Information for pregnant women about caesarean birth

BACKGROUND: Information is routinely given to pregnant women, but information about caesarean birth may be inadequate. OBJECTIVES: To examine the effectiveness of information about caesarean birth. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth register, CENTRAL (26 November 2002), MEDLINE [online via PubMed 1966-] and the Web of Science citation database [1995-] (20 September 2002), and reference lists of relevant articles. SELECTION CRITERIA: Randomised controlled trials, non-randomised clinical trials and controlled before-and-after studies of information given to pregnant women about caesarean birth. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Missing and further data were sought from trial authors unsuccessfully. Analyses were based on 'intention to treat'. Relative risk and confidence intervals were calculated and reported. Consumer reviewers commented on adequacy of information reported in each study. MAIN RESULTS: Two randomised controlled trials involving 1451 women met the inclusion criteria. Both studies aimed to reduce caesarean births by encouraging women to attempt vaginal delivery. One used a program of prenatal education and support, and the other cognitive therapy to reduce fear. Results were not combined because of differences in the study populations. Non-clinical outcomes were ascertained in both studies through questionnaires, but were subject to rates of loss to follow-up exceeding 10%. A number of important outcomes cannot be reported: knowledge or understanding; decisional conflict; and women's perceptions: of their ability to discuss care with clinicians or family/friends, of whether information needs were met, and of satisfaction with decision-making. Neither study assessed women's perception of participation in decision-making about caesarean birth, but Fraser 1997, who examined the effect of study participation on decision making, found that women in the intervention group were more likely to consider that attempting vaginal birth was easier (51% compared to 28% in control group), or more difficult (10% compared to 6%). These results could be affected by the attrition rate of 11%, and are possibly subject to bias. Neither intervention used in these trials made any difference to clinical outcomes. About 70% or more women attempted vaginal delivery in both trials, yet caesarean delivery rates exceeded 40%, at least 10% higher than was hoped. There was no significant difference between control and intervention groups for any of the outcomes measured: vaginal birth, elective/scheduled caesarean, and attempted vaginal delivery. Outcome data, although similar for both groups, were not sufficient to compare maternal and neonatal morbidity or neonatal mortality. There was no difference in the psychological outcomes for the intervention and control groups reported by either of the included trials. Consumer reviewers said information for women considering a vaginal birth after caesarean (VBAC) should include: risks of VBAC and elective caesarean; warning signs in labour; philosophy and policies of hospital and staff; strategies to improve chances of success; and information about probability of success with specific care givers. AUTHORS' CONCLUSIONS: Research has focussed on encouraging women to attempt vaginal delivery. Trials of interventions to encourage women to attempt vaginal birth showed no effect, but shortcomings in study design mean that the evidence is inconclusive. Further research on this topic is urgently needed

A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth)

Background: Tokophobia, a deep‐seated fear of childbirth, causes women emotional anguish and affects the mother‐baby relationship. It can result in women avoiding future pregnancies or requesting caesarean section. This review examines evidence for the effectiveness of planned interventions in women with okophobia in both reducing requests for caesarean section and in ameliorating maternal distress. Objectives: 1) To synthesise the best available quantitative evidence for the effectiveness of planned interventions in reducing: a) fear/anxiety in tokophobic women, b) planned caesarean sections 2) To synthesise the best available qualitative evidence relating to the experiences of tokophobic women who request a caesarean section, particularly satisfaction with interventions and the childbirth experience. Inclusion criteria: This review considered studies that included pregnant women requesting a caesarean section for tokophobia in the absence of medical (or obstetric) indications who were offered a planned intervention. Search strategy: The literature search focused on published and unpublished studies in English distributed between January 1990 and April 2012. An initial limited database search was undertaken to identify keywords, followed by an extensive search of relevant databases and potential grey material. Methodological quality: Assessment for methodological quality was carried out independently by two reviewers using the standardised appraisal tools from the Joanna Briggs Institute. Data extraction: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute. Data synthesis: Statistical meta‐analysis was not possible due to heterogeneity. Therefore, a narrative summary of the data was undertaken. Results: Nine quantitative papers (comprising eight studies: one randomised controlled trial, five case control studies and two descriptive case series) were included; two of these papers appertained to the same study. No qualitative papers were found. Definitions for tokophobia varied. Samples were confounded by the inclusion of women with complex obstetric histories or with mental health issues. Comparison groups were sometimes non‐tokophobic women. Interventions were complex and descriptions sometimes lacked clarity. Although the randomised controlled trial found no difference in birth choices between samples, a group therapy intervention predisposed women to vaginal birth. One study measured whether interventions reduced fear, finding that they did. Four studies explored satisfaction with the intervention. In three cases interventions were evaluated positively. These involved midwifery input and birth planning. Conclusion: More research is needed to identify how tokophobic women might be helped. Current guidelines should be upheld for the time being, in the absence of further evidence. Implications for practice: Due to the heterogeneous nature of the research it is impossible at this stage to draw conclusions for practice. Implications for research: Due to ethical concerns about randomising tokophobic women to non‐treatment groups, innovative research designs should be considered. More research is needed on the effectiveness of group interventions and the role of midwives in administering interventions. A standard, measurable definition for tokophobia is needed and careful documentation and differential analysis of women's parity, mental health and obstetric status should be made. Outcomes should include fear reduction. Satisfaction and birth outcome should be measured on more than one occasion

Identification of PNG kinase substrates uncovers interactions with the translational repressor TRAL in the oocyte-to-embryo transition

The Drosophila Pan Gu (PNG) kinase complex regulates hundreds of maternal mRNAs that become translationally repressed or activated as the oocyte transitions to an embryo. In a previous paper (Hara et al., 2017), we demonstrated PNG activity is under tight developmental control and restricted to this transition. Here, examination of PNG specificity showed it to be a Thrkinase yet lacking a clear phosphorylation site consensus sequence. An unbiased biochemical screen for PNG substrates identified the conserved translational repressor Trailer Hitch (TRAL). Phosphomimetic mutation of the PNG phospho-sites in TRAL reduced its ability to inhibit translation in vitro. In vivo, mutation of tral dominantly suppressed png mutants and restored Cyclin B protein levels. The repressor Pumilio (PUM) has the same relationship with PNG, and we also show that PUM is a PNG substrate. Furthermore, PNG can phosphorylate BICC and ME31B, repressors that bind TRAL in cytoplasmic RNPs. Therefore, PNG likely promotes translation at the oocyte-to-embryo transition by phosphorylating and inactivating translational repressors.National Institutes of Health (U.S.) (Grant GM39341)National Institutes of Health (U.S.) (Grant GM118090

The Disk Substructures at High Angular Resolution Project (DSHARP). II. Characteristics of Annular Substructures

The Disk Substructures at High Angular Resolution Project (DSHARP) used ALMA to map the 1.25 mm continuum of protoplanetary disks at a spatial resolution of ~5 au. We present a systematic analysis of annular substructures in the 18 single-disk systems targeted in this survey. No dominant architecture emerges from this sample; instead, remarkably diverse morphologies are observed. Annular substructures can occur at virtually any radius where millimeter continuum emission is detected and range in widths from a few astronomical units to tens of astronomical units. Intensity ratios between gaps and adjacent rings range from near-unity to just a few percent. In a minority of cases, annular substructures coexist with other types of substructures, including spiral arms (3/18) and crescent-like azimuthal asymmetries (2/18). No clear trend is observed between the positions of the substructures and stellar host properties. In particular, the absence of an obvious association with stellar host luminosity (and hence the disk thermal structure) suggests that substructures do not occur preferentially near major molecular snowlines. Annular substructures like those observed in DSHARP have long been hypothesized to be due to planet–disk interactions. A few disks exhibit characteristics particularly suggestive of this scenario, including substructures in possible mean-motion resonance and double gap features reminiscent of hydrodynamical simulations of multiple gaps opened by a planet in a low-viscosity disk

Resident Perceptions of a Controversial Annual Event

A survey of 880 residents revealed diverse attitudes toward Gold Coast Schoolies Week, an annual high school-leaver celebration characterized by partying and drinking. ‘Conditional supporters’ (33%) or ‘conditional opponents’ (34%) provided complex assessments of costs and benefits, as per social exchange theory, that include considerations of ‘noncosts’ and ‘nonbenefits’. With regard to social representations, ‘opponents’ (18%) are more likely to be influenced by mass media, social circles and negative personal exposure, whilst ‘supporters’ (15%) are more likely to rely on their own and their children’s schoolie experience. Balanced media coverage is one means for improving resident perceptions

Loss of Miro1-directed mitochondrial movement results in a novel murine model for neuron disease.

Defective mitochondrial distribution in neurons is proposed to cause ATP depletion and calcium-buffering deficiencies that compromise cell function. However, it is unclear whether aberrant mitochondrial motility and distribution alone are sufficient to cause neurological disease. Calcium-binding mitochondrial Rho (Miro) GTPases attach mitochondria to motor proteins for anterograde and retrograde transport in neurons. Using two new KO mouse models, we demonstrate that Miro1 is essential for development of cranial motor nuclei required for respiratory control and maintenance of upper motor neurons required for ambulation. Neuron-specific loss of Miro1 causes depletion of mitochondria from corticospinal tract axons and progressive neurological deficits mirroring human upper motor neuron disease. Although Miro1-deficient neurons exhibit defects in retrograde axonal mitochondrial transport, mitochondrial respiratory function continues. Moreover, Miro1 is not essential for calcium-mediated inhibition of mitochondrial movement or mitochondrial calcium buffering. Our findings indicate that defects in mitochondrial motility and distribution are sufficient to cause neurological disease

Community Service: Editor pride and user preference on local newspaper websites

Armed with readily accessible online traffic logs that provide detailed information about the items users are selecting to view, editors are voicing concern about the potential effect on their own content decisions. Through a survey of local British newspaper editors, this article examines the overlap between user preferences, as suggested by assessments of website traffic, and content that editors identify as their best. Results are considered in the context of two related subsets of agenda-setting theory, as well as the sociological process of “making news.” The study finds overlap between broad categories of stories preferred by editors and users, but a considerable disconnect over the nature of the items within those categories