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Journal of Dairy Science Apr 2024In the United States, it is becoming common for dairy herds to mate a portion of cows to beef semen to create a value-added calf. The objectives of this study were to...
In the United States, it is becoming common for dairy herds to mate a portion of cows to beef semen to create a value-added calf. The objectives of this study were to determine if dystocia risk, stillbirth (SB) risk, gestation length (GL), probability of early-lactation clinical disease events, early-lactation culling risk, or subsequent milk production differ between cows that carried calves sired by different beef breeds and those that carried Holstein-sired calves. Records from 10 herds contained 75,256 lactations from 39,249 cows that had calves with known Holstein or beef breed sires from the years 2010 to 2023. Calf sire breeds with ≥150 records included in analyses were Holstein, Angus, Simmental, Limousin, crossbred beef, and Charolais. Additional beef sire breeds that existed in lower frequency (n < 150 records) were condensed together and classified as "other." Because GL is a continuous variable, sire breed inclusion criteria were reduced to n ≥ 100 records; thus, Wagyu sires were included as their own breed group. Some records did not contain all variables of interest, thus models included fewer lactations depending on variable. Binomial generalized mixed models evaluated dystocia risk (defined as calving ease score ≥4 or calving ease score ≥3), SB risk, clinical health event risk (defined as lameness, mastitis, metabolic, reproductive, other, or any health events occurring within 60 d in milk [DIM]), and early culling risk (defined as death or culling within 60 DIM). Gestation length and test-date milk, fat, and protein yields were evaluated with mixed models. Calves sired by crossbred beef bulls had a greater probability of being stillborn (5%; 95% confidence interval lower = 2.9% upper = 9.0%) than those sired by Holstein bulls (2%; 95% confidence interval lower = 1.5%, upper = 2.7%). All beef-sired calves increased GL from that of Holstein-sired calves (277 ± 0.15 d) with Limousin (282 ± 0.81 d) and Wagyu-sired calves (285 d ± 0.79) resulting in the longest GL. The risk of dystocia, clinical health events, and early-lactation culling did not differ by calf sire breed nor did subsequent milk and component yield. Generally, carrying a calf sired by the beef breeds included in this study did not negatively affect the dairy cow.
Topics: Pregnancy; Female; Animals; Cattle; Male; Stillbirth; Reproduction; Lactation; Milk; Dystocia; Cattle Diseases
PubMed: 37949400
DOI: 10.3168/jds.2023-24112 -
BMC Pregnancy and Childbirth Jul 2024The rates of labor induction and cesarean delivery is rising worldwide. With the confluence of these trends, the labor induction rate in trials of labor after cesarean...
Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study.
BACKGROUND
The rates of labor induction and cesarean delivery is rising worldwide. With the confluence of these trends, the labor induction rate in trials of labor after cesarean can be as high as 27-32.7%. Induction of labor after one previous cesarean (IOLAC) is a high-risk procedure mainly due to the higher risk of uterine rupture. Nevertheless, the American College of Obstetricians and Gynecologists considers IOLAC as an option in motivated and informed women in the appropriate care setting. We sought to identify predictors of a composite of maternal and newborn adverse outcomes following IOLAC.
METHODS
The electronic medical records of women who delivered between January 2018 to September 2022 in a Malaysian university hospital were screened to identify cases of IOLAC. A case is classified as a composite adverse outcome if at least one of these 11 adverse outcomes of delivery blood loss ≥ 1000 ml, uterine scar complications, cord prolapse or presentation, placenta abruption, maternal fever (≥ 38 C), chorioamnionitis, intensive care unit (ICU) admission, Apgar score < 7 at 5 min, umbilical artery cord artery blood pH < 7.1 or base excess ≤-12 mmol/l, and neonatal ICU admission was present. An unplanned cesarean delivery was not considered an adverse outcome as the practical management alternative for a clinically indicated IOLAC was a planned cesarean. Bivariate analysis of participants' characteristics was performed to identify predictors of their association with composite adverse outcome. Characteristics with crude p < 0.10 on bivariate analysis were incorporated into a multivariable binary logistic regression analysis model.
RESULTS
Electronic medical records of 19,064 women were screened. 819 IOLAC cases and 98 cases with composite adverse outcomes were identified. Maternal height, ethnicity, previous vaginal delivery, indication of previous cesarean, indication for IOLAC, and method of IOLAC had p < 0.10 on bivariate analysis and were incorporated into a multivariable binary logistic regression analysis. After adjustment, only maternal height and IOLAC by vaginal dinoprostone compared to Foley balloon remained significant at p < 0.05. Post hoc adjusted analysis that included all unplanned cesarean as an added qualifier for composite adverse outcome showed higher body mass index, short stature (< 157 cm), not of Chinese ethnicity, no prior vaginal delivery, prior cesarean indicated by labor dystocia, and less favorable Bishop score (< 6) were independent predictors of the expanded composite adverse outcome.
CONCLUSION
Shorter women and IOLAC by vaginal dinoprostone compared to Foley balloon were independently predictive of composite of adverse outcome.
Topics: Humans; Female; Pregnancy; Labor, Induced; Retrospective Studies; Adult; Dinoprostone; Vaginal Birth after Cesarean; Infant, Newborn; Oxytocics; Administration, Intravaginal; Pregnancy Outcome; Cesarean Section; Malaysia; Risk Factors
PubMed: 38951754
DOI: 10.1186/s12884-024-06650-5 -
Acta Obstetricia Et Gynecologica... Feb 2024Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to...
INTRODUCTION
Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown.
MATERIAL AND METHODS
This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25-hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25-hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders.
RESULTS
Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage.
CONCLUSIONS
In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage.
Topics: Infant, Newborn; Humans; Pregnancy; Female; Postpartum Hemorrhage; Uterine Inertia; Cesarean Section; Retrospective Studies; Vitamin D Deficiency; Vitamin D
PubMed: 37960966
DOI: 10.1111/aogs.14719 -
Cureus Nov 2023Carotid artery dissection is an infrequent cause of neonatal-perinatal stroke. Its rarity may be due to underdiagnosis or lack of awareness. We report a case of a...
Carotid artery dissection is an infrequent cause of neonatal-perinatal stroke. Its rarity may be due to underdiagnosis or lack of awareness. We report a case of a full-term, large-for-gestational-age (LGA) male infant delivered at 39 weeks gestation. Pertinent prenatal and perinatal history include gestational diabetes, preeclampsia, and the use of forceps to assist in delivery due to shoulder dystocia. The infant presented with apnea and cyanosis while rooming which prompted admission to the neonatal intensive care unit (NICU). Initial sonographic investigation revealed an infarct, subsequently confirmed as a massive left-sided infarct by magnetic resonance imaging (MRI) of the brain. Further, computerized tomography (CT) angiography confirmed a dissection in the right common and internal carotid arteries. The child was treated with antiepileptic and antithrombotic medications. He is now undergoing regular neurodevelopmental monitoring and rehabilitation. As per our sources, this case is the first to report a contralateral significant perinatal stroke due to carotid artery dissection. It underscores the importance of recognizing subtle signs of neonatal encephalopathy that may be due to perinatal stroke, of which carotid artery dissection is an uncommon etiology. Assisted delivery techniques such as the use of forceps may be risk factors.
PubMed: 38073993
DOI: 10.7759/cureus.48452 -
Journal of Ayub Medical College,... 2023The most common cause of post partum hemorrhage after a cesarean section is uterine atony.
BACKGROUND
The most common cause of post partum hemorrhage after a cesarean section is uterine atony.
AIMS AND OBJECTIVE
The main aim of this study was to examine the outcomes of the B-Lynch procedure in patients who experienced primary PPH after cesarean section.
METHODS
This study spanned one year, from August 2020 to August 2021, at Ayub Teaching Hospital. Patients who developed post-partum hemorrhage after a cesarean section were enrolled in this study and a thorough review of their records was conducted to identify those who received B-Lynch sutures and assess the resulting outcomes.
RESULTS
Out of the 87 patients who experienced PPH, 24 (27.6%) patients received the B-Lynch procedure. Among these 24 patients, only two (8.3%) needed hysterectomy, while the remaining 22 successfully recovered after receiving the B-Lynch procedure.
CONCLUSIONS
The B-Lynch technique proves to be a safe, effective, and easily applicable method for stopping hemorrhage in patients who experienced significant initial postpartum hemorrhage due to uterine atony.
Topics: Pregnancy; Humans; Female; Postpartum Hemorrhage; Cesarean Section; Uterine Inertia; Suture Techniques; Retrospective Studies; Postpartum Period
PubMed: 38406954
DOI: 10.55519/JAMC-04-12198 -
Acta Obstetricia Et Gynecologica... Jun 2024Brachial plexus birth injury is the most common birth injury causing permanent disability in Finland. This study aimed to assess risk factors of a permanent brachial...
INTRODUCTION
Brachial plexus birth injury is the most common birth injury causing permanent disability in Finland. This study aimed to assess risk factors of a permanent brachial plexus birth injury and calculate the incidence.
MATERIAL AND METHODS
This is a retrospective population-based study including all deliveries between 2006 and 2022 in Southern Finland. The number of children born, obstetric data, and migrant status were gathered from the registries of the Finnish Institute for Health and Welfare, and Statistics Finland. Race of the mothers of children with a permanent brachial plexus birth injury was recorded. The severity of permanent brachial plexus birth injury was assessed using the 3-month Toronto test score. A lower score was indicative of a more severe injury (scored 0-10).
RESULTS
One hundred of the 298 428 children born during the 17-year study period sustained a permanent brachial plexus birth injury (0.34 per 1000). Mothers of children with a permanent brachial plexus birth injury had a higher body mass index (29 vs. 24 kg/m) and their pregnancies were more often complicated by diabetes (28% vs. 12%), shoulder dystocia (58% vs. 0.3%), and/or assisted deliveries (45% vs. 10%) compared with all other mothers (p < 0.001). Thirty two of the 52 725 children born to migrant mothers had a permanent brachial plexus birth injury (0.61 per 1000). The incidence of permanent brachial plexus birth injury was 5.7 times higher among children of Black migrants from Africa (18/11 738, 1.53 per 1000) compared with children of native mothers (0.27 per 1000). Black mothers had a higher body mass index at the start of pregnancy (29 vs. 26 kg/m, p = 0.02) compared with Caucasians. Children of Black mothers had a more severe injury compared with all others (p = 0.007) with a mean 3-month Toronto test score of 4.2 (range 0.0-6.5, SD ±1.6) vs. 5.6 (range 0.0-9.3, SD ±2.2).
CONCLUSIONS
Shoulder dystocia and assisted delivery are the most important risk factors for a permanent brachial plexus birth injury. Black race was associated with a higher rate and a more severe permanent brachial plexus birth injury.
Topics: Humans; Female; Retrospective Studies; Risk Factors; Pregnancy; Finland; Adult; Birth Injuries; Brachial Plexus; Incidence; Infant, Newborn; Male
PubMed: 38470173
DOI: 10.1111/aogs.14817 -
Journal of Dairy Science Mar 2024According to our recent necropsy-based study, mastitis is the most common underlying diagnosis of on-farm deaths in Finnish dairy cows. However, it remained unanswered...
According to our recent necropsy-based study, mastitis is the most common underlying diagnosis of on-farm deaths in Finnish dairy cows. However, it remained unanswered to what extent mastitis has contributed to death of all necropsied cows. In the present study, based on histopathology we detected one third of the necropsied dairy cows having active inflammatory udder lesions (n = 110). The role of mastitis varied and was interpreted by causes of death (underlying, intermediate, immediate, other significant). Mastitis was most commonly either the underlying (28%) or both immediate and underlying cause of death (48%), and only seldom the immediate (4%) or intermediate (4%) cause of death. Mastitis occurred either as the only cause leading to death (mastitis only, MO, 39%), or with many other contributing diseases (multiple diseases, MD, 61%) which were interacting with mastitis and together leading to death. Between these groups (MO vs. MD), time of mastitis occurrence during lactation, producer-reported duration of illness, clinical signs, and medication differed, as well the histopathological severity of mastitis. The cases, where mastitis was the only initial insult, occurred evenly throughout the entire lactation, but the cases with many interacting diseases clustered in early lactation. In multiple diseases -cases mastitis occurred concurrently with metritis (31%), aspiration pneumonia (24%), acute trauma/dystocia (15%), or with other diseases, such as ketosis, hepatic lipidosis, rumenitis, and abomasal diseases. For a pathologist, the gross mastitis diagnosis was most challenging at the beginning of the lactation, especially if inflammation was mild to moderate, suggesting the value of histopathological examination being highest at that time. Also, producers reported mastitis signs less frequently if cow had many simultaneously occurring diseases. Therefore, even if clinical signs of other diseases are present, the udder should be considered a potential cause of illness, and it should be examined, especially in dry and transition period cows.
PubMed: 38522830
DOI: 10.3168/jds.2024-24405 -
European Journal of Obstetrics,... Nov 2023Counter-nutation movement is deemed crucial during the management of the birth process. It is a combination of lateral ilia expansion and backward displacement of the...
BACKGROUND
Counter-nutation movement is deemed crucial during the management of the birth process. It is a combination of lateral ilia expansion and backward displacement of the promontory resulting from the external rotations of the femurs producing an enlargement of the pelvic inlet. However, since its description by Farabeuf, this mechanism has never been challenged and analyzed in a dynamic finite element study.
METHODS
Based on a female pelvic mesh and sacroiliac ligaments, we simulated external rotations of both femurs with imposed rotation of the two acetabulum centers. We hypothesize that lateral ilia expansion generates a sacrum movement resulting in a backward displacement of the promontory and a pelvic inlet enlargement.
RESULTS
Finite element simulation confirms our hypothesis and reveals that ilio-sacro-transverse and axile ligaments play an essential role in this mechanism. Indeed, the increase in stiffness (ranging from 500 MPa to 750 MPa) of these ligaments accentuates the counter-nutation movement and the opening of the inlet. Instead of the anatomic congruence between the ilium and the sacrum, the sacroiliac ligaments may explain the counter-nutation. After a 6° of femur rotation, the inlet area increases to 11 cm (141 cm vs. 130 cm). This enlargement could be noteworthy in case of obstructed labor or shoulder dystocia. Moreover, the association between external rotation and flexion of the femurs could be more efficient for opening the pelvic inlet.
CONCLUSIONS
Our result did not support the original assumption of Farabeuf. By revealing how postural adjustment increases the bony birth canal, this study provides essential information for the clinical management of the delivery.
Topics: Humans; Female; Pregnancy; Finite Element Analysis; Sacroiliac Joint; Pelvis; Sacrum; Femur; Biomechanical Phenomena
PubMed: 37738891
DOI: 10.1016/j.ejogrb.2023.08.381 -
Cureus Mar 2024Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It...
Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It is a valuable tool that can be adapted for targeted audiences of different specialities at all experience levels from medical students to senior consultants. Methods In this study, pre- and post-course questionnaires of learners with varying levels of clinical experience from Obstetrics and Gynaecology (O&G), Anaesthesia, Neonatology, Emergency Medicine, midwifery, and nursing who undertook two simulation courses (namely the Combined Obstetrics Resuscitation Training course, CORE, and the CORE Lite), which comprised lectures and simulation drills with manikins and standardized patients, between 2015 and 2023 were compared. This also included a period when training was affected by the coronavirus disease 2019 (COVID-19) pandemic. Results The results showed that both simulation courses increased confidence levels among all learners in the management of obstetric emergencies. Pre-course, participants were most confident in the management of neonatal resuscitation and severe pre-eclampsia, followed by postpartum haemorrhage. They were least confident in the management of vaginal breech delivery, uterine inversion, and twin delivery. Post-course, participants were most confident in the management of neonatal resuscitation and shoulder dystocia, followed by postpartum haemorrhage. They were least confident in the management of uterine inversion and maternal sepsis, followed by vaginal breech delivery and twin delivery. Whilst we saw a huge improvement in confidence levels for all obstetric emergencies, the greatest improvement in confidence levels was noted in vaginal breech deliverytwin deliveryand uterine inversion. Conclusion The simulation courses were effective in improving the confidence in the management of obstetric emergencies. While it may be difficult to measure the improvement in clinical outcomes as a result of simulation courses alone, the increase in confidence levels of clinicians can be used as a surrogate in measuring their preparedness in facing these emergency scenarios.
PubMed: 38590473
DOI: 10.7759/cureus.55840 -
Journal of Veterinary Internal Medicine 2023Goats are increasingly popular as both production animals and pets. The frequency of and factors associated with periparturient reproductive complications in goats are...
BACKGROUND
Goats are increasingly popular as both production animals and pets. The frequency of and factors associated with periparturient reproductive complications in goats are largely unreported.
OBJECTIVES
(1) To report the frequency of periparturient reproductive complications in does presented to university veterinary hospitals and (2) to identify factors associated with uterine tears in the study population.
ANIMALS
A total of 198 periparturient does presented to 9 university veterinary hospitals from October 2021 to June 2022.
METHODS
Multicenter, cross-sectional study, with data collected from questionnaires completed by attending veterinarians. Logistic regression was used to identify factors associated with diagnosis of uterine tears.
RESULTS
Ninety-three (47%) does had at least 1 periparturient reproductive complication. Periparturient complications included retained fetal membranes (n = 38, 26%), vaginal or perineal trauma (n = 33, 19%), uterine tears (n = 32, 18%), metritis (n = 22, 13%), uterine or vaginal hemorrhage (n = 8, 5%), Cesarean section complications (n = 8, 8%), and uterine prolapse (n = 1, 0.5%). A positive interaction effect was found between small breeds (Nigerian Dwarf and Pygmy) and manipulation on the farm by a layperson upon diagnosis of uterine tears (odd ratios [OR], 5.48; 95% confidence interval [CI], 1.41, 21.25; P = .01).
CONCLUSIONS AND CLINICAL IMPORTANCE
Periparturient reproductive complications were common. Small breed combined with manipulation on the farm by layperson was associated with diagnosis of uterine tears. Clients should be educated that in the event of dystocia, small breed does are at greater risk of uterine tears and prompt veterinary intervention is critical.
Topics: Humans; Pregnancy; Animals; Female; Hospitals, Animal; Hospitals, Teaching; Cesarean Section; Goats; Cross-Sectional Studies
PubMed: 37698350
DOI: 10.1111/jvim.16858