Thermal territories of the abdomen after caesarean section birth: infrared thermography and analysis.

OBJECTIVE: To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. METHOD: Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. RESULTS: We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram. CONCLUSION: Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel cluster dissimilarity between scar and adjacent healthy skin has potential as a method for the development of techniques targeted to early infection surveillance in women after caesarean section.

An Analysis of Behaviour Change Techniques Used in a Sample of Gestational Weight Management Trials.

INTRODUCTION: Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management. METHOD: All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain. RESULTS: The most commonly used BCTs were within the categories of "feedback and monitoring," "shaping knowledge," "goals and planning," "repetition and substitution," "antecedents," and "comparison of behaviours." For diet and mixed interventions "feedback and monitoring," "shaping knowledge," and "goals and planning" appeared the most successful BCT categories. CONCLUSIONS: Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy.

Rectorrhagia and vaginal discharge caused by a vaginal foreign body--a case report and review of literature.

An 8-year-old girl was taken to an outpatient clinic of surgery suffering from rectorrhagia and purulent, smelly vaginal discharge. Colonoscopy and biopsy were done before referring and sulfasalazine regime was administrated for probable colitis. The surgeon performed a rigid rectosigmoidoscopy under general anesthesia and no positive evidence was found. Having examined the hymen, it was found to be intact but a purulent discharge was observed. After drying the discharge, a black foreign body was seen in the bottom of the vagina and brought out by a fine forceps. It was a toy's wheel. The patient and her mother both denied foreign body abusing history. It was recommended she go for a psychological consultation. Generally speaking, all young patients suffering from vaginal or rectal bleeding with or without discharge should have their vagina checked for a foreign body. What is recommended in such cases is to undergo sonography or plain radiography before considering invasive or non-invasive procedures for evaluating anal and sigmoid abnormalities. Last but not least, a vaginal irrigation, precise examination of hymen, and posterior fossa can prove very useful for detecting simple vaginal bodies that can lead to various vaginal, rectal and abdominal complications.

Women's and Midwives' Perspectives on the Design of a Text Messaging Support for Maternal Obesity Services: An Exploratory Study.

This study was aimed to explore women's and midwives' views on the use of mobile technology in supporting obese pregnant women with healthy lifestyle choices. A purposive sample of 14 women and midwives participated in four focus groups in Doncaster, UK. A content analysis of the transcripts from the first focus group led to the emergence of three main constructs with associated subcategories including Benefits ("modernising," "motivating," "reminding," and "reducing" the sense of isolation), Risks and Limitations (possibility of "being offensive," "creating pressure or guilt," and "being influenced by mood"), and Service Delivery (making it "available to all pregnant women," giving attention to the "message tone" and development of "message content"). They also suggested the use of other modalities such as web-based services for weight management during pregnancy. Based on the above results a text messaging service was developed and presented to the 2nd focus group participants who confirmed the positive views from the first focus group on the use of the text messaging as being supportive and informative. The participants also welcomed "women's engagement and choice" in deciding the content, timing and frequency of messages. The results informed the development of a text messaging service to support maternal obesity management. The implementation and acceptability of this service requires further investigation.

Physiologically-based pharmacokinetic (PBPK) models for assessing the kinetics of xenobiotics during pregnancy: achievements and shortcomings.

The physiological changes that occur in the maternal body and the placental-foetal unit during pregnancy influence the absorption, distribution, metabolism, and excretion (ADME) of xenobiotics. These include drugs that are prescribed for therapeutic reasons or chemicals to which women are exposed unintentionally from the surrounding environment. The pregnancy physiologically-based pharmacokinetic (p-PBPK) models developed for theoretical assessment of the kinetics of xenobiotics during pregnancy should take into account all the dynamic changes of the maternal and embryonic/foetal physiological functions. A number of p-PBPK models have been reported for pregnant animals and humans in the past 3 decades which have mainly been applied in the risk assessment of various environmental chemicals. The purpose of this review is to critically evaluate the current state of the art in p-PBPK modelling and to recommend potential steps that could be taken to improve model development and its application particularly in drug discovery and development for pregnant women, with potential implications for optimal drug treatment in pregnancy. The pregnancy-induced changes in physiology and pharmacokinetics, including metabolism, are reviewed to illustrate the basic alterations essential for pregnancy model development. A systemic search of the literature for existing p-PBPK models is carried out and the model structures, governing equations, methods of modelling growth, model validation/verification as well as model applications are highlighted. This review discusses benefits and limitations of the reported p-PBPK models so far and suggests areas for model improvement. The need for establishing databases on the system-related (biological, anatomical and physiological) and drug-related (physiochemical, affinity to enzymes and transpoorters) parameters for healthy and unhealthy pregnancies is particularly emphasized.

New results regarding trends in Iranian women's health and a comparison with WHO data.

Half of the world's population consists of women, who play important roles in cultural formation and education, maintain and promote households and their health, and consequently affect the community. In a general sense, women's health may be an important cornerstone for the formation of a healthy community. In developing countries, 67% of women work in the agriculture sector and produce 55% of the food products throughout the world. In East Asian countries, which have the highest level of cloth and furniture export, 74% of workers are women. Due to these considerations, we assessed women's health indicators in Iran. We reviewed health information from national health reports, including two national health surveys conducted in 1991 and 2009 with a sample size of 1/1,000 of the Iranian population, the 2000 Iran Demographic and Health Survey, and all published indices that were calculated in 2006 or later. The most important finding was that the maternal mortality rate decreased from 54 per 100,000 live births in 1991 to 37.4 per 100,000 live births in 1997. It decreased further to 24.7 per 100,000 live births in 2006. The Millennium Development Goal is 18-22 per 100,000 live births in 2015.

Rate of use of contraceptive methods and risk factors in Tehran, the capital of Iran, in 2010 compared to other cities and regions.

BACKGROUND: Unwanted pregnancies and deaths from abortion cost the lives of 500 women daily. This study was designed to determine the rate of use of contraceptive methods and the risks. MATERIAL AND METHODS: This cross-sectional study was conducted in 2010 in Tehran, Iran. Total sample size was 304 participants who all filled out a questionnaire which had two parts. Data were analyzed by SPSS. FINDINGS: The results showed that age (p = 0.003), employment status (p = 0.001), number of children (p = 0.001), and marriage (p = 0.01), had a significant relation with type of contraceptive method while, education did not correlate with contraceptive methods. DISCUSSION: New and often younger couples with no experience about different contraceptive methods may tend to use natural methods because of their lack of knowledge of other techniques. Use of modern contraceptives early in marriage or even before marriage could be a good strategy.

The effect of lidocaine and sufentanil in preventing intraocular pressure increase due to succinylcholine and endotracheal intubation.

BACKGROUND AND OBJECTIVE: Succinylcholine administration, laryngoscopy and tracheal intubation are followed by increased intraocular pressure. Various premedications have been advocated for preventing increases in intraocular pressure, especially in patients undergoing surgical repair of open globe due to penetrating eye trauma. Results of studies in this area have been controversial. METHODS: In this double-blind study, three groups of 70 patients receiving sufentanil, lidocaine and placebo 90 s prior to intubation were evaluated and compared for intraocular pressure changes following succinylcholine administration, laryngoscopy and tracheal intubation. RESULTS: Mean intraocular pressure measured 2 and 3 min after succinylcholine administration in groups receiving sufentanil and lidocaine was significantly lower than in the placebo group. Mean intraocular pressure changes in the three groups were -1.84, -2.03 and +2.82 mmHg, respectively in minute 2; -4.78, -4.73 and +1.35 mmHg, respectively in minute 5. There was a significant intraocular pressure decrease in the sufentanil and lidocaine groups, compared to the placebo group. The eye surgeons' satisfaction was also significantly higher with the sufentanil and lidocaine groups. CONCLUSION: Previous studies have yielded controversial results as to the effect of sufentanil and lidocaine in preventing intraocular pressure following succinylcholine administration, laryngoscopy and tracheal intubation. The present study affirms the preventive effect of these drugs on intraocular pressure increase.

Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour.

BACKGROUND: Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. Currently there are no systematic reviews of the effects of placental cord drainage on the management of the third stage of labour. OBJECTIVES: The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour, with or without the prophylactic use of oxytocics. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials register (July 2005), CINAHL (1982 to December 2004) and the National Research Register (December 2004). SELECTION CRITERIA: Randomised trials involving placental cord drainage as a variable within the package of interventions as part of the management of the third stage of labour. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the quality of trials and extracted data. MAIN RESULTS: Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage could impact the third stage of labour as the results show a statistically significant reduction in the length of third stage of labour (one trial, n = 147, weighted mean difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95% CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with caution due to potential intervention bias. AUTHORS' CONCLUSIONS: It is difficult to draw conclusions from such a small number of studies, especially where the review outcomes were presented in a variety of formats. However, there does appear to be some potential benefit from the use of placental cord drainage in terms of reducing the length of the third stage of labour. More research is required to investigate the impact of cord drainage on the management of the third stage of labour.

A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum.

Many women associate one or more of their pregnancies with the development of adult obesity. Such an association has not been fully explored. This longitudinal study examines the changes in maternal anthropometric indices during pregnancy and postpartum. Seventy-seven pregnant subjects were investigated longitudinally at about 13, 25 and 36 weeks gestation, of whom forty-seven continued taking part into the postpartum period. Maternal weight, height and skinfold thickness (triceps, biceps, subscapular, suprailiac and mid thigh) were measured at each visit. Maternal fat mass was estimated from the conversion of the first four skinfold thicknesses. Maternal waist and hip circumferences were also measured at the first visit and 6 weeks and 6 months postpartum. Weight and fat gain during pregnancy (13-36 weeks gestation) was 10.9 (SD 4.7) kg and 4.6 (SD 3.3) kg (P < 0.001) respectively. A significant increase in fat mass from 13 weeks gestation to 6-months postpartum was observed (2.6 (SD 4.5), P < 0.001). The increased weight at 6-months postpartum, however, was not statistically significant (1.1 (SD 6.0) kg, P = 0.20). Based on BMI in early pregnancy, the subjects were divided into groups of underweight, normal weight, overweight and obese. The last three groups were compared using ANOVA. The obese group showed a significant difference in the pattern of changes in the skinfold thickness, waist:hip ratio and fat mass at the postpartum period, in comparison with the other two groups. In conclusion, there is a tendency in the obese group to develop central obesity at the postpartum period.