MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Perinatology' source. Thu, 09 Feb 2012 17:49:19 +0100 http://www.medworm.com/index.php?rid=5635575&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001625%2Fabstract%3Frss%3Dyes Teamwork, communication, critical incident debriefing, and grief counseling surrounding the events of an unexpected maternal death are important continuing education and practice topics for health care employees working with pregnant women. Social technologies have impacted health care institutions and systems. Ethical dilemmas have been created in hospitals as they develop policies and procedures regarding electronic communications and social networking Web sites. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635575 Fri, 27 Jan 2012 22:41:28 +0100 5635575 http://www.medworm.com/index.php?rid=5635574&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001613%2Fabstract%3Frss%3Dyes A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635574 Fri, 27 Jan 2012 22:41:28 +0100 5635574 http://www.medworm.com/index.php?rid=5635573&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001601%2Fabstract%3Frss%3Dyes Sudden unexpected changes in the life of a family create many different emotions in various family members. The death of a young woman during or after her pregnancy is especially difficult because of the strain it places on family dynamics. One of the consequences is that there is, commonly, a newborn, and perhaps other children, without a mother and caregiver. In families that relied on both parents working, there are financial hardships imposed by the death. There is the emotional void that is felt by her partner, parents, sisters, brothers, and extended family. This extreme stress leads to questions about the death that need to be addressed by the health care providers. If the anger that is part of the grieving process is not adequately resolved, healing cannot occur. It is then that th... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635573 Fri, 27 Jan 2012 22:41:28 +0100 5635573 http://www.medworm.com/index.php?rid=5635572&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001595%2Fabstract%3Frss%3Dyes Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compress... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635572 Fri, 27 Jan 2012 22:41:28 +0100 5635572 http://www.medworm.com/index.php?rid=5635571&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001583%2Fabstract%3Frss%3Dyes Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incid... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635571 Fri, 27 Jan 2012 22:41:28 +0100 5635571 http://www.medworm.com/index.php?rid=5635570&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001571%2Fabstract%3Frss%3Dyes Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. During the past 50 years, there has been a significant reduction in the rates of eclampsia, maternal mortality, and maternal morbidity in the developed countries. In contrast, the rates of eclampsia, maternal complications, and maternal mortality remain high in the developing countries. These differences are mainly due to universal access to prenatal care, access to timely care, and proper management of patients with preeclampsia–eclampsia in the developed countries. In contrast, most of maternal deaths and complications are due to lack of prenatal care, lack of access to hospital care, lack of resources, and inappropriate diagnosis and management of patients with preeclampsia–eclampsia... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635570 Fri, 27 Jan 2012 22:41:28 +0100 5635570 http://www.medworm.com/index.php?rid=5635569&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100156X%2Fabstract%3Frss%3Dyes Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635569 Fri, 27 Jan 2012 22:41:28 +0100 5635569 http://www.medworm.com/index.php?rid=5635568&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001558%2Fabstract%3Frss%3Dyes The maternal death rate in the United States has shown no improvement in several decades and may be increasing. On the other hand, hospital systems that have instituted comprehensive programs directed at the prevention of maternal mortality have demonstrated rates that are half of the national average. These programs have emphasized the reduction of variability in the provision of care through the use of standard protocols, reliance on checklists instead of memory for critical processes, and an approach to peer review that emphasizes systems change. In addition, elimination of a small number of repetitive errors in the management of hypertension, postpartum hemorrhage, pulmonary embolism, and cardiac disease will contribute significantly to a reduction in maternal mortality. Attention to t... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635568 Fri, 27 Jan 2012 22:41:28 +0100 5635568 http://www.medworm.com/index.php?rid=5635567&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001546%2Fabstract%3Frss%3Dyes Maternal mortality is a current and important issue for obstetrics. The challenge is to structure case reviews so that they develop real data that can inform and direct quality improvement activities. In this article, we describe a series of decisions we have made in California to organize and run our maternal mortality review committee. These include defining the goal of the reviews, selection of cases, composition of the committee, basic review issues, and the definitions used for analysis (eg, cause of death, contributing factors, role of cesarean delivery, preventability, identifying quality improvement opportunities). It is expected that each maternal mortality review committee will have somewhat different approaches based on local resources and case mix. (Source: Seminars in Perinato... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635567 Fri, 27 Jan 2012 22:41:28 +0100 5635567 http://www.medworm.com/index.php?rid=5635566&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001534%2Fabstract%3Frss%3Dyes At the beginning of the 20th century, maternal mortality was a leading cause of death for women of reproductive age in the United States. Obstetrical care was not standardized, and there was a lack of universal systems for monitoring maternal deaths. Public health efforts of surveillance, along with advances in medicine and sanitation, resulted in a significant decrease in maternal deaths by the early 1980s. Today, maternal death is considered to be a rare event; however, the rates of maternal mortality have not improved in almost 3 decades. There is growing evidence that many maternal deaths can still be prevented through enhanced surveillance that influences improvements in overall health and delivery of care. This paper describes the experience of establishing and maintaining a pregnanc... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635566 Fri, 27 Jan 2012 22:41:28 +0100 5635566 http://www.medworm.com/index.php?rid=5635565&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001522%2Fabstract%3Frss%3Dyes The maternal–fetal medicine subspecialist plays a critical role in the evaluation and management of women with obstetrical and medical comorbidities. These women have a higher risk for obstetrical morbidity, “near miss,” and maternal mortality. Maternal death surveillance is essential to understand the factors that contribute to maternal mortality. Maternal–fetal medicine subspecialists' involvement and leadership in peer review of maternal deaths can provide guidance in developing and supporting management protocols to the obstetrical community and health care facilities. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635565 Fri, 27 Jan 2012 22:41:27 +0100 5635565 http://www.medworm.com/index.php?rid=5635564&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001510%2Fabstract%3Frss%3Dyes The actions that have followed the recommendations of successive publications of the UK Confidential Enquiries into Maternal Deaths have helped save mothers' lives and reduced ill health and morbidity. Through the implementation of their recommendations, they have helped improve access to, and the quality of, the maternity care provided for all pregnant women in the United Kingdom. The enquires help review, assess, and identify the underlying remediable factors that contributed to mothers' deaths and aggregate the lessons learned to make recommendations to develop services that help overcome many of the barriers to safe, high-quality maternity care, which vulnerable women continue to face. This chapter provides a short summary of the positive contributions the successive reports on Confide... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635564 Fri, 27 Jan 2012 22:41:27 +0100 5635564 http://www.medworm.com/index.php?rid=5635563&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001509%2Fabstract%3Frss%3Dyes Following dramatic reductions between the early 1900s and the early 1980s, the maternal mortality ratio began to rise, reaching a peak of almost 17 maternal deaths per 100,000 live births. Although this number pales in comparison with that found in sub-Saharan Africa and India, the troubling rise in the United States is a surrogate for medical care in general and obstetrical care in particular. Both Healthy People 2010 and the United Nations Millennium Goals were aimed at reducing maternal mortality worldwide. This presentation will review the trends in maternal mortality along with the efforts some jurisdictions, along with the American Congress of Obstetricians and Gynecologists, have taken to address this obstetrical tragedy. Although maternal death is the tip of the iceberg, thousands ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635563 Fri, 27 Jan 2012 22:41:27 +0100 5635563 http://www.medworm.com/index.php?rid=5635562&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001492%2Fabstract%3Frss%3Dyes The maternal mortality review process is an ongoing quality improvement cycle with 5 steps: identification of maternal deaths, collection of medical and other data on the events surrounding the death, review and synthesis of the data to identify potentially alterable factors, the development and implementation of interventions to decrease the risk of future deaths, and evaluation of the results. The most important step is utilization of the data to identify and implement evidence-based actions; without this step, the rest of the work will not have an impact. The review committee ideally is based in the health department of a state (or large city) as a core public health function. This provides stability for the process as well as facilitates implementation of the review committees' recomme... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635562 Fri, 27 Jan 2012 22:41:27 +0100 5635562 http://www.medworm.com/index.php?rid=5635561&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001480%2Fabstract%3Frss%3Dyes Although dramatic improvements in pregnancy care and in general population health facilitated a dramatic decline in maternal mortality in the United States during the 20th century, women still die from complications of pregnancy. Moreover, rates appear to have increased during the early 21st century. This overview will provide context for understanding the problem of maternal mortality in the United States by outlining how maternal mortality rates are reported from National Vital Statistics data, and how pregnancy-related mortality ratios are reported from a national surveillance system. Trends and patterns in these deaths as well as emerging issues concerning causes of maternal deaths and the difficulty with interpreting trend data will be discussed. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635561 Fri, 27 Jan 2012 22:41:27 +0100 5635561 http://www.medworm.com/index.php?rid=5635560&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001479%2Fabstract%3Frss%3Dyes In 1631, Shah Jahan, emperor during the Mughal Empire's period of greatest prosperity, was grief-stricken when his third wife, Mumtaz Mahal, died during the birth of their 14th child, Gauhara Begum. Construction of the Taj Mahal began in 1632, 1 year after her death. The Shah was so grief-stricken that he built this tomb for his wife's final resting place. There are several messages here, one of which is the Taj Mahal is a “Temple of Love” for a mother who died. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635560 Fri, 27 Jan 2012 22:41:27 +0100 5635560 http://www.medworm.com/index.php?rid=5635559&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001911%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635559 Fri, 27 Jan 2012 22:41:27 +0100 5635559 http://www.medworm.com/index.php?rid=5635558&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001923%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635558 Fri, 27 Jan 2012 22:41:27 +0100 5635558 http://www.medworm.com/index.php?rid=5635557&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100190X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635557 Fri, 27 Jan 2012 22:41:27 +0100 5635557 http://www.medworm.com/index.php?rid=5635556&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001893%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5635556 Fri, 27 Jan 2012 22:41:27 +0100 5635556 http://www.medworm.com/index.php?rid=5437342&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001091%2Fabstract%3Frss%3Dyes The number of bariatric surgeries performed in the United States has increased exponentially. Given that most patients are female and of reproductive age, it is important for clinicians who manage women's health issues to be aware of the surgery, its long-term goals, and the potential effect on future pregnancies. Most pregnancies after bariatric surgery have successful outcomes with decreased occurrences of gestational diabetes and hypertension and lower birth weight compared with control patients. Following nutritional guidelines and supplementation in the event of deficiencies are critical in the provision of prenatal care to this unique population. Other important issues include a multidisciplinary team management, a different approach to screening for gestational diabetes, careful eva... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437342 Wed, 23 Nov 2011 10:51:00 +0100 5437342 http://www.medworm.com/index.php?rid=5437341&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100108X%2Fabstract%3Frss%3Dyes Obesity is associated with serious morbidity during pregnancy, and obese women also are at a high risk of developing complications during labor, leading to an increased risk for instrumental and Cesarean deliveries. The engagement of the obstetrical anesthetist in the management of this group of high-risk patients should be performed antenatally so that an appropriate management strategy can be planned in advance to prevent an adverse outcome. Good communication between all care providers is essential. The obese patient in labor should be encouraged to have a functioning epidural catheter placed early in labor. Apart from providing analgesia and alleviating physiological derangements during labor, the presence of a functioning epidural catheter can also be used to induce anesthesia quickly... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437341 Wed, 23 Nov 2011 10:51:00 +0100 5437341 http://www.medworm.com/index.php?rid=5437340&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001078%2Fabstract%3Frss%3Dyes Obesity has been linked as a risk factor for wound complications and is becoming a more common occurrence. We reviewed the risk factors, preventive strategies, and recommended management of wound complications in obese women undergoing cesarean delivery. The limited available data support the use of prophylactic antibiotic before cesarean delivery, closure of subcutaneous space >2 cm, and maintaining normothermia intraoperatively to help reduce the incidence of postoperative wound complications. Data regarding management of cesarean wound complications in the obese patient are sparse, but they do suggest either primary or secondary closure of wounds is preferred to healing by secondary intention. Antibiotics should be administered in the presence of cellulitis or systemic toxicity. Use of ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437340 Wed, 23 Nov 2011 10:51:00 +0100 5437340 http://www.medworm.com/index.php?rid=5437339&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001066%2Fabstract%3Frss%3Dyes The current obesity epidemic appears to contribute significantly to adverse fetal outcomes, and in this work we compile up-to-date evidence for the link between maternal obesity and risk of stillbirth. The review revealed a preponderance of evidence showing that the risk of stillbirth is increased among obese mothers with amplified risk estimates as the severity of obesity increases. Changes in interpregnancy body mass index (BMI) influence subsequent fetal survival and obese women that normalize their BMI values experience enhanced fetal survival in future pregnancies. The elevated risk of stillbirth among obese mothers affect all gestations regardless of fetal number, with the most profound risk (4-fold increase) noted among triplet gestations. The literature has predominantly reported a... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437339 Wed, 23 Nov 2011 10:51:00 +0100 5437339 http://www.medworm.com/index.php?rid=5437338&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001054%2Fabstract%3Frss%3Dyes Sleep-disordered breathing (SDB) refers to a group of disorders characterized by abnormal respiratory patterns or abnormal gas exchange during sleep. The most common type of SDB, especially among young obese women, is obstructive sleep apnea. SDB has clearly been linked to poor sleep and impaired daytime function, but there are also data linking SDB to other health outcomes, principally cardiovascular and metabolic disease. SDB symptoms are common in pregnancy, and pregnancy itself has been associated with an increase in the prevalence of SDB symptoms. Although a link between SDB and adverse pregnancy outcomes appears to be biologically plausible, data exploring this relationship are only now emerging, and large prospective studies in which the authors use objective measures of sleep are l... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437338 Wed, 23 Nov 2011 10:51:00 +0100 5437338 http://www.medworm.com/index.php?rid=5437337&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001042%2Fabstract%3Frss%3Dyes We sought to quantify the added risk of thromboembolism in the obese parturient, evaluate risk factors for thromboembolism in the obese parturient, and provide suggestions as to when and in what form thromboembolism prophylaxis should be considered. Although recent guidelines from national colleges and advisory groups have attempted to guide the clinician in thromboprophylaxis in the obese parturient, the lack of adequate prospective series and trials has lead to some contrary recommendations. The arbitrary use of bed rest in the obese patient is a significant risk factor for venous thromboembolism without proven benefit. Despite a paucity of gold standard evidence, the prevalence of obesity and its associated risk of venous thromboembolism warrants careful consideration for the use of thr... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437337 Wed, 23 Nov 2011 10:51:00 +0100 5437337 http://www.medworm.com/index.php?rid=5437336&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001030%2Fabstract%3Frss%3Dyes The epidemic of obesity continues to grow undaunted, promising to affect the lives of more women of childbearing age. The challenges facing those charged with obstetrical care of the obese may require variation in care from forethought and planning, to consultation or referral for care at specialized centers. The routine management of late pregnancy must take into account the increase in risk for late fetal loss, failed induction and trial of labor after cesarean delivery, and postcesarean complications, such as wound-related morbidity and venous thromboembolism. Awareness of prolonged labor curves and the risk of shoulder dystocia must also be part of the management of labor. The data regarding many interventions attempted on behalf of these at risk gravidas are rudimentary but may allow ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437336 Wed, 23 Nov 2011 10:51:00 +0100 5437336 http://www.medworm.com/index.php?rid=5437335&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001029%2Fabstract%3Frss%3Dyes Obesity is a major risk factor for many obstetrical complications, including pre-eclampsia, gestational diabetes, indicated preterm birth, macrosomia, and stillbirth. Clinicians should be aware of the unique obstetrical management considerations related to obesity, including recommendations for alterations in prenatal care. In addition, obese gravidas commonly have underlying medical conditions that can impact pregnancy and must be appreciated to optimize care. Obese women should be educated about these risks, ideally before pregnancy. Awareness of the complications that can arise for these women and potential changes in management offer opportunities to improve both prenatal and lifelong health. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437335 Wed, 23 Nov 2011 10:51:00 +0100 5437335 http://www.medworm.com/index.php?rid=5437334&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001017%2Fabstract%3Frss%3Dyes In the past 2 decades, dramatic changes have occurred in the population of women having infants. A greater percentage of women are entering pregnancy obese, with the related increased morbidities observed. Because many reproductive-age women present for medical care to obstetrician/gynecologists, these practitioners are ideally positioned to have an important effect on this phenomenon. For example, when patients present for their annual examination or preconceptual counseling, guidance regarding weight loss before pregnancy can be offered. During pregnancy, obstetricians can encourage the patient to follow guidelines for weight gain in pregnancy, recently reexamined by the Institute of Medicine, to prevent excessive weight gain, which women often are unable to shed after delivery. After co... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437334 Wed, 23 Nov 2011 10:51:00 +0100 5437334 http://www.medworm.com/index.php?rid=5437333&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001741%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437333 Wed, 23 Nov 2011 10:51:00 +0100 5437333 http://www.medworm.com/index.php?rid=5437332&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001753%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437332 Wed, 23 Nov 2011 10:51:00 +0100 5437332 http://www.medworm.com/index.php?rid=5437331&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100173X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437331 Wed, 23 Nov 2011 10:51:00 +0100 5437331 http://www.medworm.com/index.php?rid=5437330&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001728%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437330 Wed, 23 Nov 2011 10:51:00 +0100 5437330 http://www.medworm.com/index.php?rid=5281676&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000942%2Fabstract%3Frss%3Dyes This article summarizes the factors contributing to late spontaneous preterm birth and offers suggestions to improve care for these mothers and infants. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281676 Sat, 01 Oct 2011 04:00:00 +0100 5281676 http://www.medworm.com/index.php?rid=5281675&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000930%2Fabstract%3Frss%3Dyes Subsequent pregnancies are emotionally traumatic for families with previous stillbirths. Such pregnancies have a 2– to 10-fold increase in the risk for stillbirth as well as an increased probability of other adverse obstetrical outcomes. These medical risks as well as anxiety on the part of families and care providers contribute to an increase in late preterm and early-term birth. However, delivery before 39 weeks' gestation has not been proven to reduce the risk of recurrent stillbirth or adverse pregnancy outcomes in women with previous stillbirths. This work reviews data regarding the optimal timing of delivery in subsequent pregnancies after previous stillbirth, as well as for patients at risk from stillbirth in general. Management recommendations from current data are presented and ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281675 Sat, 01 Oct 2011 04:00:00 +0100 5281675 http://www.medworm.com/index.php?rid=5281674&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000905%2Fabstract%3Frss%3Dyes The number of pregnant women who have type 2 diabetes and the number found to have gestational diabetes are progressively increasing. In the future, as many as 20% of pregnant women may be diagnosed with diabetes. Although there is consensus regarding many issues in the treatment of pregnant women with diabetes, there are few evidenced-based studies upon which to base the timing of delivery. There must be a balance between increased neonatal morbidity of late preterm and early-term delivery and fetal mortality. Potential adverse outcomes associated with late preterm and early-term delivery include respiratory problems as well as other metabolic dysfunctions characteristic of the preterm infant of a mother with diabetes. Delivery at term increases the risk of fetal demise, fetal overgrowth,... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281674 Sat, 01 Oct 2011 04:00:00 +0100 5281674 http://www.medworm.com/index.php?rid=5281673&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000978%2Fabstract%3Frss%3Dyes Gestational hypertension/pre-eclampsia is the most frequent obstetrical complication, complicating 26%-29% of all gestations in nulliparous women. In general, the diagnosis of mild gestational hypertension/pre-eclampsia is made at 38 weeks or more in approximately 80% of cases. For many years, the optimal timing of delivery for patients with mild gestational hypertension/pre-eclampsia at 37-0/7 to 39-6/7 weeks was unclear. Recently, investigators of the HYPITAT (Pregnancy-induced hypertension and pre-eclampsia after 36 weeks: induction of labor versus expectant monitoring: A comparison of maternal and neonatal outcome, maternal quality of life and costs) randomized trial evaluated maternal and neonatal complications in patients at 36-40 weeks' gestation who were randomized to either induct... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281673 Sat, 01 Oct 2011 04:00:00 +0100 5281673 http://www.medworm.com/index.php?rid=5281672&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000991%2Fabstract%3Frss%3Dyes Measuring amniotic fluid pockets with ultrasound is an efficient and reasonably reliable method of evaluating amniotic fluid volume and categorizing relative risk of perinatal morbidity. The most commonly used ultrasound criteria for oligohydramnios, SDP (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281672 Sat, 01 Oct 2011 04:00:00 +0100 5281672 http://www.medworm.com/index.php?rid=5281671&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000929%2Fabstract%3Frss%3Dyes In this work we review the indications for late preterm and early-term birth in uncomplicated dichorionic, monochorionic, and monoamniotic twin gestations. Uncomplicated dichorionic twins have optimal outcomes when delivered at 38 weeks' gestation. Monochorionic twins, however, are at greater risk for unexpected stillbirth, and a management plan of late preterm delivery (34-37 weeks) after informed consent is reasonable. Monoamniotic twins are at even greater risk for sudden intrauterine fetal demise, and it is recommended that these expectant mothers be managed by inpatient hospitalization with fetal testing 1-3 times per day and delivery between 32 and 34 weeks' gestation. Recommendations are also provided for the circumstance of single intrauterine fetal demise in a twin gestation. (Sou... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281671 Sat, 01 Oct 2011 04:00:00 +0100 5281671 http://www.medworm.com/index.php?rid=5281670&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100098X%2Fabstract%3Frss%3Dyes Between 2% and 3% of pregnancies are complicated by fetal anomalies. For most anomalies, there is no advantage to late preterm or early-term delivery. The risks of maternal or fetal complication are specific for each anomaly. Very few anomalies pose potential maternal risk. Some anomalies carry ongoing risks to the fetus, such as an increased risk of fetal death, hemorrhage, or organ damage. In a limited number of select cases, the advantages of late preterm or early-term birth may include avoiding an ongoing risk of fetal death related to the anomaly, allowing delivery in a controlled setting with availability of subspecialists and allowing direct care for the neonate with organ injury. The optimal gestational age for delivery cannot be determined for all pregnancies complicated by fetal ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281670 Sat, 01 Oct 2011 04:00:00 +0100 5281670 http://www.medworm.com/index.php?rid=5281669&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000966%2Fabstract%3Frss%3Dyes Intrauterine growth restriction (IUGR) is commonly defined as an estimated fetal weight of less than the 10th percentile. While 70% of these are small for normal reasons and not at risk, 30% are pathologically small at risk for numerous complications including fetal death. In the late preterm IUGR fetus (>34 weeks), prematurity risks less and the risk of fetal demise becomes the primary concern. Pulsed-wave Doppler interrogation of the umbilical and middle cerebral artery is useful in reducing perinatal mortality, however, Doppler changes in these vessels of the IUGR fetus may not occur after 34 weeks gestation. There are no randomized trials addressing the timing of delivery of the IUGR fetus in the late preterm or early-term period. However, retrospective reports show an increase risk of... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281669 Sat, 01 Oct 2011 04:00:00 +0100 5281669 http://www.medworm.com/index.php?rid=5281668&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000954%2Fabstract%3Frss%3Dyes Uterine rupture is an obstetrical emergency that can be catastrophic for the mother and fetus. Previous uterine surgery, including previous cesarean delivery or myomectomy, is an established risk factor, although the exact magnitude of the associated risk remains uncertain. We reviewed the literature related to uterine rupture after previous cesarean delivery with classical incision or myomectomy in an attempt to quantify outcomes associated with various management strategies. Although cesarean delivery with a classical incision is relatively uncommon (representing 0.3%-0.4% of deliveries), it presents a significant risk of rupture in subsequent pregnancies (1%-12% on the basis of published reports). Available data suggest that scheduled cesarean at 36-37 weeks optimizes both maternal and ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281668 Sat, 01 Oct 2011 04:00:00 +0100 5281668 http://www.medworm.com/index.php?rid=5281667&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000899%2Fabstract%3Frss%3Dyes The purpose of this article is to review the risks and benefits of scheduled preterm delivery in patients with placenta accreta, increta, and percreta and to provide guidance regarding timing of delivery in such cases. Relevant documents for this opinion were identified through a search of the English literature for publications, including one or more of the keywords “accreta” or “increta” or “percreta” and “preterm” and “delivery time” by the use of PubMed (U.S. National Library Of Medicine, January 1990-January 2010), with results limited to studies involving humans. Additional information was obtained from references identified from within selected articles, from additional review articles, and from guidelines by organizations, including the American College of Obste... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281667 Sat, 01 Oct 2011 04:00:00 +0100 5281667 http://www.medworm.com/index.php?rid=5281666&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000917%2Fabstract%3Frss%3Dyes Women with placenta previa are at increased risks for complications related to obstetrical hemorrhage and the need for emergent delivery. Some will remain asymptomatic without preterm labor or vaginal bleeding, and thus the clinician must decide when to schedule cesarean delivery in a “stable” patient. Decision-making for the optimal timing of delivery across the late preterm and early-term period requires balancing the probability and severity of maternal hemorrhage at each gestational age versus the probability and severity of neonatal morbidity. On the basis of the limited available data, in women with uncomplicated complete placenta previa, scheduled delivery between 36 and 37 weeks should be considered. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281666 Sat, 01 Oct 2011 04:00:00 +0100 5281666 http://www.medworm.com/index.php?rid=5281665&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001005%2Fabstract%3Frss%3Dyes Late preterm birth (defined as birth between 34 0/7 to 36 6/7 weeks gestation) and early-term birth (defined as birth between 37 0/7 to 38 6/7 weeks gestation) have become the topic of much recent literature and discussion as the morbidity associated with delivery at these gestational ages becomes evident. Although infants delivered during this time period remain at relatively low risk for complications, the rate of morbidities in this group, particularly as it relates to respiratory function, is increased several-fold when they are compared to infants delivered at 39 weeks. The following article reviews the morbidities and mortality associated with both late preterm and early-term birth, as well available data on long-term outcomes of neonates born at these gestational ages. (Source: Semi... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281665 Sat, 01 Oct 2011 04:00:00 +0100 5281665 http://www.medworm.com/index.php?rid=5281664&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000887%2Fabstract%3Frss%3Dyes In recent years, considerable attention has been given to the issue of late preterm (34 to 36-6/7 weeks) and early term (37 to 38-6/7 weeks) birth. Current evidence suggests that infants born before 39 weeks' gestation are at increased risk for short- and long-term complications, including perinatal and infant mortality. Because of this, scheduled delivery before 39 weeks' gestation is discouraged unless there is a medical indication. With the increased awareness of the risks with delivery before 39 weeks, there has been a push to decrease these. Some of these deliveries have been identified to occur without a medical or obstetrical indication. In many areas, quality initiatives have been implemented to target medically nonindicated late preterm and early-term deliveries with marked succes... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281664 Sat, 01 Oct 2011 04:00:00 +0100 5281664 http://www.medworm.com/index.php?rid=5281663&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001261%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281663 Sat, 01 Oct 2011 04:00:00 +0100 5281663 http://www.medworm.com/index.php?rid=5281662&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001273%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281662 Sat, 01 Oct 2011 04:00:00 +0100 5281662 http://www.medworm.com/index.php?rid=5281661&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100125X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281661 Sat, 01 Oct 2011 04:00:00 +0100 5281661 http://www.medworm.com/index.php?rid=5281660&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001248%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5281660 Sat, 01 Oct 2011 04:00:00 +0100 5281660 http://www.medworm.com/index.php?rid=5068610&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000504%2Fabstract%3Frss%3Dyes Social inequalities in infant mortality can be clearly demonstrated in the countries of the United Kingdom with a social gradient between different groups. Marked variations in infant mortality between ethnic groups are also evident in England and Wales, with the highest rates seen in Pakistani and Caribbean infants and the lowest rates in the white and Bangladeshi groups. Although individual risk factors for infant mortality are well understood, the reasons why certain social and ethnic groups have higher rates remain to be fully elucidated. Policies and interventions to tackle these inequalities are likely to be most effective if they have both universal and targeted components to “level-up” rates to the rate of the most advantaged in society. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068610 Wed, 27 Jul 2011 15:44:22 +0100 5068610 http://www.medworm.com/index.php?rid=5068609&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000498%2Fabstract%3Frss%3Dyes In the United States, there is a pronounced and persistent race/ethnic disparity in the rate of preterm birth. Even after decades of basic science research and public health initiatives this disparity remains relatively unchanged. Factors that underpin this disparity are elusive and likely, at least in part, derived from complex mechanisms originating from social inequities. In this article several promising areas of research are explored. Specifically, social context or neighborhood-level exposures, maternal nativity, infection/inflammation, and preconception health differentials are discussed in the context of increasing risk of preterm birth among race/ethnic minorities. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068609 Wed, 27 Jul 2011 15:44:20 +0100 5068609 http://www.medworm.com/index.php?rid=5068608&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000486%2Fabstract%3Frss%3Dyes As with most adverse health outcomes, there has been long standing and persistent racial and ethnic disparity for stillbirth in the United States. In 2005, the stillbirth rate (fetal deaths ≥20 weeks' gestation per 1000 fetal deaths and live births) for non-Hispanic blacks was 11.13 compared with 4.79 for non-Hispanic whites. Rates were intermediate for American Indian or Alaska Natives (6.17) and Hispanics (5.44). There is racial disparity for both early ( (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068608 Wed, 27 Jul 2011 15:44:19 +0100 5068608 http://www.medworm.com/index.php?rid=5068607&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000474%2Fabstract%3Frss%3Dyes Racial and ethnic disparities in infant mortality in the United States seem to defy all attempts at elimination. Despite national priorities to eliminate these disparities, black infants are 2.5 times more likely to die in infancy compared with non-Hispanic white infants. This disparity is largely related to the greater incidence among black infants of prematurity and low birth weight, congenital malformations, sudden infant death syndrome, and unintentional injuries. This greater incidence, in turn, is related to a complex interaction of behavioral, social, political, genetic, medical, and health care access factors. Thus, to influence the persistent racial disparity in infant mortality, a highly integrated approach is needed, with interventions adapted along a continuum from childhood th... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068607 Wed, 27 Jul 2011 15:44:16 +0100 5068607 http://www.medworm.com/index.php?rid=5068606&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000462%2Fabstract%3Frss%3Dyes Infant mortality, fetal mortality, and preterm birth all represent important health challenges that have shown little recent improvement. The rate of decrease in both fetal and infant mortality has slowed in recent years, with little decrease since 2000 for infant mortality, and no significant decrease from 2003 to 2005 for fetal mortality. The percentage of preterm births increased by 36% from 1984 to 2006, and then decreased by 4% from 2006 to 2008. There are substantial race and ethnic disparities in fetal and infant mortality and preterm birth, with non-Hispanic black women at greatest risk of unfavorable birth outcomes, followed by American Indian and Puerto Rican women. Infant mortality, fetal mortality, and preterm birth are multifactorial and interrelated problems with similarities... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068606 Wed, 27 Jul 2011 15:44:13 +0100 5068606 http://www.medworm.com/index.php?rid=5068605&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000450%2Fabstract%3Frss%3Dyes Infant mortality, stillbirths, and preterm births are major public health priorities, having affected 28,527 infants in 2006, 25,894 fetuses in 2005, and 542,893 pregnancies in 2006, respectively. These numbers translate to an infant mortality rate of 6.7 deaths/1000 live births, a stillbirth rate of 6.2/1000 deliveries, and preterm births comprising of 12.8% of live births in the United States. The rate of preterm birth has been increasing each year, with a 20% increase since 1990 and accounting for more than half a million preterm births in the United States each year. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068605 Wed, 27 Jul 2011 15:44:11 +0100 5068605 http://www.medworm.com/index.php?rid=5068604&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001121%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068604 Wed, 27 Jul 2011 15:44:11 +0100 5068604 http://www.medworm.com/index.php?rid=5068603&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001133%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068603 Wed, 27 Jul 2011 15:44:11 +0100 5068603 http://www.medworm.com/index.php?rid=5068602&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100111X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068602 Wed, 27 Jul 2011 15:44:10 +0100 5068602 http://www.medworm.com/index.php?rid=5068601&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511001108%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=5068601 Wed, 27 Jul 2011 15:44:10 +0100 5068601 http://www.medworm.com/index.php?rid=4901367&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000449%2Fabstract%3Frss%3Dyes Phototherapy is the treatment of choice to reduce the severity of neonatal unconjugated hyperbilirubinemia regardless of its etiology. Its implementation requires a technical framework that conforms to existing evidence-based guidelines that promote its safer and effective use worldwide. Optimal use of phototherapy has been defined by specific ranges of total serum bilirubin thresholds configured to an infant's postnatal age (in hours) and potential risk for bilirubin neurotoxicity. Effective phototherapy implies its use at specific blue light wavelengths (peak emission, 450 ± 20 nm) and emission spectrum (range, 400-520 nm), preferably in a narrow bandwidth that is delivered at an irradiance of ≥30 μW/cm2/nm to up to 80% of an infant's body surface area. However, this is often not fea... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901367 Tue, 31 May 2011 23:00:00 +0100 4901367 http://www.medworm.com/index.php?rid=4901366&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000437%2Fabstract%3Frss%3Dyes Globally, health care providers worldwide recognize that severe neonatal jaundice is a “silent” cause of significant neonatal morbidity and mortality. Untreated neonatal jaundice can lead to death in the neonatal period and to kernicterus, a major cause of neurologic disability (choreo-athetoid cerebral palsy, deafness, language difficulty) in children who survive this largely preventable neonatal tragedy. Appropriate technologies are urgently needed. These include tools to promote and enhance visual assessment of the degree of jaundice, such as simpler transcutaneous bilirubin measurements and readily available serum bilirubin measurements that could be incorporated into routine treatment and follow-up. Widespread screening for glucose-6-phoshate dehydrogenase deficiency is needed bec... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901366 Tue, 31 May 2011 23:00:00 +0100 4901366 http://www.medworm.com/index.php?rid=4901365&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000425%2Fabstract%3Frss%3Dyes Blood exchange transfusion has become a rare event in most developed countries. As a result, many pediatricians may not have performed or even seen one. However, it remains a frequent emergency rescue procedure for severe neonatal hyperbilirubinemia in many underdeveloped regions of the world. Conventionally, exchange transfusion has been performed via a central umbilical venous catheter by pull-push cycle method and recently peripheral artery/peripheral vein has emerged as an alternative, isovolumetric route. Continuous arterio-venous exchange is possibly more effective though its automation has not been successful. Concerns for procedural and operator related adverse events have been raised in the context of declining indications. A required continued expertise for this life-saving inter... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901365 Tue, 31 May 2011 23:00:00 +0100 4901365 http://www.medworm.com/index.php?rid=4901364&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000413%2Fabstract%3Frss%3Dyes Extreme neonatal jaundice occurs infrequently but carries a high risk of permanent sequelae (kernicterus) when it does. Rapid therapeutic intervention has the potential to reduce this risk in some infants. Several case reports of infants with acute intermediate to advanced bilirubin encephalopathy shows that reversal may be possible. Phototherapy can be instituted at the flip of a switch, whereas other therapeutic measures necessarily involve delays. Therefore, high-intensity phototherapy must be regarded as an emergency measure in infants presenting with extreme jaundice and even more so in the presence of neurological symptoms. The principal and well-described effect of phototherapy involves conversion of bilirubin IXα (z, z) to more polar isomers, which are excreted in bile and urine. ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901364 Tue, 31 May 2011 23:00:00 +0100 4901364 http://www.medworm.com/index.php?rid=4901363&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000401%2Fabstract%3Frss%3Dyes Classical and subtypes of kernicterus associated with bilirubin toxicity can be differentiated in part with physiological auditory measures that include auditory-evoked potentials and measures of cochlear integrity. The combination of these auditory measures suggests that bilirubin exposure results in auditory system damage initially at the level of the brainstem, progressing to the level of the VIII cranial nerve and then to greater neural centers. There is no evidence of neural damage at the level of the cochlea. Auditory neural damage from bilirubin toxicity ranges from neural timing deficits, including neural firing delays and dyssynchrony, to neural response reduction and even elimination of auditory neural responses. This condition is comprehensively described as auditory neuropathy ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901363 Tue, 31 May 2011 23:00:00 +0100 4901363 http://www.medworm.com/index.php?rid=4901362&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000395%2Fabstract%3Frss%3Dyes Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, a commonly occurring genetic condition, is associated in neonates with severe hemolytic episodes, extreme hyperbilirubinemia, and bilirubin encephalopathy. Neonatal screening programs for the condition should increase parental and caretaker awareness, thereby facilitating early access to treatment with resultant diminished mortality and morbidity. However, screening for G-6-PD deficiency is not widely performed. Although G-6-PD-deficient males may be accurately identified, females are more difficult to categorize because many in this group may be heterozygotes with phenotype overlap between normal homozygotes, heterozygotes, and deficient homozygotes. Screening methodologies include biochemical qualitative assays, quantitative enzymati... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901362 Tue, 31 May 2011 23:00:00 +0100 4901362 http://www.medworm.com/index.php?rid=4901361&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000383%2Fabstract%3Frss%3Dyes Maternal-fetal blood group incompatibility is common but less commonly results in hemolytic disease of the fetus and newborn (HDFN). HDFN is associated with greater peak bilirubin, at an earlier age, and for longer duration than other causes of hyperbilirubinemia. It poses a substantial risk for kernicterus and accounts for the majority of exchange transfusions for hyperbilirubinemia. Advances in diagnosis and management are described, from identification of the alloimmunized pregnancy by maternal ABO and Rh typing, antibody screen (indirect Coombs test), identification and titration; laboratory evaluation of the maternal-fetal unit with a critical maternal antibody titer to prompt fetal antigen status determination; assessment of fetomaternal hemorrhage by conventional Kleihauer-Betke tes... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901361 Tue, 31 May 2011 23:00:00 +0100 4901361 http://www.medworm.com/index.php?rid=4901360&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000371%2Fabstract%3Frss%3Dyes In 2003, the Chemistry Resource Committee of the College of American Pathologists introduced a new specimen in the Neonatal Bilirubin Survey. The specimen, consisting of human serum enriched with unconjugated bilirubin and thus resembling a clinical specimen, brought about an improvement in the accuracy of the measurement of bilirubin by laboratories participating in the Neonatal Bilirubin Survey. There was also an improvement in the specificity of methods measuring direct bilirubin. However, persisting inaccuracies and variability in laboratory performance have been traced to calibrators consisting of bovine serum spiked with unconjugated bilirubin and ditaurobilirubin; bovine serum causes underestimation of both bilirubins by 8 major chemical analyzers. To eradicate inaccuracy calibrator... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901360 Tue, 31 May 2011 23:00:00 +0100 4901360 http://www.medworm.com/index.php?rid=4901359&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100036X%2Fabstract%3Frss%3Dyes Neonatal jaundice (hyperbilirubinemia), which is extremely common in neonates, can be associated with neurotoxicity. A safe level of bilirubin has not been defined in either premature or term infants. Emerging evidence suggest that the level of unbound (or “free”) bilirubin has a better sensitivity and specificity than total serum bilirubin for bilirubin-induced neurotoxicity. Although recent studies suggest the usefulness of free bilirubin measurements in managing high-risk neonates, including premature infants, no widely available method exists to assay the serum free bilirubin concentration. To keep pace with the growing demand, in addition to reevaluation of old methods, several promising new methods are being developed for sensitive, accurate, and rapid measurement of free bilirub... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901359 Tue, 31 May 2011 23:00:00 +0100 4901359 http://www.medworm.com/index.php?rid=4901358&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000358%2Fabstract%3Frss%3Dyes Elevation of the serum bilirubin level is a common, if not universal, finding during the first week of life. This can be a transient phenomenon that resolves spontaneously or can signify a serious or even life-threatening condition. There are many causes of hyperbilirubinemia and related therapeutic and prognostic implications. The diseases in which there is a primary disorder of the metabolism of bilirubin will be reviewed regarding their clinical presentation, pathophysiology, diagnosis, and treatment. These disorders—Gilbert's syndrome and Crigler-Najjar Syndrome—both involve abnormalities in bilirubin conjugation secondary to deficiency of bilirubin uridine diphosphate glucuronosyltransferase. The purpose of this article is to review the current understanding of the genetic polymor... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901358 Tue, 31 May 2011 23:00:00 +0100 4901358 http://www.medworm.com/index.php?rid=4901357&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000346%2Fabstract%3Frss%3Dyes Neonatal jaundice usually occurs in the transitional period after birth, presenting as an elevation of circulating bilirubin. Bilirubin neurotoxicity can occur if the levels of bilirubin become excessive (hyperbilirubinemia). This pathologic phenotype of newborn jaundice can develop because of excessive bilirubin production or impaired conjugation, with the risk for developing bilirubin-induced neurologic dysfunction, depending on the degree of the resultant bilirubin load. The plasma bilirubin level thus can be used to assess an infant's risk for developing bilirubin neurotoxicity relative to an infant's age in hours. Because all infants have an impaired conjugation ability, infants at greatest risk are those who have increased bilirubin production rates, because of hemolysis, for example... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901357 Tue, 31 May 2011 23:00:00 +0100 4901357 http://www.medworm.com/index.php?rid=4901356&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000334%2Fabstract%3Frss%3Dyes Encephalopathy by hyperbilirubinemia in infants has been described for decades, but neither the underlying cellular and molecular mechanisms nor the selective pattern of bilirubin deposition in the brain is well understood. The brain is composed of highly specialized and diverse populations of cells, represented by neurons and glia that comprise astrocytes, oligodendrocytes, and microglia. Although microscopic evaluation of icteric brain sections revealed bilirubin within neurons, neuronal processes, and microglia, cell dependent-sensitivity to bilirubin toxicity and the role of each nerve cell type are poorly understood. Even less considered are glial and neuronal pathologic alterations as integrated phenomena. The available knowledge on reactivity of glial cells to bilirubin and on the i... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901356 Tue, 31 May 2011 23:00:00 +0100 4901356 http://www.medworm.com/index.php?rid=4901355&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000322%2Fabstract%3Frss%3Dyes We believe that the syndrome of bilirubin-induced neurologic dysfunction [BIND] represents a spectrum of neurologic manifestations among vulnerable infants who have experienced an exposure to bilirubin of lesser degree than generally described in previous publications. Clinical neuro-motor manifestations extend to a range of subtle processing disorders with objective disturbances of visual-motor, auditory, speech, cognition, and language among infants with a previous history of moderate-to-severe hyperbilirubinemia of varied duration. Confounding effects include prematurity, hemolysis, perinatal-neonatal complications, altered bilirubin-albumin binding, severity and duration of bilirubin exposure, and the individual vulnerability of the infant related to genetic, family, social, and educat... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901355 Tue, 31 May 2011 23:00:00 +0100 4901355 http://www.medworm.com/index.php?rid=4901354&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000310%2Fabstract%3Frss%3Dyes Dramatic improvements in the overall socioeconomic conditions have yet to impact the unacceptably high maternal (approximately 1500 maternal deaths daily, worldwide) and neonatal morbidity and mortality (more than 10,000 deaths per daily 200,000 live-births, worldwide) in the developing nations. Thus, nations with emerging markets have unique health-societal needs. All infants require a safer transition from a birthing facility to home during the first week after birth and providing for a nurturing environment to prevent neonatal illnesses is integral to “good clinical practice.” The unmonitored occurrence of severe hyperbilirubinemia and kernicterus are emblematic of a fractured maternal child healthcare system. The “know-do” gaps that span private versus public health care system... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901354 Tue, 31 May 2011 23:00:00 +0100 4901354 http://www.medworm.com/index.php?rid=4901353&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000619%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901353 Tue, 31 May 2011 23:00:00 +0100 4901353 http://www.medworm.com/index.php?rid=4901352&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000620%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901352 Tue, 31 May 2011 23:00:00 +0100 4901352 http://www.medworm.com/index.php?rid=4901351&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000607%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901351 Tue, 31 May 2011 23:00:00 +0100 4901351 http://www.medworm.com/index.php?rid=4901350&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000590%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901350 Tue, 31 May 2011 23:00:00 +0100 4901350 http://www.medworm.com/index.php?rid=4652051&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000103%2Fabstract%3Frss%3Dyes Every delivery is a multidisciplinary event, involving nursing, obstetricians, anesthesiologists, and pediatricians. Patients are often in labor across multiple provider shifts, necessitating numerous handoffs between teams. Each handoff provides an opportunity for errors. Although a traditional approach to improving patient outcomes has been to address individual knowledge and skills, it is now recognized that a significant number of complications result from team, rather than individual, failures. In 2004, a Sentinel Alert issued by the Joint Commission revealed that most cases of perinatal death and injury are caused by problems with an organization's culture and communication failures. It was recommended that hospitals implement teamwork training programs in an effort to improve outcom... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652051 Wed, 30 Mar 2011 03:43:50 +0100 4652051 http://www.medworm.com/index.php?rid=4652050&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000097%2Fabstract%3Frss%3Dyes This article describes a process for testing through simulation and the systemic findings from testing existing and new facilities and services. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652050 Wed, 30 Mar 2011 03:43:50 +0100 4652050 http://www.medworm.com/index.php?rid=4652049&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000085%2Fabstract%3Frss%3Dyes Macro-systems simulation is a methodology to assess existing services and support major culture shift to a new healthcare environment. Given credible local precedent, simulation can be effective for orienting staff, identifying process gaps and enabling their refinement prior to the transition. Select strategies enable staged process translation in an intensive care unit without exposing patients to potential risk. Orchestrating immersive, realistic in-situ simulations minimizes surprises at transition and enhances patient satisfaction. Such endeavors substantially elevate the perception of the value of simulation within an institution. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652049 Wed, 30 Mar 2011 03:43:49 +0100 4652049 http://www.medworm.com/index.php?rid=4652048&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000073%2Fabstract%3Frss%3Dyes We describe the evolution of immersive learning and simulation in the Neonatal Resuscitation Program, and suggest the development of a multidisciplinary team, simulation-enhanced obstetric crisis training program (OBLS) may likewise benefit obstetrical health care professionals. OBLS would emphasize high quality basic life support, uterine displacement, use of an automatic external defibrillator, and delivery of the fetus within 5 minutes of maternal arrest should resuscitative efforts prove ineffective. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652048 Wed, 30 Mar 2011 03:43:49 +0100 4652048 http://www.medworm.com/index.php?rid=4652047&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000061%2Fabstract%3Frss%3Dyes Obstetrical practice demands sensitivity, clinical skill, and acumen. Obstetrical emergencies are rare occurrences and are most appropriately dealt with by experienced staff. Simulation provides an opportunity to gain this experience without patient risk and furthermore builds confidence and satisfaction amongst learners. There is an abundance of evidence to show the effectiveness of simulation training. Simulation has been demonstrated to reduce errors, increase knowledge, skills, communication and team working, and improve perinatal outcomes. Further research to measure the effect of training to identify what works, where and at what cost is needed. We explore the evidence for the use of simulation-based training across a broad range of obstetrical emergencies, promote collaboration amon... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652047 Wed, 30 Mar 2011 03:43:49 +0100 4652047 http://www.medworm.com/index.php?rid=4652046&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100005X%2Fabstract%3Frss%3Dyes Neonatal care occurs in extremely complex and dynamic environments and requires providers to operate under intense time pressure in coordination with multiple disciplines. Teaching the clinical skills requisite to effective practice requires the meticulous application of curricular design principles. Simulation can be used as an effective instructional strategy in achieving learner acquisition and retention of the cognitive, technical, and behavioral skills essential to optimal delivery of care in neonatology. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652046 Wed, 30 Mar 2011 03:43:49 +0100 4652046 http://www.medworm.com/index.php?rid=4652045&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000048%2Fabstract%3Frss%3Dyes The experiential learning process involves participation in key experiences and analysis of those experiences. In health care, these experiences can occur through high-fidelity simulation or in the actual clinical setting. The most important component of this process is the postexperience analysis or debriefing. During the debriefing, individuals must reflect upon the experience, identify the mental models that led to behaviors or cognitive processes, and then build or enhance new mental models to be used in future experiences. On the basis of adult learning theory, the Kolb Experiential Learning Cycle, and the Learning Outcomes Model, we structured a framework for facilitators of debriefings entitled “the 3D Model of Debriefing: Defusing, Discovering, and Deepening.” It incorporates c... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652045 Wed, 30 Mar 2011 03:43:48 +0100 4652045 http://www.medworm.com/index.php?rid=4652044&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000036%2Fabstract%3Frss%3Dyes Health care simulation is a powerful educational tool to help facilitate learning for clinicians and change their practice to improve patient outcomes and safety. To promote effective life-long learning through simulation, the educator needs to consider individuals, their experiences, and their environments. Effective education of adults through simulation requires a sound understanding of both adult learning theory and experiential learning. This review article provides a framework for developing and facilitating simulation courses, founded upon empiric and theoretic research in adult and experiential learning. Specifically, this article provides a theoretic foundation for using simulation to change practice to improve patient outcomes and safety. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652044 Wed, 30 Mar 2011 03:43:48 +0100 4652044 http://www.medworm.com/index.php?rid=4652043&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000024%2Fabstract%3Frss%3Dyes You're cruising comfortably at 35,000 feet when your plane experiences severe turbulence as the result of a sudden squall. Your knuckles are white from clutching the armrest when the pilot comes on over the loudspeaker: “Well folks, we are going to have to make an emergency landing due to inclement weather. I've never actually done this before, but no worries…I've seen senior pilots do it.”Unimaginable? Training that puts a pilot in the cockpit of an airliner without having practiced responses to common dangerous scenarios is perhaps unimaginable in the aviation industry, where cockpit simulator experience is a mandatory component of training. Indeed, pilots practice responses to many such challenges before they are put in a position in which any failure to act could compromise passe... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652043 Wed, 30 Mar 2011 03:43:48 +0100 4652043 http://www.medworm.com/index.php?rid=4652042&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051100019X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652042 Wed, 30 Mar 2011 03:43:48 +0100 4652042 http://www.medworm.com/index.php?rid=4652041&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000206%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652041 Wed, 30 Mar 2011 03:43:48 +0100 4652041 http://www.medworm.com/index.php?rid=4652040&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000188%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652040 Wed, 30 Mar 2011 03:43:48 +0100 4652040 http://www.medworm.com/index.php?rid=4652039&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000511000176%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4652039 Wed, 30 Mar 2011 03:43:48 +0100 4652039 http://www.medworm.com/index.php?rid=4388915&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001485%2Fabstract%3Frss%3Dyes Prematurely born children are at increased risk for cognitive deficits, but the neurobiological basis of these findings remains poorly understood. Because variations in neural circuitry may influence performance on cognitive tasks, recent investigations have explored the impact of preterm birth on connectivity in the developing brain. Diffusion tensor imaging studies demonstrate widespread alterations in fractional anisotropy, a measure of axonal integrity and microstructural connectivity, throughout the developing preterm brain. Functional connectivity studies report that preterm neonates, children and adolescents exhibit alterations in both resting state and task-based connectivity when compared with term control subjects. Taken together, these data suggest that neurodevelopmental impair... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388915 Mon, 24 Jan 2011 04:04:17 +0100 4388915 http://www.medworm.com/index.php?rid=4388914&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001473%2Fabstract%3Frss%3Dyes Significant benefits to infant host defense, sensory-neural development, gastrointestinal maturation, and some aspects of nutritional status are observed when premature infants are fed their mothers' own milk. A reduction in infection-related morbidity in human milk-fed premature infants has been reported in nearly a dozen descriptive, and a few quasi-randomized, studies in the past 25 years. Human milk-fed infants also have decreased rates of rehospitalization for illness after discharge. Studies on neurodevelopmental outcomes have reported significantly positive effects for human milk intake in the neonatal period and long-term mental and motor development, intelligence quotient, and visual acuity through adolescence. Body composition in adolescence also is associated with human milk int... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388914 Mon, 24 Jan 2011 04:04:17 +0100 4388914 http://www.medworm.com/index.php?rid=4388913&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001461%2Fabstract%3Frss%3Dyes Family-centered care (FCC) has been increasingly emphasized as an important and necessary element of neonatal intensive care. FCC is conceptualized as a philosophy with a set of guiding principles, as well as a cohort of programs, services, and practices that many hospitals have embraced. Several factors drive the pressing need for family-centered care and support of families of infants in NICUs, including the increase in the number of infants in NICUs; growth in diversity of the population and their concurrent needs; identification of parental and familial stress and lack of parenting confidence; and gaps in support for families, as identified by parents and NICU staff. We explore the origins of and advances in FCC in the NICU and identify various delivery methods and aspects of FCC and f... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388913 Mon, 24 Jan 2011 04:04:16 +0100 4388913 http://www.medworm.com/index.php?rid=4388912&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051000145X%2Fabstract%3Frss%3Dyes The trend toward single-room neonatal intensive care units (NICUs) is increasing; however scientific evidence is, at this point, mostly anecdotal. This is a critical time to assess the impact of the single-room NICU on improving medical and neurobehavioral outcomes of the preterm infant. We have developed a theoretical model that may be useful in studying how the change from an open-bay NICU to a single-room NICU could affect infant medical and neurobehavioral outcome. The model identifies mediating factors that are likely to accompany the change to a single-room NICU. These mediating factors include family centered care, developmental care, parenting and family factors, staff behavior and attitudes, and medical practices. Medical outcomes that plan to be measured are sepsis, length of sta... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388912 Mon, 24 Jan 2011 04:04:13 +0100 4388912 http://www.medworm.com/index.php?rid=4388911&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001448%2Fabstract%3Frss%3Dyes The newborn intensive care unit (NICU) is a life-defining place for many infants, families, and caregivers. The place in which such events occur is often remembered for its sights, sounds, and smells, but the physical environment of the NICU is far more than a memory tag; it can directly influence the quality of the experience for all of its inhabitants. A growing body of evidence demonstrates the profound impact of the physical environment on growth and development of the neonatal brain. The value of skin-to-skin care is now established. Psychology, sociology, and occupational health provide additional insight into the effect of the NICU setting on families and caregivers. Together, these lines of evidence point to the need for individualized environments. Single-family rooms are a growin... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388911 Mon, 24 Jan 2011 04:04:13 +0100 4388911 http://www.medworm.com/index.php?rid=4388910&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001412%2Fabstract%3Frss%3Dyes Women & Infants Hospital recently constructed a new, all single-family room, 80-bed Newborn Intensive Care Unit (NICU). This was the culmination of several years of study, visits to similar facilities around the country, design, and planning. During the process of identifying the single-family room model of care as most appropriate for our patients and families, we encountered many exceptionally helpful people. We were received graciously at all the hospitals we visited. They told us everything; they let us look in every closet and they answered any and all questions. We now have our own single-family room NICU, and it is spectacular. In an effort to share with the community the things we learned and the things that influenced our decision to fully embrace this model of care, we organized ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388910 Mon, 24 Jan 2011 04:04:10 +0100 4388910 http://www.medworm.com/index.php?rid=4388909&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001588%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388909 Mon, 24 Jan 2011 04:04:10 +0100 4388909 http://www.medworm.com/index.php?rid=4388908&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051000159X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388908 Mon, 24 Jan 2011 04:04:10 +0100 4388908 http://www.medworm.com/index.php?rid=4388907&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001576%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388907 Mon, 24 Jan 2011 04:04:10 +0100 4388907 http://www.medworm.com/index.php?rid=4388906&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001564%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4388906 Mon, 24 Jan 2011 04:04:10 +0100 4388906 http://www.medworm.com/index.php?rid=4189356&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001011%2Fabstract%3Frss%3Dyes The period around the time of delivery is extremely hazardous for infants in developing countries. After the first week the risk drops sharply, and survival improves markedly. To reduce perinatal mortality, a continuum of care between the home and the various facilities is essential during pregnancy, childbirth and the newborn period. This paper reviews strategies to promote the establishment of this continuum: providing health care within or close to home by frontline workers and increasing the use of services in health facilities through community mobilization and financing strategies. As perinatal care and care for seriously sick children face common challenges and lessons could be learned from successful strategies for management of other illnesses, this paper also reviews intervention... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189356 Tue, 23 Nov 2010 04:07:23 +0100 4189356 http://www.medworm.com/index.php?rid=4189355&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001084%2Fabstract%3Frss%3Dyes The Lancet Neonatal Survival Series categorized neonatal health interventions into 3 service delivery modes: “Outreach,” “Family-Community Care,” and “Facility-based Clinical Care.” Family-Community Care services generally have a greater potential impact on neonatal health than Outreach services, with similar costs. Combining interventions from all 3 service delivery modes is ideal for achievement of high impact. However, access to clinical care is limited in resource-poor settings with weak health systems. The current trend for those settings is to combine neonatal interventions into community-based intervention packages (CBIPs), which can be integrated into the local health care system. In this article, we searched several large databases to identify all published, large-scal... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189355 Tue, 23 Nov 2010 04:07:23 +0100 4189355 http://www.medworm.com/index.php?rid=4189354&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001060%2Fabstract%3Frss%3Dyes This article draws upon available evidence from prevention-oriented, community-based newborn survival trials to derive insights into the role of behavior change in neonatal mortality reduction. We propose a simple model, the intervention-causation pathway, to explain the pathway through which behavior change interventions may lead to reductions in mortality. Further, we explore the unique nature of newborn care behaviors and their underlying sociocultural context, along with state-of-the-art advances in social, behavioral, and management sciences. These principles form the basis of the behavior change management framework that has successfully guided intervention design and implementation, leading to high impact on neonatal mortality reduction, in Uttar Pradesh, India. We describe how the ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189354 Tue, 23 Nov 2010 04:07:22 +0100 4189354 http://www.medworm.com/index.php?rid=4189353&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001023%2Fabstract%3Frss%3Dyes Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were review... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189353 Tue, 23 Nov 2010 04:07:22 +0100 4189353 http://www.medworm.com/index.php?rid=4189352&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001072%2Fabstract%3Frss%3Dyes Hypothermia among newborns is considered an important contributor to neonatal morbidity and mortality in low-resource settings. However, in these settings only limited progress has been made towards understanding the risk of mortality after hypothermia, describing how this relationship is dependent on both the degree or severity of exposure and the gestational age and weight status of the baby, and implementing interventions to mitigate both exposure and the associated risk of poor outcomes. Given the centrality of averting neonatal mortality to achieving global milestones towards reductions in child mortality by 2015, recent years have seen substantial resources and efforts implemented to improve understanding of global epidemiology of neonatal health. In this article, a summary of the bu... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189352 Tue, 23 Nov 2010 04:07:20 +0100 4189352 http://www.medworm.com/index.php?rid=4189351&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001047%2Fabstract%3Frss%3Dyes An estimated one million newborns die from infections in developing countries. Despite the huge burden, high-quality data from community-based epidemiologic studies on etiology, risk factors, and appropriate management are lacking from areas in which newborns experience the greatest mortality. Several planned and ongoing studies in South Asia and Africa promise to address the knowledge gaps. However, simple and low-cost interventions, such as community-based neonatal care packages supporting clean birth practices, early detection of illness through use of clinical algorithms, and home-based antibiotic therapy in areas in which hospitalization is not feasible are already available and have the potential to bring about a drastic reduction in global neonatal mortality due to infections if the... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189351 Tue, 23 Nov 2010 04:07:20 +0100 4189351 http://www.medworm.com/index.php?rid=4189350&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001059%2Fabstract%3Frss%3Dyes Globally, each year, an estimated 13 million infants are born before 37 completed weeks of gestation. Complications from these preterm births are the leading cause of neonatal mortality. Preterm birth is directly responsible for an estimated one million neonatal deaths annually and is also an important contributor to child and adult morbidities. Low- and middle-income countries are disproportionately affected by preterm birth and carry a greater burden of disease attributed to preterm birth. Causes of preterm birth are multifactorial, vary by gestational age, and likely vary by geographic and ethnic contexts. Although many interventions have been evaluated, few have moderate-to high-quality evidence for decreasing preterm birth: smoking cessation and progesterone treatment in women with a ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189350 Tue, 23 Nov 2010 04:07:19 +0100 4189350 http://www.medworm.com/index.php?rid=4189349&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001096%2Fabstract%3Frss%3Dyes Each year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking. Approximately 60 million annual births occur outside of health facilities, and most of these childbirths are without a skilled birth attendant. Conditions that increase the risk of intrauterine hypoxia—such as pre-eclampsia/eclampsia, obstructed labor, and low birth weight—are often more prevalent in low resource settings. Intrapartum-related neonatal deaths can be averted by a range of interventions that prevent intrapartum complications (eg, prevention and management of pre-eclampsia), detect and m... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189349 Tue, 23 Nov 2010 04:07:18 +0100 4189349 http://www.medworm.com/index.php?rid=4189348&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001102%2Fabstract%3Frss%3Dyes The annual global burden of stillbirths amounts to an estimated 3.2 million%, 98% of which occur in low- and middle-income countries (LMICs). Of these, 1.02 million (32%) are intrapartum, ie, taking place during labor. The most important causes of stillbirths in LMICs include obstructed or prolonged labor, hypertensive diseases of pregnancy, syphilis and gram-negative infections, malaria in endemic areas, and undernutrition. Interventions that target these causes can play an important role in reducing stillbirths. There is a clear benefit of emergency obstetrical care, particularly Cesarean delivery, on intrapartum rates in LMICs when Cesarean rates are less than 8% to 10%. Provision of a skilled birth attendant is another important intervention whereby labor complications can be prevented... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189348 Tue, 23 Nov 2010 04:07:16 +0100 4189348 http://www.medworm.com/index.php?rid=4189347&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001175%2Fabstract%3Frss%3Dyes This article reviews progress for newborn health globally, with a focus on the countries in which most deaths occur—what data do we have to guide accelerated efforts? All regions are advancing, but the level of decrease in neonatal mortality differs by region, country, and within countries. Progress also differs by the main causes of neonatal death. Three major causes of neonatal deaths (infections, complications of preterm birth, and intrapartum-related neonatal deaths or “birth asphyxia”) account for more than 80% of all neonatal deaths globally. The most rapid reductions have been made in reducing neonatal tetanus, and there has been apparent progress towards reducing neonatal infections. Limited, if any, reduction has been made in reducing global deaths from preterm birth and for... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189347 Tue, 23 Nov 2010 04:07:15 +0100 4189347 http://www.medworm.com/index.php?rid=4189346&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001035%2Fabstract%3Frss%3Dyes In this issue of Seminars in Perinatology we examine global perinatal health, a timely topic in light of the unprecedented, high-level attention that has been given this past year to maternal, newborn, and child health (MNCH; ). Global economic powers, including governments and other donor agencies; the private sector, including multinational and national companies with a stake in MNCH; policy makers across high-, middle-, and low-income countries; academics; international and national civil society organizations, and program managers from governmental and nongovernmental organizations have met together at these various fora to assess progress, revise existing strategies, and launch new, innovative approaches to achieving a common vision for fulfillment of the Millennium Development Goals ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189346 Tue, 23 Nov 2010 04:07:15 +0100 4189346 http://www.medworm.com/index.php?rid=4189345&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001291%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189345 Tue, 23 Nov 2010 04:07:15 +0100 4189345 http://www.medworm.com/index.php?rid=4189344&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001308%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189344 Tue, 23 Nov 2010 04:07:15 +0100 4189344 http://www.medworm.com/index.php?rid=4189343&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051000128X%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189343 Tue, 23 Nov 2010 04:07:14 +0100 4189343 http://www.medworm.com/index.php?rid=4189342&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510001278%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4189342 Tue, 23 Nov 2010 04:07:14 +0100 4189342 http://www.medworm.com/index.php?rid=4011632&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051000056X%2Fabstract%3Frss%3Dyes Vaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has had a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean delivery, clinicians believed that her future pregnancies required cesarean delivery. Studies from the 1960s suggested that this practice may not always be necessary. In 1980, a National Institutes of Health (NIH) Consensus Development Conference Panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to have a trial of labor was offered and exercised more often in the 1980s through 1996. Since 1996, however, the number of VBACs has declined, contributing to the overall increase in ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011632 Wed, 29 Sep 2010 20:48:09 +0100 4011632 http://www.medworm.com/index.php?rid=4011631&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000546%2Fabstract%3Frss%3Dyes This survey was conducted to assess physician opinion regarding vaginal birth after cesarean delivery (VBAC) and to examine how physician and hospital characteristics influence the private obstetrical provider's decision to offer or not to offer trial of labor after cesarean delivery. A confidential postal survey of private practicing obstetricians in the Dallas-Ft. Worth Region (n = 774) of North Texas. Of 774 obstetrician-gynecologists, 458 completed and returned the survey for a response rate of 59%. The survey revealed that 52% of respondents offer VBAC to their patients and indicated that the most common reasons for declining use or discontinuation of VBAC were maternal-fetal safety concerns associated with uterine rupture followed by medico-legal liability concerns. Factors associate... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011631 Wed, 29 Sep 2010 20:48:09 +0100 4011631 http://www.medworm.com/index.php?rid=4011630&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000534%2Fabstract%3Frss%3Dyes We describe ethical complexities of 3 key issues that mark the debate: the cesarean delivery rate, safety, and patient autonomy. We then describe a taxonomy of considerations that should inform a responsible framework for guideline development and highlight critical distinctions between types of guidelines that have been blurred in the past. We then forward 2 central claims. First, in otherwise uncomplicated birth after a single previous cesarean, both vaginal birth after cesarean and repeat cesarean should be regarded as reasonable options; women, rather than policymakers, providers, insurance carriers, or hospitals, should determine delivery approach. Second, in complicated cases, providers and policymakers should carefully calibrate the strength of evidence to ensure differential risk a... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011630 Wed, 29 Sep 2010 20:48:09 +0100 4011630 http://www.medworm.com/index.php?rid=4011629&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000522%2Fabstract%3Frss%3Dyes Decision making regarding approach to delivery after cesarean is complex and requires consideration of the probabilities of clinical outcomes and the preferences of pregnant women. Depending on the clinical situation, a range of management options may be appropriate, and understanding women's beliefs and values regarding the process and outcomes of obstetrical interventions, as well as providing them with clear information regarding risk, is a necessary part of providing evidence-based, patient-centered care. We conducted a review of the literature on risk communication, patient and provider preferences, and obstetrical decision-making and offer recommendations on how to incorporate patient preferences in the context of delivery after cesarean. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011629 Wed, 29 Sep 2010 20:48:08 +0100 4011629 http://www.medworm.com/index.php?rid=4011628&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000510%2Fabstract%3Frss%3Dyes The promulgation of the immediately available physician standard has contributed to the rapid decline in vaginal birth after cesareans (VBACs). While having an immediately available obstetrician during a VBAC trial will reduce risk, it is not clear that similar advantage wouldn't also accrue to women without uterine scars. However, many hospitals can't staff up to that standard. In this article we suggest 1) set a goal of providing an immediately available team for all women in labor, 2) tailor informed consent to women's unique risks– unique because of their own risk profile (e.g., previous scar, hypertension, etc) or unique because of characteristics of the birthing site (e.g. a team is or is not available), 3) in smaller hospitals, if an immediately available team cannot be routinely ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011628 Wed, 29 Sep 2010 20:48:08 +0100 4011628 http://www.medworm.com/index.php?rid=4011627&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000558%2Fabstract%3Frss%3Dyes The rate of vaginal birth after cesarean delivery (VBAC) has been steadily decreasing in the United States. What is not clear, however, is what part the availability of anesthesia personnel has played in this reduction. We review the role of anesthesia services in the trend of the decreasing rates of VBAC. Three areas of particular interest to anesthesiology services are addressed: (1) the current ability of anesthesiologists in the United States to provide “immediate” availability for VBAC at all delivery locations; (2) the workforce estimates for anesthesiology staffing in the future; and (3) the barriers to the immediate availability of anesthesiologists in all hospitals that provide obstetrical care. The concept of “immediate availability” is discussed, and examples of ways to ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011627 Wed, 29 Sep 2010 20:48:08 +0100 4011627 http://www.medworm.com/index.php?rid=4011626&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000509%2Fabstract%3Frss%3Dyes The objective was to compare national guidelines regarding vaginal birth after cesarean. Along with the American College of Obstetricians and Gynecologists practice bulletin, guidelines from the Royal College of Obstetricians and Gynaecologists and the Society of Obstetricians and Gynecologists of Canada were reviewed and compared. Although the 3 organizations agree on most of the risk factors for uterine rupture and failed vaginal birth after cesarean (VBAC), there were some variances in the recommendations to women with 2 previous cesareans and those who required oxytocin augmentation. A disagreement was also present in regard to the availability and requirement of resources to allow a trial of labor after a previous cesarean. Although concerns could be raised about how the literature is... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011626 Wed, 29 Sep 2010 20:48:08 +0100 4011626 http://www.medworm.com/index.php?rid=4011625&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000492%2Fabstract%3Frss%3Dyes Hospital administrators are most concerned with the quality of medical care. With specific regard to vaginal birth after cesarean, it is essential that the surgical personnel and anesthesia be able to intervene in a timely manner for an obstetrical emergency. Other considerations are patient satisfaction, perception by the community, and cost. Budgets and balancing resources are important factors but pale in decision-making compared with the ill-publicity and medicolegal risk associated with an untoward outcome. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011625 Wed, 29 Sep 2010 20:48:08 +0100 4011625 http://www.medworm.com/index.php?rid=4011624&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000480%2Fabstract%3Frss%3Dyes In 1980, amid concern over increasing cesarean delivery rates, the National Institute of Child Health and Human Development sponsored a Consensus Development Conference on cesarean childbirth, at which the consensus panel found vaginal birth after cesarean (VBAC) to be a reasonable alternative to repeat cesarean for many women. By 1996, VBAC rates had increased to more than 28%, but the increase was short-lived, such that VBAC accounts for fewer than 8% of births after cesarean today. The reasons for this shift are not entirely understood, but likely they include concerns about potentially serious complications of VBAC attempts, as well as nonmedical factors, such as administrative policies, medicolegal pressures, professional society guidelines, and patient and provider preferences. (Sour... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011624 Wed, 29 Sep 2010 20:48:08 +0100 4011624 http://www.medworm.com/index.php?rid=4011623&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000765%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011623 Wed, 29 Sep 2010 20:48:08 +0100 4011623 http://www.medworm.com/index.php?rid=4011622&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000777%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011622 Wed, 29 Sep 2010 20:48:08 +0100 4011622 http://www.medworm.com/index.php?rid=4011621&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000753%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011621 Wed, 29 Sep 2010 20:48:08 +0100 4011621 http://www.medworm.com/index.php?rid=4011620&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000741%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=4011620 Wed, 29 Sep 2010 20:48:08 +0100 4011620 http://www.medworm.com/index.php?rid=3783782&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000479%2Fabstract%3Frss%3Dyes Vaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has had a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean delivery, clinicians believed that her future pregnancies required cesarean delivery. Studies from the 1960s suggested that this practice may not always be necessary. In 1980, a National Institutes of Health (NIH) Consensus Development Conference Panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to have a trial of labor was offered and exercised more often in the 1980s through 1996. Since 1996, however, the number of VBACs has declined, contributing to the overall increase in ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783782 Sat, 24 Jul 2010 07:34:36 +0100 3783782 http://www.medworm.com/index.php?rid=3783781&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000327%2Fabstract%3Frss%3Dyes In subsequent pregnancies after a cesarean delivery, women must choose between attempting to deliver vaginally or undergoing another cesarean delivery. Information relevant to this choice includes the long-term benefits and harms to the baby. In this article we discuss the relationship of mode of delivery (planned trial of labor, either with or without vaginal delivery, or elective repeat cesarean delivery) and long-term outcomes, including brachial plexus palsy, neurodevelopmental impairment, and asthma. No randomized trials are available that relate directly to the choice of delivery method after previous cesarean. Observational studies suggest that cesarean delivery might be associated with a greater risk of asthma, caused perhaps by altered gut colonization, increased risk of neonatal ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783781 Sat, 24 Jul 2010 07:34:36 +0100 3783781 http://www.medworm.com/index.php?rid=3783780&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000315%2Fabstract%3Frss%3Dyes Women must often choose between a vaginal birth after previous cesarean and elective repeat cesarean delivery. Short-term risks of vaginal birth after cesarean can be potentially catastrophic in the setting of uterine rupture. Although randomized controlled trials comparing these 2 modes of delivery are lacking, observational studies suggest an increased risk of perinatal mortality and hypoxic-ischemic encephalopathy in infants whose mothers undergo a trial of labor. These rare risks compete with more common, albeit less severe, short-term risks associated with elective repeat cesarean delivery, with a particular emphasis on increased respiratory morbidities. Further studies are needed to identify potential strategies to improve perinatal outcomes and help guide physicians and patients in ... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783780 Sat, 24 Jul 2010 07:34:36 +0100 3783780 http://www.medworm.com/index.php?rid=3783779&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000297%2Fabstract%3Frss%3Dyes Uterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth f... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783779 Sat, 24 Jul 2010 07:34:36 +0100 3783779 http://www.medworm.com/index.php?rid=3783778&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000303%2Fabstract%3Frss%3Dyes Most studies of cesarean morbidity focus on short term, rather than long term complications. However, women undergoing cesarean delivery are at increased risk for a chronic problems as well. These include pain and surgical adhesions, as well as a possible increased risk for infertility or sub-fertility and perinatal complications in subsequent pregnancies. The most serious risk for women undergoing multiple repeat cesarean deliveries is a dramatically increased risk for life threatening hemorrhage and morbidity in the setting of placenta accreta. This chapter outlines these long term risks of cesarean delivery so that they may be factored into the risk:benefit ratio for women considering vaginal birth after cesarean delivery (VBAC). (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783778 Sat, 24 Jul 2010 07:34:36 +0100 3783778 http://www.medworm.com/index.php?rid=3783777&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000285%2Fabstract%3Frss%3Dyes An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman’s health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consis... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783777 Sat, 24 Jul 2010 07:34:36 +0100 3783777 http://www.medworm.com/index.php?rid=3783776&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000273%2Fabstract%3Frss%3Dyes There have been multiple observational studies that have assessed the probability that a woman who undertakes a trial of labor after a previous cesarean delivery will have a vaginal birth. These studies have demonstrated a population-level probability of a successful vaginal birth after cesarean (VBAC) that ranges between 60% and 80%. However, within a population the chances for success of a given individual may vary to a significant degree on the basis of particular demographic characteristics and obstetric history. This review summarizes the different characteristics that have been prominently associated with successful VBAC as well as the different attempts that have been made to develop accurate prediction models for successful VBAC. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783776 Sat, 24 Jul 2010 07:34:36 +0100 3783776 http://www.medworm.com/index.php?rid=3783775&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000261%2Fabstract%3Frss%3Dyes A review of the literature and analysis of the National Inpatient Sample Database was performed to describe the trends in vaginal birth after cesarean availability in the United States and the factors associated with changing use. Vaginal birth after cesarean increased after the first National Institutes of Health Consensus Conference on Cesarean Childbirth in 1981. It increased from 3% to a maximum rate of 28.3% in 1996. Despite studies reporting stable success rates of approximately 70% and low complication rates ( (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783775 Sat, 24 Jul 2010 07:34:36 +0100 3783775 http://www.medworm.com/index.php?rid=3783774&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS014600051000025X%2Fabstract%3Frss%3Dyes In 1980, amid concern over increasing cesarean delivery rates, the National Institute of Child Health and Human Development sponsored a Consensus Development Conference on cesarean childbirth, at which the consensus panel found vaginal birth after cesarean (VBAC) to be a reasonable alternative to repeat cesarean for many women. By 1996, VBAC rates had increased to more than 28%, but the increase was short lived, such that VBAC accounts for fewer than 8% of births after cesarean today. The reasons for this shift are not entirely understood but likely include concerns about potentially serious complications of VBAC attempts, as well as nonmedical factors, such as administrative policies, medicolegal pressures, professional society guidelines, and patient and provider preferences. (Source: Se... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783774 Sat, 24 Jul 2010 07:34:35 +0100 3783774 http://www.medworm.com/index.php?rid=3783773&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000601%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783773 Sat, 24 Jul 2010 07:34:35 +0100 3783773 http://www.medworm.com/index.php?rid=3783772&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000595%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783772 Sat, 24 Jul 2010 07:34:35 +0100 3783772 http://www.medworm.com/index.php?rid=3783771&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000583%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783771 Sat, 24 Jul 2010 07:34:35 +0100 3783771 http://www.medworm.com/index.php?rid=3783770&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000571%2Fabstract%3Frss%3Dyes (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3783770 Sat, 24 Jul 2010 07:34:35 +0100 3783770 http://www.medworm.com/index.php?rid=3595120&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000224%2Fabstract%3Frss%3Dyes Phototherapy for jaundice is a common treatment in neonatal medicine and is used to prevent the neurotoxic effects of bilirubin. Studies have assessed the optimal wavelength of phototherapy light, the importance of irradiance and spectral power, and the types of light source, including the use of single versus multiple light sources. Outcome measures have been duration of need for phototherapy or rate of reduction of serum bilirubin over a given time. An apparent resurgence of kernicterus in recent years has forced us to focus on the emergency management of severely jaundiced infants. Several studies have shown that very rapid reductions of total serum bilirubin levels are possible. The speed with which photoisomers are formed appears to be important both from this perspective and theoreti... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595120 Tue, 25 May 2010 15:18:46 +0100 3595120 http://www.medworm.com/index.php?rid=3595119&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000212%2Fabstract%3Frss%3Dyes Premature birth and disruption of the normal maturation process leave the immature ductus arteriosus unable to respond to postnatal cues for closure. Strategies that advocate conservative management of the patent ductus arteriosus (PDA) in premature infants are dependent on identification of the symptomatic PDA and understanding the risk factors that predispose to PDA. Exposure of premature infants to unintended vasodilatory stimuli may be one of the risk factors for PDA that is underrecognized. In this article, we summarize the clinical factors that are associated with PDA and review commonly used neonatal drugs for their vasodilatory properties. Data demonstrating relaxation of the ductus arteriosus by gentamicin and other aminoglycoside antibiotics, by cimetidine and other H2 receptor a... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595119 Tue, 25 May 2010 15:18:46 +0100 3595119 http://www.medworm.com/index.php?rid=3595118&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000200%2Fabstract%3Frss%3Dyes The role of inflammation in the pathogenesis of bronchopulmonary dysplasia (BPD) is not well understood. By using a transgenic mouse expressing the inflammatory cytokine interleukin (IL)-1β in the lung, we have shown that perinatal expression of IL-1β causes a BPD-like illness in infant mice. We have used this model to identify mechanisms by which inflammation causes neonatal lung injury. Increased matrix metalloproteinase (MMP)-9 activity is associated with BPD. MMP-9 deficiency worsens alveolar hypoplasia in IL-1β−expressing newborn mice, suggesting that MMP-9 has a protective role in neonatal inflammatory lung injury. The beta6 integrin subunit, an activator of transforming growth factor-beta, is involved in adult lung disease. Absence of the beta6 integrin subunit improves alveola... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595118 Tue, 25 May 2010 15:18:46 +0100 3595118 http://www.medworm.com/index.php?rid=3595117&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000194%2Fabstract%3Frss%3Dyes The long-term consequences of small size at birth have been well described during the last 2 decades. It is important to assess the fetal growth velocity and to recognize that newborns may have growth restriction even with a normal birth weight. Intrauterine growth retardation suggests decreased growth velocity in the fetus as the result of a certain pathophysiologic process. An infant born after a short period of intrauterine growth retardation may not necessarily be small for gestation at birth. Several cohorts of adults born after a normal intrauterine growth have been followed for long term. Greater weight gain and fat mass early in life after thinness at birth are risk factors for overweight and cardiovascular diseases. Other risk factors include prematurity, bottle feeding, and tobac... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595117 Tue, 25 May 2010 15:18:46 +0100 3595117 http://www.medworm.com/index.php?rid=3595116&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000182%2Fabstract%3Frss%3Dyes The newborn shows several signs of consciousness, such as being awake and aware of him/herself and mother. The infant processes olfactory and painful inputs in the cortex, where consciousness is believed to be localized. Furthermore, the newborn expresses primary emotions such as joy, disgust, and surprise and remember rhymes and vowels to which he or she has been exposed during fetal life. Thus, the newborn infant fulfills the criteria of displaying a basic level of consciousness, being aware of its body and him/her-self and somewhat about the external world. Preterm infants may be conscious to a limited degree from about 25 weeks, when the thalamocortical connections are established. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595116 Tue, 25 May 2010 15:18:46 +0100 3595116 http://www.medworm.com/index.php?rid=3595115&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000170%2Fabstract%3Frss%3Dyes Although recent studies have documented compensatory generation of neurons in adult brains in response to various insults, a noninjurious short episode of hypoxia in rat neonates has been shown to trigger neurogenesis within the ensuing weeks, without apparent brain lesions. Very little is known of the long-term consequences. We therefore investigated the effects of such a conditioning-like hypoxia (100% N2, 5 min) on the brain and the cognitive outcomes of rats at 40 to 100 days of age. Control and posthypoxic rats developed similar learning capacities over postnatal days 14 to 18, but hypoxia was associated with enhanced scores in a test used to evaluate memory retrieval between 40 and 100 days. A striking sexual dimorphism was observed, with an earlier functional gain observed in female... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595115 Tue, 25 May 2010 15:18:46 +0100 3595115 http://www.medworm.com/index.php?rid=3595114&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000169%2Fabstract%3Frss%3Dyes Low birth weight infants, in particular those born preterm, have been shown to develop increased arterial blood pressure and hypertension at adulthood. Three main systems are involved in the developmental programming of hypertension: the kidney, the neuroendocrine system, and the vascular tree. This review focuses on vascular dysfunction and discusses clinical and experimental evidence that relates low birth weight and the risk for hypertension at adulthood. Recent studies demonstrate an impairment of vascular structure and function. Both arterial vessels, through altered arterial stiffness and endothelium-dependent vasodilation, and the capillary bed, through microvascular rarefaction, are involved in the early pathogenesis of hypertension. The key role of the endothelium, as shown by alt... Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595114 Tue, 25 May 2010 15:18:46 +0100 3595114 http://www.medworm.com/index.php?rid=3595113&cid=s_38432_69_f&fid=38432&url=http%3A%2F%2Fwww.seminperinat.com%2Farticle%2FPIIS0146000510000236%2Fabstract%3Frss%3Dyes Hypertension is a major risk factor for ischemic heart disease and stroke, which are leading causes of morbidity and death worldwide. Besides the contributions from genes and adult life-style, this review highlights that adult hypertension is likely to be a legacy of preterm birth. This knowledge has important health implications for the new and rapidly growing population of young people born very preterm. Increased awareness among both families and professionals about preterm birth being a perinatal risk factor for adult hypertension is needed. Measurement of blood pressure in children and young people born preterm is also recommended, all to detect and treat hypertension in young people born preterm long before end organ damage occurs. (Source: Seminars in Perinatology) Seminars in Perinatology journals http://www.medworm.com/rss/comments.php?id=3595113 Tue, 25 May 2010 15:18:46 +0100 3595113