What does cyclicity on amplitude-integrated EEG mean?

In the context of amplitude-integrated electroencephalography (aEEG), the term 'sleep-wake cycling' (SWC), which is frequently used by clinicians and researchers, should be changed to 'cyclicity'. SWC is a technical term that refers to the biological pattern of alternating sleeping and waking states, which is difficult to define with only aEEG and no physical parameters. Additionally, the absence of cyclicity on aEEG is a more robust reflection of the sequence of the suppressed background patterns of an aEEG following cerebral injury or dysfunction than are sleep/wake states.     

What does it mean for youngsters to grow up in a lesbian family created by means of donor insemination?

In many countries fertility services still refuse to inseminate lesbian couples because they believe the child's welfare would be at stake. One of their concerns is that these children will be stigmatized because of their non-traditional family structure. In this follow-up study, we interviewed children from lesbian donor insemination (DI) families about how they present their 'non-traditional' family to people in their immediate social environment. We also explored whether or not children were teased or harassed about their lesbian family and whether or not coping with a non-traditional family constellation was reflected in their psychological well-being. According to this study, almost all children from lesbian DI families share the fact that they live in a two-mother unit spontaneously with close friends who react positively. Others are only informed about the non-traditional family structure when they ask questions about it. From the children's answers, we can conclude that for some peers it is hard to understand that someone can have two mothers without having a father somewhere. Compared with children from heterosexual families, these DI children are not more likely to be teased but they are more prone to family-related teasing incidents. However, introducing their non-traditional family into their peer group does not seem to interfere with their psychological well-being. Nonetheless, teachers indicate that children from lesbian families experience more attention problems compared with children from heterosexual households.     

Evidence-based fertility treatment: what do we mean?

This article explores the meaning of 'evidence-based fertility treatment' and reviews the relevance of evidence-based health care to the proposed National Service Framework (NSF) for Infertility Services. It summarizes the principles of systematic literature reviewing and proposes an agenda for those developing the NSF. This agenda is illustrated by data from a preliminary review by the authors. The main strength of the proposed NSF lies in the National Evidence-Based Clinical Guidelines but the main weakness lies in the lack of rigorous positive evidence underpinning these guidelines. The NSF team will have to appraise, enhance, extend and synthesize these reviews. The lack of an NSF would threaten the future effectiveness and cost-effectiveness of infertility services in the UK.     

What does 'diagnostic hysteroscopy' mean today? The role of the new techniques

PURPOSE OF REVIEW: Visual examination of the uterine cavity and contextual operative facilities have provided the gynecologist with the perfect 'diagnostic' tool, making it possible to examine the cavity and biopsy suspected areas under direct visualization. RECENT FINDINGS: The approach used to insert the scope, together with the diameter of the hysteroscope and the distention of the uterine cavity, are of extreme importance in reducing patient discomfort to a minimum during an outpatient examination. The vaginoscopic approach (without speculum or tenaculum) has definitively eliminated patient discomfort related to the traditional approach to the uterus. One of the major problems for endoscopists is passing through the internal cervical os; the new generation of hysteroscopes, with an oval profile and a total diameter between 4 and 5 mm, are strictly correlated to the anatomy of the cervical canal. Miniaturized instruments have enabled the physician not only to perform targeted hysteroscopic biopsies, but also to treat benign intrauterine pathologies, such as polyps and sinechiae, without any premedication or anesthesia. This has been defined as a 'see & treat' procedure: there is no longer a distinction between the diagnostic and operative procedures, but a single procedure in which the operative part is perfectly integrated in the diagnostic work-up. SUMMARY: Diagnostic hysteroscopy has long paid the price of being a purely visual method of investigation. Today, thanks to recent advances in instrumentation and to modified techniques related to the simultaneous use of the scope and of instruments, hysteroscopy is finally achieving the full accuracy that has been awaited for the last 20 years.     

Nordic couples’ decision-making processes in anticipation of contacting a fertility clinic

This study concerns midwives' obedience/conformity to direction from a senior person. We sought to identify whether midwives just went along with what a midwife at management level suggested, or instead altered their views to match. In the first condition, a postal Social Influence Scale‐Midwifery (SIS‐M) measured and scored 209 midwives' private responses to 10 clinical questions. In a second condition, a senior midwife successfully influenced 60 of these midwives to alter their SIS‐M decisions to agree with her suggested correct responses. In a third condition, a postal condition again measured the midwives private SIS‐M responses. The aim was to elicit whether the midwives' simply complied with the senior midwife's suggestions during interview or actually changed their opinions to match hers. A 3 (E (lowest grade), F (middle grade) & G (sister grade)) × 3 (above conditions) ANOVA found a significant main effect for conditions (F(2, 94) = 151.87, p = 0.001) with higher scores in the interview condition when the senior midwife passively influenced participant responses. Results inform that the interview manipulation had no lasting social influence effect, consistent with Milgram's transient situational argument. That is, in the presence of senior staff, midwives' decisions are profoundly influenced.     

Isolated acute funisitis in the absence of acute chorioamnionitis: What does it mean?

ObjectiveAcute funisitis (AF) is most commonly associated with acute chorioamnionitis (AC) and ascending infection. The significance of cases of AF without associated AC or isolated funisitis (IF) is unknown. Our objective was to evaluate clinical and pathologic features of IF and to determine its significance.Study designThis was a retrospective review of placentas of patients delivering at our institution from 1997 to 2017. Placentas with the diagnosis of IF comprised the study population and placentas without either AF or AC served as controls.ResultsThere were 156 cases and 181 controls identified. Maternal age, gestational age, birthweight and mode of delivery were similar in both groups. 132 (84.6%) of cases of IF had meconium, with 62 (47.0%) having meconium only in the membranes, 36 (27.3%) in the membranes and cord and 34 (25.6%) in the membranes and cord with associated myonecrosis. 72 (38.7%) of controls had microscopically identified meconium, with only one (1.4%) showing meconium in the cord. None had myonecrosis (p < .001). There was also a significantly higher rate of intrauterine fetal demise (IUFD) in the IF group (p = .027). but the rate of suspected Intrauterine growth restriction (IUGR) was significantly greater in the controls (p = .014).ConclusionIF is highly associated with the presence of meconium discharge and meconium-associated myonecrosis of umbilical vessels. The inflammation in IF may be the result of damage to the muscle fibers of the cord due to meconium but additional studies are necessary to understand the significance of these findings.     

What does an embryo need?

This review argues that the question "What does an embryo need?" cannot be adequately answered in quantitative terms to allow the formulation of media for culturing early mammalian embryos. It can be shown experimentally that "needs" in terms of the nutrients an embryo chooses to consume, and their rates of consumption, vary widely, as they are determined by the concentration of the nutrients under consideration and other constituents in the culture medium. Similarly, it is impossible to define "needs" from knowledge of the kinetic properties of nutrient transport systems. Measurements of nutrient consumption, are, however, valuable in determining overall metabolic activity and the balance between oxidative and glycolytic metabolism, in demonstrating qualitative requirements for specific nutrients and in providing markers of normality or abnormality against which to devise methods for diagnosing embryo health. On the basis of these and other considerations, a strategy is proposed for the formulation of embryo culture media that promotes metabolism that is "quiet" rather than "active", reduces the concentrations of nutrients to match those in the Fallopian tube, selects the "quietest" embryos for transfer, and trusts the autonomy of the embryo.     

Changing Concepts of Women’s Health—What does this mean for Obstetrics and Gynaecology?

Over the past decade, increased attention has focused on the topic of women’s health. Traditionally, women’s health was considered to encompass only reproductive health and health care. Currently, however, women’s health is defined as involving women’s social, cultural, spiritual, emotional and physical well-being, and is influenced by social, political and economic factors, as well as by a woman’s biology. Therefore, in providing health care to women, one must address not only their biology and their reproductive functions but also the broader determinants of health and in particular the critical role of gender as a determinant of health. The health priorities women themselves identify, their own perceptions of their health and well-being and the diversity of women are all key components of optimal care for women. While obstetricians and gynaecologists have played a leading role in improving reproductive and gynaecologic care and outcomes, they must identify, acknowledge and address the multiple factors which influence the health and illness of their patients. Together with other physicians and health professionals, obstetricians and gynaecologists through their clinical work, their educational activities and their research must integrate and apply this broader understanding of women’s health if they are to provide appropriate holistic care to their women patients.     

Stem cells and fertility: what does the future hold?

PURPOSE OF REVIEW: The long-held belief that 'the total number of oocytes present in the mammalian ovary is generated during fetal ovarian development with no additional oocyte formation during reproductive life' has recently been challenged. This review aims to summarize the scientific evidence and discuss the criticism put forth by other investigators in the field. In addition, we will entertain possible future directions, underlining clinical implications of de-novo oocyte formation during adulthood. RECENT FINDINGS: An initial report of oocyte generation from mouse stem cells in vitro was followed by a publication by Johnson et al., suggesting that new oocyte formation occurs in adult mice. Their more recent findings point toward bone marrow as a source of germline stem cells that give rise to new oocytes. SUMMARY: The findings of Johnson et al. strongly suggest the generation of oocytes from stem cells in the adult mouse. Criticism by prominent investigators in the field has been voiced but not yet adequately supported by experimental evidence. Crucially, independent confirmation of the findings of Johnson et al. is also lacking. If proven to occur in human, de-novo oocyte formation from stem cells would have significant implications for fertility preservation.     

Hypotension in small preterms: what does it mean?

Abstract

Introduction: Small preterms often have low blood pressure readings in the first few days of life. However, what is hypotension in preterms? Should there be an aggressive approach to its management? What are the immediate and long-term side effects of powerful medications? Alternatively, could a low blood pressure be accepted instead?

Materials and methods: Data were collected from files of all live babies with gestational age (GA) between 23^0/7 and 31^6/7 weeks over two different periods: years 2000–2004 and 2008–2012.

Results: Our data show that, despite extremely low gestational age (ELGA)/extremely low birth weight (ELBW) neonates, almost half of these tiny babies have neither low mean arterial pressure (MAP) readings nor clinical signs of impaired perfusion. Yet, many of them are, variously treated or not, depending on individual decisions, rather than on sound evidence.

Discussion: We suggest, should it be required to treat persistent hypotension, rather than treating just a low MAP recording, to address the whole issue of hypotension in the overall picture of clinical settings; we to assess organ dysfunction caused by low output and use the least aggressive measures, preferably within written protocols, tailored to the given unit, but equally, sufficiently flexible to individual babies. Furthermore, allow for “permissive hypotension” especially if transient, in the absence of clinical signs of hypoperfusion, with normal superior vena cava (SVC) flow, normal cardiac output, and normal brain scanning with normal cerebral Doppler flows. Whether treating hypotension, by whichever definition, “per se”, will make any difference to both, immediate and late outcomes; in the end, treating remains open to questioning and calls for careful follow-up of these very susceptible preterms.