Prolonged Birth Research Articles

Birth Admission Length-of-Stay and Hospital Readmission in Children With Congenital Diaphragmatic Hernia

BackgroundThe objective of this study was to identify factors associated with prolonged birth admission length of stay (LOS) and to evaluate the association between these characteristics and readmission in the year following discharge for children with congenital diaphragmatic hernia (CDH). MethodsThis was a single-center retrospective cohort study of children with isolated CDH born in the Special Delivery Unit and admitted to the Newborn/Infant Intensive Care Unit at Children's Hospital of Philadelphia from April 2008 to August 2019. Birth admission hospitalization was categorized into 3 groups (≤35, 36–75, and >76 days) based on the data distribution. Participant factors included gestational age (days), side of CDH (right/left), liver position (up/down), CDH repair technique (open/minimally invasive), exposure to extracorporeal membrane oxygenation, lung-to-head circumference ratio, and feeding tube at discharge. Chi-squared, t-tests and analysis of variance were used to examine bivariable associations between participant characteristics, birth admission LOS and readmission in the year following initial hospital discharge. Multivariable logistic regression was used to evaluate factors associated with readmission. ResultsChildren hospitalized ≥76 days at birth had 4.33 (95% CI: 1.2, 15.2) higher odds of readmission than those admitted for ≤35 days. Children with a non-operative feeding tube at discharge had 4.12 (895% CI: 1.6, 10.5) higher odds of readmission when compared to those with no feeding tube at discharge. ConclusionsLonger birth hospitalization and non-operative feeding tube are associated with increased readmissions in the year after discharge. Level of EvidenceLevel III.

Tau protein hyperphosphorylation in children with cerebral palsy with sleep disorders

Aims: In this study, we aimed to evaluate the relationship between sleep disorder and serum tau protein levels in children with cerebral palsy.
 Methods: The sample was selected among children aged 6-10 years who applied to our physical medicine and rehabilitation outpatient clinic. In order to evaluate sleep quality, the Pittsburgh Sleep Quality Index (PSQI) questionnaire was recorded by asking parents of all participants. Children with CP who had a Pittsburgh Sleep Quality Index value above 5 were determined as the sleep disorder group. We recruited 27 children with CP and sleep disorders in the first patient group (Group 1), 27 children with CP but without sleep disorders in the second group (Group 2). The third group (Group 3), which was the healthy group, included 27 children without any disease. We also recorded the age of children at diagnosis, risk factors for CP (premature, prolonged birth, etc.), CP type, gross motor function classification system (GMFCS), botox application, orthoses usage, maternal age at birth, and additional problems. We measured total tau protein (T-tau) and phosphorylated tau protein (P-tau) levels in blood samples through a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). The correlation between tau protein and PSQI values was examined.
 Results: Maternal age (p=0.001), gross motor function classification system (GMFCS) (p=0.001), and pittsburgh sleep quality index (PSQI) (p=0.001) were significantly higher in the group with sleep disorders. There was a statistically significant difference between the groups in terms of serum T-Tau and P-tau protein levels (T-tau p=0.003, P-tau p=0.004). In the group sleep disorders, PSQI was significantly correlated with T-tau (r=0.499) and P-tau (r=0.473).
 Conclusion: This study shows that tau protein levels are higher in CP patients with sleep disorders than in participants without sleep disorders. In the correlation analyzes, a positive and significant correlation was observed between PSQI values and T-tau and P-tau in sleep disorders groups, and no correlation was found in without sleep disorders.

Perinatal and pediatric outcomes associated with the use of fertility treatment: a population-based retrospective cohort study in Ontario, Canada

BackgroundAround 2% of births in Ontario, Canada involve the use of assisted reproductive technology (ART), and it is rising due to the implementation of a publicly funded ART program in 2016. To better understand the impact of fertility treatments, we assessed perinatal and pediatric health outcomes associated with ART, hormonal treatments, and artificial insemination compared with spontaneously conceived births.MethodsThis population-based retrospective cohort study was conducted using provincial birth registry data linked with fertility registry and health administrative databases in Ontario, Canada. Live births and stillbirths from January 2013 to July 2016 were included and followed to age one. The risks of adverse pregnancy, birth and infant health outcomes were assessed by conception method (spontaneous conception, ART – in vitro fertilization and non-ART – ovulation induction, intra-uterine or vaginal insemination) using risk ratios and incidence rate ratios with 95% confidence intervals (CI). Propensity score weighting using a generalized boosted model was applied to adjust for confounding.Result(s)Of 177,901 births with a median gestation age of 39 weeks (IQR 38.0–40.0), 3,457 (1.9%) were conceived via ART, and 3,511 (2.0%) via non-ART treatments. There were increased risks (adjusted risk ratio [95% CI]) of cesarean delivery (ART: 1.44 [1.42–1.47]; non-ART: 1.09 [1.07–1.11]), preterm birth (ART: 2.06 [1.98–2.14]; non-ART: 1.85 [1.79–1.91]), very preterm birth (ART: 2.99 [2.75–3.25]; non-ART: 1.89 [1.67–2.13]), 5-min Apgar < 7 (ART: 1.28 [1.16–1.42]; non-ART: 1.62 [1.45–1.81]), and composite neonatal adverse outcome indicator (ART: 1.61 [1.55–1.68]; non-ART: 1.29 [1.25–1.34]). Infants born after fertility treatments had increased risk of admission to neonatal intensive care unit (ART: 1.98 [1.84–2.13]; non-ART: 1.59 [1.51–1.67]) and prolonged birth admission (≥ 3 days) (ART: 1.60 [1.54–1.65]; non-ART: 1.42 [1.39–1.45]). The rate of emergency and in-hospital health services use within the first year was significantly increased for both exposure groups and remained elevated when limiting analyses to term singletons.Conclusion(s)Fertility treatments were associated with increased risks of adverse outcomes; however, the overall magnitude of risks was lower for infants conceived via non-ART treatments.

Postnatal maternal behaviour expression depends on lambing difficulty in Merino ewes

Dystocia, a prolonged or non-progressive birth event, is the main contributor to lamb mortality in Australia and across the world. Dystocia can cause neonatal hypoxia, central nervous system (CNS) damage leading to increased risk of starvation, exposure and mismothering, and death. These prolonged birth events can also cause fatigue, injury and death in the ewe. Dystocia may interrupt the expression of maternal behaviour and the strength of the ewe-lamb bond, and consequently lamb survival. This study focused on the effect of dystocia on ewe behaviour in the 2 h post-lambing. A total of 18 ewes were chosen for continuous behaviour annotation and analysis (dystocic (n = 9) and eutocic (n = 9)) based on the quality of video recordings, length of stage 2 parturition and classification by a single experienced observer. Dystocic ewes showed significantly lower expression of maternal behaviours and a significantly greater expression of avoidance behaviours compared to eutocic ewes. Additionally, dystocic ewes performed fewer behaviours in total compared to eutocic ewes.Dystocia can significantly affect the quality and quantity of ewe maternal behaviour expression, leading to increased avoidance of the lamb, increased risk of maternal disinterest, and increased risk of death for the lamb. If dystocic events can be identified quickly and accurately, measures can be taken to ensure the ewe and lamb recover successfully.

Risk Factors for Prolonged Birth Interval in Modern Swine Farms in Vietnam

The present study aimed to investigate factors influencing the prolonged birth interval in swine, defined as a birth interval longer than 30 minutes. In total, 3380 piglets born from 239 Landrace x Yorkshire sows from 5 farms in the North of Vietnam were included in this study. The dependent variable was the prolonged birth interval, and independent variables included parity, gestation length, litter size, relative birth order, crown-rump length, birth weight, body-mass index, ponderal index, piglet’s gender, dead-born piglet, and oxytocin use. Important factors for the prolonged birth interval were determined by using Generalized Linear Mixed Models. The incidence of the prolonged birth interval was 14.5%. Crown-rump length (OR=1.09, 95% CI=1.06-1.14), birth weight (OR=1.06, 95% CI=1.02-1.09), and dead-born piglet (OR=1.98-2.08, 95% CI=1.38-2.97) were positively associated with the prolonged birth interval, while litter size (OR=0.90, 95% CI=0.96-0.94) negatively correlated with the prolonged birth interval. The incidence of prolonged birth interval decreased with an increase in relative birth order, bottoming at relative birth order of 40-80, and then increased to the end of parturition. The last piglets had the highest risk of experiencing prolonged birth intervals. This study indicated that prolonged birth interval in swine was common; therefore, careful farrowing supervision should be practiced to reduce stress in sows and piglets.

Neonatal Encephalopathy in the Term Newborn

Perinatal brain injury is the third leading cause of child mortality globally. Purpose: Evaluation of perinatal risk factors for encephalopathy in neonates in order to prevent deaths and disabilities Method: This is a prospective, case-control study conducted in the Maternity Hospital “K. Gliozheni” during the time period 2012 – 2016. 65 newborns at term ≥37 weeks diagnosed with encephalopathy according to the Thompson classification &gt;5 within 12 hours of birth were compared with a control group, infants without encephalopathy in a 1:1 ratio selected casual and gender-appropriate. Results: Total antepartum risk factors were found in (70.8%) of cases and (18.5%) of controls (p&lt;0.01). Sentinel events were found in 38.5% of cases and in 9.2% of controls. (p&lt;0.01). Acute intrapartum events in total were found in (38.5%) of cases and (9.2%) of controls (p&lt;0.01). 43.1% of babies had a combination of antepartum and intrapartum factors (p&lt;0.01). Significant and independent predictive factors of risk for neonatal encephalopathy resulted: from maternal factors, mother’s age &gt;35 years (p=0.03). Of the intrapartum factors: pregnancy with twins (p&lt;0.01), hypertension/preeclampsia (p&lt;0.01), non-reactive FHR before delivery (p&lt;0.01). MEDICUS No. 6, ISSUE 2/ 2022 103 From intrapartum factors: breech birth (p=0.01), emergency cesarean section (p=0.01), meconial amniotic fluid (p=0.02), prolonged birth (p=0.01). Conclusion: Knowledge of perinatal risk factors associated with neonatal encephalopathy is essential for developing interventions to prevent neonatal death and disability.

Preeclampsia—an immune disease? An epidemiologic narrative

The maternal syndrome preeclampsia is triggered by syncytiotrophoblast (STB) stress; the heterogeneity of the syndrome is caused by the different pathways leading to this STB stress. Inflammation plays a pivotal role in the pathogenesis of preeclampsia. While, the immune system at large is therefore intimately involved in the causation of this heterogeneous syndrome, the role of the adaptive immune system is more controversial. The classic paradigm placed preeclampsia as the disease of the nulliparous pregnant women. Up to the later part of the 20th century, human reproduction, particularly in Western societies, was characterised by a low rate of pre-marital sex, and the great majority of children being born within one stable sexual relationship. More prolonged periods of regular sexual intercourse within a stable relationship have been demonstrated to reduce the risk of preeclampsia and fetal growth restriction. Primarily animal studies have indeed shown that repetitive sperm exposure leads to partner specific mucosal tolerance. Societal changes made partner change over the reproductive period of individual women extremely common. For the adaptive immune system of multiparous women, being pregnant in a new sexual relationship (primipaternity) would represent being faced with a new “hemi-allograft”. In these pregnancies, potential couple-specific immune “maladaptation” could lead to the superficial cytotrophoblast invasion of the spiral arteries, known to be associated with early-onset preeclampsia. Having a new pregnancy in a different relationship does indeed increase the risk for this type of preeclampsia. Large epidemiologic population studies identified prolonged birth interval but not “primipaternity” as a risk factor for preeclampsia in multiparous women. This apparent contradiction is explained by the fact that the great majority of preeclampsia cases in these population studies involve term preeclampsia. In late-onset preeclampsia, the far more common phenotype of the syndrome, STB stress is not caused by lack of proper spiral artery modification, but involves maternal genetic predisposition to cardiovascular and metabolic disease, with in particular obesity/metabolic syndrome representing major players. Partner or couple specific issues are not detectable in this disease phenotype.

The Association of Social Factors and Time Spent in the NICU for Mothers of Very Preterm Infants.

Evaluate the association between maternal social factors and maternal time spent in the NICU for very preterm infants admitted to 4 level III and IV NICUs. In this prospective observational cohort study, we enrolled mother-infant dyads whose infants were born <32 weeks' gestation. Enrollment occurred after 2 weeks of NICU exposure, when maternal social factors and demographic information was collected. Maternal time spent in the NICU was abstracted from the electronic medical record and was dichotomized into 0 to 6 days and ≥6 days per week. Demographic differences between the 2 groups were compared by using χ2 tests. Logistic regression was used to assess the independent association between maternal social factors and the average number of days per week spent in the NICU. A total of 169 mother-infant dyads were analyzed. Maternal social factors associated with more time spent in the NICU included an annual household income of >$100 000, compared with those with an annual household income of <$50 000 (adjusted odds ratio [aOR]: 5.68; 95% confidence interval [CI] 1.77-18.19), a travel time <30 minutes to the NICU (compared with those who traveled >60 minutes [aOR: 7.85; 95% CI 2.81-21.96]), and the lack of other children in the household, compared with women with other children (aOR: 3.15; 95% CI 1.39-7.11). Maternal time spent in the NICU during a prolonged birth hospitalization of a very preterm infant differed by socioeconomic status, travel time, and presence of other dependents. Strategies to better identify and reduce these disparities to optimize engagement and, subsequently, improve infant health outcomes is needed.

Quantifying the forces applied during assisted calvings and the impacts on newborn beef calves

Dystocia is recognized as the leading cause of mortality in the beef industry, with almost 26% of neonatal calf losses being attributed to birth-related issues. The term dystocia is defined as a prolonged or difficult birth that may or may not require human intervention, while calving ease is a subjective measure of the effort required for an assisted delivery. A Canadian study reported that 8.9% of calvings in beef herds required assistance, with severe dystocia occurring in 3.7% of births. Similarly, in the United States, 7.7% and 3.4% of heifers and 3.2% and 1% of cows, respectively, required easy and hard pulls to deliver their calf. Despite the incidence and impacts of assisted calvings, there is little available data that quantifies the forces applied during an assisted delivery and the associated compromise in the newborn calf. The objectives of this study were to: 1) quantify the force applied during manual and mechanical delivery of beef calves, and 2) examine the association of force with calf birthweight, vigour, acidemia, and tissue trauma.

Primipaternity and birth interval; independent risk factors for preeclampsia

Background: The exact cause of preeclampsia remains unknown. The past decade has seen an ongoing debate on the relative importance of primipaternity versus prolonged birth/pregnancy interval.Aims: The aim of the current study was to analyze these two major potential risk factors in a high risk population in the Northern suburbs of Adelaide; a socioeconomically disadvantaged area characterized by instable relationships and overall poor health and lifestyle.Methods: A retrospective cohort study was performed on all multigravid women birthing at the Lyell McEwin Hospital, Adelaide, from July 2011 to August 2012; 2003 patients were included in this analysis. Basic demographic data, previous pregnancy outcomes, paternity, and birth and pregnancy intervals were recorded.Results: Women with a previously normal pregnancy had a significantly increased risk of developing preeclampsia in subsequent pregnancy with a new paternity (OR: 2.27 [p = .015]). Increasing birth and pregnancy intervals were associated with a significantly increased risk of developing preeclampsia in later pregnancies, with OR 1.39 at 3 years (p = .042) and OR 2.05 at 4 years (p = .002).Conclusions: The results of this study indicate that both prolonged birth interval and primipaternity are independent risk factors for preeclampsia in multigravidae.

The predictive role of support in the birth experience: A longitudinal cohort study.

Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. The aim of this study was to describe women's birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. A longitudinal cohort study was conducted with a convenience sample of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11-16 weeks of pregnancy (T1, n=1111), at five to six months (T2, n=765), and at 18-24 months after birth (T3, n=657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on women's perception of birth experience.

Association of Low-Birth Weight with Malnutrition in Children under Five Years in Bangladesh: Do Mother's Education, Socio-Economic Status, and Birth Interval Matter?

BackgroundMalnutrition in children under five years remains a significant problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although several studies have been conducted to identify the important risk factors of malnutrition, none of them assess the role of low birth weight (LBW) despite its high prevalence (36%). This study examines the association between LBW and malnutrition using data from the Bangladesh Demographic and Health Survey (BDHS) 2011 and provides practical guidelines for improving nutritional status of children.MethodsMalnutrition in children is measured in terms of their height-for-age, weight-for-height, and weight-for-age. Children whose Z-scores for either of these indices are below two standard deviations (–2SD) from median of WHO’s reference population are considered as stunted, wasted or underweight, respectively. The association between malnutrition and LBW was investigated by calculating adjusted risk-ratio (RR), which controls for potential confounders such as child’s age and sex, mother’s education and height, length of preceding-birth-interval, access to food, area of residence, household socio-economic status. Adjusted RR was calculated using both Cochran-Mantel-Haenszel approach and multivariable logistic regression models controlling for confounder.ResultsThe prevalence of malnutrition was markedly higher in children with LBW than those with normal birth-weights (stunting: 51% vs 39%; wasting: 25% vs 14% and underweight: 52% vs 33%). While controlling for the known risk factors, children with LBW had significantly increased risk of becoming malnourished compared to their counter part with RR 1.23 (95% CI:1.16–1.30), 1.71 (95% CI:1.53–1.92) and 1.47 (95% CI: 1.38–1.56) for stunting, wasting and underweight, respectively. The observed associations were not modified by factors known to reduce the prevalence of malnutrition, such as higher education of mother, better household socio-economic conditions and longer birth-interval.ConclusionsHigher education of mother, better household socio-economic conditions and prolonged birth intervals alone are not sufficient in bringing about substantial reductions in prevalence of child malnutrition in Bangladesh. Targeted interventions should be designed to reduce prevalence of LBW in addition to improving mother’s education and other socio-demographic conditions.

Hospital readmissions in late preterm infants

Neonatologists generally recognize that late preterm infants face more problems in the immediate newborn period compared with their full-term counterparts. [1,2]. This excess morbidity extends beyond the initial birth hospitalization [3] and the literature recognizes that readmission rates of late preterm infants are 1.5 to 3 times that of term infants [4-7]. In this group of infants, the overwhelming reasons for rehospitalisation are jaundice and feeding problems. The most widely studied metric of health care utilization in late preterm infants is short-term readmission (the first two weeks) after birth hospitalization. Escobar [8] found that late preterm babies with short NICU stays had the highest rehospitalisation rates and in a follow-up study they found that rehospitalisation rates within 2 weeks were higher among late preterm infants who never were admitted to the NICU [4]. Shapiro-Mendoza [7] found that late preterm babies discharged early were at greater risk of neonatal morbidity. They also found that risk factors for subsequent readmissions were birth hospital stays less than 4 days, breastfeeding, Asian/Pacific Islanders, first born infants, and public payers at the time of delivery. In the United Kingdom, Oddie [9] also noted that late preterm infants had the highest rate of readmission but infectious disease and not jaundice was the leading factor for readmission, which the investigators attributed to a differing approach to management of jaundice in the United Kingdom. Escobar[10] examined late rehospitalisation (after the first two weeks) and found 36 week gestation newborns at higher risk for readmission. Paradoxically, babies of 34 and 35 weeks were not at higher risk and this may be explained by more frequently delayed discharge of infants of shorter gestational age. McLaurin [5] also demonstrated increased late rehospitalisation rates in late preterm infants and found that the subset with prolonged birth hospitalizations (≥4 days) had the highest rates of rehospitalisation. Respiratory disease (bronchiolitis and pneumonia) was the most common cause of readmission. The late preterm infant is particularly responsive to the benefits but vulnerable to the risks of early discharge home. Longer length of stay before discharge is protective against readmission but it is not reasonable to prolong the birth hospitalization of newborns who meet criteria for discharge. More effort needs to be placed to reduce the risk of jaundice and feeding problems in these patients: to avoid mother and infant separation during birth hospitalization, to arrange a follow-up appointment within 48 hours of discharge, to promote and support lactation before and after discharge.

Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda

BackgroundSpousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives.MethodsA qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti.ResultsFive themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation.ConclusionDecision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services.

Risk Factors, Clinical Presentation, and Neuroimaging Findings of Neonatal Perforator Stroke

To date, studies on neonatal stroke have mainly focused on cortical stroke. We have focused on perforator strokes, noncortical strokes in the arterial vascular perforator area. We sought to identify risk factors and evaluate clinical presentation and neuroimaging findings for neonatal perforator stroke, which seems to be under-recognized. All infants admitted to our tertiary intensive care unit in ≈12 years, whose perforator stroke was diagnosed with postnatal brain imaging, were enrolled in this study. Demographic, perinatal, and postnatal data were evaluated. Seventy-nine perforator strokes were detected in 55 patients (28 boys), with a median gestational age of 37 1/7 weeks (range 24 1/7 to 42 1/7 weeks, 25 preterm). Perforator stroke was asymptomatic in most patients (58%). Initial diagnosis was predominantly made with cranial ultrasound (80%) in the first week of life (60%). Risk factors for stroke were present in all cases: maternal, fetal, and perinatal. Likely pathogenic mechanisms were prolonged birth asphyxia (16%), hypoxia or hypotension (15%), embolism (15%), infection (15%), acute blood loss (9%), and birth trauma (9%). Previously described risk factors for developing neonatal main artery stroke are probably also associated with neonatal perforator stroke. Perforator stroke is often asymptomatic, but cranial ultrasound is a reliable diagnostic tool in diagnosing perforator stroke.

The cardiac biomarkers troponin I and CK-MB in nonpregnant and pregnant goats, goats with normal birth, goats with prolonged birth, and goats with pregnancy toxemia

This study was designed to establish the reference range for the cardiac biomarkers cardiac troponin I (cTnI) and creatine kinase myocardial band (CK-MB) in nonpregnant and pregnant goats, goats with normal birth, goats with prolonged birth associated with dystocia, and goats with pregnancy toxemia. Fifty-seven does, categorized into three groups (G1 to G3), were used. These groups were comprised of 20 healthy does (G1), 19 does with prolonged birth (G2), and 18 does with pregnancy toxemia (G3). Six blood samples (T0 to T5) were collected from G1. The first blood sample (T0) was taken before insemination, the second (T1) at the first trimester, the third (T2) at the second trimester, the fourth (T3) at the last trimester, the fifth (T4) within 12 h of parturition, and the sixth blood sample (T5) was taken 10 days after parturition. A sample of blood was obtained from G2 and G3 upon admission to the hospital. At T0 to T3, no cTnI was detected in any of the 20 does in G1. At parturition (T4), seven of the 20 goats (35%) exhibited slightly elevated cTnI concentrations (range, 0.01 to 0.04 ng/mL). Ten days after parturition (T5), cTnI was not detected in any of the 20 goats. In 10 of the 19 goats (53%) with prolonged birth (G2), the cTnI was significantly elevated to a mean value of 0.094 ± 0.155 ng/mL, with a maximum value of 0.61 ng/mL. In 16 of the 18 goats (89%) with pregnancy toxemia (G3), the cTnI was significantly elevated to a value of 0.852 ± 1.472 ng/mL, with a maximum value of 5.219 ng/mL. Comparing the values of CK-MB in G1 (T0 to T5), G2 and G3 revealed nonsignificant differences. Only a slight elevation in the CK-MB levels in goats with prolonged birth (G2) was noted. We concluded that in healthy does, the cardiac biomarker cTnI is not elevated during normal pregnancy. The serum cTnI concentration may be elevated in a number of goats at normal vaginal or cesarean delivery. Finally, cTnI is significantly elevated in does with pregnancy toxemia and could be used as a prognostic indicator in such cases. The cardiac biomarker CK-MB is not a good indicator of parturition stress in does. Serum cTnI is elevated in goats with pregnancy toxemia, indicating some degree of cardiac dysfunction.

Associations between intrapartum death and piglet, placental, and umbilical characteristics1

Intrapartum death in multiparous gestations in sows (Sus scrofa) is often caused by hypoxia. There is little information in the literature on the assessment of the placenta in relation to intrapartum death in piglets. The aim of this study was to evaluate the impact of the placental area and weight upon piglet birth characteristics and intrapartum death. Litters from 26 Landrace-Yorkshire sows were monitored during farrowing and the status of each piglet was recorded, including blood parameters of piglets and their umbilical veins. Of 413 piglets born, 6.5% were stillborn. Blood concentrations of glucose, lactate, and CO(2) partial pressure were increased in the stillborn piglets (P < 0.05) and corresponding umbilical veins (P < 0.01) vs. live-born piglets, whereas pH and base excess were decreased (P < 0.001). Time from onset of parturition until birth was increased for piglets born dead vs. live (P < 0.001). Mean birth weight for piglets born dead was not different from live-born piglets (P = 0.631), whereas mean body mass index was reduced (P < 0.001). Mean placental area and placental weight belonging to stillborn piglets were not different from live-born piglets (P = 0.662 and P = 0.253, respectively). Blood concentrations of lactate, hemoglobin, and hematocrit recorded in all piglets pooled were associated with placental area (P < 0.05), but not with placental weight (P > 0.2). Piglet BW was positively correlated with placental area and placental weight (P < 0.001). The risk of being born dead increased with increasing birth order group, and broken umbilical cords explained 71% of the stillbirths (P = 0.001). We conclude that placental area and placental weight are both positively associated with piglet birth weight, but not with the probability of being born dead. Placental area was a better predictor of piglet vitality than placental weight. Because umbilical cord rupture and prolonged birth time were associated with being born dead, umbilical cord rupture and placental detachment seem to be probable causes of intrapartum death.

Proportion of the litter farrowed, litter size, and progesterone and estradiol effects on piglet birth intervals and stillbirths

Stillbirth in swine ranges from 2 to 9%, resulting in a significant loss of piglets. Previous studies clearly indicate a relationship between prolonged birth intervals and stillbirth, but factors influencing birth intervals are not fully known. To characterize birth intervals and stillbirth, farrowing was recorded during three farrowing seasons. Blood samples were collected on d 110 and d 113 of gestation, and were assayed for progesterone and estrogen. Relationships between estrumate (cloprostenol sodium, an analogue of prostaglandin F 2α) usage, litter size, proportion of the litter farrowed, progesterone and estrogen concentrations, birth intervals, and stillbirth were analyzed using regression analysis. A clear relationship between birth intervals and stillbirth was observed. Stillbirth rate was unaffected by birth intervals of <1 h, and increased ( P < 0.01) for birth intervals >1 h. A significant negative association between litter size and birth intervals was observed ( P < 0.01). Birth intervals were unaffected by proportion of the litter farrowed until the last piglet in the litter, whose birth interval increased dramatically (1.5-fold; P < 0.01). Stillbirth rates increased as proportion of the litter farrowed increased, and a dramatic increase in stillbirth occurred for the last piglet in the litter. Neither d 110 nor 113 plasma progesterone concentrations were associated with litter size, birth intervals, or stillbirth rates. Curvilinear relationships were present between d 110 or 113 plasma estradiol concentrations and litter size. However, neither d 110 nor 113 estradiol concentrations were associated with birth intervals or stillbirth rates. These results indicate that (1) birth intervals greater than 1 h are associated with increased stillbirth; (2) larger litter size reduces birth intervals; (3) the last piglet in the litter has both a prolonged birth interval and increased risk of stillbirth; (4) plasma progesterone before farrowing does not influence birth intervals or stillbirth; and (5) plasma estradiol does not influence birth interval or stillbirth, despite a positive relationship between litter size and plasma estradiol. An understanding of the effects of litter size and proportion of the litter farrowed on birth intervals might be exploited to decrease stillbirth in piglets.

Risk factors for preeclampsia in multiparous women: Primipaternity versus the birth interval hypothesis

Introduction. To determine whether the risk of preeclampsia in multiparous women with a previous normal pregnancy is related to changing paternity or to prolonged birth interval, a retrospective study was conducted at the Lyell McEwin Health Service (University of Adelaide).Methods. The study included all multiparous women known to the hospital because of their preceding 1st delivery in the same hospital followed by their 2nd and/or 3rd ongoing pregnancy resulting in a delivery in the period 2001 – 2003. Case records were analyzed for birth interval, pregnancy interval, paternity and recognized risk factors such as booking weight and smoking. For the analysis both the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition and the more recently introduced classification by the Australian Society for the Study of Hypertension in Pregnancy (ASSHP) were used.Results. In the 656 women in this study cohort, 148 (26.2%) women had a different partner in their 2nd and/or 3rd ongoing pregnancy. Using the ISSHP definition for preeclampsia, changing partners had an odds ratio (OR) of 1.304 (95% CI 0.43 – 3.99); using ASSHP criteria an OR of 1.556 (95% CI 0.6506 – 3721); and looking at the combined group of pregnancy-induced hypertensive disorders an OR of 1.99 (95% CI 1.01 – 3.89). A longer birth interval if anything was associated with a lower risk of preeclampsia (non-significant), whatever definition was used. Also the inter-pregnancy interval did not show a consistent relation with the risk for developing a hypertensive complication.Conclusions. The results of this study on risk factors for preeclampsia in multiparous women appear to be in line with the primipaternity hypothesis, but are in direct contrast with the so-called birth interval hypothesis.

Effect of prolonged birth spacing on maternal and perinatal outcome

Researchers have held varied opinions on the effect of prolonged birth spacing on maternal and perinatal outcome. To determine the reasons for prolonged birth spacing and to compare the maternal and perinatal outcome compared to shorter normal birth spacing. Comparative case - controlled study between January 1st, 2001 to December 31st, 2002. Obstetric Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Fifty cases consisted of multiparae with prolonged birth spacing (> or =6 years) and controls consists of similar number of multiparae with shorter normal birth spacing (2 - 5 years) matched for age, parity and socio-economic status. Labour outcome, Apgar scores, operative and vaginal delivery rates, perinatal and maternal outcome, reasons for prolonged birth spacing. There was no significant difference observed with respect to spontaneous onset of labour, induction or argumentation of labour, duration of labour, spontaneous vaginal delivery rates, Caesarean section rates, instrumental vaginal deliveries, analgesic requirement, postpartum haemorrhage, and Apgar scores in both groups. There were no perinatal or maternal deaths. The commonest reason adduced for prolonged birth spacing is failed contraception (56%), followed by secondary infertility (24%) and to a lesser extent re-marriage, improved income and sheer desire. There was no significant difference in maternal and perinatal outcome in pregnancy between women with prolonged birth spacing and those with normal shorter birth spacing.