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Third Trimester (third + trimester)
Selected AbstractsScreening Strategies for Group B Streptococcus in the Third Trimester of PregnancyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2002APRN-BC, FAANP, Lorna Schumann PhD Purpose To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review. Data Sources Selected research articles, texts, and Internet sources. Conclusions Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached. Implications for Practice Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life-long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture-based or risk factor-based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease. [source] MR imaging methods for assessing fetal brain developmentDEVELOPMENTAL NEUROBIOLOGY, Issue 6 2008Mary Rutherford Abstract Fetal magnetic resonance imaging provides an ideal tool for investigating growth and development of the brain in vivo. Current imaging methods have been hampered by fetal motion but recent advances in image acquisition can produce high signal to noise, high resolution 3-dimensional datasets suitable for objective quantification by state of the art post acquisition computer programs. Continuing development of imaging techniques will allow a unique insight into the developing brain, more specifically process of cell migration, axonal pathway formation, and cortical maturation. Accurate quantification of these developmental processes in the normal fetus will allow us to identify subtle deviations from normal during the second and third trimester of pregnancy either in the compromised fetus or in infants born prematurely. © 2008 Wiley Periodicals, Inc. Develop Neurobiol, 2008 [source] Fetal cyclic motor activity in diabetic pregnancies: Sensitivity to maternal blood glucoseDEVELOPMENTAL PSYCHOBIOLOGY, Issue 1 2003Steven S. Robertson Abstract Spontaneous fetal movement in the last third of human gestation is dominated by irregular oscillations on a scale of minutes (cyclic motility, CM). The core properties of these oscillations are stable during the third trimester of gestation in normal fetuses, but disrupted by poorly controlled maternal diabetes. Here we investigated whether fetal CM is linked to short-term instabilities in maternal glucose metabolism. The fetuses of 40 mothers with type I (n,=,28) or gestational (n,=,12) diabetes were studied one to six times between 27 and 40 postmenstrual weeks of gestation. Fetal movement and maternal blood glucose concentration were measured during two separate periods of fetal activity in each session. Fetal CM was quantified with spectral analysis. Early in the third trimester, changes in the rate of oscillation in fetal CM between the two periods of activity were inversely related to changes in maternal blood glucose levels. Fetal CM was unrelated to concurrent maternal blood glucose levels at any point in the third trimester. The pattern of results suggests that disruption of the temporal organization of spontaneous fetal motor activity in pregnancies complicated by maternal diabetes represents an acute response to fluctuations in the metabolic environment rather than an alteration of CM development. © 2003 Wiley Periodicals, Inc. Dev Psychobiol 42: 9,16, 2003. [source] Lopinavir protein binding in HIV-1-infected pregnant womenHIV MEDICINE, Issue 4 2010FT Aweeka Background Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and ,-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ,1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy. [source] Pregnancy, but not the allergic status, influences spontaneous and induced interleukin-1, (IL-1,), IL-6, IL-10 and IL-12 responsesIMMUNOLOGY, Issue 1 2006Petra Amoudruz Summary In this study, we investigated how pregnancy influences cytokine production in response to stimulation of the innate and the adaptive immune system, respectively. Peripheral blood mononuclear cells (PBMCs) from allergic (n = 44) and non-allergic (n = 36) women were collected at three time-points: during the third trimester, at delivery and at a non-pregnant state 2 years after delivery. The production of interleukin-1, (IL-1,), IL-6, IL-10 and IL-12 was measured by enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunospot assay (ELISPOT). The spontaneous cytokine production, and the response following stimulation with agents that primarily activate the adaptive part of the immune system [phytohaemagglutinin (PHA), allergen extracts from cat and birch], or lipopolysaccharide (LPS) that activate innate immunity was measured in vitro. There was a significantly higher spontaneous in vitro production of IL-1,, IL-6 and IL-10 by PBMCs during pregnancy than 2 years after pregnancy, and this was not affected by the allergic status of the women. Conversely, in PHA-stimulated cell cultures there was a lower production of IL-10 and IL-12 during pregnancy than 2 years after pregnancy. LPS-induced IL-6 levels were significantly lower in PBMCs obtained during pregnancy than at 2 years after pregnancy. In addition, we made the interesting observation that in allergic women total immunoglobulin E (IgE) levels were significantly lower 2 years after pregnancy compared to the levels during pregnancy. Taken together, our results indicate that while atopic allergy in women does not have a substantial effect on cytokine production, pregnancy has an obvious effect on the immune system in terms of cytokine production as well as on the total IgE levels. [source] Prenatal Maternal Anxiety and Depression Predict Negative Behavioral Reactivity in InfancyINFANCY, Issue 3 2004Elysia Poggi Davis The effects of maternal antenatal and postnatal anxiety and depression on infant negative behavioral reactivity were examined in a sample of 22 mother-infant pairs. Maternal anxiety and depression were assessed by standardized measures during the third trimester of pregnancy and postpartum. Infant negative behavioral responses to novelty were assessed using a previously validated measure at 4 months of age. Maternal anxiety and depression during the prenatal, but not the postnatal period, were related to infant negative behavioral reactivity to novelty. These data illustrate that prenatal maternal psychological state can exert persisting influences on human infant behavior. [source] Understanding the "ghosts in the nursery" of pregnant women experiencing domestic violence: Prenatal maternal representations and histories of childhood maltreatment,INFANT MENTAL HEALTH JOURNAL, Issue 4 2010Johanna C. Malone Selma Fraiberg and colleagues (1975) conceptualized the "ghosts in the nursery" as experiences from a mother's past that influenced her ability to form a warm and attuned relationship with her child. Contemporary infant mental health interventions often ask the mother to reflect on her own history of attachment relationships to gain insight into as well as to strengthen her developing relationship with her child. This study investigated the association between a mother's history of childhood maltreatment (CM) and her subsequent prenatal maternal representation during the third trimester of pregnancy. Controlling for domestic violence (DV), distorted prenatal representations were associated with higher rates of self-reported childhood physical neglect. In addition, DV moderated the relationship between representations and CM, such that women who were exposed to DV during pregnancy and had distorted prenatal representations were least likely to report childhood physical and sexual abuse. Implications are discussed in relation to infant mental health interventions which rely on a parent's ability to psychologically access and reflect on childhood histories to more sensitively parent her own child. Selma Fraiberg y colegas (1975) definió el concepto de "fantasmas en el cuarto de los niños" como experiencias del pasado de las madres que ejercen influencia en la habilidad de ella para formarse una cálida y afinada relación con su infante. A menudo, las intervenciones contemporáneas de la salud mental infantil les piden a las madres que reflexionen sobre su propia historia de relaciones afectivas con el fin de lograr un mejor conocimiento y al mismo tiempo hacer más fuerte la relación que están desarrollando con sus hijos. Este estudio investigó la asociación entre la historia de una madre que tuvo una niñez llena de maltratos (CM) y su subsiguiente representación maternal prenatal durante el tercer trimestre del embarazo. Considerando por medio del experimento de control la variable de la violencia doméstica, (DV), las representaciones prenatales distorsionadas se asociaron con puntajes más altos de la auto-reportada negligencia física en la niñez. Es más, la violencia doméstica (DV) sirvió para moderar la relación entre las representaciones y el maltrato en la niñez (CM), a tal punto de que las mujeres que habían estado expuestas a la violencia doméstica (DV) durante el embarazo y tenían representaciones prenatales distorsionadas fueron las menos propensas a reportar el abuso físico y sexual en la niñez. Se discuten las implicaciones en relación con las intervenciones de la salud mental infantil que dependen de la habilidad de la madre de acceder a y reflexionar sobre sus historias de la niñez, sicológicamente, con el fin de criar a su propio infante con una mayor sensibilidad. Selma Fraiberg et collègues (1975) conceptualisa les "fantômes dans la crèche" en tant qu'expériences d'un passé de la mère qui ont influencé sa capacité à former une relation chaleureuse et sensible avec son enfant. Les interventions contemporaines de santé mentale du nourrisson demandent souvent à la mère de faire un effort de réflexion sur sa propre histoire de relations d'attachement afin d'arriver à mieux connaître sa relation qui se développe avec son enfant, et aussi de la renforcer. Cette étude s'est penchée sur l'association entre l'histoire de maltraitance durant l'enfance de la mère (abrégé CM en anglais) et sa représentation maternelle prénatale ultérieure durant le troisième trimestre de la grossesse. Avec un contrôle pour la violence conjugale (abrégée DV en anglais), les représentations prénatales déformées étaient liées à des taux plus élevés de négligence physique durant l'enfance auto-rapportées. De plus, la violence conjugale (DV) modérait la relation entre les représentations et la maltraitance durant l'enfance (CM), d'une telle manière que les femmes qui ont été exposées à la violence conjugale (DV) durant la grossesse et qui faisaient preuve de représentations prénatales déformées étaient les moins à même de signaler une maltraitance physique et des abus sexuels. Les implications sont discutées en relation aux interventions de santé mentale du nourrisson qui reposent que la capacité d'un parent à accéder psychologiquement aux histoires de son enfance et à y réfléchir de fa,on à élever son propre enfant de plus sensiblement. Selma Fraiberg und Kollegen (1975) konzeptualisiert die "Gespenster im Kinderzimmer", als Erfahrungen aus der Vergangenheit der Mutter, die ihre Fähigkeit, eine warme und angemessene Beziehung zu ihrem Kind aufzubauen. Zeitgemäße Interventionen der seelische Gesundheit von Kleinkindern fragen Mütter oft nach ihrer eigenen Geschichte von Bindungsbeziehungen, um einen Einblick zu bekommen, damit die sich entwickelnde Beziehung zu ihrem Kind gestärkt werden kann. Die vorliegende Studie untersuchte den Zusammenhang zwischen mütterlichen Misshandlungserfahrungen (CM) und deren späteren Schilderungen im dritten Trimenon ihrer eigenen Schwangerschaft. Maßgeblich für häusliche Gewalt (DV) war eine verzerrte Darstellung, die mit einer höheren Rate von selbst berichteter körperlicher Verwahrlosung assoziiert war. Darüber hinaus beeinflusste DV die Beziehung zwischen den Vorstellungen und den CM, so dass Frauen, die während der Schwangerschaft DV ausgesetzt waren, und verzerrten Darstellungen hatten mit großer Wahrscheinlichkeit von körperlichen und sexuellen Missbrauch berichteten. Die Auswirkungen werden in Bezug auf Interventionen der psychischen Gesundheit von Kindern diskutiert, die die elterliche Fähigkeit, psychologische Zusammenhänge zu verstehen und darüber hinaus zu Reflexion über die eigenen Kindheitsgeschichten anregen, damit die Eltern sensibler auf ihr eigenes Kind reagieren können. [source] The effect of different soothing interventions on infant crying and on parent,infant interactionINFANT MENTAL HEALTH JOURNAL, Issue 3 2002M. Ruth Elliott Professor Emeritus Conducted in the home environment, this study examines the effects of three complementary soothing techniques on the duration of infant crying and on caregiver,infant interaction. In one group, the caregivers apply massage; in another, they provide supplemental carrying to their infants, and in the last, the caregivers both massage and provide supplemental carrying. Measurements, for the one control and three treatment groups took place prenatally (third trimester) and in the first 16 weeks postpartum for parental perception of infant temperament, parental sense of competence, parent,infant interaction, and the duration of infant crying. Whereas analyses indicate no statistically significant differences between groups in reducing infant crying, results approached significance (p , .06) in favor of the combined supplemental carrying/massage group. These results challenge accepted beliefs that tactile stimulation and/or supplemental carrying enhance parental sense of competence, positive parental perceptions, and interactions with infants. Practitioners can apply these conclusions when counselling parents on the advisability of selecting any one complementary soothing technique. ©2002 Michigan Association for Infant Mental Health. [source] Roman Period fetal skeletons from the East Cemetery (Kellis 2) of Kellis, EgyptINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 5 2005M. W. Tocheri Abstract Much can be learned about the religious ideology and mortuary patterns as well as the demographic and health profiles of a population from archaeological human fetal skeletons. Fetal skeletons are rare, however, largely due to poor preservation and recovery, misidentification, or non-inclusion in general burial populations. We present an analysis of 82 fetal/perinatal skeletons recovered from Kellis 2, a Roman Period cemetery dated to the third and fourth centuries AD, located in the Dakhleh Oasis, Egypt. Most of the fetal remains were individually wrapped in linen and all were buried among the general cemetery population in a supine, east,west orientation with the head facing to the west. Gestational age estimates are calculated from diaphysis lengths using published regression and Bayesian methods. The overall similarity between the fetal age distributions calculated from the regression and Bayesian methods suggests that the correlation between diaphysis length and gestational age is typically strong enough to avoid the ,regression' problem of having the age structure of reference samples adversely affecting the age distribution of target samples. The inherent bias of the regression methods, however, is primarily reflected in the gestational age categories between 36 and 42 weeks corresponding with the expected increase in growth variation during the late third trimester. The results suggest that the fetal age distribution at Kellis 2 does not differ from the natural expected mortality distribution. Therefore, practices such as infanticide can be ruled out as having a significant effect on the observed mortality distribution. Moreover, the Kellis 2 sample is well represented in each gestational age category, suggesting that all premature stillbirths and neonatal deaths received similar burial rites. The age distribution of the Kellis 2 fetal remains suggests that emerging Christian concepts, such as the ,soul' and the ,afterlife', were being applied to everyone including fetuses of all gestational ages. Copyright © 2005 John Wiley & Sons, Ltd. [source] Neuroimaging of cortical development and brain connectivity in human newborns and animal modelsJOURNAL OF ANATOMY, Issue 4 2010Gregory A. Lodygensky Abstract Significant human brain growth occurs during the third trimester, with a doubling of whole brain volume and a fourfold increase of cortical gray matter volume. This is also the time period during which cortical folding and gyrification take place. Conditions such as intrauterine growth restriction, prematurity and cerebral white matter injury have been shown to affect brain growth including specific structures such as the hippocampus, with subsequent potentially permanent functional consequences. The use of 3D magnetic resonance imaging (MRI) and dedicated postprocessing tools to measure brain tissue volumes (cerebral cortical gray matter, white matter), surface and sulcation index can elucidate phenotypes associated with early behavior development. The use of diffusion tensor imaging can further help in assessing microstructural changes within the cerebral white matter and the establishment of brain connectivity. Finally, the use of functional MRI and resting-state functional MRI connectivity allows exploration of the impact of adverse conditions on functional brain connectivity in vivo. Results from studies using these methods have for the first time illustrated the structural impact of antenatal conditions and neonatal intensive care on the functional brain deficits observed after premature birth. In order to study the pathophysiology of these adverse conditions, MRI has also been used in conjunction with histology in animal models of injury in the immature brain. Understanding the histological substrate of brain injury seen on MRI provides new insights into the immature brain, mechanisms of injury and their imaging phenotype. [source] Ontogeny of human hepatic cytochromes P450JOURNAL OF BIOCHEMICAL AND MOLECULAR TOXICOLOGY, Issue 4 2007Ronald N. Hines Abstract Significant changes in drug-metabolizing enzyme (DME) expression occur during ontogeny. Such changes can have a profound effect on therapeutic efficacy in the fetus and child, as well as the risk for adverse drug reactions. To gain a better understanding of DME ontogeny, enzyme contents for six key cytochromes P450 were measured in 240 human liver samples representing ages from 8 weeks gestation to 18 years. Where possible, both quantitative western blotting and activity assays with probe substrates were performed. Although oversimplified, the DME can be grouped into one of three categories. As typified by CYP3A7, some enzymes are expressed at their highest level during the first trimester and either remain at high concentrations or decrease during gestation and are silenced or expressed at low levels within 1,2 years after birth. These data cause one to query whether these enzymes have an important endogenous function. Representatives of a second group, CYP3A5 and CYP2C19, are expressed at relatively constant levels throughout gestation. Postnatal increases in CYP2C19 are observed within the first year, but not for CYP3A5. CYP2C9, 2E1, and 3A4 are more typical of a third group of enzymes that are not expressed or are expressed at low levels in the fetus with the onset of expression generally in either the second or third trimester. Substantial increases in expression are observed within the first 1,2 years after birth; however, considerable interindividual variability is observed in the immediate postnatal (1,6 months) onset or increase in expression of these enzymes, often resulting in a window of hypervariability. © 2007 Wiley Periodicals, Inc. J Biochem Mol Toxicol 21:169,175, 2007; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/jbt.20179 [source] A Detailed Assessment of Alterations in Bone Turnover, Calcium Homeostasis, and Bone Density in Normal PregnancyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2000A. J. Black Abstract The effects of pregnancy on bone turnover and the potential risk of developing an osteoporotic fracture in pregnancy are controversial. Utilizing biochemical markers of bone formation and resorption and dual-energy X-ray absorptiometry (DEXA), bone turnover before, during, and after pregnancy was studied in detail. Ten women (mean age 30 years; range 23,40) were recruited. Prepregnancy data were obtained and then a review was performed at 2-week intervals, once pregnancy was confirmed, until 14 weeks of gestation and thereafter monthly until term. Bone mineral density (BMD) was estimated by DEXA scanning of hip, spine, and forearm preconception and postpartum. In addition, BMD of the forearm at 14 weeks and 28 weeks gestation was obtained. All pregnancies had a successful outcome. Urinary free pyridinium cross-links, free pyridinoline (fPyr) and free deoxypyridinoline (fDPyr), were normal prepregnancy (mean [±SD]) 14.6 nmol/mmol (1.8) and 5.0 nmol/mmol (1.0) creat, respectively. By 14 weeks, they had increased to 20.8 nmol/mmol (4.3) and 6.1 nmol mmol (1.4) (both p < 0.02) and by 28 weeks to 26.3 nmol/mmol (5.6) and 7.4 nmol/mmol (1.6) (both p < 0.01). The ratio of fPyr to fDPyr remained constant. A similar significant increase was observed in N-telopeptide (NTx). Bone formation was assessed by measurement of carboxy-terminal propeptide of type 1 collagen (P1CP) and bone-specific alkaline phosphatase (BSAP). Neither were altered significantly before 28 weeks, but subsequently mean P1CP increased from 110 ,g/liter (23) to 235 ,g/liter (84) at 38 weeks and mean BSAP increased from 11.1 U/liter (5.0) to 28.6 U/liter (11.1) (p < 0.01 for both variables). Lumbar spine (L1,L4) BMD decreased from a prepregnancy mean of 1.075 g/cm (0.115) to 1.054 g/cm2 (0.150) postpartum (p < 0.05). Total hip BMD decreased from a prepregnancy mean of 0.976 g/cm2 (0.089) to 0.941 g/cm2 (0.097) (p < 0.05). Forearm BMD at midradius, one-third distal and ultradistal decreased but did not reach statistical significance. As assessed by these bone markers, in the first 2 trimesters of pregnancy, bone remodeling is uncoupled with a marked increase in bone resorption. A corresponding increase in formation markers is not observed until the third trimester. Spinal BMD exhibits a significant decrease from prepregnancy to the immediate postpartum period with a mean reduction in BMD of 3.5% in 9 months. [source] Evaluating effects of a prenatal web-based breastfeeding education programme in TaiwanJOURNAL OF CLINICAL NURSING, Issue 8 2007Mei Zen Huang MS Aims., The objectives of this study were to evaluate a web-based breastfeeding education programme provided to primigravida in the third trimester of pregnancy with the aim of deepening breastfeeding knowledge and enhancing skills. The study was conducted at a hospital in Taiwan. Background., Education is the cornerstone supporting the framework of lactation and breastfeeding. Web-based instruction is an efficient way to provide education. Design., A quasi-experimental design was used. Methods., The target population was women at 29,36 weeks gestation using the Internet on regular basis. The primigravida were assigned to either the control group (n = 60) or the experimental group (n = 60) according to time sequence. Results., Women who received web-based breastfeeding education had a higher mean breastfeeding knowledge score and more positive attitude about breastfeeding. In addition, generalized estimating equations (GEE) model was used to examine the breastfeeding rate at different time points. After adjusting for the time trend and infant birth weight, there was a significant effect in exclusive breastfeeding for the experimental group. On the other hand, the web-based breastfeeding education programme also had a significant effect on mixed feeding rate for the experimental group. Conclusion., Results suggest that web-based breastfeeding education may contribute to breastfeeding knowledge and attitude and improved breastfeeding rate. Relevance to clinical practice., Web-based breastfeeding education programme can achieve success in promoting breastfeeding and provide health professionals with an evidence-based intervention. [source] Gingival changes during pregnancy: II.JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2010Influence of hormonal variations on the subgingival biofilm Carrillo-de-Albornoz A, Figuero E, Herrera D, Bascones-Martínez A. Gingival changes during pregnancy: II. Influence of hormonal variations on the subgingival biofilm. J Clin Periodontol 2010; 37: 230,240. doi: 10.1111/j.1600-051X.2009.01514.x. Abstract Aim: To determine whether the exacerbated gingival inflammation that develops in pregnant women is related to a change in the subgingival biofilm induced by the increase in hormone levels during pregnancy. Material and Methods: This open cohort study included 48 pregnant and 28 non-pregnant women without periodontitis. Pregnant women were evaluated in the first, second and third trimester and at 3 months after delivery. Non-pregnant women were evaluated twice, with a 6-month interval, assessing microbiological, clinical and hormonal variables at each visit. Total anaerobic counts and frequency of detection and proportions were calculated. The Friedman test with the Bonferroni correction was used for intra-group comparisons and Mann,Whitney U -tests for inter-group assessment. Correlations were analysed by means of Spearman's rank correlation coefficient. Results: Proportions of the subgingival periodontal pathogens did not differ throughout pregnancy, although significant differences were found for all the pathogens after delivery. Porphyromonas gingivalis -positive patients presented an increase in gingival inflammation (p<0.001) that was not related to plaque. Correlations were found between maternal hormone levels and P. gingivalis and Prevotella intermedia. Conclusion: Qualitative differences in periodontal pathogens were found from pregnancy to post-partum. Patients harbouring P. gingivalis presented and increased gingival inflammatory status. [source] The dynamic fetal brainJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2007Dena Towner MD Abstract Purpose. To evaluate fetuses with normal intracranial anatomy in the second trimester that became abnormal in the third trimester. Methods. We sonographically examined 6 fetuses with a normal second-trimester head sonogram that presented later in pregnancy with an abnormal head sonogram. Results. Four categories of intracranial pathology were depicted: obstructive hydrocephalus, intraventricular intracranial hemorrhage, non-intraventricular intracranial hemorrhage, and porencephaly. Conclusions. Despite a normal midtrimester intracranial examination, evaluation of the fetal intracranial contents should be undertaken in subsequent sonographic examinations, because significant pathology can develop spontaneously. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007 [source] Sonographic measurement of the fetal cerebellum, cisterna magna, and cavum septum pellucidum in normal fetuses in the second and third trimesters of pregnancyJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2003Selami Serhatlioglu MD Abstract Purpose Absence of the cavum septum pellucidum (CSP), the cisterna magna (CM), or both, and enlargement of either or both structures are associated with various central nervous system malformations. In an effort to determine normal sizes and relationships between these cranial structures, we measured the CSP and CM in normal fetuses in the second and third trimesters of pregnancy using transabdominal sonography. Methods Women with uncomplicated pregnancies and normal singleton fetuses between 16 and 38 weeks' menstrual age were included in this prospective study. The width and anteroposterior (AP) diameters of the CSP were measured on the transverse transventricular plane, and the AP diameter of the CM was measured on the transcerebellar plane from the posterior aspect of the cerebellar vermis to the inner edge of the cranium. The transverse and AP diameters of the cerebellum were also measured. In addition, we measured the biparietal diameters (BPDs). Results In total, 130 women participated; 64 were examined in their second trimester and 66 in their third trimester. The mean age of the women was 27.4 ± 4.8 years (range, 18,38 years), and the mean menstrual age of the fetuses was 26.9 ± 6.7 weeks (range, 16,38 weeks). The mean BPD was 66.8 ± 18.7 mm (range, 30,96 mm). The mean width and AP diameter of the CSP and the mean AP diameter of the CM differed significantly between the second and third trimesters (p < 0.001). All measured parameters correlated significantly with menstrual age and BPD. Conclusions In normal fetuses, the CSP and CM should be visible on transabdominal sonography between 16 and 38 weeks' menstrual age. Because abnormalities in these cranial structures may be indicative of central nervous system malformations, the availability of mean sonographic measurements from normal fetuses should be helpful in determining the need for additional testing in fetuses with abnormal measurements. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:194,200, 2003 [source] The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical DistressJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2009Amy E. Beddoe ABSTRACT Objective: To examine the feasibility and level of acceptability of a mindful yoga intervention provided during pregnancy and to gather preliminary data on the efficacy of the intervention in reducing distress. Design: Baseline and post-treatment measures examined state and trait anxiety, perceived stress, pain, and morning salivary cortisol in a single treatment group. Postintervention data also included participant evaluation of the intervention. Setting: The 7 weeks mindfulness-based yoga group intervention combined elements of Iyengar yoga and mindfulness-based stress reduction. Participants: Sixteen healthy pregnant nulliparous women with singleton pregnancies between 12 and 32 weeks gestation at the time of enrollment. Methods: Outcomes were evaluated from pre- to postintervention and between second and third trimesters with repeated measures analysis of variance and post hoc nonparametric tests. Results: Women practicing mindful yoga in their second trimester reported significant reductions in physical pain from baseline to postintervention compared with women in the third trimester whose pain increased. Women in their third trimester showed greater reductions in perceived stress and trait anxiety. Conclusions: Preliminary evidence supports yoga's potential efficacy in these areas, particularly if started early in the pregnancy. [source] Group A streptococcal toxic shock syndrome with extremely aggressive course in the third trimesterJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2010Takashi Sugiyama Abstract Group-A-streptococcus-(GAS)-induced toxic shock syndrome (TSS) is uncommon, but carries a high risk of maternal mortality during pregnancy. The onset of gravidic GAS-TSS has been reported mostly during the puerperium. A 16-year-old woman, who was at 37 weeks of gestation, and without obstetrical care during the last 30 weeks, was referred to our hospital. She complained of fever for one day with headache and abdominal pain after the fever developed. On admission, her consciousness was drowsy, intrauterine fetal death was recognized, and she rapidly developed shock status with coma and hypotension, hemolysis, disseminated intravascular coagulation (DIC), and multi-organ failure. Although we had not obtained the results of a bacterial culture, we suspected sepsis with DIC with homolysis and multi-organ failure resulting from an infection. The patient was treated with antibiotics and intubation because of respiratory insufficiency. Twelve hours after admission to the intensive care unit in our hospital, she died. Cultures from blood, subcutaneous tissue, vaginal discharge, and pharynx all revealed GAS bacteria, and therefore she was diagnosed as having GAS-TSS. GAS-TSS in pregnancy is rare. However, once the infection occurs in a pregnant woman, it rapidly develops into sepsis with multi-organ failure. Therefore, early recognition and intensive treatment for GAS during pregnancy is recommended in women with high fever, muscular pain, hemolysis and DIC during pregnancy. [source] Evaluation of D-dimer during pregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009Ayano Nishii Abstract Aim:, The purpose of the present study was to elucidate the change of D-dimer and the possibility of deep vein thrombosis screening by D-dimer during pregnancy. Methods:, One thousand, one hundred and thirty-one pregnant women were enrolled in the study from April 2006 to March 2007. D-dimer was measured by latex immunoassay at 6 to 14 and 30 to 36 weeks of gestation, respectively, and the veins of the lower extremities were examined by ultrasound at 30 to 36 weeks of gestation. Results:, The mean and standard error of D-dimer was 1.1 ± 1.0 µg/mL in the first trimester and 2.2 ± 1.1 µg/mL in the third trimester, and both values were significantly higher than adult values. In addition, D-dimer significantly increased during pregnancy. D-dimer was not significantly different between singleton and twin pregnancies in the first trimester, but in the third trimester, the values of twin pregnancies were higher than singleton pregnancies (2.2 ± 1.6 vs 3.7 ± 2.5 µg/mL). The mean value of D-dimer of ultrasonographically positive women was 2.6 ± 2.0 µg/mL, which was significantly higher than the value for negative woman during the third trimester (2.2 ± 1.6 µg/mL). The positive predictive value was 7.4% and negative predictive value was 95.5% for ultrasonographically positive women when D-dimer was set at 3.2 µg/mL. Conclusion:, We clearly found a change of D-dimer during pregnancy. When D-dimer was higher than 3.2 µg/mL, the percentage of ultrasonographically positive women was high. We propose that women with D-dimer higher than 3.2 µg/mL are closely monitored for prevention of pulmonary thromboembolism. [source] Maternal and fetal serum transformed alpha-fetoprotein levels in normal pregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009Fernando González-Bugatto Abstract Aim:, To evaluate transformed alpha-fetoprotein (t-AFP) (a new molecular conformation of alpha-fetoprotein) levels in maternal serum and fetal serum in normal pregnancy. Methods:, Prospective longitudinal study. Fifty pregnant women were studied in two groups: 25 were evaluated in each trimester of pregnancy and near term (12, 20, 32 and 36 weeks) and the other 25 were evaluated at the time of planned cesarean section at term. In the first group, maternal serum t-AFP was measured and in the second group, maternal and fetal serum t-AFP were analyzed. Results:, Maternal serum t-AFP levels (medians) were 14.73 ng/mL in the first trimester, 28.29 ng/mL in the second trimester, 30.45 ng/mL in the early third trimester and 8.06 ng/mL in late pregnancy. t-AFP levels were significantly higher in maternal than in fetal serum (P < 0.001). There were no significant correlations between AFP and t-AFP levels in maternal versus fetal serum. Conclusions:, t-AFP increases during pregnancy until the early third trimester and then falls before delivery. t-AFP levels are higher in maternal than in fetal serum which suggests that native AFP is transformed to t-AFP either in the mother or in the placenta. [source] Helicobacter pylori infection detected by 14C-Urea breath test is associated with iron deficiency anemia in pregnant womenJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2008s Mulayim Abstract Aims:, To determine whether there is a relationship between Helicobacter pylori (H. pylori) infection, iron deficiency anemia and thrombocytopenia in pregnant women. Methods:, Hemoglobin and ferritin levels and platelet counts of pregnant women were measured during the third trimester. H. pylori infection was determined using a 14C-urea breath test (14C-UBT) after delivery. Statistical analyses were determined with a Mann,Whitney U -test and the ,2 test. Statistical significance was determined with a P -value less than .05. Results:, Seventy-two of 117 women had positive results on the 14C-UBT. Overall, 27 of 117 pregnant women had anemia (23.1%), and all them were in the H. pylori -positive group; 18 of 27 (66.7%) had iron deficiency anemia. Median hemoglobin levels and neonatal body weights were 12.0 g/dL vs 12.0 g/dL and 3320.0 grams vs 3520.0 grams in the H. pylori -positive and negative groups, respectively. Serum hemoglobin and ferritin levels and neonatal body weight were found to be lower in the anemic group compared with the non-anemic group among H. pylori -infected women (P = 0.0001, P = 0.02, P = 0.008, respectively). There were no statistically significant differences with regard to gestational thrombocytopenia between the H. pylori -positive and H. pylori -negative groups (P = 0.532). Conclusions:, Our study indicates that there is a strong relationship between H. pylori infection and iron deficiency anemia in women with uncomplicated pregnancy. However, an association between H. pylori infection and thrombocytopenia was not found. [source] Characteristics of antepartum and intrapartum eclampsia in the National Maternal and Child Health Center in CambodiaJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2004Kanal Koum Abstract Aim:, To measure maternal and perinatal outcome and analyze risk factors for antepartum and intrapartum eclampsia, which is one of main causes of high maternal mortality at the top referral hospital in the Kingdom of Cambodia. Methods:, A hospital-based retrospective study of 164 antepartum and intrapartum eclampsia cases out of 20 449 deliveries. Results:, Overall case,fatality rate was 12%. Rate of stillbirth and low birth weight were 20% and 44%, respectively. Eighty percent of the cases presented signs of severe pre-eclampsia and 27% of the patients who gave birth received cesarean section. Living outside the capital city, teenage pregnancy and twin pregnancy are more frequently associated with eclampsia. Conclusion:, Antepartum and intrapartum eclampsia is associated with severe pre-eclampsia and with poor maternal and perinatal outcome. Recommendations to reduce the burden of eclampsia are promoting and improving quality of antenatal care and health education especially in the third trimester; increasing access to high-quality essential obstetric care; improving the service delivery in rural areas; and monitoring the progress by hospital data. [source] Changes in serum concentrations of tumor necrosis factor , and adhesion molecules in normal pregnant women and those with pregnancy-induced hypertensionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2003Keiichi Matsubara Abstract Aim:, To study whether serum tumor necrosis factor , gene (TNF,) and adhesion molecule levels are indicators of the onset of pregnancy-induced hypertension (PIH), we compared levels of these molecules between normal pregnant women and PIH patients from the first to the third trimester. Methods:, We serially measured serum concentrations of TNF,, soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin (sE-selectin), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble P-selectin (sP-selectin) using enzyme immunoassay kits in 10 normal pregnant women and 10 pregnant women who developed PIH late in gestation. Results:, Serum TNF,, sICAM-1 and sE-selectin levels in PIH affected women were significantly higher from the first trimester compared with those in normal pregnancy. sVCAM-1 and sP-selectin levels were not significantly changed. Conclusion:, Serum TNF,, sE-selectin and sICAM-1 levels might be effective indicators of the onset of PIH. [source] The Application of Magnetic Cell Sorter (MACS) to Detect Fetal Cells in Maternal Peripheral BloodJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2001Dr. Akimune Fukushima Abstract Objectives: The aim of the present study was to investigate the effectiveness of sorting fetal nucleated red blood cells (FNRBC) from maternal peripheral blood, particularly during early gestation periods, by a combination of specific gravity centrifugation and magnetic cell sorter (MACS). Methods: Without prior knowledge of the gender of the fetus, we determined gender by analyzing a Y-chromosome specific sequence by nested-PCR, using 10 ml of the peripheral blood of healthy primigravida women at different stages of gestation (first trimester: n = 17, second trimester: n = 13, and third trimester: n = 19). The results of this prenatal sex determination were compared to the sex of newborns. Results: The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of the present method during the first trimester were 100, 81.8, 100, and 75%, respectively; during the second trimester, 80, 50, 80, and 50%, respectively; and during the third trimester, 25, 63.6, 53.8, and 33.3%, respectively. Conclusion: The results show that this prenatal sex determination method has a highly accurate diagnostic rate during the first trimester, suggesting that it could be developed as a practical, non-invasive prenatal diagnostic technique for use during early gestation periods. [source] Intracranial Venous Thrombosis Associated with Severe Antithrombin-III Deficiency in PregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2001Dr. Serdar Özsener Abstract We report a patient with intracranial venous thrombosis in the third trimester of pregnancy associated with severe antithrombin-III deficiency. The evaluation of protein C, protein S and antithrombin-III levels in patients with thrombotic events during pregnancy may reveal the specific cause of the thrombotic event and thereby influence patient management [source] Ethanol Acutely Inhibits Ionotropic Glutamate Receptor-Mediated Responses and Long-Term Potentiation in the Developing CA1 HippocampusALCOHOLISM, Issue 4 2010Michael P. Puglia Background:, Developmental ethanol (EtOH) exposure damages the hippocampus, causing long-lasting alterations in learning and memory. Alterations in glutamatergic synaptic transmission and plasticity may play a role in the mechanism of action of EtOH. This signaling is fundamental for synaptogenesis, which occurs during the third trimester of human pregnancy (first 12 days of life in rats). Methods:, Acute coronal brain slices were prepared from 7- to 9-day-old rats. Extracellular and patch-clamp electrophysiological recording techniques were used to characterize the acute effects of EtOH on ,-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor (AMPAR)- and N -methyl- d -aspartate receptor (NMDAR)-mediated responses and long-term potentiation (LTP) in the CA1 hippocampal region. Results:, Ethanol (40 and 80 mM) inhibited AMPAR- and NMDAR-mediated field excitatory postsynaptic potentials (fEPSPs). EtOH (80 mM) also reduced AMPAR-mediated fEPSPs in the presence of an inhibitor of Ca2+ permeable AMPARs. The effect of 80 mM EtOH on NMDAR-mediated fEPSPs was significantly greater in the presence of Mg2+. EtOH (80 mM) neither affected the paired-pulse ratio of AMPAR-mediated fEPSPs nor the presynaptic volley. The paired-pulse ratio of AMPAR-mediated excitatory postsynaptic currents was not affected either, and the amplitude of these currents was inhibited to a lesser extent than that of fEPSPs. EtOH (80 mM) inhibited LTP of AMPAR-mediated fEPSPs. Conclusions:, Acute EtOH exposure during the third-trimester equivalent of human pregnancy inhibits hippocampal glutamatergic transmission and LTP induction, which could alter synapse refinement and ultimately contribute to the pathophysiology of fetal alcohol spectrum disorder. [source] Prenatal Alcohol Exposure Alters Biobehavioral Reactivity to Pain in NewbornsALCOHOLISM, Issue 4 2010Tim F. Oberlander Objectives:, To examine biobehavioral responses to an acute pain event in a Cape Town, South Africa, cohort consisting of 28 Cape Colored (mixed ancestry) newborns (n = 14) heavily exposed to alcohol during pregnancy (exposed), and born to abstainers (n = 14) or light (,0.5 oz absolute alcohol/d) drinkers (controls). Methods:, Mothers were recruited during the third trimester of pregnancy. Newborn data were collected on postpartum day 3 in the maternity obstetrical unit where the infant had been delivered. Heavy prenatal alcohol exposure was defined as maternal consumption of at least 14 drinks/wk or at least 1 incident of binge drinking/mo. Acute stress-related biobehavioral markers [salivary cortisol, heart rate (HR), respiratory sinus arrhythmia (RSA), spectral measures of heart rate variability (HRV), and videotaped facial actions] were collected thrice during a heel lance blood collection (baseline, lance, and recovery). After a feeding and nap, newborns were administered an abbreviated Brazelton Neonatal Behavioral Assessment Scale. Results:, There were no between-group differences in maternal age, marital status, parity, gravidity, depression, anxiety, pregnancy smoking, maternal education, or infant gestational age at birth (all ps > 0.15). In both groups, HR increased with the heel lance and decreased during the postlance period. The alcohol-exposed group had lower mean HR than controls throughout, and showed no change in RSA over time. Cortisol levels showed no change over time in controls but decreased over time in exposed infants. Although facial action analyses revealed no group differences in response to the heel lance, behavioral responses assessed on the Brazelton Neonatal Scale showed less arousal in the exposed group. Conclusions:, Both cardiac autonomic and hypothalamic,pituitary,adrenal stress reactivity measures suggest a blunted response to an acute noxious event in alcohol-exposed newborns. This is supported by results on the Brazelton Neonatal Scale indicating reduced behavioral arousal in the exposed group. To our knowledge, these data provide the first biobehavioral examination of early pain reactivity in alcohol-exposed newborns and have important implications for understanding neuro-/biobehavioral effects of prenatal alcohol exposure in the newborn period. [source] Replicability and stability of the multidimensional model of the Edinburgh Postnatal Depression Scale in late pregnancyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2007J. JOMEEN phd ma rm rgn The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool for post-natal depression (PND). Recent factor analytic investigations of the EPDS have suggested the instrument may be useful in the prediction of PND as the instrument appears to be multidimensional, thus facilitating sub-scale development for this purpose. The psychometric properties of the EPDS were evaluated in women in the third trimester of pregnancy. Confirmatory factor analyses found support for the multidimensionality of the instrument; however, there was clear variability in model fit to data suggesting previous reports of the stability of the underlying factor structure of this instrument may be over-optimistic. The potential for development of the EPDS as a predictive screening measure of PND is likely to be optimistic because of variability in the factor structure of the instrument over the course of pregnancy and in the post-natal period. [source] Alterations in Circadian Rhythm Phase Shifting Ability in Rats Following Ethanol Exposure During the Third Trimester Brain Growth SpurtALCOHOLISM, Issue 5 2006Hiromi Sakata-Haga Background: Disruptions in sleep and feeding rhythms are among the consequences of prenatal alcohol exposure. Previously, we reported that ethanol exposure during the second trimester equivalent in rats produces long-lasting impairments in circadian system functioning. In the present study, we examined the effects of ethanol exposure during the third trimester equivalent brain growth spurt on the development of the circadian clock system. Methods: Sprague,Dawley male rat pups were exposed to 6.0 g/kg/d ethanol via an artificial rearing procedure on postnatal days (PD) 4 through 9 (EtOH). An artificially reared gastrostomized control group and a normally reared suckle control group were also included. At 10 to 12 weeks of age, wheel-running behavior was measured continuously under a 12-hour/12-hour light/dark (LD) cycle. Thereafter, subjects were exposed to a 6-hour phase delay of the LD cycle, and the ability to adjust to the new LD cycle was evaluated. Results: Before the phase delay, onset time of activity and acrophases of activity in all 3 groups were not significantly different from one another. After the 6-hour LD cycle delay, EtOH subjects were slower to adapt to the new cycle compared with both control groups, as measured by both activity onset and acrophase. Throughout the experiment, activity levels of EtOH subjects tended to be higher compared to both controls. Conclusions: These data demonstrate that ethanol exposure during the third trimester disrupts the ability to synchronize circadian rhythm to light cues. Disruptions in circadian regulation may cause abnormal behavioral rhythmicity, such as disrupted sleep and feeding patterns, as seen in individuals prenatally exposed to ethanol. [source] Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic neviJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2007AS Aktürk Summary Background, It is a common opinion that expansion and darkening in melanocytic nevi may occur during pregnancy. The main problem is that whether it is a usual finding, or it is a condition that requires suspicion about melanoma. Objectives, It was aimed to find the changes that might occur in the sizes and structures of melanocytic nevi during pregnancy. Methods, Ninety-seven nevi of the 56 pregnant women in the first trimester were evaluated in the study. The localization and size of the nevi were recorded on a standard body diagram. After clinical examination, dermoscopic analyses were applied. Pattern analyses were done, and total dermoscopy scores (TDS) were calculated by applying ABCD scoring system. All subjects were seen again during the third trimester. Results, There was a statistically significant difference between the mean diameters of nevi in the first and third trimester (P = 0.001). Of nevi whose diameters increased, 10 (50.00%) were localized on the front of body, 6 (30.00%) on the face and neck, 3 (15.00%) on the legs, and 1 (5.00%) on the back. The enlargement in diameters was more significant on the front of the body, but there was no statistically significant difference. Compared according to the pattern analysis, new dot formation was observed only on the structure of six nevi during the last trimester. Four of them were localized on the front of the body. There was statistically significant increase in mean TDS in comparison between the first and third trimesters (P = 0008). Conclusions, During the pregnancy, widening in diameters and structure changes of nevi may be seen especially on the front of the body. We also think that these findings might be connected with expansion of the skin during pregnancy. Dermoscopic controls are the first choice of method to analyse the nevi since the patient may not recognize these changes. [source] | |||||||||||||||||||||||||||||||||||||||||||