Understanding Clinician Knowledge About Race Adjustment in the Vaginal Birth After Cesarean Calculator.

Disparities in maternal health outcomes are striking. Historical and biased clinical support tools have potential to exacerbate inequities. In 2022, NewYork-Presbyterian, with ∼25,000 annual births, and our academic partners, Columbia and Weill Cornell, launched a program to better understand practice patterns and clinician attitudes toward a vaginal birth after cesarean (VBAC) calculator, which predicts VBAC success. This article summarizes the program, focusing on the VBAC calculator utilization survey, which measured provider awareness of the revised calculator and key factors considered in patient counseling. Our preliminary findings warrant future research and education on the calculator's implications for counseling and outcomes.

Can pelvic floor dysfunction after vaginal birth be prevented?

INTRODUCTION AND HYPOTHESIS: Significant breakthroughs in our understanding of pelvic floor dysfunction have occurred in the past two decades. The next step is to translate this understanding into effective preventative and early intervention strategies to minimize maternal morbidity from vaginal birth. We have learned enough to chart a course toward prevention. METHODS: This article outlines some major advances in understanding the pathophysiology of pelvic floor dysfunction and suggests strategies for future prevention research. RESULTS: Vaginal birth is the primary risk factor for the development of pelvic floor disorders and this is compounded by forceps use. Age, race, and genetics are also risk factors. Steps to prevent or minimize the development of pelvic floor problems include moderating forceps use and utilizing risk assessment tools to offer cesarean delivery to those at greatest risk. CONCLUSION: These actions would represent one giant step forward in advancing the practice of obstetrics into the modern age of personalized medicine.

Differences in continence system between community-dwelling black and white women with and without urinary incontinence in the EPI study.

OBJECTIVE: We sought to compare continence system function of black and white women in a population-based sample. STUDY DESIGN: As part of a cross-sectional population-based study, black and white women ages 35-64 years were invited to have pelvic floor testing to achieve prespecified groups of women with and without urinary incontinence. We analyzed data collected from 335 women classified as continent (n = 137) and stress (n = 102) and urge (n = 96) incontinent based on full bladder stress test and symptoms. Continence system functions were compared across racial and continence groups. RESULTS: Comparing black to white women, maximal urethral closure pressure (MUCP) was 22% higher in blacks than whites (68.0 vs 55.8 cm H(2)O, P < .0001). White and black women with stress incontinence had MUCP 19% and 23% lower than continent women. MUCP in urge incontinent white women was as low as stress incontinent whites, but blacks with urge had normal urethral function. CONCLUSION: Black women have higher urethral closure pressures than white women. White women with urge incontinence, but not black women, have reduced MUCP.

Perfil bioquímico de algumas enzimas no plasma sangüíneo de potras da raça Brasileiro de Hipismo (BH) criadas em Colina, Estado de São Paulo / Biochemical profile of some plasmatic enzymes in BH (Brasileiro de Hipismo) filies bred Colina in São Paulo State

Com o propósito de avaliar o perfil bioquímico de algumas enzimas,em potras sadias da raça BH (Brasileiro de Hipismo), utilizaram-se380 amostras de plasma sangüíneo colhidas de 19 animais desde o nascimento até 24 meses de vida. Na análise dos resultados evidenciou-se que os valores médios das enzimas FA (fosfatase alcalina) e CK( creatina quinase) foram máximos entre o nascimento e 24 horas devida (FA-1995.50 UI/ ; CK-189.13UI/L), enquanto que para a LD(lactato desidrogenase) e GGT (gama glutamiltransferase) as maiores magnitudes ocorreram, respectivamente, entre 3 e 4 dias (LD-479.11UI/L) e aos 10 dias de idade (GGT-18.70UI/L). As FA, CK,LD e GGT, mostraram diminuições dos valores médios,respectivamente, até 6 meses (FA-323.50UI/L), 20 dias (CK-51UI/L), 19 meses (LD-214.00UI/L) e 4 meses (GGT-11.40UI/L)estabilizando-se a seguir, com pequenas variações. A atividade da AST (aspartato aminotransferase) que foi mínima logo após o nascimento (AST- 43.38UI/L), aumentou até os sete dias de vida(AST-110.89UI/L), e a seguir diminuiu progressivamente, com pequenas oscilações, até o final do estudo. Todas as enzimas avaliadas sofreram variações influenciadas pelo fator etário, particularmente no período inicial de vida dos animais estudados.

380 plasma samples were used with the purpose of evaluate the biochemical profile of some enzymes in healthy BH (Brasileiro deHipismo) fillies. These samples were collected from 19 animals since birth until 24 months of age. The results showed that the mean values of ALP (alkaline phosphatase) and CK (creatine kinase) were higher between birth and 24 hours of life (FA-1995.50 UI/; CK-189.13UI/L), where as for LD (lactate dehidrogenase) and GGT (gama glutamiltransferase) the highest values were, respectively, between 3 and 4 days (LD-479.11UI/L) and with 10 days of life (GGT-18.70UI/L). AP, CK, LD and GGT showed a reduction of the mean values,respectively, until 6 months (FA-323.50UI/L), 20 days (CK-51UI/L), 19 months (LD-214.00 UI/L) and 4 months (GGT-11.40UI/L)stabilizing with some oscillations. The activity of AST (aspartate aminotransferase) was minimal after birth (AST- 43.38UI/L) increased until the seventh day of life (AST-110.89UI/L) and next it diminished progressively with little oscillations until the end of the study. Allenzymes evaluated were influenced by age, particularly in the initial period of life of the animals studied.

Establishing the prevalence of incontinence study: racial differences in women's patterns of urinary incontinence.

PURPOSE: We examine racial differences in urinary incontinence prevalence, frequency, quantity, type, and risk factors in a population based sample of community dwelling black and white women. MATERIALS AND METHODS: Women 35 to 64 years old were sampled from telephone records from 3 southeast Michigan counties. Women self-identifying as black or white race completed a telephone interview that assessed demographics, health history, lifestyle factors and urinary incontinence experience. Statistical analysis included descriptive statistics, factor analysis and multivariable logistic regression to determine adjusted odds of urinary incontinence. Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings. RESULTS: Interviews were completed by 1,922 black and 892 white women (response rate = 69%). The overall prevalence of urinary incontinence was 26.5%. By race, urinary incontinence prevalence was 14.6% for black women and 33.1% for white women (p <0.001). Among incontinent women there was no difference by race in the frequency of urinary incontinence. However, black women reported more urine loss per episode (p <0.05). A larger proportion of white women with incontinence (39.2%) reported symptoms of pure stress incontinence compared to black women (25.0%), whereas a larger proportion of black women (23.8%) reported symptoms of pure urge incontinence compared to white women (11.0%). Risk factors for urinary incontinence were generally similar for white and black women. CONCLUSIONS: In this population based study we observed racial differences in prevalence, quantity and type of urinary incontinence. Frequency of and risk factors for urinary incontinence were generally similar for white and black women.

Vaginal birth and de novo stress incontinence: relative contributions of urethral dysfunction and mobility.

OBJECTIVE: To evaluate the relative contributions of urethral mobility and urethral function to stress incontinence. METHODS: This was a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9-12 months postpartum were compared with 80 primiparous continent controls to identify impairments specific to stress incontinence. Eighty nulliparous continent controls were evaluated as a comparison group to allow us to determine birth-related changes not associated with stress incontinence. Urethral function was measured with urethral profilometry, and vesical neck mobility was assessed with ultrasound and cotton swab test. Urethral sphincter anatomy and mobility were evaluated using magnetic resonance imaging. The associations among urethral closure pressure, vesical neck movement, and incontinence were explored using logistic regression. RESULTS: Urethral closure pressure (+/-standard deviation) in primiparous incontinent women (62.9+/-25.2 cm H(2)0) was lower than in primiparous continent women (83.9+/-21.0, P<.001; effect size d=0.91) who were similar to nulliparous women (90.3+/-25.0, P=.091). Vesical neck movement measured during cough with ultrasonography was the mobility measure most associated with stress incontinence; 15.6+/-6.2 mm in incontinent women compared with 10.9+/-6.2 in primiparous continent women (P<.001, d=0.76) or nulliparas (9.9+/-5.0, P=.322). Logistic regression disclosed the two-variable model (max-rescaled R(2)=0.37, P<.001) was more strongly associated with stress incontinence than either single-variable model, urethral closure pressure (R(2)=0.25, P<.001) or vesical neck movement (R(2)=0.16 P<.001). CONCLUSION: Lower maximal urethral closure pressure is the measure most associated with de novo stress incontinence after first vaginal birth followed by vesical neck mobility. LEVEL OF EVIDENCE: II.

Determinações plasmáticas de glicose, colesterol e triglicérides em potras sadias, da raça Brasileiro de Hipismo / Plasma values of glucose, cholesterol and triglycerides of healthy Brasileiro de Hipismo fillies

Utilizaram-se 380 amostras de plasma sangüíneo coletadas de 22 potras Brasileiro de Hipismo, sadias, desde o nascimento até 24 meses de idade. Os valores médios de colesterol foram máximos entre o nascimento e 24 horas de vida, enquanto que para glicose e triglicérides, o maior valor ocorreu entre três e quatro dias de vida. Os valores médios de colesterol e triglicérides diminuíram progressivamente até os 13 meses de idade, quando se estabilizaram. Foi observada redução progressiva das concentrações de glicose até nove meses, estabilizando-se a seguir. Houve influência dos fatores etários sobre as variações de todas as determinações bioquímicas, particularmente no período inicial de vida dos animais estudados.

Plasma biochemical values were determined in 380 samples obtained from 22 clinically normal Brasileiro de Hipismo fillies from birth to 24 months old. Statistical analysis showed higher concentrations of cholesterol between 0-4 hours and 24 hours after birth, while glucose and triglycerides with 3-4 days of age. Glucose concentrations decreased until nine months old, then remained fairly constant. Cholesterol and triglycerides decreased gradually with advancing of age until 13 months and then stabilized. It was concluded that the plasma biochemical values were influenced by age, particularly in the newborn foals considered in the study.

Anatomic variations in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance imaging.

OBJECTIVE: The purpose of this study was to develop a system to quantify interindividual variation in the appearance of continence system structures in normal continent nulliparous women. STUDY DESIGN: Magnetic resonance imaging (1.5 T) was performed in 20 healthy continent nulliparous women (mean age, 30.1 +/- 5.1 years) with normal pelvic organ support and urodynamics. Morphometric measurements of the levator ani muscle, endopelvic fascia, and urethra were performed. RESULTS: The ratio of the maximum-to-minimum measured values shows that 2- to 3-fold differences occur in distance, area, or volume measures of continence system morphologic features. The mean urogenital hiatus area was 15.2 +/- 2.9 cm(2) in women without a visible connection of the levator ani muscle to the pubic bone (4/20 women) and 12.3 +/- 2.4 cm(2) in women with an levator ani muscle-pubic bone connection (16/20 women, P =.05). CONCLUSION: Considerable variation that was not attributable to limitations of the measuring technique that was used occurs in the size and configuration of the urethral support structures in nulliparous asymptomatic women.

Serum cortisol, lactate and creatinine concentrations in Thoroughbred fillies of different ages and states of training

Exercise can be defined as "normal stress" stimulating body functions. Some reports suggest lactate as a stimulator of cortisol levels, while creatinine varies according to the amount of muscle tissue. In the present study we investigated the relationship between creatinine, serum lactate concentration and cortisol levels in training horses. Twenty-three Thoroughbred fillies were used, divided into 3 groups according to age and training protocol: G1, 1-2 years of age (N=7) on pasture, G2, 2-3 years (N=9) starting to be mounted, and G3, 3-4 years (N=7) racing at the Jockey Club. Blood samples were collected weekly during a six-month period at about 1:00 p.m. while the animals were resting. Cortisol was quantified with a commercial kit (Coat-a Count®) and serum creatinine and lactate were evaluated with an autoanalyzer with commercial reagents. Data were evaluated using non-parametric statistical tests, with the level of significance set at P< 0.05. Cortisol concentrations were 149ª + 7, 126b + 6, and 101c + 5 nmol/l, lactate concentrations were 2.1ª + 0.1, 2.0ª + 0.1, and 1.75b + 0.1 mmol/l, and creatinine concentrations were 125ª + 2, 132ª + 2 145b + 3 mumol/l in G1, G2 and G3, respectively. Only G2 showed a low but significant positive correlation of cortisol with lactate and a negative correlation of cortisol with creatinine levels. It was possible to conclude that cortisol, lactate and creatinine varied during horse aging and physical conditioning. The decrease of cortisol concentration (G2) suggests that the better physical condition acquired during training led to the increase of creatinine concentration, possibly related to muscle mass. The lower cortisol and lactate concentrations observed in G3 animals may have been due to greater muscle mass inducing an increase in creatinine concentrations or changes in muscle fiber type during training

Relato de um caso de transmissão transplacentária de anaplasmose bovina. Observações clínico-laboratoriais

Relata-se a ocorrência de transmissão transplacentária de anaplasmose em um bezerro da raça Jersey, com 7 dias devida, proveniente de propriedade localizada no Município de São Miguel Arcanjo, Estado de São Paulo, destacando-seas observações clínico-laboratoriais realizadas durante a evolução do quadro nosológico.