Congenital cytomegalovirus (CMV) is a leading cause of disability, including sensorineural hearing loss, developmental delay, and mental retardation. Understanding risk factors for acquisition of CMV infection in adolescent females will help determine vaccine strategies.Females (12-17 years) were recruited from primary care settings in Cincinnati, Galveston, Houston, and Nashville from June 2006 to July 2010 for a seroepidemiologic study, from which seronegative participants were recruited for a CMV vaccine trial. Participants (n = 1585) responded to questions regarding potential exposures. For those with young children in the home (n = 859), additional questions were asked about feeding and changing diapers, and for those > 14 years of age (n = 1162), questions regarding sexual activity were asked. Serum was evaluated for CMV antibody using a commercial immunoglobulin G assay.Cytomegalovirus antibody was detected in 49% of participants. In the univariate analyses, CMV seroprevalence was significantly higher among African Americans, those with children < 3 years of age in the home, and those with a history of oral, anal, or vaginal intercourse. Among those with young children in the home, feeding children and changing diapers further increased the association with CMV infection. However, in the final multivariate analysis, only African Americans and household contact with young children were associated with CMV infection.By age 12, evidence of CMV infection was common. Multiple factors regarding race and personal behaviors likely contribute to seroconversion earlier in life.

Hypertensive disorders complicating pregnancy seriously endanger the safety of the mother and fetus during pregnancy. Very few studies have explored hypertensive disorders of pregnancy in India, even though this disease has been associated with adverse maternal and perinatal outcomes. This study aimed to analyze the disease pattern and risk factors associated with the disorder and assess the maternal and fetal outcomes in cases of hypertensive disorders of pregnancy.This case-control study was carried out over 1 year from 2011 to 2012 at the Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India. A total of 149 patients were enrolled in the study. As seven were lost to follow-up, analysis was carried out on 142 cases. Patients were further classified according to the National High Blood Pressure Education Program Working Group (2000) as having mild preeclampsia (65 cases), severe preeclampsia (32 cases), or eclampsia (45 cases). Thirty-one healthy pregnant non-hypertensive women were enrolled into the study as controls.The most common manifestation was edema, seen in 90% of cases. Proteinuria was also relatively common, 26.76% of patients with proteinuria of ≥300 mg/24 hours, 47.88% with proteinuria of ≥2 g/24 hours, and 25.35% with a urinary protein excretion of 3-5 g/24 hours. Central nervous system involvement was observed in 42.2% of cases, elevated bilirubin levels in 47.0%, visual symptoms in 6.4%, vaginal bleeding in 11.3%, and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was reported in 2.80%. Maternal deaths occurred in 2.8% of cases, all of which were from the eclampsia group. Stillbirths occurred in 16.9% of cases, and overall neonatal death observed in 4.23% of cases.Women with hypertensive disorders of pregnancy were more prone to adverse maternal and fetal outcomes than normotensive pregnant women, but we observed a decreasing trend in the present study compared with that reported in other studies, which might be due to the increased number of hospital deliveries that occurred in our study.

The influences of F-strain Mycoplasma gallisepticum (FMG) vaccine inoculation during the pullet period on the subsequent productive and reproductive performance of parent broiler chicken breeders on a multi-age farm were evaluated. Three thousand breeders were randomly divided into 2 treatment groups that were either vaccinated with FMG (FMG-vaccinated group) or not vaccinated with FMG (FMG-free group). Body weight and egg production were determined through approximately 50 wk of age. Egg weight and feed conversion was determined at 26, 32, 35, 38, and 43 wk of age. Egg quality parameters, including eggshell strength, egg-specific gravity, egg shape index, blood-meat spots, Haugh unit score, eggshell thickness, yolk:albumen ratio, percentage yolk, albumen and eggshell weights, and percentage fertility, hatchability, and second-quality chicks were determined at 26, 32, and 43 wk of age. Air sacs were examined and lesions were scored at 20, 32, and 50 wk of age. The number of mature ovarian follicles, histologies of ovary, and lengths, and histologies of the infundibulum, magnum, isthmus, uterus, and vagina were determined. In the present study, an increase in egg production of broiler breeder hens in the FMG-vaccinated group during peak of lay was compared with the FMG-free group. Feed conversion of hens in the FMG-vaccinated group was significantly less at 32, 35, 38, and 43 wk of age. Eggs from hens in the FMG-vaccinated group had a significantly higher Haugh units score at 26 wk of age and had a significantly higher eggshell thickness and lower incidence of blood-meat spots at 32 wk. Hatching eggs from hens in the FMG-vaccinated group had a significantly higher hatchability. The mean lesion score of air-sac lesion of birds in the FMG-vaccinated group was significantly less than FMG-vaccinated group. Uteruses of hens in the FMG-vaccinated group had a significantly longer length compared with the FMG-free group at 32 wk of age. The results indicate that inoculation of commercial parent broiler chicken breeders with the FMG vaccine before laying may prevent infection by field M. gallisepticum, and facilitate productive and reproductive performance.

OBJECTIVE:

To assess the effectiveness of inner thigh "Taping" compared to "Traction" using a weighted bag when an intracervical Foley catheter is used for cervical ripening.

STUDY DESIGN:

We performed a randomized controlled trial at a tertiary hospital on women with a singleton pregnancy in cephalic presentation admitted for labor induction with a Bishop score ≤6. A 30ml intracervical Foley catheter was placed for ripening. Women were randomly allocated to inner thigh Taping or to Traction with a 500ml weighted bag of fluid. The primary outcome was time to delivery. Secondary outcomes were: time to expulsion of the catheter, maternal discomfort (visual analogue scale), mode of delivery, and maternal morbidities.

RESULTS:

We randomized 197 women. After exclusions (4 ineligible, 2 withdrawn by provider), we analyzed 191 (96 Taping, 95 Traction) women in their assigned groups. Groups were similar regarding maternal race, age, parity, gestational age, and induction indication. Time to delivery was not significantly different (Mean ± Standard deviation: 19.8 ± 8.5 vs. 18.8 ± 8.0 hours, P=0.39). Time to catheter expulsion was shorter in the Traction Group [Median, (Range): 2.6, (0.2 - 10.8) vs. 1.5 (0.1 - 6.3) hours, P< 0.001]. Change in Bishop and pain scores, cesarean delivery rates, clinical amnionitis, and other maternal morbidities were similar between groups. Subset analyses of those with vaginal delivery and among nulliparas, and multiparas revealed similar results.

CONCLUSION:

Traction on the intracervical Foley catheter during cervical ripening shortens the time to spontaneous catheter expulsion without affecting the time to delivery. Clinicaltrials.gov registration number: NCT00976703.

Nanopharmaceuticals have the potential to revolutionise medical treatment by permitting the design of more potent, less toxic "smart" therapeutics, ultimately leading to personalised medicine. This review summarises the challenges and potential uses of nanodelivery system for the topical drug therapy of vaginal diseases. The vaginal route of drug administration remains a challenge in the development of novel drug therapies, including nanomedicines. We attempted to provide an unbiased overview of currently investigated nanodelivery systems, some of which remain to be extensively studied under laboratory conditions, and some of which are already in clinical trials. Most nanodelivery systems are aimed at improving the treatment of vaginal infections, including HIV prevention. Promising new approaches in nanopharmaceutical design are discussed in this review, as well as the controversies related to mucoadhesiveness of nanopharmaceuticals.

OBJECTIVES:

augmented and not augmented women without dystocia were compared to investigate associations between oxytocin and adverse birth outcomes. Augmented women with and without dystocia were compared, to investigate associations between dystocia and adverse birth outcomes.

DESIGN:

a cohort of low-risk nulliparous women originally included in a randomised controlled trial.

SETTING:

the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway.

PARTICIPANTS:

the study population consists of 747 well defined low-risk women.

MEASUREMENTS:

incidence of oxytocin augmentation, and associations between dystocia and augmentation, and mode of delivery, transfer of newborns to the intensive care unit, episiotomy and postpartum haemorrhage.

FINDINGS:

of all participants 327 (43.8%) were augmented with oxytocin of which 139 (42.5%) did not fulfil the criteria for dystocia. Analyses adjusted for possible confounders found that women without dystocia had an increased risk of instrumental vaginal birth (OR 3.73, CI 1.93-7.21) and episiotomy (OR 2.47, CI 1.38-4.39) if augmented with oxytocin. Augmented women had longer active phase if vaginally delivered and longer labours if delivered by caesarean section if having dystocia. Among women without dystocia, those augmented had higher body mass index, gave birth to heavier babies, had longer labours if vaginally delivered and had epidural analgesia more often compared to women not augmented. KEY

CONCLUSION:

in low-risk nulliparous without dystocia, we found an association between the use of oxytocin and an increased risk of instrumental vaginal birth and episiotomy.

IMPLICATIONS FOR PRACTICE:

careful attention should be paid to criteria for labour progression and guidelines for oxytocin augmentation to avoid unnecessary use.

OBJECTIVES:

Delivery care giving is undergoing excessive interventionism today, not supported by scientific evidence, neglecting organisational aspects and individualisation. This study analyses the perception of mothers during their delivery, postpartum and breastfeeding periods in the Galician Health Service, in order to inform and help to improve this service.

MATERIAL AND METHODS:

A total of 14 focus group meetings were held (one in each Galician public hospital), consisting of women who, in 2008, delivered by vaginal delivery or those who were not scheduled for a caesarean section.

RESULTS:

The process of birth analysis can identify a sequence of important elements both positive and negative, for mothers, and may lead to suggestions for improvement. Their experiences and opinions, especially in aspects such as participation in decision-making, mechanisation of labour and lactation, may help to conduct an assessment of the maternity ward operating. When investigating expectations and demands from users, information from perceived quality is received, and also mothers' experience is shared.

CONCLUSIONS:

Mothers call for humanity, empathy, information and participation. Facing the implementation of these elements, the key processes for working harder are the dilation stage and hospital staying.

OBJECTIVE:

To evaluate the therapeutic value of radical hysterectomy and vaginectomy with sigmoid vaginoplasty among patients with International Federation of Gynecology and Obstetrics stage I vaginal carcinoma.

METHODS:

A retrospective study was conducted of 5 women (age range, 45-55years) with stage I vaginal carcinoma who underwent surgery at Shengjing Hospital of China Medical University, Shenyang, China, between January 4, 2009, and December 30, 2011. All participants had lesions in the upper third of the vagina and wished to retain sexual function. Patients underwent radical hysterectomy and vaginectomy with pelvic lymphadenectomy, followed by sigmoid vaginoplasty for vaginal reconstruction.

RESULTS:

The mean operative time was 248.0±39.6minutes and the mean intraoperative blood loss was 335.0±76.6mL. All patients recovered well after surgery and no delayed complications or recurrence were experienced during a mean follow-up of 22.8±9.98months. None of the patients developed vaginal stenosis and all were satisfied with their postoperative sexuality. The mean Female Sexual Function Index was 28.0±1.92.

CONCLUSION:

Radical hysterectomy and vaginectomy with sigmoid vaginoplasty was a reasonable option for patients with stage I vaginal carcinoma who wished to retain sexual function after surgery.

Luman (also known as LZIP and CREB3) is a basic leucine zipper transcription factor of the cAMP response element-binding protein/activating transcription factor gene family. Although Luman had specific roles near termination of Drosophila embryogenesis, the physiological functions of Luman in female mammals have apparently not been reported. Therefore, our objective was to investigate the spatiotemporal expression and regulation of Luman in the mouse uterus during the peri-implantation period. Luman protein was clearly present in the luminal and glandular epithelium on days 1 to 4 of pregnancy (day 1, presence of a vaginal plug) and was observed in decidual cells on day 6 of pregnancy. Expression had progressively increased to day 7 when the second decidual zone was formed. On day 8, apoptosis of the decidualized cells was present, and Luman protein expression was decreased (in close association with decidualization). Luman protein was also present in decidual cells of the artificially decidualized uterus. The expression of Luman was regulated by an activated embryo (according to its expression patterns during pseudopregnancy and delayed implantation). Furthermore, expression of Luman was induced by estrogen in ovariectomized mice. We have concluded that Luman might have important roles in embryo implantation and decidualization.