes in large-scale studies (g) the development of a more potent and optimal insulin-sensitizing drug for PCOS and (h) large prospective trials evaluating the chronic use of metformin in women with PCOS for long-term cardiovascular and diabetes risk reduction.

Number of Cells Biopsied

In regard to this practice, it is important to bear in mind that the potential to implant decreases with greater amount of embryonic mass removed (91, 93). However, recent studies have shown that there is no difference in pregnancy and implantation and live birth rates when two cells are biopsied compared to one (7). This ties in with data obtained by Hardy et al. (48), who showed that there was no significant difference in the ratio of TE and ICM nuclei when up to two cells were biopsied at the eight-cell stage. The decision to take one or two cells is based on the stage of development of the embryo and the type of diagnosis. In cases of dominant disorders discovered by PCR it has become essential to analyze two cells because allele dropout can cause serious misdiagnosis if diagnosis is based on one cell analysis. However, for sex-ing by FISH as well as for diagnosis of autosomal recessive disorders, one-cell diagnosis can be considered because transferring carrier...

Minimally Invasive Treatments for Leg Pain

Agents and it is not until the early 60's that electrotherapy reappeared. The publication by Wall and Merzack in 1965 of the ''Gate control theory'' of pain gave birth to the contemporary spinal cord stimulation (Melzack and Wall, 1965). The argument that electrical stimulation of large fibers would close the gate to input from the smaller diameter and unmyelinated A-delta and C fibers mediating pain was determinant to the success of SCS. Since, this hypothesis has been subject to criticism and we know now that it is not the only mechanism involve in pain control (Linderoth et al., 1999).

The Skull in Infancy and Childhood

Skull Infancy

The head of an infant could not fit through the mother's pelvic outlet at birth were it not for the fact that the bones of its skull are not yet fused. The shifting of the skull bones during birth may cause the infant to appear deformed, but the head soon assumes a more normal shape. Spaces between the unfused cranial bones are called fontanels,32 after the fact that pulsation of the infant's blood can be felt there. The bones are joined at these points only by fibrous membranes, in which intramembranous ossification will be completed later. Four of these sites are especially prominent and regular in location the anterior, posterior, sphenoid (anterolat-eral), and mastoid (posterolateral) fontanels (fig. 8.17). Most fontanels ossify by the time the infant is a year old, but the largest one the anterior fontanel can still be palpated 18 to 24 months after birth.

Evolutionary Reinforcement Learning

The components making up an individual are illustrated schematically in figure 3.6. Each agent possesses two feedforward neural networks an evaluation network that takes as input the agent's state at time t and produces on its single output unit an activation representing a judgment about how good that state is for the agent, and an action network that takes as input the agent's state at time t and produces on its two output units a code for the action the agent is to take on that time step. The only possible actions are moves from the current lattice site to one of the four neighboring sites, but actions can result in eating, being eaten, and other less radical consequences. The architectures of these two networks are common to all agents, but the weights on the links can vary between agents. The weights on a given agent's evaluation network are fixed from birth this network represents innate goals and desires inherited from the agent's ancestors (e.g., being near food is good). The...

Physical Abnormalities

Horse Cryptorchid Testis

Testicular hypoplasia or degeneration. Testicular hypoplasia or degeneration is often a secondary condition, resulting from another primary abnormality (often cryptorchidism or herniation). Both hypoplasia and degeneration are terms given to an underdeveloped and, therefore, underfunctioning organ. In general, hypoplasia is the term given to a condition present from birth. In the case of testicular hypoplasia, the testes, for some reason, have never developed beyond an immature stage, resulting in inadequate development of primitive germinal cells in the fetus along with retardation of the normal accelerated germinal cell development at puberty (Roberts, 1986a Varner and Schumacher, 1991 Varner et al., 1991b). Its causes are many, including cryptorchidism and hernias, but also malnutrition, endocrine malfunction, infections, irradiation or toxins, and it may also be an inherited condition (Roberts, 1986).

What Are Epicanthal Folds Will They Disappear As My Babys Facial Features Grow

O'Brian was by now pretty far along in another pregnancy. Very busy, hopeful that therapy would bring good improvement, she did not bring Michael to the genetics clinic. In April of 1987, she gave birth to a healthy daughter who developed normally. The following autumn, she took Michael, now 3 years old and still quite delayed, to see a geneticist. Perhaps deciding that physicians had no more to offer them, the O'Brians did not stay in touch with the specialists. In 1991 they gave birth to a second son who soon fell behind in his development. In 1993 a different physician ordered a newly available DNA test. It revealed that Michael and his younger brother had a hereditary form of mental retardation called Fragile X syndrome. Soon after learning the diagnosis, the O'Brians sued the clinical geneticist who had examined Michael. They claimed that if the geneticist had correctly diagnosed Michael, they would have learned of the high recurrence risk they faced for having a son with...

Perinatal Infection

Rubella Virus

The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...

Thyroid and Parathyroid Disorders

Endemic Goiter

Congenital hypothyroidism is thyroid hyposecretion present from birth it was formerly called cretinism, now regarded as an insensitive term. Severe or prolonged adult hypothyroidism can cause myxedema (MIX-eh-DEE-muh). Both syndromes are described in table 17.8, and both can be treated with oral thyroid hormone.

Modification of labour pain Psychological factors

There is considerable evidence that preparation for childbirth can significantly modify the degree of pain experienced. This was the basis of the 'childbirth without fear' movement, which was popular in the 1960s. Although there can be little doubt that fear, fatigue and anxiety enhance pain perception, for the majority of mothers it is misleading to suggest that good antenatal education will lead to painless childbirth. Such expectations may in fact have the reverse effect, since the mother may develop complete loss of self-confidence when she begins to experience significant labour pain. Women whose pregnancy is unplanned or unwanted are likely to experience more pain, as are those who have no birth partner to support them during labour. Conversely, the continuous presence of a midwife or female birth partner (doula) has been shown to reduce the amount of pain reported.

Perch hyperplasia virus PHV A tentative

Perinatal infections Virus infections acquired by the neonate during delivery or shortly thereafter. The placenta provides a powerful barrier that allows transit of maternal IgG to the fetus whilst preventing a large number of infective agents from reaching the embryo or the fetus. However, the neonate may be exposed to a number of harmful viruses during passage through the birth canal or from breast milk.

Mice and

Fibroblast Cells From Mammal

For a female elephant to produce two offspring which reach adulthood, she will need to give birth to at least three (taking into account infant and child mortality), and have a lifespan of nearly 30 years, which is about 40 of the maximum lifespan. On the other hand, a mouse need survive only about 12 weeks (assuming that on average only one litter is produced), which is less than 10 of the maximum lifespan of 3 years. A survey of a wide range of mammalian species demonstrates beyond question that there is an inverse relationship between maximum reproductive potential and maximum lifespan. This is illustrated in Figure 5.

Metformin Weight Loss and PCOS

The initial use of metformin in the treatment of PCOS has now been widely accepted to be a valuable and inexpensive therapeutic modality. Recent systematic reviews have indicated that metformin is highly effective in inducing ovulation and increasing pregnancy rates (8,9). The numbers needed to treat for ovulation are around four patients, and there is an improvement in serum insulin levels and a reduction in free testosterone in response to metformin. The drug appears to be safe in early pregnancy with respect to congenital abnormalities, although it is controversial whether miscarriage rates are reduced. The predictors of success of metformin have not been established, although there is some evidence that patients who are substantially overweight do not respond as well. Side effects of metformin include nausea, vomiting, diarrhea, and other forms of gastrointestinal intolerance, and patients need to be warned about the interaction between metformin and alcohol. The ovulatory...

Anaerobic Fermentation

Skeletal muscle is relatively tolerant of anaerobic fermentation, and cardiac muscle is less so. The brain employs almost no anaerobic fermentation. During birth, when the infant's blood supply is cut off, almost every organ of its body switches to anaerobic fermentation thus they do not compete with the brain for the limited supply of oxygen.

Laughing Gas Ether And Surgical Anesthesia

Laughing Gas Surgical Operation

The safety of anesthesia was not the only point of contention, as demonstrated by the ferocity of the attack on the use of anesthetics in obstetrics. Clergymen, doctors, and assorted amateur moralists argued that pain had a God-given, and therefore holy role to play in the lives of men, and especially in the lives of women. Midwives had been put to death for the blasphemous, sinful, unnatural crime of attempting to alleviate the pains of childbirth. Clergymen denounced Simpson and commanded women to endure the pains of childbirth with patience and fortitude. Did the Bible not say that Eve was condemned to bring forth children in sorrow Obstetricians warned women that labor contractions were identical to labor pains. Therefore, without pain there would be no contractions and normal delivery could not occur. Suffering was inherent in female physiology and labor pains enhanced woman's capacity for tenderness, femininity, and maternal feelings. Saddened by the controversy, Simpson met his...

Forecasting Pediatric Aids

Where jV( is the number of infected women at age i is the proportion of women at age i who give birth in the year (i.e., the age specific fertility rate) and is the probability of transmission from an infected mother to child. A number of different epidemiological studies have suggested that the transmission probability, p, is approximately one-third (Section 2.4.3).

Midwives And Medical

Parto Eucharius Lin

Of course, puerperal fever was not always an epidemic disease and childbirth did not always fall within the province of medical men. While women were almost universally excluded from the medical profession, the province of midwifery was once exclusively theirs. Until very recent times, childbirth was considered a natural, rather than a medical event. When labor began, a woman remained at home and sent for her female friends, relatives, and a midwife. This ''social childbirth'' provided a support system in which women comforted the laboring woman, shared experience and advice, provided witnesses against accusations of infanticide, and helped the new mother through the lying-in period. Throughout much of European history, religious authorities exerted considerable influence over the selection of midwives character and piety were essential criteria for obtaining approval. Midwives were forbidden to perform abortions or conceal a birth. They were expected to make the mothers of...

Ignaz Philipp Semmelweis


To protect new mothers from acquiring contagious diseases, Frank stipulated that the lying-in ward should be quite separate from the general hospital. Ideally, the lying-in ward should have three departments one where pregnant women could rest and prepare for the ordeal of childbirth the second should be dedicated to women giving birth and the third should have small rooms with only two or three beds reserved for postpartum women. Women who needed surgical intervention during childbirth should not be kept in the common labor room, Frank warned, because the sights and sounds of such ''artificial births'' would have a bad effect on women in labor. The lying-in ward did not need rooms for the sick, because postpartum women who became ill should be transferred to the general hospital. Hospital managers and physicians, however, considered such elaborate precautions unnecessary, irrational, and, most of all, too costly for a largely charitable enterprise. In the 1840s, the Vienna Hospital...

Successes of Epidemiology and Public Health

The accomplishments of epidemiology, public health, and related social changes have changed the pattern of death and disease in modern society. Infant mortality in the United States has fallen from 150 per 1,000 live births in 1900 to 8.5 per 1,000 in 1992 (Taylor et al. 1993 National Center for Health Statistics 1996a). Life expectancy from birth has risen from 47 years in 1900 to more than 75 years in 1992 (National Center for Health Statistics 1996a). This represents an increase of over 2 days of life expectancy for every week since the beginning of this century. Only about 5 of the additional 30 years gained in life expectancy can be attributed to the work of the medical care system (Bunker et al. 1994). It is likely that the majority of the gain in life expectancy can be attributed to provision of safe water and food, sewage disposal, control of infectious diseases through immunization, and other population-based, public health activities (Centers for Disease Control and...

Anterior Lobe Hormones

Prolactin10 (PRL) PRL is secreted by lactotropes (mam-motropes), which increase greatly in size and number during pregnancy. PRL level rises during pregnancy, but it has no effect until after a woman gives birth. Then, it stimulates the mammary glands to synthesize milk. In males, PRL has a gonadotropic effect that makes the testes more sensitive to LH. Thus, it indirectly enhances their secretion of testosterone.

Confounding Effect Modification Bias Confounding

A variable that is a known or suspected cause of the outcome under study (or is a surrogate for cause) and is also statistically associated with the exposure of interest is a confounding variable. Formally, a confounding variable may be defined as a variable that is causally related to the condition under study independently of the exposure of primary interest, and is associated with the exposure of primary interest in the study population, but is not a consequence of the exposure. Because of confounding (among other issues), a statistical association between an exposure and a condition does not necessarily mean that the exposure is causally related to the condition. For instance, a statistical association between coffee drinking during pregnancy and an increased likelihood of giving birth to an infant of low birth weight might occur because women who drink coffee are more likely to smoke than non-coffee drinkers. It is possible that cigarette smoking, not coffee drinking, is the...

Correlated Gamma Frailty Model

In order to adjust for year at birth, a variable for different birth periods was created. This variable was divided into three categories, 1886-1905, 1906-1915, and 1916-1925. The period between 1886 and 1905 served as the reference category. Information on dates about childbirth was obtained by means of linkage with the Swedish Multi Generation Register. This register contains information on all Swedish residents born on or after 1932 who did not die before 1961. The variable age at first birth was divided into four groups younger than 25 years (reference category), 25 up to 30 years, 30 years and older and no children. The last category also contains all women with no information about childbirth, especially all women from the older birth cohorts, who gave birth before 1932. a significant higher risk 2.016, 3.160) to breast cancer. The parameters (33,04, and 35 show the effect of age at first birth. Women giving birth at age between 25-30 show a significant increased risk (03 0.769)...

Effect of Metformin on Anovulation and Infertility 2211 Metformin Monotherapy in PCOS

Clomiphene citrate has been the initial therapeutic option for the management of anovulatory infertility for many years. Metformin was directly compared to clomiphene in a recent double-blind, placebo-controlled trial in non-obese women (average body mass index BMI 27 kg m2) with PCOS (24). After progesterone-induced withdrawal bleeds, 100 women with PCOS were randomized to metformin (850 mg twice daily) or clomiphene citrate (150 mg for 5 days on a monthly basis) for 6 months. Although there was no difference in ovulation rates between the metformin and clomiphene groups, the pregnancy rate was higher (15.1 vs 7.2 p 0.009) and spontaneous abortion rate lower (9.7 vs 37.5 p 0.045) in the metformin group. There was also a favorable trend for the live-birth rate with metformin compared to clomiphene (83.9 vs 56.3 p 0.07).

Desmoplakin Mutant Murine Model

Using the Cre-LoxP system 43 , a cardiac-restricted exon 2 deletion in DSP was created in mice by Garcia-Gras et al. 44 . These animals were engineered by crossing mice in which the second ex-on of the murine DSP gene is flanked by loxP sequence (floxed DP mice 129 SvJ strain) with mice expressing Cre recombinase under the control of the a-MHC promoter (a-MHC-Cre mice FVB N strain). Homozygous (DP- -) mutant mice had a high rate of embryonic lethality, consistent with that previously reported by Gallicano et al. 45,46 in germline DP-null mice. These homozygous mutant mouse embryos exhibited growth arrest at embryonic stage E10-E12, appeared pale, had no circulating red blood cells in organs, and were growth retarded. Histopathologic evaluation revealed poorly formed hearts with no chamber specification and unorganized cardiac myocytes. In addition, red blood cells were localized to the pericar-dial sac instead of within the cardiac chambers. Furthermore, an excess number of cells...

Neonatal Infections

The incidence of infection in the fetus and newborn infant is high. As many as 2 of fetuses are infected in utero and up to 10 of infants are infected during delivery or in the first few months of life. The predominant microorganisms known to cause these infections are cytomegalovirus, herpes simplex virus, rubella virus, Toxoplasma gondii, Treponema pallidum, Chlamydia, Group B Streptococcus, Enterococcus spp., Escherichia coli, and anaerobic bacteria. All of these agents can colonize or infect the mother and infect the fetus or newborn either intrauterinely or during the passage through the birth canal. Although anaerobic bacteria cause a small number of these infections, the conditions predisposing to anaerobic infections in newborns are similar to those associated with aerobic microorganisms. Furthermore, the true incidence of anaerobic infections may be underestimated because techniques for the recovery and isolation of anaerobic bacteria are rarely used, or are inadequate....


Pneumonia in the newborn can be classified according to the mode of acquiring the infection and the time when the infection takes place. The infection can be acquired in utero by trans-placental route or following intrauterine infection. The pneumonia could be acquired during delivery by aspiration of bacteria that colonize the birth canal. The type of infection contracted after birth is acquired by contact with environmental objects (e.g., a tracheostomy tube) or by human contact. Aspiration can occur in up to 80 of intubated premature infants (32) and is common in newborns with gastroesophageal reflux (33) or those who require general anesthesia (34), or have swallowing dysfunction (35). During vaginal delivery, the neonate is exposed to the cervical birth canal flora, which includes both aerobic and anaerobic bacteria. Almost every normal baby born by vaginal delivery swallows potentially pathogenic aerobic and anaerobic bacteria (14). These bacteria can be cultured in the infant's...


Recessive ARVC D always presents in association with hair and skin phenotype. Woolly hair is apparent from birth and palmoplantar keratoderma or similar skin defects develop during infancy or early childhood. Mutations in genes encoding the desmosomal proteins plakoglobin and desmoplakin were identified to underlie this cardiocutaneous syndrome. The heterogeneity of cardiac phenotype may be attributed to the location of the causative mutation in the desmosomal plaque. In the plako-globin mutation, functioning at the outer dense plaque of the desmosomes, the cardiac phenotype is that of the ordinary ARVC D with predominantly right ventricular involvement (Naxos disease). Mutations that truncate the intermediate filament-


Can et al. 21, 96 have addressed the issues noted by Coatrieux et al. using a stricter model for the vessels in an algorithm. Their algorithm and implementation gave birth to what is referred to as RPI-Trace in this chapter. Can et al. overcome two hard problems described by Coatrieux et al., namely, (1) robust and accurate handling of branching and crossover points and (2) improved handling of discontinuous regions by relying on local contrast and edge information (as opposed to gray values), instead of a global intensity threshold. It also overcomes the wandering and looping artifact using an improved stopping criterion. Some tracing accuracy improvement is also gained by more accurate angular discretization, more filtering across and along the vessels, and more careful handling of the discrete image space. Computationally, this algorithm is comparably attractive. The very strict rules used by this algorithm for validation and verification of initial seed points allow it to reject...

Disorders of mood

There are various types of depression, or, perhaps, it is better to say, various causes of depression, that can be distinguished. For example, depression might come primarily from an external event, such as career reversal, or from an internal event such as a neurochemical imbalance. Depression might be the main problem or might be secondary to something else, such as extreme anxiety. It might occur with advancing years or after giving birth, and some depressions seem to occur seasonally for some people (seasonal affective disorder - SAD). This is as 'real' a disorder as any other and appears to be the result of very short winter days in some of the more northerly northern hemisphere countries.

Clinical Evaluation

In the literature there is a great variation in the functional results after repair of ARM. There is no generally agreed method by which to assess the bowel function of patients with ARM, and the main problem in comparing different series is the highly variable criteria used in the evaluation of fecal continence. Evaluation of bowel function during childhood may be biased because the information concerning the functional outcome is derived mainly from the parents they may not want to report unfavorable results to a surgeon who has been responsible for the treatment of their child. The parents may also ignore minor and moderate defects in continence in a child whose bowel function has been deficient from birth or, in the case of smaller children, may consider them to be part of normal maturation of defecation. The final outcome may not be assessed until the patients have reached adulthood and, as independent individuals, can evaluate the social consequences of possibly defective bowel...


In our laboratory, increasingly longer delays were introduced over successive sessions in adult monkeys from two studies, those with steady-state blood lead levels of 11 or 13 g dl 70 and the groups in which potential sensitive periods were assessed (dosed during infancy only, beginning after infancy, or continuously from birth 71 ). In contrast to the study discussed above, the task included a correction procedure, such that if the monkey responded incorrectly on a button, a correct response on the opposite button was required before the alternation schedule resumed. Sessions consisted of 100 correct trials thus each incorrect response extended the session. All treated groups in both studies were impaired on the acquisition of this task because of indiscriminate responding on both buttons. Treated monkeys were impaired at the beginning of the experiment (short delays), unimpaired at intermediate delay values, and increasingly more impaired at the 5- and 15-sec delays. In the study...

Pcb 153

Rice (1997) examined inhibitory control in monkeys exposed from birth until 20 weeks of age to 7.5 g kg day of a PCB mixture representative of the PCBs typically found in human breast milk. The specific dosing protocol has been described earlier in this chapter, as these monkeys were previously tested on reversal learning and DSA (Rice and Hayward, 1997). When the monkeys were 4 years old, performance under a multiple FI-fixed ratio (FR) schedule of reinforcement was assessed across 48 sessions. The FI was 6 min for all sessions. The FR schedule required a fixed number of responses in order to receive the reinforcer and was increased sequentially from FR 2 to FR 10 by session 16. The active schedule was indicated by illumination of a different color on the response button (FI white, FR yellow). PCB exposure resulted in impaired performance on the FI schedule the FR component was not substantially affected. The PCB-exposed monkeys had shorter mean interresponse times (IRTs) than the...

Piaget and cognition

In this first stage, the infant is dealing practically and overtly with the physical and social world. During this period (roughly from birth until 2 years) the child will learn, for example, that objects do not disappear when a screen is put in front of them. So, if a marble rolls under the fridge, it remains under the fridge. If the child's father seems suddenly to have disappeared behind a newspaper, then he has not disappeared altogether. In other words, they learn the principle of object permanence which is one of the many practical ways in which they learn that the world is orderly. The stage ends with the development of symbolic thought.


The effects of lead on sustained attention in children were explored in a number of studies using reaction time tasks, either on a simple reaction time task, in which the subject is asked to respond as quickly as possible to a single stimulus, or on a vigilance task, in which the subject is required to respond to a target stimulus and refrain from responding to others. Stimuli are presented at variable intervals, and the task is sufficiently long to require sustained attention. Increased reaction times were observed in groups of children with blood lead concentrations of 17, 24, or 35 g dl compared with those with average lead levels of 7.4 g dl 42, 83 , as well as at higher blood lead concentrations 84 , with the greatest impairment occurring at a 12-sec compared with a 3-sec delay, and at the end of the task compared with the beginning. Increased reaction time compared with controls was also observed on a simple reaction time task in a group of 20-year-olds with a history of lead...

Vitamin A

Individuals with HIV and patients with AIDS present a variety of pathologic alterations that influence their nutritional status during various stages of the disease. Some studies have revealed a greater level of malnutrition and an elevated excretion of vitamin A in the urine of AIDS patients. Secretion of vitamin A in urine has been associated with infection, fever, and acute diarrhea. Therefore, the monitoring of nutritional status, especially in relation to vitamin A is recommended for patients with HIV and AIDS. Studies show that around 10-40 of HIV-positive women will give birth to children who are also infected. However, the risk factors for transmission from mother to child are not well understood and the effects of maternal nutritional status on fetal transmission are unknown.Vitamin A is an essential micronutrient for normal immune function. Vitamin A deficiency is common among HIV-infected pregnant women and is associated with higher mother-to-child transmission ofHIV-1 and...

People or Property

The first case to confront the uncertain legal status of human embryos arose in the early 1980s when a wealthy Los Angeles couple, Mario and Elsa Rios, died in a plane crash in Chile. In 1981 they had traveled to the Queen Victoria Medical Center in Melbourne, Australia to undergo IVF. Doctors had implanted one embryo and frozen two. When the couple died a year later, the clinic realized that the Rioses had never indicated their wishes concerning disposition of unused embryos, that it had no policy on the subject, and that the law of Australia could provide little guidance. Mr. and Mrs. Rios had no heirs and had left no will. Thus, their frozen legacy raised a number of perplexing issues. What is the legal status of a frozen embryo If a now-dead couple made no provision for an embryo, does the state have a right to donate it to another couple or destroy it Should next of kin control the fate of the embryo Should the clinic If the clinic donated the two embryos to an infertile couple,...


The presence of polycystic ovaries and or PCOS is important for determining the results of treatment with IVF because a longer time is required for pituitary suppression and there is higher sensitivity to gonadotropins during ovarian stimulation and a higher risk of OHSS. However, clinical pregnancy rates and live-birth rates after IVF treatment are generally higher in women with polycys-tic ovary PCOS compared with women with morphologically normal ovaries. IVM is an alternative treatment option that avoids the risks of ovarian stimulation in this group. In some centers, IVM outcomes are comparable to overall IVF outcomes.

Teenage Pregnancy

To put this in context, throughout most of Western Europe teenage birth rates have fallen rapidly since the 1970s, while in the United Kingdom the rates have remained at the 1980s level or above. In 2001 the United Kingdom had the highest rate of live births to teenage girls in the European Union, with an average of 29 live births per 1000 girls aged 15-19. This was nearly 44 per cent higher than Portugal, the country with the next highest rate. Sweden and Italy had the lowest rates, at around 7 live births per 1000 girls aged 15-19 (Social Trends 33,2003).

Lacrimal Gland

Near the anterior margin of the eye lids there are two or three rows of cilia - the eyelashes (Fig. 1.2). In the middle of the lid is the cross-striated orbicularis oculi muscle. The fiber bundles of its palpebral part overlap one another like tiles on a roof. Orbicularis action is triggered by the facial nerve leading to time-shifted lid closure from temporally to nasally and at the same time moving the tears to the medial cantal region and lacrimal lake (Fig. 1.3). The tendon of the cross-striated levator palpebral muscle is inserted into anterior one-third of the tarsus with extension to the skin layer to help define the eyelid crease. The smooth tarsalis muscle originates and lies on the posterior surface of the levator muscle and inserts into the superior tarsal margin. The tone of the latter muscle is determined by autonomic nervous supply, and responds to neosynephrine stimulation. This contributes to the elevation of the upper eyelid. Its action is specifically demonstrated...

Mosaic Trisomy

Goldenhar Syndrome

Sucking blisters (sucking calluses) on the lips are present in the newborn infant. From birth, the lips show a sharp line of demarcation where the skin meets the mucosa. The mucosa is slightly elevated, moist, glistening deep red or purple and ends abruptly with the skin which forms one-third of the visible lip. The term sucking calluses is a misnomer because they are not callosities due to pressure or friction. They have been seen at their most florid in infants who have never sucked (for example those with congenital heart disease). Efficient sucking requires a complete seal of the lips around the nipple, hence the development of these calluses.

Myopathy or myositis

Zidovudine has been shown to reduce perinatal transmission. However, many women who are HIV-positive have reservations about taking the drug. Concerns revolve around fear of toxic effects on the mother, fear of toxic effects on the baby, fear of drug resistance, the belief that healthy women don't need zidovudine, and having given birth to a healthy baby without using zidovudine. Clearly, additional educational interventions are needed to increase the use of zidovudine during pregnancy to reduce perinatal transmission (58).


In a subsequent study on possible sensitive periods for deleterious effects produced by lead, monkeys were exposed to lead either continuously from birth, during infancy only, or beginning after infancy 51 . Lead levels were about 30 to 35 g dl when monkeys were exposed to lead and given access to infant formula, and 19 to 22 g dl when monkeys were dosed with lead after withdrawal of infant formula. These monkeys were tested as juveniles on the same nonspatial discrimination reversal tasks described above. Both the group dosed continuously from birth and the group dosed beginning after infancy were impaired over the course of the reversals in a way similar to that observed in the study discussed above, including increased distractibility by irrelevant cues. The higher exposure levels in this study were reflected in impairment on all three tasks, whereas in the previous study lead-treated monkeys were impaired on only the first two tasks. The group exposed only during infancy was...

Which dog would fly

It was actually surprising that Kudryavka was chosen for this important flight, which would ultimately make her the most famous dog in history, as she was not considered the most qualified of the satellite dogs. Kudryavka was known for her calm disposition, and she had also scored high marks in training by quickly adjusting to extreme conditions. But, according to Vladimir Yazdovskiy, Albina was the best candidate for the flight 10 . However, Albina missed her chance at fame for several reasons. For starters, she had already flown twice before, and so it was reasoned that she had done her part for science. Second, she had recently given birth to a litter of puppies and it would not be right to take her from them. And, perhaps the reason that carried the most weight - she was everyone's favourite, and they did not want to sacrifice her on this one-way mission.

In Vitro Maturation

Transvaginal Oocyte Recovery

The recovery of immature oocytes (Fig. 4) followed by IVM and IVF is an attractive alternative to conventional IVF treatment in which controlled ovarian stimulation with gonadotropins is used to increase the number of available oocytes and embryos (41). Significant progress has been made in improving implantation and pregnancy rates from in vitro matured oocytes (Fig. 4). The high numbers of antral follicles in patients with polycystic ovaries or PCOS make them prime candidates for IVM treatment, even if the appearance of polycystic ovaries in the scan is not associated with an ovulation disorder. Indeed, the main determinant of clinical success rates of IVM treatment is antral follicle count (42). When hCG priming is used before oocyte retrieval, it has been found that immature oocytes retrieved from normal ovaries, polycystic ovaries, or women with PCOS have a similarly high maturation, fertilization, and cleavage potential (43). However, although the implantation rate was lower,...

The Medical Papyri

Although midwives were probably the main childbirth attendants, physicians were acquainted with various gynecological conditions, including prolapse of the uterus, cancer, leucorrhoea, dysmenorrhea, amenorrhea, and menopause. Because the uterus was thought to be a mobile organ that could cause mischief by wandering about the body, doctors prescribed special fumigants to lure it back to its proper position. Complex and noxious mixtures were recommended for wandering uterus, abnormal delivery, and miscarriage. Such remedies were said to warm the breasts, cool the womb, regulate menstruation, and increase milk production. Generally, these medicines were taken as fumigants, douches, or suppositories, but in some cases, the woman simply sat on the remedy. Fertility tests were based on the assumption that in fertile women free passages existed between the genital tract and the rest of the body. Therefore, when the woman sat on a test substance, such as date flour mixed with beer, vomiting...

KAIT Case Study

M. reported that Jeff's prenatal and birth history were unremarkable. She had a normal, full-term pregnancy, and gave birth to Jeff through a normal delivery. Jeff weighed 7 pounds, 3 ounces at birth and was 20 inches long. According to his mother, Jeff's medical history includes having tubes placed in his ears at age 3, due to repeated ear infections. He also had chicken pox at age 5, and is currently affected mildly by hay fever. No other major illnesses or injuries were reported. His parents indicated that he has a physical exam annually for his participation in school athletics.

Pregnancy And Childbirth

Pregnancy And Childbirth

If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?

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