Partum Research Articles

Pregnancy and cardiac maternal outcomes in women with inherited cardiomyopathy: interest of the new CARPREG II risk score

Abstract Introduction Inherited cardiomyopathies are rare but at high risk of cardiac maternal morbidity and mortality during pregnancy and post-partum. However data for risk stratification remains scarce. The new CARPREG II index score emerged to better predict prognosis in pregnancies with heart disease. Still, role of this score in inherited cardiomyopathies is unclear. Objective To describe characteristics and cardiac maternal outcomes in patients with inherited cardiomyopathy during pregnancy, and to evaluate the interest of the various index scores in this population. Methods In this retrospective monocentric study, 90 pregnancies of 74 patients were included (mean age 32 ± 5 years), with 28 dilated cardiomyopathies (DCM), 46 hypertrophic cardiomyopathies, 11 arrhythmogenic right ventricular cardiomyopathies and 5 left ventricular non compaction, excluding peri partum cardiomyopathies. Results A cardiac maternal complication was observed for 18 (20%) pregnancies, mainly driven by arrythmia and heart failure, and with 3 cardiovascular deaths. 43 (48 %) presented fetal or neo natal complications, with 18 premature delivery and 3 fetal or neonatal death. Median CARPREG II score was 2 [0;3], higher in the DCM subgroup. CARPREG II was significantly associated with the onset of cardiac maternal complication (p< 0.05 for all) and seemed to show a better performance for risk stratification than previous scores (Area under curve of ROC: 0.782 for CARPREG II, AUC 0.755 and 0.697 for CARPREG and mWHO respectively). Prior hospitalization for heart failure, left ventricular dysfunction, multiple line treatments, cardiac symptoms prior to pregnancy and late pregnancy assessment were associated with cardiac complications (p < 0.05 for all) Conclusion Pregnancy in women with inherited cardiomyopathy remains at high risk of maternal cardiovascular major events. Late pregnancy assessment and initial severity of cardiomyopathy were found associated with cardiac prognosis. The new CARPREG II score appeared as the most efficient for cardiac risk stratification in this population.

Birth-Related Risk Factors Impact Cognitive and Academic Outcomes in Children with Sickle Cell Disease

Pre- and peri-natal-related risk factors are associated with slowed neurocognitive development and increased risk of learning difficulties in the general population. A recent study reported expressive language deficits were associated with preterm birth in young children with sickle cell disease (SCD) (Bills et al., 2021); however, no studies to date have examined the long-term impact of low birth weight in children and adolescents with SCD. In this cohort study, we examined associations between low birth weight (<2500g) and cognitive and academic outcomes, including formal school support services (i.e., 504 Plan or Individual Education Program), in children with SCD. Gestational age and neonatal intensive care unit (NICU) admission were investigated as covariates. Participants were children ages 8-18 years old with SCD enrolled in the Sickle Cell Clinical Research and Intervention Program (SCCRIP), an observational cohort study of clinical outcomes in SCD. Participants received targeted neurocognitive evaluations as standard of care every 3-4 years. Performance-based neurocognitive measures were used to assess cognitive and academic abilities, including the Wechsler Abbreviated Scale of Intelligence, Second Edition; Wechsler Intelligence Scale for Children, Fourth and Fifth Editions; Wechsler Adult Intelligence Scale, Fourth Edition; Delis Kaplan Executive Function System; Conners Continuous Performance Test, Second and Third Editions; and Woodcock-Johnson Tests of Achievement, Third and Fourth Editions. Multivariable generalized linear regression examined associations between birth-related risk factors (i.e., birth weight, gestational age, and NICU admission) and cognitive outcomes, academic achievement, and need for school support services after adjusting for age, sex, hydroxyurea treatment, sickle genotype, and socioeconomic status. P-values <0.05 were considered significant. False discovery rate-adjusted p-values or q-values were calculated across the outcomes and all birth-related risk factors to correct for multiple corrections. Of the 326 participants in SCCRIP who completed neurocognitive evaluations, 282 children had normal birth weight (HbSS/HbSβ 0thalassemia=56%) and 44 children were born with low birth weight (HbSS/HbSβ 0=45%). Birth weight groups (<2500g and >2500g) were matched for demographic and disease characteristics (Table 1). The mean age at time of cognitive evaluation was 11.16 (SD= 3.27) years and half of participants were male (51%). Low birth weight was associated with worse word reading (p=0.011; Table 2). Across all participants, admission in the NICU was associated with lower verbal reasoning (p=0.022), processing speed (p=0.017), working memory (p=0.044), word reading (p=0.021), and math fluency (p=0.05). Similarly, across all participants, earlier gestational age was associated with lower verbal fluency (p=0.011). Low birth weight and gestational age predicted need for school support services (p=0.003 and p=0.007, respectively). History of birth-related risk factors should be considered a comorbidity for neurodevelopmental differences in SCD. Specifically, children with SCD who are born with low birth weight or admitted to the NICU are at increased risk for difficulties with processing speed, working memory, language, and academics. The need for formal school support services in SCD is associated with gestational age and birth weight.

Prenatal Exposure to Heavy Metals and Adverse Birth Outcomes: Evidence From an E-Waste Area in China.

Electronic waste that has not been properly treated can lead to environmental contamination including of heavy metals, which can pose risks to human health. Infants, a sensitive group, are highly susceptible to heavy metals exposure. The aim of this study was to investigate the association between prenatal heavy metal exposure and infant birth outcomes in an e-waste recycling area in China. We analyzed cadmium (Cd), chromium (Cr), manganese (Mn), lead (Pb), copper (Cu), and arsenic (As) concentrations in 102 human milk samples collected 4weeks after delivery. The results showed that 34.3% of participants for Cr, which exceeds the World Health Organization (WHO) guidelines, as well as the mean exposure of Cr exceeded the WHO guidelines. We collected data on the birth weight (BW) and length of infants and analyzed the association between metal concentration in human milk and birth outcomes using multivariable linear regression. We observed a significant negative association between the Cd concentration in maternal milk and BW in female infants (β=-162.72, 95% CI=-303.16, -22.25). In contrast, heavy metals did not associate with birth outcomes in male infants. In this study, we found that 34.3% of participants in an e-waste recycling area had a Cr concentration that exceeded WHO guidelines, and there was a significant negative association between prenatal exposure to the Cd and infant BW in females. These results suggest that prenatal exposure to heavy metals in e-waste recycling areas may lead to adverse birth outcomes, especially for female infants.

Live birth rate following endometrial preparation with daily versus depot GnRH agonist

Background Gonadotrophin-releasing hormone agonist (GnRHa) downregulates gonadotropin secretion in the pituitary gland. It is used both in ovulation induction protocols and in artificial endometrium preparation. Frozen—thawed embryo transfer to artificially prepared endometrium (FET-APE) is a frequent procedure in vitro fertilization (IVF) which requires GnRHa. It can be used either as a daily low-dose injection or as a single depot injection. It is unclear which of these two regimens is superior for artificial endometrium preparation. Methods We evaluated the data of 72 patients who had undergone frozen embryo transfer following the 5th day Preimplantation Genetic Test-aneuploidy (PGT-A) between 2018–2021. All embryos were genetically screened, and euploid single embryos were transferred. Group 1 (n: 36) used depot GnRHa, and Group 2 (n: 36) used single daily injections for artificial endometrial preparation. The outcomes for Beta Human Chorionic Gonadotrophin (BHCG) positivity and live birth rates (LBR) was compared. Results The BHCG positivity for Group 1 and Group 2 was 75% and 80.6%, respectively. The LBR for Group 1 and Group 2 were found to be 58.3% and 63.9%, respectively. There was no statistically significant differences between the two groups. Conclusions In artificial endometrium preparation, depot GnRHa offers cheaper and more convenient alternative to single daily dose injections, particularly in busy clinical settings.

Type of delivery, birthweight, breastfeeding and overweight: the 2019 Italian results

Abstract Introduction According to recent studies, childhood obesity can be affected by type of delivery, birthweight and breastfeeding. The data from the surveillance system OKkio alla SALUTE, coordinated by the Italian National Institute of Health, have been used to investigate this association. OKkio alla SALUTE, promoted by the Italian Ministry of Health, is part of the WHO European Childhood Obesity Surveillance Initiative. Methods The study population are children aged 8 or 9 years in the third grade of all primary schools. A stratified cluster sample design, with class as the sampling unit, was used. Children were weighed and measured by trained local health staff and were classified as overweight or obese using the age and sex-specific International Obesity Task Force cut-offs. Parents of children completed a brief questionnaire to assess risk behavior, including information about the birth and the first few months of life of their child. Results In 2019, the sixth round of data collection involved 47,219 children and 50,370 parents with a response rate higher than 94%. 20.4% (95% CI 19.9-20.9) of 8-9 years old children were overweight and 9.4% (95% CI 9.0-9.7) were obese. The prevalence of obesity has decreased steadily since 2008 to 2019. The prevalence of overweight and obesity was higher for children born by caesarean section (33% vs 27% by vaginal childbirth), increased with birthweight (for birthweight >4,000 kg: 39.4% vs for birthweight<2,500 kg: 25.1%) and among children who had been breastfed never or less than 1 month (33.6% vs breastfeeding 6 months and above: 28.9%). Logistic regression analysis confirms the association between characteristics at birth/breastfeeding and overweight/ obesity. Conclusions Type of delivery, birth weight and breastfeeding seem to play a role in the prevalence of childhood overweight and obesity. Although these results may be affected by recall bias, this is unlikely to materially affect the results. Key messages • Type of delivery, birth weight and breastfeeding seem to play a role in the prevalence of childhood overweight and obesity. • Information on breastfeeding and other characteristics at birth that might be associated with overweight and obesity is essential for tracking progress in countries.

Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort.

Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.

Prevalence of pelvic floor dysfunction and associated risk factors among Nulligravida college students: a cross-sectional study

BackgroundPelvic floor dysfunction (PFD) is a global health problem affecting millions of women worldwide. Vaginal childbirth has been reported to be the most important factor in the etiology of PFD though a prior study also reported a high prevalence of PFD in nulliparous women. Some previous studies had suggested Urinary incontinence before pregnancy as a major risk factor for incontinence later in life, thus prevention of PFD has become a major priority in women’s health, and identification of women at risk is a key element in current prevention strategies It is therefore necessary to investigate the prevalence and risk factors for PFD in Nulligravida women who have never been pregnant to enable preventative measures especially as it regards lifestyle modification.MethodsParticipants were 160 Nulligravida students aged between 17 and 26 years. They were screened for pelvic floor dysfunction using an Australian pelvic floor questionnaire which assessed their bladder function, bowel function, pelvic organ prolapse, and sexual function. Descriptive statistics of frequency and percentage were used to summarize categorical variables. Univariate analysis of Fisher’s exact test and Wilcoxon rank-sum test were conducted to show the association of categorical and continuous variables with pelvic floor dysfunction (PFD) respectively. The risk factors of PFD with p values < 0.05 were considered significant. All analyses were performed using R Statistical Computing Programming version 4.2.2.ResultsThe prevalence of having at least one of any of the PFD was 73.1% while the prevalence of bladder, bowel, prolapse, and sex dysfunction were 25.63% (41/160), 53.75% (86/160), 1.88% (3/160), and 23.13% (37/160) respectively. BMI was not a significant risk factor for any type of PFD while multi-variable logistic regression identified the level of study, height, history of UTI, and non-sport participation as significant (p < 0.05) risk factors for at least one type of PFD with Odd ratio of 4.91, > 100, 8.47, and 2.86 respectively.ConclusionThere is high prevalence of PFD among Nulligravida students, with non-participation in sports and history of urinary tract infections being the main significant risk factors.

НЕКОТОРЫЕ АСПЕКТЫ ДИАГНОСТИКИ И ПРОФИЛАКТИКИ НЕДОСТАТОЧНОСТИ ТАЗОВОГО ДНА У ЖЕНЩИН РЕПРОДУКТИВНОГО ВОЗРАСТА

The aim of the study: to assess the significance of the study of the state of the pelvic floor in women of reproductive age who have risk factors for the development of pelvic organ plolapse; to evaluate the effectiveness of an electric exercise machine in combination with Kegel exercises in the preven-tion of pelvic organ prolapse. Matherial and methods: 363 women with a history of vaginal childbirth were examined, which, depending on parity and body mass index, were divided into 4 groups. Ultra-sound measurement of the height of the tendon center of the perineum, the width of the muscle bun-dles of the levator legs (m. bulbospongiosus, m. bulbocavernosus), the angle of urethral incline (alpha angle), vesico-urethral angle (betta angle), the length of the urethra was performed. The results of the study: obtained indicate the expediency of performing ultrasound scans with study of the muscles that form the pelvic floor in women who gave birth with perineal trauma, for early detection of pelvic floor insolvency. The effectiveness of using electric exercise machines in combination with a set of physical exercises to strengthen the pelvic floor muscles in women with preclinical manifestations of pelvic floor muscle failure has been proven.

Translation and validation of the Japanese version of the Birth Satisfaction Scale-Revised.

This study aimed to develop a Japanese version of the Birth Satisfaction Scale-Revised and evaluate its reliability and validity. After translating the Birth Satisfaction Scale-Revised into Japanese, we conducted an Internet-based cross-sectional study with 445 Japanese-speaking women within 2 months of childbirth. Of these, 98 participated in the retest 1 month later. Data were analyzed using the COSMIN study design checklist for patient-reported outcome measurement instruments. Content validity was evaluated through cognitive debriefing during the translation process into Japanese. Confirmatory factor analysis was conducted to verify structural and cross-cultural validities. For hypothesis testing, we tested correlations with existing measures for convergent and divergent validities, and for known-group discriminant validity, we made comparisons between types of childbirth. Internal consistency was calculated using Cronbach's α, and test-retest reliability was evaluated using the intraclass correlation coefficient. For the Japanese-Birth Satisfaction Scale-Revised, the established three-factor model fit poorly, whereas the four-factor model fit better. Full metric invariance was observed in both the nulliparous and multiparous groups. Good convergent, divergent, and known-group discriminant validities and test-retest reliability were established. Internal consistency observations were suboptimal; however for vaginal childbirth, the Cronbach's α of the total score was .71. The Japanese-Birth Satisfaction Scale-Revised is a valid and reliable scale, with the exception of internal consistency that requires further investigation. If limited to vaginal childbirth, research, clinical applications, and international comparisons can be drawn.

Physical and psychological recovery after vaginal childbirth with and without epidural analgesia: A prospective cohort study.

Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the physical and psychological recovery of women after vaginal childbirth are limited. Whether neuraxial labor analgesia influences postpartum recovery is unknown. Primiparous women anticipating a vaginal childbirth between January 2020 and May 2021 were enrolled. Women with major comorbidities or postpartum complications and those who underwent a cesarean delivery were excluded. Daily step count was measured using a wrist-worn activity tracker (FitbitTM Inspire HR) for 120 hours after vaginal childbirth. Subjective fatigue levels and health-related quality of life were assessed using the Multidimensional Fatigue Inventory (MFI) and EuroQol 5 Dimension 5 Level (EQ-5D-5L), respectively, at the 3rd trimester antenatal visit, on postpartum day 1 and 3, and at the one-month postpartum visit. Rest and dynamic pain scores and the location of pain were documented by participants during postpartum hospitalization. Among 300 women who were enrolled antenatally, 95 and 116 had a vaginal delivery without (NCB group) and with (EPL group) epidural analgesia, respectively. The median number of steps per 24 hours increased daily in both groups, and no significant difference was detected between the groups. Postpartum pain was mild overall, with median rest and dynamic pain scores being less than 4 and similar between the groups. MFI and EQ-5D-5L scores were the worst on postpartum day 1 in both groups and gradually improved to antepartum level by the one-month postpartum visit. Higher MFI score on postpartum day 1, but not the use of epidural analgesia, was associated with lower odds of achieving adequate postpartum ambulation (defined as >3500 steps between 48 and 72 hours postpartum). The use of epidural analgesia was not associated with worse recovery outcomes during postpartum hospitalization. UMIN-CTR, #UMIN000039343, registered on January 31, 2020.

“I was afraid, because I was naked”: Ethical literary criticism, the fall of Adam and Eve and moral teaching

This article explores the moral teachings in the fall of Adam and Eve (Gen 2:4–3:24) from the perspective of ethical literary criticism. According to the theory of three stages in human civilization—natural, ethical and scientific selection, the fall of Adam and Eve represents the historical process of human civilization going from natural selection to ethical selection. It is ethical selection that enables Adam and Eve to have ethical consciousness and distinguish themselves from animals, which provides ideas for the birth and growth of humans and highlights the function of “moral teaching and learning” in children's education. Besides, the so-called original sin is the animal factor remained in human beings after natural selection, which can bring about different ethical predicaments of “to be or not to be” and lead to making wrong ethical choices. The fall of Adam and Eve indicates that human beings are born with Sphinx factor—human factor and animal factor and integrate into the secular life and religious activity with divine factor. Once the animal factor of an individual is out of control, breaking the ethical taboo and violating the moral order or religious rule without exerting the power of human factor or divine factor, there will inevitably be punishments and tragedies. The fall of Adam and Eve is such an ethical tragedy, which purifies primitive desires and evokes moral emotions through pity and fear to uphold the morality in society and the authority in religion.

The Mawlid Tradition of Muhammad in Sudan

Sufi in Sudan have the unique ways of preaching and spiritual practices, contributing to Sudan's reputation as the "land of a thousand Dervishes." The religious spirit in Sudan fosters a deep love for the Quran and unique traditions that reflect their faith in murshids and the Prophet's descendants. This study aims to provide an overview and mufassir interpretation of the tradition of the Prophet Muhammad's Mawlid in Sudan, which is unique compared to other countries. This research is qualitative, with the characteristics of dissecting documents and several journal articles that match. The author also took data from various articles in the mass media and journals to strengthen this research information. This type of research is library research and different kinds of unstructured interview methods by various sources. The results of this study show that the celebration of the birthday of the Prophet Muhammad in Sudan has its uniqueness, including setting up tents in the field filled with various congregations. It is filled with readings of suluk, poetry, and stories of the Prophet Muhammad's missionary struggle. Then, one of the mufassir's interpretations of this tradition, namely As-Suyuti. He believed that traditions like this are a profound gratitude to God, the creator of His creatures, Allah, for the birth and creation of humans as a mercy for the entire universe.

ADI SHANKARACHARYA’S HAGIOGRAPHY AND FIVEFOLD DISCIPLINE TO BRING OUT PERFECTION IN HUMAN

Homo species in creation have special quality ‘organic capacity’ to explore both the outer and inner worlds, means man has knowledge of secular as well as spiritual knowledge. That’s why human birth is considered as most rare birth, in this life only he gets the opportunity to conquer lower nature and manifest the higher. With the development of science and technology man tries to control nature and become civilized and cultured. He knows the world better but he must know himself is first step is most important for spiritual destiny as well as for the welfare of humanity. Human being has an animal instinct to evolve himself he has to do special efforts which is known as ‘Sadhana’. Through science progress and technology development man achieved comforts in his life but lost the peace of mind due to which he is unable to enjoy life any more. Our ancient seers had given us the most precious tools (Sadhana) as per individual needs, at different times he may require different Sadhana. According to our ancient scriptures to bring out change in human beings Sadhana plays a vital role. Sadhana means continuous endurance with firm determination to realize ultimate goal of human life. Bring out divinity in every individual which help to reform society; ultimately develop peace and harmony will go together hand in hand in the world.

НЕКОТОРЫЕ АСПЕКТЫ ДИАГНОСТИКИ И ПРОФИЛАКТИКИ НЕДОСТАТОЧНОСТИ ТАЗОВОГО ДНА У ЖЕНЩИН РЕПРОДУКТИВНОГО ВОЗРАСТА

The aim of the study: to assess the significance of the study of the state of the pelvic floor in women of reproductive age who have risk factors for the development of pelvic organ plolapse; to evaluate the effectiveness of an electric exercise machine in combination with Kegel exercises in the preven-tion of pelvic organ prolapse. Matherial and methods: 363 women with a history of vaginal childbirth were examined, which, depending on parity and body mass index, were divided into 4 groups. Ultra-sound measurement of the height of the tendon center of the perineum, the width of the muscle bun-dles of the levator legs (m. bulbospongiosus, m. bulbocavernosus), the angle of urethral incline (alpha angle), vesico-urethral angle (betta angle), the length of the urethra was performed. The results of the study: obtained indicate the expediency of performing ultrasound scans with study of the muscles that form the pelvic floor in women who gave birth with perineal trauma, for early detection of pelvic floor insolvency. The effectiveness of using electric exercise machines in combination with a set of physical exercises to strengthen the pelvic floor muscles in women with preclinical manifestations of pelvic floor muscle failure has been proven.

Comparison of Hospital Online Price and Telephone Price for Shoppable Services

US hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital's prices posted online correlate with the prices they give to a telephone caller is unknown. To compare hospitals' online cash prices for vaginal childbirth and brain magnetic resonance imaging (MRI) with prices offered to secret shopper callers requesting price estimates by telephone. This cross-sectional study included cash online prices from each hospital's website for vaginal childbirth and brain MRI collected from representative US hospitals between August and October 2022. Thereafter, again between August and October 2022, simulated secret shopper patients called each hospital requesting their lowest cash price for these procedures. We calculated the difference between each hospital's online and phone prices for vaginal childbirth and brain MRI, and the Pearson correlation coefficient (r) between the online and phone prices for each procedure, among hospitals able to provide both prices. A total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non-top-ranked, non-safety-net hospitals) were included in the analysis. For vaginal childbirth, 63% (12 of 19) of top-ranked hospitals, 30% (6 of 20) of safety-net hospitals, and 21% (4 of 19) of non-top-ranked, non-safety-net hospitals provided both online and telephone prices. For brain MRI, 85% (17 of 20) of top-ranked hospitals, 50% (10 of 20) of safety-net hospitals, and 100% (20 of 20) of non-top-ranked, non-safety-net hospitals provided prices both online and via telephone. Online prices and telephone prices for both procedures varied widely. For example, online prices for vaginal childbirth posted by top-ranked hospitals ranged from $0 to $55 221 (mean, $23 040), from $4361 to $14 377 (mean $10 925) for safety-net hospitals, and from $1183 to $30 299 (mean $15 861) for non-top-ranked, non-safety-net hospitals. Among the 22 hospitals providing prices both online and by telephone for vaginal childbirth, prices were within 25% of each other for 45% (10) of hospitals, while 41% (9) of hospitals had differences of 50% or more (Pearson r = 0.118). Among the 47 hospitals providing both online and phone prices for brain MRI, prices were within 25% of each other for 66% (31) of hospitals), while 26% (n = 12) had differences of 50% or more (Pearson r = -0.169). Among hospitals that provided prices both online and via telephone, there was a complete match between the online and telephone prices for vaginal childbirth in 14% (3 of 22) of hospitals and for brain MRI in 19% (9 of 47) of hospitals. Findings of this cross-sectional study suggest that there was poor correlation between hospitals' self-posted online prices and prices they offered by telephone to secret shoppers. These results demonstrate hospitals' continued problems in knowing and communicating their prices for specific services. The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for health care.

Use of the narcotic analgesic fentanyl to correct violations of the autonomic regulation of childbirth

Background. The problem of effective prolonged epidural analgesia (PEA) in case of hypotonic labor, which allows minimal intervention in the process of labor activity while providing adequate analgesia, remains unresolved. A study was conducted to increase the effectiveness of PEA use during the first state of childbirth in women with hypotonic labor. The purpose: to increase the effectiveness of prolonged epidural analgesia in case of hypotonic labor during vaginal childbirth. Materials and methods. We performed analgesia to 60 women with a diagnosis of stage 1 hypotonic labor who were divided in 2 groups: the main one (n = 35) and the controls (n = 25). ASA status in both groups was I–II. In both groups, the epidural space was punctured at L1-L2. A test 4-ml dose of 2% lidocaine solution was administered and 5 minutes after, the epidural catheter was inserted. Then, in the main group, 1 ml of fentanyl solution and 6 ml of 0.9% NaCl were injected into the epidural space; in the control group, 6–8 ml of 0.125% bupivacaine solution. The effectiveness was evaluated according to the visual analogue scale, hemodynamic changes and the outcome of childbirth (conservative or operative). The condition of the fetus was assessed according to cardiotocography data. Statistical processing of the material was carried out using Excel. Results. The use of fentanyl in 69 % of cases allowed finishing the birth conservatively, the condition of the fetus and newborn was considered satisfactory. In the control group, 72 % of births resulted in cesarean section. Indications for surgery were hypotonic labor and fetal distress. Conclusions. The use of the narcotic analgesic fentanyl for prolonged epidural analgesia in hypotonic labor effectively relieves pain and increases the likelihood of conservative childbirth. It is safe for mother, fetus and newborn.

Gender differences in congenital heart defects: a narrative review.

Congenital heart defects (CHD) represent the most frequent human birth defects, occurring in almost 1% of all live newborns. Understanding the effects of gender in the prevalence of CHD has a key role in defining personalized prevention, disease identification, prognosis definition and individualized therapeutic strategies. Recently, the attempt to achieve a holistic approach to patients with CHD cannot be separated from accounting for existing gender differences. The main aim of this narrative review is to provide an overview of gender differences in the epidemiology of CHD. A standardized research through three electronic databases (PubMed/Scopus/Embase) was performed using a combination of keywords and Medical Subject Headings (MeSH) terms to include congenital heart diseases, gender difference(s), prevalence. Observational, prospective, population based and retrospective studies reporting gender differences in the prevalence of CHD were included. Conference abstracts were excluded as well as studies not written in English language and non-human studies. Further relevant papers were selected by hand-searching of the references list of selected articles. Search results returned 1,904 papers. Screening articles by title and abstracts resulted in 17 articles for full text review. Of these, 10 were included for analysis and additional 11 articles were included after hand searching review of reference lists. A total of 21 articles were included. Our narrative review confirms that there is a significant gender variation in specific CHD subgroups. In particular, we summarized the evidence that there is a significantly greater risk for males to be born with severe CHD and for females with milder CHD subtypes. The etiology of the different distribution of CHD among genders is still under investigation and a deeper understanding of how gender influences the risk for CHD is warranted. In the future, a gender-based management of CHD should become an established medical approach.

Transcriptional diversity of the oxytocin receptor in prairie voles: mechanistic implications for behavioral neuroscience and maternal physiology.

The neurohormone oxytocin regulates many aspects of physiology primarily by binding to its receptor, the oxytocin receptor. The oxytocin receptor gene (Oxtr) has been shown to have alternative transcripts in the mouse brain which may each have different biological functions or be used in specific contexts. A popular animal model for studying oxytocin-dependent social behaviors is the prairie vole, a biparental and monogamous rodent. Alternative transcriptional capacity of Oxtr in prairie voles is unknown. We used 5' rapid amplification of cDNA ends to identify alternative Oxtr transcription start sites in prairie vole brain tissue and uterine tissue. We then validated expression of specific transcripts in fetal brains and assessed the impact of exogenous oxytocin administration in utero on offspring brain development. We identified seven distinct Oxtr transcripts, all of which are present in both brain and uterine tissue. We then demonstrated that maternal oxytocin administration alters expression of a specific subset of Oxtr transcripts and that these different transcripts are under unique epigenetic regulation, such that in the perinatal period only one of the alternative transcripts is associated with DNA methylation in the Oxtr promoter. These data establish the existence of multiple Oxtr transcripts in prairie vole brain and uterine tissue and implicate oxytocin in the regulation of alternative transcript expression. These data have significant implications for our understanding of null mutant models in both mice and voles and translation in human birth and behavior.

Maternal vitamin D deficiency in early pregnancy and perinatal and long-term outcomes

BackgroundVitamin D deficiency is common in pregnant women. Some studies have linked vitamin D deficiency to obstetric complications such as gestational hypertension, gestational diabetes, and preterm birth. Therefore, the objective of this study is to investigate the potential impact of vitamin D deficiency during pregnancy on both perinatal and long-term outcomes. MethodsIn this retrospective study, conducted between 2017 and 2021, we analyzed the data of 1079 singleton pregnant women with no medical or surgical complications prior to pregnancy. We evaluated obstetric and perinatal outcomes, as well as neurodevelopmental outcomes using Bayley-III tests, Gross Motor Function Measure, or chart review. ResultsThe maternal serum vitamin D level in the first trimester was 18.2 ± 9.0 ng/mL. Vitamin D deficiency (<20 ng/mL) was found in 308 (62.0%) women in the first trimester, of which 288 women (26.7%) were in the very deficient group (<10 ng/mL). There were no differences in maternal age, body mass index, and previous preterm birth between the group with vitamin D < 10 ng/mL and ≥10 ng/mL group. There were also no differences in the rates of gestational hypertension, gestational diabetes, and preterm birth between the two groups, except for the rate of preterm birth before 37 weeks of gestation, which was significantly higher in the very deficient group (adjusted odds ratios [aOR] = 7.78, 95%CI [2.23–27.12], p = 0.001). In the very deficient group, the risk of developmental delay was also higher (aOR = 4.28, 95%CI [1.40–13.05], p = 0.011). ConclusionsThis is the first study to analyze the effects of maternal vitamin D deficiency during pregnancy on both long-term developmental outcomes and perinatal prognosis. Vitamin D deficiency, defined as a level lower than 10 ng/mL in the first trimester, may increase the risk of preterm birth and developmental delay in children.

Global epidemiologic patterns of oropharyngeal cancer incidence trends.

The emergence of human papillomavirus (HPV)-positive oropharyngeal cancer and evolving tobacco use patterns have changed the landscape of head and neck cancer epidemiology internationally. We investigated updated trends in oropharyngeal cancer incidence worldwide. We analyzed cancer incidence data between 1993 and 2012 from 42 countries using the Cancer Incidence in Five Continents database volumes V through XI. Trends in oropharyngeal cancer incidence were compared with oral cavity cancers and lung squamous cell carcinomas using log-linear regression and age period-cohort modeling. In total, 156 567 oropharyngeal cancer, 146 693 oral cavity cancer, and 621 947 lung squamous cell carcinoma patients were included. Oropharyngeal cancer incidence increased (P < .05) in 19 and 23 countries in men and women, respectively. In countries with increasing male oropharyngeal cancer incidence, all but 1 had statistically significant decreases in lung squamous cell carcinoma incidence, and all but 2 had decreasing or nonsignificant net drifts for oral cavity cancer. Increased oropharyngeal cancer incidence was observed both in middle-aged (40-59 years) and older (≥60 years) male cohorts, with strong nonlinear birth cohort effects. In 20 countries where oropharyngeal cancer incidence increased for women and age period-cohort analysis was possible, 13 had negative or nonsignificant lung squamous cell carcinoma net drifts, including 4 countries with higher oropharyngeal cancer net drifts vs both lung squamous cell carcinoma and oral cavity cancer (P < .05 for all comparisons). Increasing oropharyngeal cancer incidence is seen among an expanding array of countries worldwide. In men, increased oropharyngeal cancer is extending to older age groups, likely driven by human papillomavirus-related birth cohort effects. In women, more diverse patterns were observed, suggesting a complex interplay of risks factors varying by country, including several countries where female oropharyngeal cancer increases may be driven by HPV.