Amniotic fluid C-reactive protein as a predictor of infection in caesarean section: a feasibility study

This study evaluated the feasibility of maternal C-reactive protein (CRP) in amniotic fluid (AF) as a predictor of post-partum infection in women who undergo emergency or elective caesarean section (CS). AF bacterial culture and levels of hs-CRP in maternal serum and AF were evaluated in Day 0 and three days thereafter (Day 3) in 79 women undergoing CS. Univariate analyses assessed the clinical and demographic characteristics, whereas the ROC curves assessed the feasibility of hs-CRP as marker of inflammation in women who undergo CS. There was no difference in AF, Day 0, and Day 3 serum hs-CRP levels between women with sterile compared to those with bacterial growth in AF. Among women with positive AF cultures, AF and Day 0 serum hs-CRP levels were higher in women who underwent emergency compared to those who had elective CS (p = 0.04, and p = 0.02 respectively). hs-CRP in Day 0 and Day 3 serum but not in AF has a fair predictor value of infection in emergency CS only (AUC 0.767; 95% CI 0.606-0.928, and AUC 0.791; 95% CI 0.645-0.036, respectively). We conclude that AF hs-CRP is not feasible in assessing the risk of post-cesarean inflammation or infection

Cardiovascular and renal effects of ANG II and NO in the newborn: roles of AT1Rs and /or AT2Rs

The vasoactive factors angiotensin II (ANG II) and nitric oxide (NO), and the balance between them play a major role in regulating cardiovascular and electrolyte homeostasis. During the perinatal period, both factors are elevated, yet their physiological roles have not been clearly defined. Furthermore, the temporal and spatial expression of the receptors for ANG II (AT1Rs and AT2Rs) is developmentally regulated, although their physiological roles are also unknown. The present study aimed to elucidate for the first time, the physiological effects of ANG II on the kidney during postnatal maturation, as well as the potential role of the ATRs in initiating these physiological effects. In addition, this study investigated for the first time the interaction between ANG II and NO in regulating cardiovascular and renal function during the period of adaptation of the newborn to life after birth. Two study protocols were carried out in conscious lambs at two stages of postnatal maturation - one and six weeks. The first protocol evaluated (a) the individual functions of ATRs and (b) any possible interaction between them in mediating haemodynamic and renal physiological responses of ANG II. The second protocol investigated the roles of ATRs in modulating physiological roles of endogenoulsy produced NO during development. Results from these experiments show for the first time, that there does not appear to be any interaction between AT1Rs and AT2Rs in mediating haemodynamic effects of endogenous ANG II early in life. In contrast, the renal effects of ANG II are mediated through AT1Rs in an age-dependent manner, whereas AT2Rs buffer these effects. My research also shows for the first time, that ANG II modulates the effects of NO on renal haemodynamics and function but not systemic haemodynamics in an age-dependent manner through activation of AT1Rs and AT2Rs. Furthermore, it appears that AT2Rs interact with AT1Rs in mediating the renal effects of NO in developing newborn animals. This is the first description of renal effects of ANG II and a new and important interaction between ANG II and NO under physiological conditions early in life

Angiotensin receptors modulate the renal hemodynamic effects of nitric oxide in conscious newborn lambs

Article deposited according to John Wiley & Sons OnlineOpen policy for Physiological Reports, http://olabout.wiley.com/WileyCDA/Section/id-406241.html, July 17 2014.YesFunding provided by the Open Access Authors Fund

Additional file 1: Table S1. of Renal effects of angiotensin II in the newborn period: role of type 1 and type 2 receptors

Haemodynamic effects of AT1R antagonist, ZD 7155 and AT2R antagonist, PD123319 in conscious lambs. (DOCX 38 kb

Experiences with prenatal counselling among women who do not meet gestational weight gain guidelines

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Additional file 2: Table S2. of Renal effects of angiotensin II in the newborn period: role of type 1 and type 2 receptors

Effects of AT1R antagonist, ZD 7155 and AT2R antagonist, PD123319 on plasma variables in conscious lambs. (DOCX 20 kb

The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective

Pregnancy-related acute kidney injury (PR-AKI) is a heterogeneous disorder with multiple aetiologies that can occur at any time throughout pregnancy and the post-partum period. PR-AKI is an important obstetric complication that is associated with significant maternal and foetal morbidity and mortality. Although there has been an overall decline in the incidence of PR-AKI worldwide, a recent shift in the occurrence of this disease has been reported. Following improvements in obstetric care, PR-AKI incidence has been reduced in developing countries, whereas an increase in PR-AKI incidence has been reported in developed countries. Awareness of the physiological adaptations of the renal system is essential for the diagnosis and management of kidney impairment in pregnancy. In this review we scrutinize the factors that have contributed to the changing epidemiology of PR-AKI and discuss challenges in the diagnosis and management of acute kidney injury (AKI) in pregnancy from an obstetrics perspective. Thereafter we provide brief discussions on the diagnostic approach of certain PR-AKI aetiologies and summarize key therapeutic measures

Women’s recall of health care provider counselling on gestational weight gain (GWG): a prospective, population-based study

Abstract Background Prenatal care has been validated to provide medical and educational counselling intended to reduce the risk of adverse pregnancy conditions and improve the maternal and fetal outcomes. Prenatal targeted information regarding nutrition, lifestyle, and weight gain is predictive of meeting Institute of Medicine (IOM) 2009 gestational weight gain (GWG) guidelines. There is limited information about women’s experiences with these prenatal counselling domains, particularly in women who do not meet GWG recommendations. The objective of this study was to evaluate the impact of women’s recall of prenatal counselling and its effect on meeting their GWG within guidelines in a prospective, community-based pregnancy cohort. Methods A sample of 2909 women with singleton pregnancies was drawn from the prospective community-based pregnancy cohort All Our Families from Alberta, Canada. Women were stratified into three GWG groups, adequate, inadequate, and excessive GWG, based on pre-pregnancy BMI and the adherence to the Institute of Medicine weight gain in pregnancy guidelines. At less than 25 and 34 to 36 weeks’ gestation, maternal socio-demographic information and women’s recall of prenatal counselling experiences was collected through self-administered questionnaires. Multivariate logistic regression analyses tested GWG strata impact on women’s recall of the prenatal counselling advice in eight domains of nutrition, lifestyle, and weight management during pregnancy. Results Adequate GWG was reached by 35.9% of women, 46.5% gained excessive and 17.6% gained inadequate weight. Women who were overweight and obese prior to pregnancy were more likely to gain excessive weight than women who were normal weight (OR 3.3, 95% CI 2.6–4.1; and OR 2.9, 95% CI 2.1–3.9, respectively). Most women reported having no difficulties in finding prenatal care, felt comfortable with their health care provider and were satisfied with the answers received. There was no difference in the recall of prenatal advice received in any of the eight domains of prenatal counselling assessed among women with appropriate and non-optimal GWG. Conclusion Women with adequate and non-optimal GWG received comparable prenatal counselling on nutrition, weight gain, and lifestyle modifications. There remain missed opportunities in targeting prenatal counselling advice to women at risk for suboptimal or excessive GWG

Maternal Body Mass Index and the prevalence of spontaneous and elective preterm delivery in an Irish obstetric population: a retrospective cohort study

Objective: To estimate the association between maternal body mass index (BMI) and risk of spontaneous preterm delivery (sPTD) and elective preterm delivery (ePTD) in singleton and multiple pregnancies. Design: Retrospective cohort study. Setting: Electronic records of all deliveries from 2009 through 2013 in a tertiary university hospital were abstracted for demographic and obstetrical information. Participants: A total of 38 528 deliveries were included. Participants with missing data were excluded from the study. BMI was calculated from the measurement of height and weight at the first prenatal visit and categorised. Sonographic confirmation of gestational age was standard. Outcome measures: Primary outcomes, sPTD and ePTD in singleton and multiple pregnancies, were evaluated by multinomial logistic regression analyses, stratified by parity, controlling for confounding variables. Results: Overall rate of PTD was 5.9%, from which 2.7% were sPTD and 3.2% ePTD. The rate of PTD was 50.4% in multiple pregnancies and 5.0% in singleton pregnancies. The risk of sPTD was increased in obese nulliparas (adjusted OR (aOR) 2.8, 95%CI 1.7 to 4.4) and underweight multiparas (aOR 2.2, 95%CI 1.3 to 3.8). The risk of ePTD was increased in underweight nulliparas (aOR 1.8; 95%CI 1.04 to 3.4) and severely obese multiparas (aOR 1.4, 95%CI 1.02 to 3.8). Severe obesity increased the risk of both sPTD (aOR 1.4; 95%CI 1.01 to 2.1) and ePTD (aOR 1.4; 95%CI 1.1 to 1.8) in singleton pregnancies. Obesity did not influence the rate of either sPTD or ePTD in multiple pregnancies. Conclusion: Maternal obesity is an independent risk factor for PTD in singleton pregnancies but not in multiple pregnancies. Obesity and nulliparity increase the risk of sPTD, whereas obesity and multiparity increase the risk of ePTD