Posts Tagged ‘birth’

By Laura Kurtzman

Scientists at UC San Francisco have developed a test to predict a woman’s risk of preterm birth when she is between 15 and 20 weeks pregnant, which may enable doctors to treat them early and thereby prevent severe complications later in the pregnancy.

Preterm birth is the leading cause of death for children under five in the United States, and rates are increasing both in the U.S. and around the world. It is often associated with inflammation and has many potential causes, including an acute infection in the mother, exposure to environmental toxins, or chronic conditions like hypertension and diabetes.

The new test screens for 25 biomarkers of inflammation and immune system activation, as well as for levels of proteins that are important for placenta development. Combined with information on other risk factors, such as the mother’s age and income, the test can predict whether a woman is at risk for preterm birth with more than 80 percent accuracy. In the highest risk pregnancies—preterm births occurring before 32 weeks or in women with preeclampsia, a potentially fatal pregnancy complication marked by high blood pressure in the mother—the test predicted nearly 90 percent of cases.

In the study, published Thursday, May 24, 2018, in the Journal of Perinatology, the researchers built a comprehensive test that would capture both spontaneous preterm births, which occurs when the amniotic sac breaks or contractions begin spontaneously, and “indicated” preterm birth, in which a physician induces labor or performs a cesarean section because the health of the mother or baby is in jeopardy. The researchers also wanted to be able to identify risk for preeclampsia, which is not included in current tests for preterm birth.

“There are multifactorial causes of preterm birth, and that’s why we felt like we needed to build a model that took into account multiple biological pathways,” said first author Laura Jelliffe-Pawlowski, PhD, director of Precision Health and Discovery with the UCSF California Preterm Birth Initiative and associate professor of epidemiology and biostatistics at UCSF. “The model works especially well for early preterm births and preeclampsia, which suggests that we’re effectively capturing severe types of preterm birth.”

The researchers developed the screen using blood samples taken from 400 women as part of routine prenatal care during the second trimester, comparing women who went on to give birth before 32 weeks, between 32 and 36 weeks, and after 38 weeks (full-term). The researchers first tested the samples for more than 60 different immune and growth factors, ultimately narrowing the test down to 25 factors that together could help predict risk for preterm birth. When other data, including whether or not the mother was over 34 years old or if she qualified as low income (indicated by Medicaid eligibility), improved the accuracy of the test by an additional 6 percent.

Researchers said the test could help prevent some cases of preterm birth. Based on a woman’s probability of preterm birth derived by the test, she could discuss with her clinician how best to follow-up and try to lower her risk. Some cases of preterm birth, including those caused by preeclampsia, can be prevented or delayed by taking aspirin, but treatment is most helpful if started before 16 weeks. Physicians could also evaluate high-risk women for underlying infections that may have gone undetected but could be treated. For others, close monitoring by their doctor could help flag early signs of labor like cervical shortening that can be staved off with progesterone treatment.

“We hope that this test could lead to more education and counseling of women about their level of risk so that they know about preterm birth and know what preeclampsia or early signs of labor look like,” said Jelliffe-Pawlowski. “If we can get women to the hospital as soon as possible, even if they’ve gone into labor, we can use medications to stave off contractions. This might give her some additional days before she delivers, which can be really important for the baby.”

A test for preterm birth is currently available, but it is expensive and only screens for spontaneous preterm birth, not for signs that could lead to indicated preterm births or for preeclampsia. Jelliffe-Pawlowski said that the new screen would likely be a fraction of the cost, making it more accessible to women who need it the most.

“One of the reasons we’re most excited about this test is that we see some potential for it addressing preterm birth in those most at risk, including low-income women, women of color, and women living in low-income countries,” she said. “We want to make sure that we’re developing something that has the potential to help all women, including those most in need.”

Other authors on the study were Larry Rand, Scott Oltman, and Mary Norton of UCSF; Bruce Bedell, Jeffrey Murray, and Kelli Ryckman of the University of Iowa; Rebecca Baer of UC San Diego; and Gary Shaw and David Stevenson of Stanford University.

https://www.ucsf.edu/news/2018/05/410456/risk-preterm-birth-reliably-predicted-new-test?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+ucsf_press_releases+%28UCSF+Press+Releases%29


Female burial from near Bologna Italy (c. 7th c AD)

by Kristina Killgrove

An early Medieval grave near Bologna, Italy, was revealed to contain an injured pregnant woman with a fetus between her legs. Based on the positioning of the tiny bones, researchers concluded this was a coffin birth, when a baby is forcibly expelled from its mother’s body after her death. The pregnancy and the woman’s head trauma may also be related.

The burial, dating to the 7th-8th century AD, was found in the town of Imola in northern Italy in 2010. Because the adult skeleton was found face-up and intact, archaeologists determined it to be a purposeful burial in a stone-lined grave. The fetal remains between her legs and the injury to her head, however, triggered an in-depth investigation, which was recently published in the journal World Neurosurgery by researchers at the Universities of Ferrara and Bologna.

Based on the length of the upper thigh bone, the fetus was estimated to be about 38 weeks’ gestation. The baby’s head and upper body were below the pelvic cavity, while the leg bones were almost certainly still inside it. This means it was positioned like a near-term fetus: head down in preparation for birth. But it also means that the fetus was likely partially delivered.

Although rare in the contemporary forensic-medical literature and even more so in the bioarchaeological record, this appears to be a case of post-mortem fetal extrusion or coffin birth. Bioarchaeologist Siân Halcrow of the University of Otago explains that, in the case of the death of a pregnant woman, sometimes the gas that is created during normal decomposition builds up to such an extent that the fetus is forcibly expelled.

The actual mechanism of coffin birth is somewhat less understood, however. “The cervix shouldn’t relax with death after rigor mortis disappears,” Dr. Jen Gunter, a San Francisco Bay area OB/GYN, says. “I suspect that what happens is the pressure from the gas builds up, and the dead fetus is delivered through a rupture – it basically blows a hole through the uterus into the vagina, as the vagina is much thinner than the cervix.”

This example of coffin birth is interesting from an archaeological standpoint, but the state of the mother’s health makes it completely unique: she had a small cut mark on her forehead and a 5 mm circular hole next to it. Taken together, these are suggestive of trepanation, an ancient form of skull surgery. Not only was the pregnant woman trepanned, but she also lived for at least a week following the primitive surgery.

In the World Neurosurgery article, the Italian researchers proposed a correlation between the mother’s surgery and her pregnancy: eclampsia. “Because trepanation was once often used in the treatment of hypertension to reduce blood pressure in the skull,” they write, “we theorized that this lesion could be associated with the treatment of a hypertensive pregnancy disorder.”

Eclampsia is the onset of seizures in a pregnant woman with preeclampsia (high blood pressure related to pregnancy) and, particularly in the time periods prior to modern medicine, was likely a common cause of maternal death. A pregnant woman suffering in early Medieval times from high fevers, convulsions, and headaches may very well have been recommended trepanation as a cure.

“Given the features of the wound and the late-stage pregnancy,” the authors note, “our hypothesis is that the pregnant woman incurred preeclampsia or eclampsia, and she was treated with a frontal trepanation to relieve the intracranial pressure.”

If the researchers’ conclusions are correct, the mother’s condition was not cured by the cranial surgery and she was buried, still pregnant, in a stone-lined grave. As her body decomposed, her deceased fetus was partially extruded in a coffin birth. Halcrow, however, cautions that this may not be the best explanation. “In this instance,” she says, “the woman could just as likely have died as the result of normal complications from childbirth.”

Whether or not the trepanation and pregnancy are linked, Halcrow does note that “it is pleasing to see a study that is focused on maternal and infant mortality and health in the past, because this subject is often overlooked.” The unique case of the demise of a pregnant woman soon after invasive skull surgery is unparalleled in the archaeological record and therefore important for our understanding of ancient health and disease.

https://www.forbes.com/sites/kristinakillgrove/2018/03/23/pregnant-medieval-woman-gave-birth-in-grave/#17697bc81663

Moments before her planned cesarean delivery last year Gerri Wolfe scrubbed up and donned surgical gloves.

She took her place on the surgical table and her doctors delivered an anesthetic into her spine.

When her surgeon gave her the signal, she reached down and helped deliver her own twin babies. Seconds after they entered the world, she was holding them close to her chest.

In a maternal-assisted cesarean, Mom doesn’t have to miss out on a thing.

Wolfe’s experience wasn’t an isolated case.

Other mothers in Australia have also participated in their cesarean deliveries.

In fact, the Western Australia Department of Health provides guidelines for mother-assisted elective cesarean.

Dr. David Garfinkel, OB-GYN, is an attending physician at Morristown Medical Center in Morristown, New Jersey, and senior partner at One to One FemaleCare. Healthline asked if he has had requests for mother-assisted cesarean delivery.

“I have not been asked to do that, but I would be open to it so long as I could ensure a safe and sterile environment,” he said. “There is a special system (drapes and sterile gloves for the mother) that can help facilitate that request. Safety is number one in providing care for the mother and the newborn.”

In the first half of the 20th century, control over how women gave birth went from mothers and midwives to doctors and hospitals.

By the 1960s, there was a growing movement to turn that around again. Moms wanted to be awake and alert. They also wanted fathers and partners to be able to share the experience.

Today, mothers-to-be work with their doctors, midwives, and support systems to create a personalized childbirth experience.

When you’re planning for a cesarean delivery, it’s an entirely different story.

While some cesarean deliveries are emergencies, many are planned ahead of time. Among the reasons for this are multiple births, large babies, or maternal health conditions that complicate labor and delivery.

In the United States, the cesarean delivery rate is slightly more than 32 percent of all births, according to the Centers for Disease Control and Prevention (CDC).

It’s a common procedure, but that doesn’t make it a minor one. A planned cesarean delivery is generally performed using an epidural so the mother can stay awake but not feel the pain of surgery.

A small curtain prevents the mother from seeing her own abdomen get cut open. It also prevents her from seeing her newborn enter the world.

Some mothers and doctors want to change that.

Mother-assisted cesarean delivery may not be all the rage in the United States, but there is a movement toward friendlier cesarean birth.

“A gentle C-section is a change in the attitudes toward C-sections,” said Garfinkel. “It’s where the care team (the OB, anesthesiologists, and nurse) aims to make the C-section experience in the operating room as similar as possible to the labor and delivery room.”

Garfinkel explained that with a gentle C-section, there are no drapes to block the woman’s view.

“While the patient may not be pushing, a patient can see the baby entering into the world for the first time. Unlike a traditional C-section, where the baby and partner are taken out of the room, a gentle C-section allows the family to stay together in one room, with the baby being cared for in the same room as the mother,” he said.

How women give birth has been evolving for decades. Now some are assisting in their own cesarean deliveries.

women watching c-sections
Moments before her planned cesarean delivery last year Gerri Wolfe scrubbed up and donned surgical gloves.

She took her place on the surgical table and her doctors delivered an anesthetic into her spine.

When her surgeon gave her the signal, she reached down and helped deliver her own twin babies. Seconds after they entered the world, she was holding them close to her chest.

In a maternal-assisted cesarean, Mom doesn’t have to miss out on a thing.

I have not been asked to do that, but I would be open to it so long as I could ensure a safe and sterile environment.
Dr. David Garfinkel, Morristown Medical Center
Wolfe’s experience wasn’t an isolated case.

Other mothers in Australia have also participated in their cesarean deliveries.

In fact, the Western Australia Department of Health provides guidelines for mother-assisted elective cesarean.

Dr. David Garfinkel, OB-GYN, is an attending physician at Morristown Medical Center in Morristown, New Jersey, and senior partner at One to One FemaleCare. Healthline asked if he has had requests for mother-assisted cesarean delivery.

“I have not been asked to do that, but I would be open to it so long as I could ensure a safe and sterile environment,” he said. “There is a special system (drapes and sterile gloves for the mother) that can help facilitate that request. Safety is number one in providing care for the mother and the newborn.”

Read More: Cesarean Rates Starting to Drop in the United States »

Changing Attitudes About Childbirth
In the first half of the 20th century, control over how women gave birth went from mothers and midwives to doctors and hospitals.

By the 1960s, there was a growing movement to turn that around again. Moms wanted to be awake and alert. They also wanted fathers and partners to be able to share the experience.

Today, mothers-to-be work with their doctors, midwives, and support systems to create a personalized childbirth experience.

When you’re planning for a cesarean delivery, it’s an entirely different story.

women watching c-sections
While some cesarean deliveries are emergencies, many are planned ahead of time. Among the reasons for this are multiple births, large babies, or maternal health conditions that complicate labor and delivery.

In the United States, the cesarean delivery rate is slightly more than 32 percent of all births, according to the Centers for Disease Control and Prevention (CDC).

It’s a common procedure, but that doesn’t make it a minor one. A planned cesarean delivery is generally performed using an epidural so the mother can stay awake but not feel the pain of surgery.

A small curtain prevents the mother from seeing her own abdomen get cut open. It also prevents her from seeing her newborn enter the world.

Some mothers and doctors want to change that.

Read More: A Mother’s Journey Through Chemotherapy and Pregnancy »

The ‘Gentle C-Section’
Mother-assisted cesarean delivery may not be all the rage in the United States, but there is a movement toward friendlier cesarean birth.

“A gentle C-section is a change in the attitudes toward C-sections,” said Garfinkel. “It’s where the care team (the OB, anesthesiologists, and nurse) aims to make the C-section experience in the operating room as similar as possible to the labor and delivery room.”

Garfinkel explained that with a gentle C-section, there are no drapes to block the woman’s view.

“While the patient may not be pushing, a patient can see the baby entering into the world for the first time. Unlike a traditional C-section, where the baby and partner are taken out of the room, a gentle C-section allows the family to stay together in one room, with the baby being cared for in the same room as the mother,” he said.

The gentle C-section allows immediate skin-to-skin contact or breastfeeding.

More patients at his facility are asking about them, said Garfinkel. He believes gentle C-sections are the future.

Besides the mother, this type of cesarean delivery benefits the father or partner and allows family bonding time.

The experience may feel gentler, but Garfinkel makes it clear that it’s still major surgery.

“As a physician, I am not being more gentle as I do the surgery,” he said.

He performs gentle C-sections, but Garfinkel has no interest in increasing the rate of cesarean births unnecessarily. He and his practice promote vaginal births whenever possible.

But if a cesarean delivery is called for, he wants his patients to have the option of a gentler, more emotional experience.

“A gentle C-section allows a woman to be almost as involved as if her birth was happening vaginally,” he said. “I believe all women should be given the opportunity to be as much a part of their births as they want.”

For those who are interested in pursuing a gentle C-section, Garfinkel recommends interviewing providers and asking about their attitudes toward these types of deliveries well in advance of the due date.

http://www.healthline.com/health-news/women-who-want-to-watch-their-c-sections#5