Preterm delivery and low birth weight in singleton pregnancies conceived by women with and without a history of infertility

OBJECTIVE: To determine predictors of low birth weight (LBW) and preterm delivery (PTD) in singleton pregnancies conceived by women with and without a history of infertility. DESIGN: Retrospective cohort study. SETTING: Eleven infertility clinics in Northern California. PATIENTS: Three groups of women who carried singleton pregnancies to ≥ 20 weeks gestation: 542 infertile women who conceived after treatment, 441 infertile women who conceived spontaneously, and 1008 fertile women for comparison. INTERVENTIONS: Chart review. MAIN OUTCOME MEASURES: Association of LBW or PTD with infertility treatment, maternal age, parity, obesity, or development of gestational diabetes. RESULTS: Infertile women who conceived with treatment were more likely to be obese, develop gestational diabetes, and have ovarian, ovulatory, or male factor infertility than infertile women who conceived spontaneously. Infertile women who conceived after treatment had 1.61 (95% CI 1.08– 2.41) times greater odds of having a LBW infant. Nulliparity was an independent predictor of LBW 1.54 (95% CI 1.09– 2.16) and PTD (OR 1.72, 95% CI 1.20–2.49) in all three groups after controlling for maternal age, history of infertility, infertility treatment, obesity, and gestational diabetes. CONCLUSIONS: Nulliparous women and women with a history of infertility who conceive a singleton after treatment may be at increased odds for having a LBW infant. Infertile women do not appear to be at increased odds for PTD

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs).Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957-2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (-13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (-1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (-69.2%). The slope of the MMR did not appear to be altered by the change in abortion law.Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion

Diagnóstico seguro de placenta previa con eco transvaginal

La tasa de morbimortalidad causada por la placenta previa es alta y el diagnóstico oportuno es pieza fundamental en el tratamiento de exitoso de este tipo de pacientes. Desde que se describió en 1966, la ecografía transabdominal se ha convertido en valiosa herramienta diagnóstica de la placenta previa por ser método seguro, rápido y cada vez más accesible.  Sin embargo, hay situaciones que le restan confiabilidad a este examen, tales como la existencia de placenta previa posterior, la obesidad materna y algunos factores técnicos como la sobredistensión de la vejiga y la presencia de sangre en el canal cervical

Diagnóstico seguro de placenta previa con eco transvaginal

La tasa de morbimortalidad causada por la placenta previa es alta y el diagnóstico oportuno es pieza fundamental en el tratamiento de exitoso de este tipo de pacientes. Desde que se describió en 1966, la ecografía transabdominal se ha convertido en valiosa herramienta diagnóstica de la placenta previa por ser método seguro, rápido y cada vez más accesible.  Sin embargo, hay situaciones que le restan confiabilidad a este examen, tales como la existencia de placenta previa posterior, la obesidad materna y algunos factores técnicos como la sobredistensión de la vejiga y la presencia de sangre en el canal cervical

Serum metabolomic markers for traumatic brain injury: a mouse model

Introduction Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function.Objectives Evaluate the use of metabolomics for the development of biomarkers of TBI for the diagnosis and timing of injury onset.Methods A validated model of closed injury TBI was employed using 10 TBI mice and 8 sham operated controls. Quantitative LC–MS/MS metabolomic analysis was performed on the serum.Results Thirty-six (24.0 %) of 150 metabolites were altered with TBI. Principal component analysis (PCA) and Partial least squares discriminant analysis (PLS-DA) analyses revealed clear segregation between TBI versus control sera. The combination of methionine sulfoxide and the lipid PC aa C34:4 accurately diagnosed TBI, AUC (95 % CI) 0.85 (0.644–1.0). A combination of metabolite markers were highly accurate in distinguishing early (4 h post TBI) from late (24 h) TBI: AUC (95 % CI) 1.0 (1.0–1.0). Spermidine, which is known to have an antioxidant effect and which is known to be metabolically disrupted in TBI, was the most discriminating biomarker based on the variable importance ranking in projection (VIP) plot. Several important metabolic pathways were found to be disrupted including: pathways for arginine, proline, glutathione, cysteine, and sphingolipid metabolism.Conclusion Using serum metabolomic analysis we were able to identify novel putative serum biomarkers of TBI. They were accurate for detecting and determining the timing of TBI. In addition, pathway analysis provided important insights into the biochemical mechanisms of brain injury. Potential clinical implications for diagnosis, timing, and monitoring brain injury are discussed.</div