- J. E. Baumueller added an answer:Is the maneuver Fundal pressure - vis a tergo - expressio fetus a safe maneuver?
I'm very interested in this maneuver because it is common practice though there is little evidence on it.
who has interesting research ideas on this topic? who has already useful protocols and instruction tools for this maneuver?
"Also, have you ever thought about that fact that if you can vacuum the baby out, you can push the baby out?". That sounds a little idealistic. Vacuum or Kristeller, if not used for fetal reasons, are helpful when all conventional methods (including pushing and/or squatting) dont work. And with Vacuum, you can correct the position of the head. Anyways, Kristeller is painful for the parturient, no question. Still, trying to enhance the uterine power during one or two contractions is worth a try before using more invasive techniques. You dont have to sit on the parturient ;) just pushing with one or two hands and see if it´s effective
To Nerry Omolo:
as far as i know, but a veterinary doctor should tell us the truth, wild animals (and domestic ones too) have often a "more appropriate" Pelvisshape in comparison to the human pelvis. Or?
- Elizabeth Skinner added an answer:Does anyone have a good indicator scale or tool for PTSD?
I am researching the psychological effects of birth trauma to women and an emerging theme of 40 interviews appears to be PTSD. However, it would be beneficial to examine the accuracy of this theme.
Dear Beatrice and Daniel
Thank you so much for this great information - I will also share this with Prof Hans Peter Dietz - the head of this research team re levator ani/ OASIS birth injuries.Following
- Judy Slome Cohain added an answer:Can anyone suggest a possible method to prevent meconium aspiration in the presence of thick or thin meconium?http://www.youtube.com/watch?v=O-OqnqfHQ2Q
As explained in these youtubes, I have been preventing all meconium aspiration by delivery on hands and knees, and waiting a minute or more between delivery of head and body. This gives a minute for meconium and vernix to drain from the lungs, trachea and nose. By the time the body is delivered, the lungs and trachea are clear of all meconium.
Suction should not be used routinely because it pushes vernix and meconium further down into the lungs making things worse:
A 2009 review of RCT trials(1) found pulmonary hypertension and asphyxia, and NOT meconium are now considered to be the important risk factors for Meconium Aspiration Syndrome MAS. It is likely that perinatal distress and aspiration of meconium occur earlier in the pregnancy, not at birth, which is why suctioning or cesarean delivery does not improve outcomes. Universal intrapartum suction of infants with meconium stained amniotic fluid has been proven to be a useless protocol . Instead, endotracheal intubation and suctioning are currently recommended only for nonvigorous infants. Respiratory failure in infants with MAS is treated initially with mechanical ventilation and surfactant administration.
1. Vain NE, Szyld EG, Prudent LM, Aguilar AM. What (not) to do at and after delivery? Prevention and management of meconium aspiration syndrome. Early Hum Dev. 2009;85(10):621-6.Following
- Patricia D Ndhlovu added an answer:Should you treat Schistosomiasis during pregnancy?Schistosomiasis morbidity has been reported to be associated with adverse pregnancy outcomes like low birth weight, prenatal death and maternal death. The most implicating risk factor is anaemia. Recent studies have also stressed the poor immunogenicity of vaccine in neonates of untreated infected mothers and there have been reports on the occurrence of proinflammatory cytokines associated with Schistosoma fibrosis in neonates of infected mothers suggesting a possibility of congenital transmission and adverse effects in neonates. While the WHO has recommended the administration of praziquantel to infected mothers during pregnancy (though without many randomized control trials as at the time of the recommendation), recent evidences have however shown beneficial effects as regards non-treatment during pregnancy. In one study, the children of treated women were reported to show high prevalence of eczema! Furthermore, the most acclaimed risk factor of infection (anaemia) which is the major cause of LBW, prenatal death etc was reported not to be associated with schistosomiasis ruling out coinfection with hookworm and Plasmodium falciparum. Infact another observation showed no association between mother's infection and response to vaccination in children. I want your opinion in this regards as Schistosoma researcher. If you have done something related to this subject matter, I would love to know your findings.
No you can not treat pregnant women with praziquantel.Following
- Masako Fujita asked a question:Does anyone know the serum FOLR1 concentration equivalent to serum folate conc of 8 ug/L?
We would like to determine the prevalence of folate deficiency in our serum samples using FOLR1 ELISA. We found the deficiency cutoff for serum folate, but no luck finding the one using FOLR1. Thank you!Following
- Olga Lebedeva added an answer:Can anybody suggest any correlation between expression of antimicrobial peptides in cervix uteri and endometrium?
Please, advise me any publications in this topic would also be helpful.
Thank you very much for your answer, Maria! Yes, there are some publications separately about endometrial cells or about cervix uteri, but not about interrelations between both sites.Following
- Zelalem Tafese Wondimagegne added an answer:Is there any association between incidence of eclamsia and the nutritional status and or the nutrient profile of a woman in developing countries?
Eclamsia is a major cause of maternal mortality, morbidity and adverse fetal and neonatal outcome. There are research attempts to investigate the factors associated with eclamsia; but is there any recent finding that suggests the association of eclamsia with specific nutrient deficiency in developing countries.
Thank you for all who respond to my question.Following
- Kalkidan Hassen Abate added an answer:Does anyone know what the terms "redlive", "benworn" and 'dimifew" may have to do with maternal health or calcium supplementation?
Working on a maternal health project
O' lord i barely speak English.Following
- Christopher C Rout added an answer:Does anyone have experience with the assessment of maternal cardiac output?
How can I manage a decrease of maternal CO during Cesarean section ?
Can you provide a few more specifics? For example preoperative morbidity - has she valvular heart disease, a cardiomyopathy or what? Also, what sort of anaesthetic are you using and are you measuring cardiac output? What is causing the decrease in cardiac output?
The simplistic (and not very helpful) answer to your question is to increase it. But depending on cause and amount by which the CO is decreased there are a number of possible options including nothing at all (i.e. watch and wait), but we need more details.Following
- Arthur Fougner added an answer:What are the possible differential diagnostics for multilocular ovarian cyst with multifocal dermoid cysts?
For a case of unilateral serous multilocular ovarian cyst with multifocal dermoid cysts incorporated in the wall of the cyst in a 29 years old female with 2 living children?
what about differential diagnosis and possible ones ?
Check out the lectures on sonoworld.com - registration is free.
These two would be a good start.
- Jennifer L Barkin added an answer:Other than the Edinburgh Postnatal Depression Scale and PDSS, what other assessments measure postpartum risk?I am researching whether postpartum risk assessment scales are adequately measuring all risk variables that contribute to crimes of maternal infanticide.
Sorry, this one - the Barkin Index of Maternal FunctioningFollowing
- Clara Isaza added an answer:Would Histopaque 1077 interact with cell free DNA?
We have plasma, that we kept from a previous experiment, that was obtained after separating blood using Histopaque 1077. Now we would like to use that plasma to extract cell free DNA. Would you expect to be able to recover cell free DNA from that plasma? Or would the histopaque 1077 interact with the cfDNA during the blood separation and possible deplete plasma of it?
Dear Dr. Mishra,
Thank you very much for your answer.
- Prabhat Chandra Mondal added an answer:How can severe postcesarean hypertension be managed?
I am working in a warm country. It is my experience and observation that is very interesting. During winter season when suddenly temperature falls, we get more eclamptic mothers from rural area. when there is heavy rainfall, we get more eclamptic mothers. There are some research articles describing this. This could be due to vasospasm or water restriction. In western country this has been explained as less sunlight exposure.Following
- Shahnawaz Khan added an answer:How does paid maternal leave influence well being?Most countries, other than the USA, have some sort of social support to assist new parents. The duration or paid leave is varied, as is the percentage of salary that mothers receives. What are the goals of maternal paid leave in each country? Do countries evaluate the efficacy of the program? Are there long-term impacts that have been researched?In a developing country like India paid maternal leaves are a mandatory process for the working women because women have to manage professional matters as well as family because education of child fully depends on the mother's input in their basic as well higher education along with physical growth by breast-feeding and feeding from other sources etc., if a mother has not been given paid maternity leaves how she will manage their family, this factor directly suffer their family and child basic education, personality and physical growth. In other words if a brain is not satisfied with the physical things of world, how that brain works better. It is suggested that for a healthy world it should be necessary to run a policy for paid maternity leaves for working women and welfare of human being.Following
- Therese H Doan added an answer:Why is there lactation suppression following delivery in cases of Gestational Diabetes Mellitus?Gestational Diabetes Mellitus and Lactation suppressionHi All,
I agree with Megan. Effective lactation support and management in this case is most important. Gestational diabetes, in effect, resolves itself after the birth of baby (and the placenta). These GDM mothers may need more help with breastfeeding, specifically latching on technique, to ensure effective suckling, mother-baby interaction, and of course, let-down reflex. The article by Arthur et al. (1994) suggested a delay in increase of lactose in breast milk of women with insulin dependent diabetic mothers, not GDM mothers.Following
- Igor Lakhno added an answer:What is the best way to analyze periodic changes in the maternal heart rate under resting conditions in late pregnancy but before the onset of labour?We captured the raw data of the maternal heart rate as part of another study, but would like to analyze it later to determine possible associations with pregnancy outcome.Maternal HRV is a convinient instrument to evaluate regulatory balance that could promote control of hemodynamics. Variability (oscillations) of maternal hemodynamic processes spreads its influence through placental barrier and provide fetomaternal cooperation. Maternal sinus respiratory arrhythmia is the most valuable oscillator in the system of "mother-placenta-fetus".Following
- Fernando Neuspiller added an answer:If the previous cesarean scar on skin is a verical midline, where to put incision next time for the cesarean section?Vertical or TransverseVertical, and remove de previous scarFollowing
- Helen Muscat added an answer:What should be the correct birthing position?Most places women give birth in un-natural position like lithotomy position leading to more tears of perineum and also difficult last phase of deliveryIt is interesting that some of the comments include the "operator" or those "conducting" the delivery. It is worth considering that the woman will birth the baby and have some instinct as to the best position. This said the medicalisation of birth often means that women conform to recumbent position which suits the medical model. Even when there is intervention such as CTG etc a more woman centred approach can be considered.Following
- Genevieve Ellen Becker added an answer:Does anyone known about the mechanisms of breast milk production?I'm doing an epidemiological major and I am still creating my thesis. So if we give a supplementation for breastfeeding to women how long will the composition of milk be changed? Please share.I agree with earlier responses, it depends what the supplement is. Some will have an effect on the amount of the supplement (if any) that reaches the milk ( a complex biochemical process). Or a supplement may affect the mother in some way. For example, if the mother is deficient in iron and is given an iron supplement the amount of iron in her milk will not change but she may feel better and feed the baby more effectively - thus the iron supplement could contribute to increased milk intake by the baby.
I suggest you read some of the basic lactation textbooks on how milk is made as a first step.Following
- Taiar Redha added an answer:Is anyone using - or do you know of - a global measure for maternal well-being?This question came to me through our Perinatal Mood Disorders Coalition from a researcher in Pennsylvania. I focus on local public health and don't know of any global measures.Dear Faith, thanks for the question and to the others for the interesting responses. Totaly agree with Fionnuala.
- Fekadu Mazengia Alemu added an answer:Has anyone looked at the prevalence of obstetric fistula in chronic conflict situations?I assume that restriction of access to emergency obstetric care, which occurs in acute and chronic conflict settings, would result in increased incidence of obstetric fistula. There is some evidence of this in Darfur. I am looking for other settings in which this may be an issue.In conflict situations you can take South Sudan as an example in recent survey minimal estimated prevalence of at least 30 fistulas per 100,000 women of reproductive age (95% CI 10–100) was estimated.Following
- Aisha Adamu added an answer:Should oxytocin be administered before or after placental expulsion?To prevent retention of placenta and also with reference to delayed cord clamping.It should be administered before placental expulsion, not only would it act to prevent post partum haemorrhage, it would also facilitate placental separationFollowing
- Caroline Rodgers added an answer:Can elevated maternal temperature cause copy-number variations in 5-week-old embryos?Women often do not realize they are pregnant at five weeks, when they may be subject to fevers, infections or take prescription or recreational drugs that can disrupt the regulatory system. Could this explain some de novo copy-number variations?It is my understanding that teratogenesis specifically denotes a malformation of some kind and does not include "subtle" effects that cannot be determined at birth, such as neurological disorders.
What I am really look for is what I asked: Can elevated maternal heat cause copy number variations and if so, would an embryo that is only five or six weeks old be vulnerable to copy number variations if there were an elevation in maternal heat. The source of de novo copy number variations, which are not inherited, does not seem to be well understood, yet we live in a world of cause and effect so I am trying to determine what might be causing de novo copy number variations associated with neurological disorders such as autism and ADHD.Following
- Prabhat Chandra Mondal added an answer:A woman was found abnormal TSH at 35+5 weeks of gestation. Her TSH was 4.0 with normal FT3 and FT4. Should she be advised to take levothyroxine?A woman was found abnormal TSH at 35+5 weeks of gestation. Her TSH was 4.0 with normal FT3 and FT4. Should she be advised to take levothyroxine?No treatment is required. It is a case of subclinical hypothyroism. What will be the benifit to the fetus if thyroxine is given at 37th week of gestation. Only TPOAbs are to be screened.Following
- Ajlana Mulic-Lutvica added an answer:Is there any experience on maintenance tocolysis with ATOSIBAN?There is no published trial and it might be an option for pregnancies extremely premature with uterine activity or modified cervixThere is any evidence that maintanance tocolysis (independently of chosen tocolytic) helps, neider for prolonging of gestational age, or regardinng fetal morbidity and mortality.Following
- Ahmed Samy El-agwany added an answer:Which IV Fluid should be used for the administration of Oxytocin?For induction/ augmentation of labor or for prevention and treatment of PPHSaline or ringer solution are better than non electrolytic solutions to decrease fluid retention . Glucose solutions better reserved for nourishment with low intake in labour.Following
- Harald Mangge added an answer:Does maternal obesity have an impact on offspring development?Obese women have an increased risk of pregnancy-related complications, including hypertension, gestational diabetes, and blood clots. Maternal obesity is also known to be associated with increased rates of complications in late pregnancy such as cesarean delivery, and shoulder dystocia.In our STYJOBS / EDECTA cohort (http://clinicaltrials.gov/ct2/show/NCT00482924) which was established at the Medical University of Graz since several years and comprises now around 1300 participants we observe a strong positive correlation between maternal obesity, offspring overweight/obesity and also metabolic Syndrome. The correlation is stronger between mother and offspring compared to father and offspring.Following
- Amani Obeid added an answer:What is the best therapeutic approach for Bell's palsy during pregnancy?24 year old female patient presented with total peripheral facial nerve paralysis at 28th gestational week. She had 2 miscarriages before. Notwithstanding the associated risks and complications she insists on taking steroid treatment. What would your approach be?I wouldn't be worried starting steroids in her as she is in her 3rd trimester. Personally, I would give her the option of a short course of steroids for 5-7 days.
from UpToDate regarding steroid in pregnancy:
"Some studies have suggested that there may be a very small increased risk of cleft lip or cleft palate in the babies of mothers who took oral steroid medications during the first 13 weeks of pregnancy. Two studies found a slightly increased risk of premature delivery, and one study found a slightly increased risk of having a low birth weight baby. However, the researchers could not rule out the possibility that these effects were related to the woman's underlying medical condition rather than use of the drug."Following
- Bridget Akin-Otiko added an answer:What could be the cause of sepsis at 35 day after C-section?We have patient, which had c-section 35 days ago because of preeclampsia at 34 week of gestation. She was in ICU during 16 days because of gestosis complications (oliguria) and was administered hemosorption few times and she recieved meronem 10 days and after that - zyvox for 7 days.
After that she was in nephrological department during next 14 days and already was getting ready to discharge. 3 days ago fever appeared (39,5 degree centigrade), procalcitonin is 100 ng/ml, leucocytes amount 3 days ago was 30*10^9/ml, today - 0,5*10^9/ml and agranulocytosis was detected. It was an episode of low blood pressure (60/30), which was treated with dopamine. In blood Staphylococcus epidermidis is discovered.
Pulse is 130/min, breath rate 40/min, saturation with oxygen is 97%, without oxygen - 92%.
Low-lobe pneumonia and serose liquid in pleura and peritoneum were discovered.
US of kidney and urine samples are normal. US of uterus is normal. No bacteria was discovered in bacteriological investigation of urine and cervix uteri.
Now she receives vancomycin and plasmapheresis.
Where could be nidus (focal point) of infection? What additional examination should we do?Good to know she was discharged in good condition. Please follow-up proactively . ThanksFollowing
- Marya G Zlatnik added an answer:If a woman has an eclamptic fit, the priority is to control seizures, control BP and seizures, then deliver. Does it have to be a CS?Just to clarify, I am talking about POST eclamptic seizure, NOT in the case of severe pre-eclampsia. MNoFollowing
About Maternal Health
Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality.