Current use of noninvasive prenatal testing in Europe, Australia and the USA : A graphical presentation

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Preconception counselling optimising reproductive health and wellbeing

• Preconception counselling forms the basis of a preconception care program and is one of the most potent opportunities to practise preventative medicine. • Topics that may be covered in preconception counselling are conception, contraception, sexually transmitted infections, cervical screening, dietary advice (preconception folate, iron and vitamin C supplementation), weight optimisation, smoking cessation, and alcohol use and risk behaviour modifications. • Lifestyle modifications should involve both the woman and her partner; if they do not, success is likely to be limited or at least only short term. • Some patients will ask directly about preconception care but usually the GP will have to broach the subject during consultations for other reasons. • Patients with certain medical diseases or personal or family histories implying specific disease risks and/or inheritable genetic disorders should be prepared for pregnancy well before it occurs, with a plan of action formulated using a multidisciplinary approach

IL-6 and TNF alpha across the umbilical circulation in term pregnancies: Relationship with labour events

Objective. We have determined venous and arterial cord blood levels for IL-6 and TNF alpha at the time of delivery to assess gestational tissue versus fetal sources in labouring and non-labouring patients at term, and the relationship to labour event

Inotropes do not increase cardiac output or cerebral blood flow in preterm piglets

Background: The preterm newborn is at high risk of developing cardiovascular compromise during the first day of life and this is associated with increased risk of brain injury. Standard treatments are volume expansion and administration of inotropes, typically dopamine and/or dobutamine, but there is limited evidence that inotropes improve clinical outcomes. This study investigated the efficacy of dopamine and dobutamine for the treatment of cardiovascular compromise in the preterm newborn using a piglet model. Methods: Preterm and term piglets were assigned to either dopamine, dobutamine or control infusions. Heart rate, left ventricular contractility, cardiac output, blood pressure, and cerebral and regional blood flows were measured during baseline, low (10 μg/kg/h), and high (20 μg/kg/h) dose infusions. Results: At baseline, preterm piglets had lower cardiac contractility, cardiac output, blood pressure, and cerebral blood flow compared to term piglets. The response of preterm piglets to either dopamine or dobutamine administration was less than in term piglets. In both preterm and term piglets, cardiac output and cerebral blood flow were unaltered by either inotrope. Conclusion: In order to provide better cardiovascular support, it may be necessary to develop treatments that target receptors with a more mature profile than adrenoceptors in the preterm newborn

Reduced blood volume decreases cerebral blood flow in preterm piglets

Key points: Preterm infants often have poor cardiovascular function that is associated with adverse neurodevelopmental outcomes. Preterm infants may be vulnerable to hypovolaemia due to excessive vasodilatation and leaky capillaries. Following reduction in blood volume, cardiac output and mean arterial pressure were reduced to the same extent in term and preterm piglets. Cerebral blood flow was maintained following blood volume reduction in term but not in preterm piglets. Effective detection and treatment of functional hypovolaemia may reduce the risk of brain injury in preterm infants. Preterm infants often have impaired cardiovascular function that may contribute to poor neurodevelopmental outcomes. The study aimed to determine the effects of reduced blood volume on cardiovascular function, including cerebral blood flow, in preterm and term piglets. In preterm (97/115 days) and term piglets, up to 10% of the estimated blood volume was removed. Removal of blood was stopped if MAP dropped below 20 mmHg. Heart rate, cardiac contractility and relaxation, cardiac output, mean arterial pressure (MAP), and cerebral blood flow were measured at baseline and again after blood volume reduction. The volume of blood removed was less in preterm piglets than in term piglets (5.1 ± 1.8 vs. 7.7 ± 0.9 mL kg-1, mean ± SD, P \u3c 0.001). Cardiac output and MAP decreased to the same extent in term and preterm piglets. Cerebral blood flow decreased in preterm but not term piglets and cerebral vascular conductance increased in term piglets only. Compensatory responses to maintain cerebral blood flow after blood volume reduction are active in term piglets but not in preterm piglets. As a result, even a small reduction in blood volume, or an increase in the capacity of the circulatory system leading to functional hypovolaemia, may lead to a significant reduction in cerebral blood flow and contribute to brain injury in preterm neonates. Journal compilatio

Inotropes do not increase cardiac output or cerebral blood flow in preterm piglets

Background: The preterm newborn is at high risk of developing cardiovascular compromise during the first day of life and this is associated with increased risk of brain injury. Standard treatments are volume expansion and administration of inotropes, typically dopamine and/or dobutamine, but there is limited evidence that inotropes improve clinical outcomes. This study investigated the efficacy of dopamine and dobutamine for the treatment of cardiovascular compromise in the preterm newborn using a piglet model. Methods: Preterm and term piglets were assigned to either dopamine, dobutamine or control infusions. Heart rate, left ventricular contractility, cardiac output, blood pressure, and cerebral and regional blood flows were measured during baseline, low (10 µg/kg/h), and high (20 µg/kg/h) dose infusions. Results: At baseline, preterm piglets had lower cardiac contractility, cardiac output, blood pressure, and cerebral blood flow compared to term piglets. The response of preterm piglets to either dopamine or dobutamine administration was less than in term piglets. In both preterm and term piglets, cardiac output and cerebral blood flow were unaltered by either inotrope. Conclusion: In order to provide better cardiovascular support, it may be necessary to develop treatments that target receptors with a more mature profile than adrenoceptors in the preterm newborn

Reduced blood volume decreases cerebral blood flow in preterm piglets

Preterm infants often have impaired cardiovascular function that may contribute to poor neurodevelopmental outcomes. The study aimed to determine the effects of reduced blood volume on cardiovascular function, including cerebral blood flow in preterm and term piglets. In preterm (97/115d) and term piglets, up to 10% of the estimated blood volume was removed. Removal of blood was ceased if MAP dropped below 20\ua0mmHg. Heart rate, cardiac contractility and relaxation, cardiac output, mean arterial pressure (MAP), and cerebral blood flow were measured at baseline and again after blood volume reduction. The volume of blood removed was less in preterm piglets than in term piglets (5.1\ua0±\ua01.8\ua0vs 7.7\ua0±\ua00.9\ua0mL/kg, Mean ± SD,

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders

© 2019 International Federation of Gynecology and ObstetricsPlacenta accreta spectrum is impacting maternal health outcomes globally and its prevalence is likely to increase. Maternal outcomes depend on identification of the condition before or during delivery and, in particular, on the differential diagnosis between its adherent and invasive forms. However, accurate estimation of its prevalence and outcome is currently problematic because of the varying use of clinical criteria to define it at birth and the lack of detailed pathologic examination in most series. Adherence to this new International Federation of Gynecology and Obstetrics (FIGO) classification should improve future systematic reviews and meta-analyses and provide more accurate epidemiologic data which are essential to develop new management strategies.info:eu-repo/semantics/publishedVersio