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The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
The traditional view that has dominated the study of preterm parturition is that spontaneous labor at term and preterm labor fundamentally involves the same processes, albeit occurring at different gestational ages. Indeed, term and preterm labor share a common pathway. We have defined the “common pathway of parturition” as the anatomic, biochemical, endocrinologic, and clinical events that occur in the fetus and/or mother in both term and preterm labor (17–22). Broadly conceptualized, the common pathway of parturition can be considered to have uterine (maternal and fetal) and extrauterine components. The uterine components (which are a subject of wide attention in clinical obstetrics) include increased uterine contractility, cervical ripening, and decidual/membrane activation (17,18). The extrauterine components include endocrinologic and metabolic changes associated with labor. For example, labor is associated with increased caloric metabolic expenditures (21), and an increase in maternal and fetal cortisol (20).
Necrotizing Enterocolitis Risk From a Maternal-Fetal Medicine Perspective
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Mark L. Kovler, Savannah Ireland, Angie C. Jelin, Eric B. Jelin
In an effort to further understand the predisposing risk factors for NEC, several aspects of prematurity and preterm birth have been evaluated in the pathogenesis of the disease. The care of the preterm infant frequently begins in the antenatal period and continues through parturition and the neonatal stage. Therefore, care is delivered by a multidisciplinary group of clinicians specializing in multiple subspecialties including maternal-fetal medicine, neonatology, and pediatric surgery. In this chapter we review the medical and surgical aspects of preterm birth with special consideration to their effects on NEC.
The Reproductive System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The process of giving birth is called parturition. This includes labor, which is divided into four stages, and delivery, the passage of the fetus and placenta from the genital canal into the external world. Terms associated with the birth process refer to presentation of the fetus (breech, vertex, transverse, face, cephalic, depending on which fetal structure faces the cervix) or to procedures involved (episiotomy, hysterotomy, Cesarean section). Immediately after delivery of the fetus, the secundines or "afterbirth," which includes the placenta and attached umbilical cord, are expelled as the final stage of labor. Lochia refers to the discharge of mucus, blood, and tissue debris that continues for a period of time following childbirth.
Fetal Tethered Spinal Cord: Diagnostic Features and Its Association with Congenital Anomalies
Published in Fetal and Pediatric Pathology, 2023
Xiaomei Yang, Shiyu Sun, Yizheng Ji, Yasong Xu, Li Sun, Qichang Wu
This is a retrospective observational analysis of clinical data conducted in the prenatal diagnosis department of Xiamen Maternal and Child Health Hospital from January 2014 to December 2019. Clinical data including maternal age, medical history, gestational age at ultrasound, prenatal imaging results, and postpartum pathology outcomes were collected from pregnant women who underwent abortions due to fetal malformation. A multidisciplinary consultation, including a pediatric neurosurgeon, was first conducted with the pregnant women and their family, in which potential complications and postnatal treatment options were discussed. In China, pregnancy can be terminated in any trimester if the fetus has suspected anomalies and/or genetic syndromes. In all cases, invasive prenatal diagnosis for fetal chromosomal karyotype analysis was conducted at the patient’s request prior to induced abortion. Fetal pathological examination was conducted after the parturition. This study was approved by the Medical Ethics Committee of Xiamen Maternal and Child Health Hospital (Ethics board approval number is KY-2019-065, registered date is 2019.12.31). All participants and their families were fully informed of the conduct of this study, and informed consent forms were signed.
Dynamic Changes in Retinal Vessel Diameters and Arteriovenous Ratio within 10 Days of Birth
Published in Current Eye Research, 2023
Previous studies in adults have shown that the retinal artery’s diameter decreases with the onset of diabetes while the retinal vein’s diameter widens.3 In addition, when systemic blood pressure continues to rise, self-regulating vessels narrow the arterioles.4 Moreover, retinal vascular morphological changes may predict age-related cognitive decline,5 and a low AVR may indicate adverse pregnancy outcomes.6 Similarly, newborns experience parturition from inside to outside in the neonatal period. Whole-body microcirculation is influenced by sudden changes in the environment, the gradual establishment of pulmonary circulation, and changes in blood oxygen content. These changes may theoretically lead to severe relaxation and contraction of the retinal blood vessels shortly after birth. With the development of fundus photography systems and semi-automatic measurement software for newborns, the diameter of the retinal vessels in newborns can also be quantitatively analyzed. Kandasamy et al. measured the retinal blood vessels of 20 full-term newborns within 7 days of birth using digital software and found that the average AVR was 0.66. However, there are no studies on early changes in the retinal vessel diameter and AVR with age in full-term newborns.
Can maternal hormones play a significant role in delivery mode?
Published in Journal of Obstetrics and Gynaecology, 2022
Christina Pappa, Fani Gkrozou, Evangelos Dimitriou, Orestis Tsonis, Aikaterini Kitsouli, Dimitrios Varvarousis, Vasileios Xydis, Minas Paschopoulos, Panagiotis Kitsoulis
The precise mechanism that activates the initiation and establishment of human parturition has still not been clarified. Hormonal fluctuations along with mechanical forces caused by the foetus are believed to lead to morphological alterations to promote natural vaginal childbirth (Hashem et al. 2006; Yan et al. 2015; Okunowo et al. 2017). Every pregnant woman may have different pelvic traits and a unique hormonal profile, which affect childbirth. Thus, it is imperative to clearly understand the background of delivery and pinpoint specific maternal and foetal factors that can interfere with the normal mechanism of labour, to ensure a safe delivery (Ikhena et al. 1999; Rustamova et al. 2009). Aim of our study was to evaluate the different levels of PRG, E2 and RLX during the different ways of childbirth and to assess the impact of maternal hormonal alterations and foetal size in maternal pelvis changes during different delivery modes.