Category: Obstetrics & Gynaecology

Categories : General Interest Obstetrics & GynaecologyTags :

South African Woman Gives Birth to 10 Babies in World First

On By ModernMedia
Photo by William Fortunato from Pexels

In a world first, a Gauteng woman has given birth to 10 babies. It was only last month when Malian woman Halima Cissé had set the record when she gave birth to nine children in Morocco.

Gosiame Thamara Sithole, 37, delivered her seven boys and three girls by Caesarean section at 29 weeks along last night at a Pretoria hospital, according to her husband Teboho Tsotetsi. 

While such large numbers are usually a result of fertility treatment, Sithole had told the Pretoria News that her pregnancy was natural. She already has a pair of six-year-old twins.

Sithole said in an interview that she was shocked and fascinated by the pregnancy.

The retail store manager was told she had sextuplets, before that was revised to octuplets and finally decuplets because two foetuses were hidden in the fallopian tubes.

“I am shocked by my pregnancy. It was tough at the beginning. I was sick. It was hard for me. It’s still tough but I am used to it now. I don’t feel the pain anymore, but it’s still a bit tough. I just pray for God to help me deliver all my children in a healthy condition, and for me and my children to come out alive. I would be pleased about it,” Sithole said.

At first, she was dubious when the doctors informed her she was pregnant with octuplets.

“I didn’t believe it. I doubted it. I was convinced that if it was more, it would be twins or triplets, not more than that. When the doctor told me, I took time to believe it. Even when I saw the scans I didn’t believe it. But, as time went by, I realised it was indeed true. I battled to sleep at night though.”

Sithole had worried a great deal about her unborn children.

“How would they fit in the womb? Would they survive? What if they came out conjoined at the head, in the stomachs or hands? Like, what would happen? I asked myself all these questions until the doctor assured me that my womb was starting to expand inside. God made a miracle and my children stayed in the womb without any complications.”

Tsotetsi, who is unemployed, also said he was shocked when he heard the news.

“I could not believe it. I felt like one of God’s chosen children. I felt blessed to be given these kinds of blessings when many people out there need children. It’s a miracle which I appreciate. I had to go do my own research on whether a person could really conceive eight children. It was a new thing. I knew about twins, triplets and even quadruplets,” Tsotetsi said.

“But after I found out that these things do happen, and saw my wife’s medical records, I got even more excited. I can’t wait to have them in my arms.”

Professor Dini Mawela, deputy head of the school of medicine at the Sefako Makgatho Health Sciences University, said Sithole’s case was rare and usually the result of fertility treatments. Because it was a “high risk” situation, the children will spend the next few months in an incubator, she said. Termed ‘grand multiparity‘, such pregnancies can be risky, and a pregnancy with 10 babies is of course unprecedented.  

“It’s quite a unique situation. I don’t know how often it happens. It’s extremely high risk (pregnancy). It’s a highly complex and high-risk situation. The danger is that, because there is not enough space in the womb for the children, the tendency is that they will be small. What would happen is that they would take them out pre-term because there is a risk if they keep them longer in there. The babies will come out small, chances of survival compromised. But all this depends on how long she carried them for.”

Source: IOL

Categories : Obstetrics & GynaecologyTags :

Team Investigates The Hazards of Vaping During Pregnancy

On By ModernMedia

Motivated by widely assumed and unproven presumptions that vaping is safer than cigarette smoking, a team at West Virginia University (WVU) is conducting a three-year study on the effects of vaping during pregnancy.

Smoking during pregnancy continues to be a public health problem. It is estimated that around half of women who smoke before becoming pregnant will continue to smoke during and after the pregnancy. Smoking during pregnancy can lead to preterm birth, birth defects and an increased risk of sudden infant death syndrome. Because of this, an increasing number of women who choose to smoke while pregnant are being encouraged to switch to vaping.

“We know that when someone vapes, their blood vessels react by temporarily constricting – or getting smaller, which affects children while in the womb because their fetal environment is also altered,” said contact principal investigator Mark Olfert, associate professor at WVU.

Altering the blood supply in the foetal environment can create a hostile environment for the foetus, leading to serious issues during child and adult life. A previous study in 2018 showed that vaping induced a similar dysfunctional response in the blood vessels of both male and female animals as did smoking cigarettes. So there is great concern that women who are switching to vaping during pregnancy because they think it is safer than smoking are wrong, and that vaping will result in the same problems and complications for offspring as smoking.

Investigations are underway into the reasons behind the harm, and, importantly, what effect these have on the long-term vascular health beyond childhood in offspring that experienced foetal exposure to maternal vaping.

Source: News-Medical.Net

Categories : Genetics Obstetrics & GynaecologyTags :

Foetal Genetics Drive Birth Defects and Pregnancy Loss

On By ModernMedia
Pregnant belly with ultrasound image superimposed. Image by Rudy and Peter Skitterians from Pixabay

A study by Yale researchers has shown that the genetics of the foetus and placenta drive developmental abnormalities, including those that lead to pregnancy loss and autism.

In the US, a birth defect is diagnosed in about 3% of children born every year, according to the Centers for Disease Control and Prevention. Birth defects also occur in most cases of pregnancy loss, and also result in many deaths in the first year of life. The causes are thought to be a complex interplay of environmental and biological factors.

“Mothers often feel that they are responsible for these defects,” explained senior author Dr Harvey Kliman,  Research Scientist at the Department of Obstetrics, Gynecology & Reproductive Services, Yale School of Medicine. “But it’s not their fault. This new research points to the genetics of these children as being the most important cause.”

Dr Kliman and his team examined placental data for nearly 50 sets of identical and non-identical twins. They discovered identical twins had similar numbers of abnormal cell growths called trophoblast inclusions (TIs), which are markers for a number of developmental abnormalities, while non-identical twins showed a markedly different TI count.

While identical twins share the same DNA, non-identical twins only share half of their DNA. Identical twins were found to often have the same number of TIs or were within one of having the same TI count. Non-identical twins had TI counts that differed by four or five on average.

“This work suggests that developmental abnormalities are much more likely to be due to the genetics of the child, and not the mother’s fault,” Dr Kliman explained.

The findings were reported in the journal Placenta.  

First author Julia Katz, a former Yale undergraduate and now medical student at Hofstra University, provided the inspiration for the study.

Katz and her brother, Jesse, who was born underweight and with several congenital abnormalities, are non-identical twins. “I had a lot of guilt, growing up, about why my twin had certain conditions that I didn’t,” Katz explained. “I think mothers also tend to blame themselves.”

After a lecture,  Katz approached Dr Kliman and asked him what causes babies to be born undersized, a conversation which led to a discussion about developmental abnormalities and Katz’s desire to find out more about her and her twin’s genetics — including looking at her own placental slides from birth.

It also led Dr Kliman, Katz, and co-author Parker Holzer, a graduate student in the Yale Department of Statistics and Data Science, to conduct the new study.

“Julia’s need to resolve this burden is what propelled our study,” Dr Kliman said. “Hopefully, this finding will help many other people, as well.”

“This experience has shown me that if you have a question, ask it,” Katz added. “And if you don’t get an answer, try to answer it yourself.”

Source: News-Medical.Net

Journal information: Katz, J., et al. (2021) Genetics, not the uterine environment, drive the formation of trophoblast inclusions: Insights from a twin study. Placenta. doi.org/10.1016/j.placenta.2021.04.010.

Categories : Obstetrics & GynaecologyTags :

‘Absolutely Amazing’ Results of Baby’s Surgery in the Womb

On By ModernMedia
Baby's hand holding on to an adult's finger. Image by RitaE from Pixabay

When her mother learned of her condition while still pregnant with her, baby Mila became one of dozens of babies with spina bifida who have been treated in the womb with a revolutionary procedure, according to the Great Ormond Street Hospital (GOSH) for Children in London.

Spina bifida is a congenital malformation which occurs in the 4th week post-fertilisation where the embryonic neural tube fails to close, leaving the spinal column split (bifid) and open, exposing the spinal cord. Below the level of the damage on exposed spinal cord, there can be motor and sensory neurological deficit. Orthopaedic abnormalities such as clubfoot are possible. Additionally, the higher up the damage is on the spine, the higher the mortality rate. 

Helena, a mother from the UK who had become pregnant after six IVF attempts, at 20 weeks discovered her baby had spina bifida. A scan showed a huge open lesion on her baby’s lumbar sacral region, exposing her spinal cord. But Helena was aware of pioneering open foetal surgery carried out by the NHS following a diagnosis with a previous pregnancy, and was determined to apply for it.

“I knew if I didn’t get the operation the quality of her life would be very different,” Helena told BBC News.

“It was a very large lesion on her back and half of her spine was exposed. They said that it was likely she will be paralysed, incontinent and will need a shunt to drain the fluid from her brain later on.”

A US study, as reported previously on QuickNews, showed that the benefits of foetal repair surgery continued into later childhood, with those having had foetal repair being six times more likely to go to the toilet unaided than those who had surgery after birth, and were 70% more likely to walk unaided, and twice as likely to walk without braces. They were also more likely to use self-care skills such as brushing teeth and using a fork.  

“The procedure is complex, time-sensitive and not without its risks, but the significant and life-changing impact on babies … and their families, cannot be overstated,” explained Dr Dominic Thompson, lead neurosurgeon at GOSH. “This makes all the difference to the quality of their lives.”

Twenty-five clinicians from GOSH and University College London Hospitals, as well as University Hospitals Leuven in Belgium, were involved in Helena’s surgery, according to BBC News.

The procedure generally involves administering an anaesthetic to the mother, which passes to the foetus through the placenta, and then cutting through the abdomen and uterus to reach the foetus’s spine. Neurosurgeons then take off any skin attached to the exposed spinal cord and place the cord inside the spinal canal before stitching the tissues closed.

In her 23rd week of pregnancy, she received surgery at a specialist hospital in Belgium, and three months later, she gave birth to her daughter Mila at University College London Hospital. According to GOSH, some excess fluid still remains on the newborn’s brain, but Mila is showing signs of healthy development.

“She can move her legs, and she’s got feeling to her toes so it’s absolutely amazing,” Helena told BBC News. “I’m just so grateful to the surgeons who’ve done this operation because her life would look very different without it.” Including Mila, the team has performed the same operation on 32 babies since January 2020.

“We’re very excited about the next phase of the prenatal surgery for babies with spina bifida, including less invasive approaches,” Dr. Paolo De Coppi, part of the fetal surgical team for spina bifida, said in the statement.

“As with any new approach, we first need to fully understand the benefits and risks involved to mother and baby,” De Coppi noted. “While we look to make these future procedures as safe as possible, what is clear is that prenatal surgery for patients with spina bifida leads to better outcomes.”

Source: Live Science

Categories : Obstetrics & Gynaecology Pain ManagementTags :

Epidurals Do Not Increase Autism Risk for Babies

On By ModernMedia

A Canadian study showed that children born to mothers who used epidural analgesia during labour were not at increased risk of developing autism spectrum disorder (ASD).

Epidural analgesia is administered into the epidural space around the spinal cord, typically during labour. Besides easing pain and reducing the use of other analgesics, it has also been shown to lower cortisol levels, expedite the return of bowel function, decrease the incidence of PE and DVT in the postoperative period, and reduce hospital stays.

Epidural analgesia is used by 73% of pregnant women in the U.S. for pain during labour. Since the US incidence of ASD increased from 0.66% in 2002 to 1.85% in 2016, there have been more efforts to identify environmental factors that put children at risk, the researchers said.

Elizabeth Wall-Wieler, PhD, of the University of Manitoba in Winnipeg, and colleagues drew from population datasets and included vaginal deliveries of singleton babies born in Canada from 2005 to 2016, following children from birth up until 2019.

Of the more than 123 000 infants included in the study, approximately 38% were exposed to epidural analgesia during delivery, and about 80 000 had a sibling in the study cohort. The mean age of mothers was 28 years. The children’s median age at their first diagnosis of ASD was 4 years. Births with epidural analgesia were more likely to be nulliparous or involve other factors such as foetal distress.
About 2.1% of children exposed to epidural labour analgesia (ELA) later developed ASD, compared with 1.7% who were not exposed, the team reported. But after factor adjustments, the researchers found no association between epidural analgesia and childhood ASD risk, they wrote in JAMA Pediatrics.

“This finding is of clinical importance in the context of pregnant women and their obstetric and anesthesia care professionals who are considering ELA during labor,” Dr Wall-Wieler and colleagues noted.

The group’s results contrast with Qiu et al.’s recent study that found a 37% increased risk of autism in children whose mothers used epidural analgesia during their delivery. Their study did not account for key perinatal factors, such as induction of labor, labor dystocia, and foetal distress, and drew criticism from five medical societies for possible residual confounding.

Dr Wall-Wieler and colleagues said that ELA is “recognized as the most effective method of providing labor analgesia,” adding that future qualitative research should assess how their findings — as well as the prior ones — have altered the perceptions about the perceived risk of ASD in offspring among both pregnant women and healthcare providers.

In an accompanying editorial, Gillian Hanley, PhD, of the University of British Columbia in Vancouver, and colleagues said that given the concerns stemming from previous findings, “it thus comes with some relief that Wall-Wieler et al found no association when controlling for key maternal sociodemographic and perinatal factors.”

“Epidural labor analgesia is an extremely effective approach to obstetric analgesia,” Dr Hanley’s group noted. “We have a collective responsibility to understand whether it is a safe option that sets a healthy developmental pathway well into childhood.”

The researchers observed an association between ELA and autism risk before accounting for confounders; but after controlling for all maternal sociodemographic, pre-pregnancy, pregnancy and perinatal factors, there was no longer a correlation.

In an analysis of siblings, researchers again observed a null association after controlling for all confounders and family fixed effects. Siblings who were exposed to epidural analgesia had a 2% cumulative risk of developing autism, and unexposed siblings had a risk of 1.6%.

The accuracy of inpatient and outpatient diagnostic codes for ASD, as well as coding for ELA was acknowledged as a study limitation by the researchers, as well as a lack of data describing epidural analgesia drug doses.

Source: MedPage Today

Journal information: Wall-Wieler E, et al “Association of epidural labor analgesia with offspring risk of autism spectrum disorders” JAMA Pediatr 2021; DOI: 10.1001/jamapediatrics.2021.0376.

Categories : Obstetrics & GynaecologyTags :

Rate of Twin Births At A Global High

On By ModernMedia
Image by atomicqq from Pixabay

The first comprehensive global survey of twinning has reported an enormous increase in the number of twin births around the world, but appears to be plateauing.

One main reason for the increase is that, due to IVF and other fertility services being more readily available, the number of non-identical twin births is increasing. This is due to practices such as hormone stimulation releasing multiple ova, as well as the now discouraged practice of releasing multiple embryos into the womb in IVF. A systematic review also found that with IVF, letting embryos mature before implantation is also linked to increased odds of monozygotic twins. as well as women becoming pregnant later in life – age increases the likelihood of having natural, non-identical twins, peaking at age 35 to 39.

However, instead of continuing to climb, there are signs that twin births have reached a maximum.

“The trends are really quite striking,” said Christiaan Monden, a professor of sociology and demography at Oxford University. “Over the past 40 to 50 years we’ve seen a strong increase in twinning rates in rich, developed countries, and that has led to more twins in both a relative and an absolute sense than we’ve seen ever before.”

The researchers analysed twinning rates from 2010 to 2015 in 165 countries, which covered 99% of the world’s population. In 112 of those countries, they examined further birth records for 1980 to 1985. 

Although Africa is still the leading continent for twin births, other regions are catching up. The researchers found that, since the 1980s, twinning rates have risen from 9 to 12 per 1000 births, with the greatest rise in more developed regions such as  America (71%), Europe (60%) and Asia (32%).

In the UK, twinning rates rose about 62% but are thought to have fallen since the launch of a campaign to reduce multiple births in 2007. 

Raj Mathur, the chair of the British Fertility Society and a consultant gynaecologist at St Mary’s Hospital, said: “It doesn’t surprise us that twinning rates have increased because the availability of assisted reproduction has increased and also because women are slightly older when they have their first children, and both those things will increase the twin rate.[…]

“I think we’ve reached a peak in terms of twinning rates from medical interventions, certainly in the developed world, but the spread of IVF in Africa and South America is still rather limited on a per capita basis, and there are vast numbers of sub-fertile people in Africa particularly who don’t have access to IVF.

Dr Mathur added a note of caution about IVF, as twins have more risks such as lower birth weights and higher still birth and infant mortality rates

“The challenge will be how to spread IVF to them without also giving them higher twin rates. The majority of twin babies are absolutely fine, but there is no doubt that a twin pregnancy carries greater risks for the mother and the baby, so when we can avoid it we should avoid it. The principle we follow is neatly summed up by the phrase ‘one at a time’,” Mathur said.

Source: The Guardian

Categories : Obstetrics & GynaecologyTags :

New Study Finds Marijuana THC Persists in Breast Milk

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A new study has found that tetrahydrocannabinol (THC) from marijuana can linger in breast milk for up to six weeks after ceasing marijuana use.

Marijuana is the most commonly used dependent substance in pregnancy, with up to half of users continuing through pregnancy. The use of marijuana through pregnancy is likely due to its perceived safety as well as   THC readily crosses the placental barrier, and cannabinoid receptors have been identified in both the placenta and the foetus. However, most studies done on marijuana and pregnancy dates from the 1980s –  this study is the first of its kind to examine the levels of THC in breast milk since one in 1982.

“With the increasing utilisation of marijuana in society as a whole, we are seeing more mothers who use marijuana during pregnancy,” said primary investigator Erica Wymore, MD, MPH, Neonatologist, Children’s Colorado and Assistant Professor of Pediatrics, University of Colorado School of Medicine. “However, given the lack of scientific data regarding how long THC persists in breast milk, it was challenging to provide mothers with a definitive answer regarding the safety of using marijuana while breastfeeding and simply ‘pumping and dumping’ until THC was no longer detectable in their milk. With this study, we aimed to better understand this question by determining the amount and duration of THC excretion in breast milk among women with known prenatal marijuana use.”

The researchers screened women at the Children’s Colorado and UC Health’s University of Colorado Hospital for reported marijuana use or detected THC, who were willing to abstain from marijuana for the six week duration of the study. Of the 394 women screened, 25 enrolled in the study. Seven of these women were able to abstain from their marijuana use, while the others were not able to due depending on it for stress, sleep, and pain relief.

“This study provided invaluable insight into the length of time it takes a woman to metabolise the THC in her body after birth, but it also helped us understand why mothers use marijuana in the first place,” said Maya Bunik, MD, MPH, senior investigator, medical director of the Child Health Clinic and the Breastfeeding Management Clinic at Children’s Colorado and professor of pediatrics at the CU School of Medicine. “To limit the unknown THC effects on foetal brain development and promote safe breastfeeding, it is critical to emphasise marijuana abstention both early in pregnancy and postpartum. To help encourage successful abstention, we need to look at – and improve – the system of supports we offer new moms.”

While the study was not about the impact of maternal marijuana use on childhood development, longitudinal studies dating from the 1980s show that for children born to mothers who smoked marijuana during pregnancy, there are long-term issues with cognitive and executive functioning, including impulsivity, as well as deficits in learning, sustained attention and visual problem-solving skills. One recent retrospective study has also linked marijuana use in pregnancy to autism in children. Dr Wymore points out that this is cause for concern as currently available marijuana has a potency five to six times greater than what was available prior to legalisation.

Source: News-Medical.Net

Journal information: Wymore, E.M., et al. (2021) Persistence of Δ-9-Tetrahydrocannabinol in Human Breast Milk. JAMA Pediatrics. doi.org/10.1001/jamapediatrics.2020.6098.

Categories : Neurology Obstetrics & GynaecologyTags :

Brain ‘Rewired’ by Sound Early in the Womb

On By ModernMedia

Playing music to foetuses in the womb to enhance their brain development is a popular practice even if thus far not grounded in science, but new research has shown that there may be some effect even at very early stages.

New research from John Hopkins University indicates that ‘wiring changes’ made in response to sounds occur even earlier than thought before. The ear canals of newborn mice only open after 11 days, while in humans, the ear canals open at 20 weeks’ gestation. The researchers used the mice as a model for human foetuses, and examined their neural connections at one week old.

“As scientists, we are looking for answers to basic questions about how we become who we are,” said Patrick Kanold, PhD, professor of biomedical engineering at The Johns Hopkins University and School of Medicine. “Specifically, I am looking at how our sensory environment shapes us and how early in foetal development this starts happening.”

Prof Kanold started out in electrical engineering before switching to neuroscience. His field of research is on the cortex, the outer layer of neurons underneath which lies the white matter which consists of connective neurons.

In developing foetuses, in the white matter, subplate neurons can be found at 12 weeks in human gestation and the second embryonic week in mice. This subplate neurons are the precursors to neurons and die off over a period lasting from before birth to several months old. Before they disappear, they make a connection between the thalamus, which is an important sensory gateway, and the middle layers of the cortex.

“The thalamus is the intermediary of information from the eyes, ears and skin into the cortex,” explained Prof Kanold. “When things go wrong in the thalamus or its connections with the cortex, neurodevelopmental problems occur.”

The subplate neurons respond to sound before the cortical neurons, prompting two questions for Prof Kanold: When sound signals reach the subplate neurons, does anything happen, and can a change in sound signals reflect changes in the brain circuits at these young ages?

To answer these questions, the researchers used mice genetically engineered to be deaf, unable to convert sound into nerve signals. In deaf, week-old mice, there were 25-30% more connections between subplate and cortical neurons.

“When neurons are deprived of input, such as sound, the neurons reach out to find other neurons, possibly to compensate for the lack of sound,” said Prof Kanold. “This is happening a week earlier than we thought it would, and tells us that the lack of sound likely reorganises connections in the immature cortex.”

To compare the difference extra auditory stimuli made, the researchers put 2-day old pups in a quiet enclosure or an enclosure with a constant beeping sound. There were differences between the subplate neuron connections for beeping and quiet enclosure mice, but not as great as between the deaf and hearing mice. The quiet enclosure mice had stronger connections between the subplate and cortical neurons, similar to the deaf mice. The mice in the beeping enclosure also had a greater diversity in neural circuitry.

“In these mice we see that the difference in early sound experience leaves a trace in the brain, and this exposure to sound may be important for neurodevelopment,” explained Prof Kanold.

The researchers are planning to examine how sound in early development impacts the brain in later life, as well as how sounds in the womb influences neural wiring. This has application for cochlear implants for children born deaf. They also plan to study premature infants neural wiring problems and develop biomarkers for abnormal subplate neuron development. 

Source: Medical Xpress

Journal information: Early peripheral activity alters nascent subplate circuits in the auditory cortex, Science Advances (2021). DOI: 10.1126/sciadv.abc9155

Categories : Obstetrics & GynaecologyTags :

Onset of Morning Sickness Narrowed Down

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The onset of “morning sickness”, the nausea and vomiting that often occurs near the beginning of pregnancy and normally resolves at 12-14 weeks, has been narrowed down in a new study from researchers at the University of Warwick.

The cause of nausea and vomiting of pregnancy (NVP) had historically been ascribed to psychological conditions, but currently is believed to have a multifactorial basis, involving various genetic, endocrine and gastrointestinal factors.

The study involved 256 women who became pregnant, keeping a diary recording the onset of nausea and vomiting, their last menstruation and date of ovulation as measured by a urine test.Determining the date of the start of pregnancy as determined by the date of their last ovulation, the first onset of NVP was 8 to 10 days, compared to 20 to 30 days as measured from the date of their last menstruation.

Lead author Prof Roger Gadsby, Warwick Medical School, said: “The precise course of pregnancy sickness is unknown, but this research shows that it occurs at a specific developmental stage, in a specific timeslot. For researchers it narrows our focus in terms of where we look for the cause. If we know that symptoms occur in a very narrow window 8-10 days after ovulation, researchers can concentrate their efforts on that particular stage of development to find the cause of the condition, both anatomically and biochemically.”

Knowing that the onset of NVP has such a tight timeframe will help future research narrow down a biological cause behind it, and help generate targets for treatment development.

An unexpected outcome of the study was a very high prevalence of NVP of 94%, compared to the 80% calculated in prior research. This is explained by the fact that data were regularly collected from participants from before they became pregnant to 60 days after their last menstruation, as opposed to most studies asking women to recall symptoms after they became pregnant.

Prof Gadsby added, “What we’ve shown is that more people get symptoms of pregnancy sickness than has ever been shown before, and one of the reasons for that is that this research has picked up mild early symptoms that tend to fade by 7-8 weeks. In other studies those symptoms would have faded by the time the research started.”

Source: News-Medical.Net