A belt to stop cesareans

At a medical conference in southern Italy in 2006, Sergio bioengineer Casciaro asked a group of gynecologists to use a monitor to oversee a birth . A doctor said, " we rely on the digital method . " Y "digitalis," continued the doctor, "I refer to the digits that extend from the palm of my hand "and waved his fingers in the air. Casciaro was dumbfounded . "I could not believe it still would not have technology that would provide an objective review of birth, "he says, trying to fill this gap, Casciaro and his team of researchers devised AMOLAB - Automatic Control of Labor. Tying a belt transducer over a woman's pelvis, the device is capable of transmitting live images of the position and angle of the fetus until birth. Designed by scientists at the National Research Council in their spare time, and AMOLAB has won the National Award for Innovation in Italy.

This summer, they began their first clinical trials . To provide evidence of the continuing developments of the birth , the instrument Casciaro says 3-D ultrasound could deter doctors from performing unnecessary cesareans. "If the national rate of caesarean sections has reached the 40 percent, and in the south of Italy there are peaks of up to 65 percent, there must be a problem, " said Casciaro. "I think the situation is out of control." For decades, obstetricians and midwives have been based largely on their own clinical intuition . They combine their experience with a variety of instruments - including his own hands - to help manage everything related to the fetal heartbeat and contractions , the size and angle of the baby. However, these traditional tools , as demonstrated by a recent study in the American Journal of Obstetrics and Gynecology, expose even experienced physicians high margins of error .

The doctors know this, so that at any sign of any complications during childbirth , many prefer to make an incision, rather to endanger the baby and the mother or face a lawsuit. "Definitely, currently there is an overuse of cesarean section , "says Dr. Gianfranco Nacci, head of Obstetrics and Gynecology Perrino Hospital in Brindisi , one of the major medical centers in the heel of the boot of Italy. "This situation affects not only Italy but all countries in the world , including, unfortunately, in developing countries, "explains Throughout the Western world, the number of cesarean sections performed has increased dramatically . Since the 1980s, the World Health Organization has insisted that all countries should limit cesarean procedures to no more than 15 percent of total births. United States , the rates have reached a national record 37 percent , according to a recent National Center for Health Statistics.

Today in Italy the number of babies born by Caesarean section has reached 38 percent. This figure is has doubled in 15 years. This does not necessarily mean increased the level of medical intervention in childbirth . The Perrino Hospital, where Nacci has helped bring babies into the world for 20 years, the use of cesarean sections has replaced the high-risk procedures and older - as the use of forceps or vacuum extraction to move a baby along the birth canal. "But they went too far," Nacci said. "We have reached cesarean rates that have no clinical justification. " To complicate matters, doctors say that patients' expectations regarding the timing of natural childbirth have changed. "In the past, mothers were more likely to wait and work longer hours delivery " , says Laura Bruno, an obstetrician who works with Dr. Nacci at the Hospital of Brindisi. "But now, some women come to the hospital awaiting a caesarean section. However, Sergio Casciaro, expectations are not mothers, but the desire of doctors get home for dinner that influences the final result.

In addition, says Casciaro, in most Italian regions, hospitals can charge double rates for cesarean section, which tips the scales continuously compared with vaginal delivery. "What I want to provide both physicians and mothers is the ability to have a tangible, solid , to show who made ​​the best decision at that stage, "said Casciaro. Although the sections can indeed save the lives of mothers and infants, the intervention also leads to a longer recovery for the mother and the possibility of side effects. "Right now everything is subjective" , continues Casciaro, who thinks the discretion of doctors do not always safeguard mothers during childbirth. However, AMOLAB may also have a benefit for physicians, which is the provision of information to protect them from unfair trials. AMOLAB team has registered his invention at an international patent and is now in talks with private investors to finance the jump the commercial market.

High temperatures can shorten pregnancy

The study, led by Dr. Payam Dadvand, we measured the short-term impact of maternal exposure to environmental extremes during pregnancy in a sample of 7585 births that occurred during the period 2001-2005 in Barcelona. They used national data on the heat and daily temperature for the period 1983-2006, using three indicators of conditions of extreme heat exposure based on the unusual heat and high humidity. Thus, quantified the change in duration of pregnancy after maternal exposure to extreme heat.

Thus, the results show that maternal exposure to extreme heat can have an immediate effect on the duration of pregnancy, and that these extreme temperatures are associated with a reduction in mean gestational age of the children. Previous studies have pointed to increased vulnerability of pregnant women to heat, relating these extreme conditions with the induction of uterine contractions, increased secretion of hormones related to childbirth (oxytocin
and prostaglandins) and an increase in levels of heat shock protein 70 associated with preterm birth.

Heat stress is a function of the interaction of internal heat production, the capacity of the heat loss to the environment and environmental heat load. During pregnancy, increased fat deposition and internal heat production due to fetal growth and metabolism.

Dadvand has acknowledged, although further studies are needed to confirm these results in different contexts, an episode of unusual warmth the day before delivery is associated with a reduction of average day of pregnancy. He adds told the News and Information Service Science (SINC), these data could achieve a reduction of five days to more extreme values.

In fact, weather forecasts and taking into account that a reduction of up to one week in duration of pregnancy has been associated with adverse health outcomes of newborns, the authors argue that future studies should consider these factors to inform public health interventions appropriate to the subject.

The home delivery has more risk

Give birth at home or in hospital? The dilemma of pregnancy it should be less for new mothers. A recent study says that women who give birth for the first time and do it at home are nearly three times more likely to suffer complications if they go to a hospital. The baby born at home are more likely to suffer from lack of oxygen in the delivery According to the study, conducted at the University of Oxford , babies born at home are 2.8 times more likely to suffer from anxiety problems or lack of oxygen during birth. These risks may reach the fetus result in death , death in the first week, brain injuries, fractures and faeces in the lungs. The serious problems of this type are rare and occur only 3.5 times per 1,000 births in an obstetric unit of any hospital. However, the study reveals that the figure rises to 9.5 per 1,000 babies if the mother chooses a home birth.

No differences in low-risk pregnancies

The work points out the risks for mothers, clarifies, however, that in low-risk deliveries there is little difference between giving birth in hospitals or at home with the help of a midwife. The work, led by Peter Brocklehurst, director of the Institute Health of Women in the University College Hospital in London, and published in the British Medical Journal , was made ​​on the basis of 65,000 births classified as low risk. "I would never say that a woman should give birth in a place particular, but I hope this will give women more information to make an appropriate decision , "said Brocklehurst.

More care for pregnant women with polycystic ovary syndrome

Under the long names 'Stein-Leventhal syndrome' or 'polycystic ovary syndrome' (SOP) hides the problem to get pregnant for about 15% of the female population of reproductive age. This is mainly due to a hormonal imbalance characterized by irregularities and changes in menstrual cycles, excessive hair, tendency to obesity and the appearance of small cysts on the edges of the ovaries.

Well, in severe cases, women who have PCOS have , And in most cases have no choice but to resort to fertility treatment. However, there are still many unanswered questions: What is the exact origin of this disorder? Are there problems for the mother or fetus during the gestation period?

Indeed, in response to the latter issue, the magazine 'British Medical Journal published in its latest issue, a study by Swedish researchers at the Karolinska Institute and University Hospital of the same name, who have collected national data of those born between 1995 and 2007, separated whose mothers suffered from this syndrome and those without.

The results are quite surprising. According to the authors, those females suffering from Stein-Leventhal syndrome are more likely to have problems during pregnancy , whether they have undergone fertility treatments.

High-risk patients?

After investigating nearly 4,000 women with this syndrome more than a million who did not, the author lists the most common complications in the first group: "We found that these women are more likely to have diabetes caused by pregnancy, preeclampsia -induced hypertension during pregnancy, or premature delivery. " But they are not alone. According to this study, the fetus also has consequences: "Babies born to these mothers are more likely to be larger for gestational age, leading to an increased incidence of caesarean sections," and there is a higher incidence of asphyxia childbirth ".

In light of these data, the experts are torn between whether to treat these women as high-risk pregnant or not. Javier Martinez, chief of Obstetrics and Osbtetricia Severo Ochoa Hospital in Madrid, there are insufficient data to consider these mothers in this category: "Keep in mind that a significant percentage of women with PCOS in this study were patients serious, but in most cases the only difficulties that go with respect to a pregnant woman without this syndrome is only when you want to stay pregnant, "she says. "Once in pregnancy there is usually no problem and less to the fetus, "says the specialist.

However, Laura Prieto Sanchez, a gynecologist at the University Hospital Madrid's La Paz explains that more comprehensive monitoring of these patients avoid possible problems. "In fact these results are a series of complications chained by the SOP . A woman with this disorder and is resistant to insulin usually have a tendency to gain weight and the more obese, the greater the risk to suffer, for example, diabetes or preeclampsia "argues the gynecologist.

"Indeed, a small percentage of women with this syndrome and fewer still get to have serious problems once they become pregnant because, indeed, the main conflicts are at the time of becoming pregnant," says the specialist. "But that does not mean that these women are more prone to a number of complications during pregnancy and they can get to situations like those observed in this study, "says Dr. Prieto.

So how about it? For authors to Dr. Prieto, the solution is to better control these pregnant women . "Often these investigations are more a warning to physicians to patients. Just to make more revisions could avoid possible complications, whereas what is usually done is act after something happened," said Laura Prieto.

Folic acid also helps prevent delays in language

For years, gynecologists recommend taking folic acid to women who are considering pregnancy or already in the early weeks of pregnancy since it has been shown that this supplement is beneficial to the unborn baby.

So far, it was known that folic acid is very useful to reduce the risk of congenital problems such as neural tube defects (anencephaly, spina bifida, hydrocephalus), although, judging by the results of recent research, the list of disorders that may prevent could be longer .

According to data published in the latest issue of the journal 'Journal of the American Medical Association's ("JAMA"), folic acid intake from four weeks prior to conception until at least eight weeks of gestation associated with a lower risk of language delay in the baby.

The authors of this research, led by Christine Roth, Institute of Public Health, Oslo (Norway), conducted a follow-up to the mothers of 38,954 children born between 1999 and 2008. Among other tests, each of the participants referred to the researchers' responses to a questionnaire about their habits in pregnancy, the motor skills of their children and their communication skills at age three.

Across the data, researchers found that those lower risk of language delay had were the children of participants who had taken folic acid in pregnancy period stages.

In contrast, there was no association between folic acid consumption and small motor skills, which, according to researchers, reinforces the hypothesis that there is an independent association between intake of dietary supplement and neurocognitive development of small .

Confirmation

Still, they recognize that their work could not determine the cause of this association and further work is needed to prove that there is a causal link between the two.

"If in the future, research shows that there is a causal relationship, these will have important implications for understanding the biological processes behind the problems of neurodevelopmental disorder prevention in this field and to carry out policies of dietary supplements women of reproductive age, "they conclude.

For Jose Garcia Flores, a gynecologist at the University Hospital Madrid Chiron, the hypothesis presented by Norwegian researchers is very plausible because folic acid, present in many green leafy foods "can be considered a food for cells . "

"It's a helper for cell division, so it makes sense that their role is important in various stages of development," says the specialist.

He explains that in Spain there is a universal recommendation for folic acid intake, as it has detected a deficit in the intake of this vitamin, which is associated with numerous benefits.

In the case of pregnant women, we recommend starting with the extra two or three months before conception and continue it during infancy, although in most cases "pregnant women start taking folic acid at the beginning of pregnancy. "

A urine test to predict preeclampsia

Scientists at the Mayo Clinic (USA) presented at the annual meeting of the American Society of Nephrology one test can predict which pregnant women will experience preeclampsia during pregnancy. The test detects the presence in the urine of a renal cell type, a factor indicative of this disorder.

The pre-eclampsia is a potentially fatal complication of advanced stages of pregnancy characterized by increased blood pressure and protein in the urine (proteinuria). This disorder occurs in about 5% of pregnant women.

The study, presented at the Kidney Week, held these days in Philadelphia (USA), researchers conducted the test, which detects the presence of podocytes in urine, 315 women had elapsed when half of pregnancy (before day 210). They also measured their blood pressure and the ratio protein / creatinine used to diagnose preeclampsia.

Of all participants, 15 developed this complication and eventually all of them had a positive urine test . While the 15 pregnant women who had hypertension and 44 just selected as controls and whose pregnancy was normal had negative tests.

Although it has been tested on a small number of women, the authors note that their high accuracy could help early detection of this condition. This could save thousands of lives each year.