Virtual Childbirth Simulator Improves Safety of High-Risk Deliveries

ScienceDaily (Dec. 6, 2011) Newly developed computer software combined with magnetic resonance imaging (MRI) of a fetus may help physicians better assess a womans potential for a difficult childbirth. Results of a study using the new software were presented November 29 at the annual meeting of the Radiological Society of North America (RSNA). Because a womans birth canal is curved and not much wider than a fetuss head, a baby must move through the canal in a specific sequence of maneuvers. A failure in the process, such as a head turned the wrong way at the wrong time, can result in dystocia, or difficult labor. "The mechanics of the human birth canal make for a very complicated delivery process compared to other mammals," said Olivier Ami, M.D., Ph.D., an obstetrician in the Department of Radiology at Antoine Bclres Hospital, Universit Paris Sud, France. "We now have computersimulated childbirth to identify potential problems." Using the new software, called PREDIBIRTH, Dr. Ami and a team of researchers processed MR images of 24 pregnant women. The result was a three-dimensional (3-D) reconstruction of both the pelvis and the fetus along with 72 possible trajectories of the babys head through the birth canal. Based on these simulations, the program scored each mothers likelihood of a normal birth. "This goes beyond simple imaging," Dr. Ami said. "The software simulates the properties of potential deliveries." For purposes of the study, the PREDIBIRTH scores were computed retrospectively and measured against delivery outcomes for the 24 women. Thirteen women delivered normally. These deliveries were scored as highly favorable by the simulator. Three women who delivered by elective cesarean-section (C-section) -- two of which involved babies of excessive weight -- were scored at high risk for dystocia. Of the five women delivered by emergency C-section, two involved heart rhythm abnormalities and were scored mildly favorable and favorable. Three involved obstructed labor, all of whom scored at high risk of dystocia. Three women delivered with vacuum extraction and had mildly favorable simulator scores. "The results in predicting dystocia were highly accurate," Dr. Ami said. "Our simulation predictions seem to be a significant improvement over pelvimetry." Pelvimetry, which measures the pelvis manually or by imaging to determine its adequacy for childbirth, is commonly used but not entirely reliable, according to Dr. Ami. "A small pelvis may be able to deliver without problems, and a big pelvis might require mechanical help during childbirth," he said. "This uncertainty raises the rate of C-sections." In the U.S., C-sections account for approximately one-third of all births. In France, the rate of mechanical problems is 30 percent, two-thirds of which are emergency procedures. "An emergency C-section has six to seven times more morbidity and mortality than a planned Csection," Dr. Ami said. "With this virtual childbirth software, the majority of C-sections could be

planned rather than emergency, and difficult instrumental extractions might disappear in the near future." Coauthors are Lucie Cassagnes, M.D., Jean-Francois Uhl, M.D., Didier Lemery, M.D., Ph.D., Vincent Delmas, Grard Mage, M.D., Ph.D., and Louis Boyer, M.D. http://www.sciencedaily.com/releases/2011/11/111129092415.htm

Unhealthy' Changes in Gut Microbes Benefit Pregnant Women

ScienceDaily (Aug. 2, 2012) The composition of microbes in the gut changes dramatically during pregnancy, according to a study published by Cell Press in the August 3rd issue of the journal Cell. Although these changes are associated with metabolic disease under most circumstances, they could be beneficial in pregnant women.

"This is the first in-depth characterization of the gut microbiota associated with pregnancy," says senior study author Ruth Ley of Cornell University. "The findings suggest that our bodies have coevolved with the microbiota and may actually be using them as a tool -- to help alter the mother's metabolism to support the growth of the fetus." In nonpregnant animals, changes to gut microbe composition can cause symptoms of metabolic syndrome, including weight gain, abnormal glucose metabolism, and inflammation -- an immune response that normally protects the body but can cause health problems. These symptoms also appear during pregnancy, but the underlying causes have been unclear, and few studies have examined the potential link to gut microbiota during pregnancy. To address this question, Ley and her team obtained stool samples from 91 pregnant women. They found that gut microbes changed in composition from the first trimester to the third trimester, becoming less "normal" and less diverse over time. Health-boosting bacteria decreased in abundance, while disease-related bacteria increased in number. In addition, signs of inflammation increased over the course of the pregnancy. "The changes in gut microbes were not related to diet, so we think the immune system or hormones play a role," Ley says. When gut microbes from pregnant women were transferred to healthy germ-free mice, animals that received microbes from the third trimester became fatter and had higher levels of inflammation markers and worse glucose metabolism than mice that received microbes from the first trimester.

"By the third trimester, the microbiota can induce changes in metabolism," Ley says. "In the context of pregnancy, these metabolic changes in the mother are healthy, because they promote energy storage in fat tissue and help support the fetus. Outside of pregnancy, however, these changes can lead to the development of type 2 diabetes and other health problems." http://www.sciencedaily.com/releases/2012/08/120802122506.htm

Maternal Iodine Supplementation Linked to Congenital Hypothyroidism in Newborns

ScienceDaily (July 26, 2012) Congenital hypothyroidism is thyroid hormone deficiency at birth that, if left untreated, can lead to neurocognitive impairments in infants and children. Although the World Health Organization recommends 200-300 g of iodine daily during pregnancy for normal fetal thyroid hormone production and

neurocognitive development, the US Institute of Medicine considers 1,100 g to be the safe upper limit for daily ingestion. A case series scheduled for publication in The Journal of Pediatrics describes three infants who developed congenital hypothyroidism as a result of excess maternal iodine supplementation. Kara Connelly, MD, and colleagues from Oregon Health & Science University, Doernbecher Children's Hospital, Boston University School of Medicine, State of Oregon Public Health Laboratory, and Randall Children's Hospital at Legacy Emanuel describe three infants with congenital hypothyroidism whose mothers had taken 12.5 mg of iodine daily, 11 times more than the safe upper limit, while pregnant and/or breastfeeding. Iodine is transferred from the mother to the infant through the placenta or breast milk. The three infants had blood iodine levels 10 times higher than healthy control infants (measured from newborn screening filter paper). Excess iodine causes the thyroid to temporarily decrease function to protect against hyperthyroidism (Wolff-Chaikoff effect). Adults and older children are able to "escape" from this effect after several days of excess iodine to avoid hypothyroidism. However, the immature thyroid glands of fetuses and newborns have not developed this protective effect and are more susceptible to iodine-induced hypothyroidism. Although infants recover normal thyroid function after acute iodine exposure (e.g., a few days of topical iodine application), continuous excessive iodine exposure to the fetal and neonatal thyroid gland may cause long-term harmful effects on thyroid function. Sources of iodine include nutritional supplements, prenatal vitamins, and seaweed (kelp). According to Dr. Connelly, "The use of iodine-containing supplements in pregnancy and while breastfeeding is recommended in the United States. However, these cases demonstrate the potential hazard of exceeding the safe upper limit for daily ingestion." Excess iodine ingestion from supplementation is often unrecognized because it is not routine practice to ask mothers of infants with congenital hypothyroidism about nutritional supplements taken during pregnancy. Pregnant or breastfeeding women should discuss the safe dosages of nutritional supplements with their doctors prior to including them in their daily regimen. http://www.sciencedaily.com/releases/2012/07/120726094508.htm

Chlorhexidine Umbilical Cord Care Can Save Newborn Lives

ScienceDaily (Feb. 7, 2012) Cleansing a newborn's umbilical cord with chlorhexidine can reduce an infant's risk of infection and death during the first weeks of life by as much as 20 percent, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, conducted in rural Bangladesh in partnership with ICDDR,B and a Bangladeshi NGO Shimantik and funded by the United States Agency for International Development (USAID) and Save the Children's Saving Newborn Lives program, is the latest in a series of studies showing that umbilical cord cleaning with chlorhexidine can save lives.

For the study, Johns Hopkins researchers and colleagues in Bangladesh enrolled more than 29,000 newborns in a randomized trial to determine the effectiveness of single cleansing with 4 percent chlorhexidine or 7-day cleansing with chlorhexidine as compared to the standard dry cord care. According to the study, infants that received a single cleansing with chlorhexidine were 20 percent less likely to die compared to infants that received the standard dry cord care. Reductions in mortality were not statistically significant among the 7-day cleansing group compared to dry care, but they did have fewer signs of cord infection. "Chlorhexidine cord cleansing is a simple, safe, effective, and inexpensive intervention. Large-scale implementation of this intervention with universal coverage has the potential to avert an estimated half a million neonatal deaths per year," said Abdullah Baqui, MBBS, DrPH, senior author and principal investigator of the study and professor in the Bloomberg School's Department of International Health. An early study conducted by Johns Hopkins researchers in Nepal, showed cleansing the umbilical cord with chlorhexidine for 7 days of the first 10 days of life resulted in a 24 percent decrease in mortality compared to children who received dry-cord care. A separate study by researchers from Aga Khan University in Pakistan, which also appears in the current issue of The Lancet, found that cord cleansing with chlorhexidine reduced infant mortality 38 percent and infections by 42 percent. "Giving birth and a child's first week is a risky time for a mother and her newborn," said Dr. Rajiv Shah, the Administrator of the U.S. Agency for International Development. "These studies provide evidence of a simple, low-cost technology that can prevent illness and death for the most vulnerable children. USAID is committed to transforming research into better results and access to life saving interventions." Neonatal deaths account for more than 40 percent of the estimated 8.8 million deaths of children under 5 each year worldwide. In high mortality settings, more than half of those neonate deaths are the result of serious infection. http://www.sciencedaily.com/releases/2012/02/120207202759.htm http://www.thesenatorsfirm.com/excessive-maternal-iodine-supplementation-linked-tocongenital-hypothyroidism