Human embryo before ultrasound visualization

Gestation begins with the first day of bleeding of the last menstrual period preceding fertilization. The average gestation is usually divided into several stages. The pregestation stage includes the days of the last menstruation and the days preceding fertilization. The pre-embryonic stage comprises fertilization, repeated divisions (cleavage) of the oocyte and formation of the hollow sphere known as the blastocyst. After implantation, the inner cell mass of the blastocyst differentiates into external and internal germ layers known as ectoderm and endoderm. Formation of the three germ layers, between days 7 and 20, is known as gastrulation and followed by embryonic organogenesis.     

Infant development in two cultural contexts: Cameroonian Nso farmer and German middle‐class infants

Objective and Background: Cultures differ in their emphases on specific developmental milestones which may be associated with early developmental differences. This study compares the developmental states of three‐ and six‐month‐old Cameroonian Nso farmer and German middle‐class infants assessed with the Bayley Scales of Infant Development. Methods: The Bayley Scales were used with 345 three‐month‐old infants in Cameroon (n = 73) and Germany (n = 272). Most of the infants were reassessed at six months of age (n = 72 of the Cameroonian and n = 222 of the German infants). Results: The study showed significant differences in gross motor development in favour of the Cameroonian children and in receptive as well as expressive communication in favour of the German infants. These findings are consistent throughout both age samples. The cognitive and fine motor development is significantly advanced in the three‐month‐old German infants, but not at six months of age. Conclusion: The results are interpreted to reflect different socialisation strategies as a result of different cultural orientations of Cameroonian Nso and German middle‐class mothers and it is important to assess developmental pathways in multiple cultural environments, in order to gain an understanding of the encompassing conceptions of development.     

A prospective longitudinal study of the physical, psychomotor, and intellectual development of singleton children up to 5 years who were conceived by intracytoplasmic sperm injection compared with children conceived spontaneously and by in vitro fertilization

OBJECTIVE: To assess the somatic, psychomotor, and intellectual development of children conceived through intracytoplasmic single sperm injection (ICSI) over the whole preschool period. DESIGN: Prospective, controlled, cohort study. SETTING: Fertility clinic in Brussels, Belgium. PATIENT(S): Sixty-six ICSI-conceived children prospectively compared with 52 IVF-conceived and 59 spontaneously conceived children. All children were full-term singletons. INTERVENTION(S): Home visits by a trained psychologist. Standardized interviews. Assessments using the revised Brunet-Lézine scale and the revised Wechsler preschool and primary scale of intelligence. MAIN OUTCOME MEASURE(S): Physical growth and general health. Formal developmental and intellectual assessments. RESULT(S): Children conceived by ICSI were healthy: no significant differences appeared in the incidence of combined congenital malformations (11.3%), health problems (44.1%), surgical interventions (18.6%), and hospitalizations (6.8%), nor for the developmental assessments (mean developmental quotient at 9 months: 93.9; at 18 months: 102.0). For the intellectual assessments, the between-group differences disappeared when adjusted for levels of parental education (mean intelligence quotient at 3 years: 97.0; at 5 years: 103.3). CONCLUSION(S): This pilot study shows that throughout the preschool period, ICSI-conceived children have psychomotor and intellectual development similar to that of IVF-conceived and spontaneously conceived children. These conclusions need to be confirmed by multicenter studies.     

The effect of infertility and assisted reproduction on first-trimester placental and fetal development

Our investigation of differences in first-trimester placentation and/or fetal biometry in pregnancies conceived spontaneously compared with those conceived through fertility treatment, and comparing less invasive fertility treatment with in vitro fertilization found no statistically significant difference in first-trimester abnormal placentation or fetal growth between pregnancies conceived spontaneously and those conceived through fertility treatment, or between the in vivo and in vitro subgroups.     

Antenatal dexamethasone has no adverse effects on child physical and cognitive development: a long-term cohort follow-up investigation

Objective: Antenatal corticosteroids are extensively given in pregnancies with threatened preterm labour as a prophylactic method to reduce some kinds of neonatal diseases. Dexamethasone is one kind of commonly used corticosteroid, but controversies still remain whether it leads to adverse effects on neonatal long-term development or not. The purpose of this study was to investigate the influence of prenatal exposure to one or two dosages of dexamethasone on neonatal physical and cognitive development of children at 1, 3 and 6 years of age. Methods: This was a retrospective cohort study. The body length, head circumference and body weight were measured in every infant and child to evaluate physical development. The mental development index (MDI) and a psychomotor development index (PDI) were used to evaluate mental and cognitive development in children of ages 1 year and 3 years while verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ) scores were used to evaluate mental and cognitive development in children of age of 6 years. There were 1554 infants at 1 year, 1328 children at 3 years and 1297 preschool children at 6 years followed. Results: There were no significant differences between antenatal dexamethasone exposure groups and antenatal dexamethasone non-exposure groups on physical development index and MDI, PDI, VIQ and PIQ. Conclusions: The results of this investigation suggested that one or two dosages of antenatal dexamethasone is safe for the use of inevitable preterm birth.     

产前应用地塞米松对早产仔鼠脑发育的影响

Objective To explore the effects of different courses of antenatal dexamethasone on brain development of premature SD rats. Methods The pregnant rats were randomly assigned to 3 groups: 3-dose dexamethasone (group 1), 1-dose dexamethasone group (group 2) and control group. The treated were sacrificed on 19 days of gestation, body and whole brain weight of the offspring rats were measured. Meanwhile the expression o{ neuron specific enolase (NSE) in brains of offspring rats was detected by immunohistochemical staining. The histological structures of baby rat brain were observed under transmission electron microscope. The differences among the three groups were analyzed by ANOVA. Results (1) The body and whole brain weight, the brain and body weight ratio were (1.543±0.052) g, (88.80±7.12) mg, and (5.75±0.38)% in group 1 and (1.584±0.035) g,(98.21±3.71) mg, and (6.20±0.26)% in group 2, both were lower than the control group [(1.696±0.076) g, (111.53±6.29) mg, (6.59±0.48)%], (P<0.01 or P<0.05, respectively). (2) The expression of NSE in cortex in group 1 and 2 were lower than that in control group (0.223±0.054, 0.381±0.041 vs 0.590±0.064) (P<0.01). The expression of NSE in hippocampi in group 1 and 2 were also lower than that in the control group (0.192±0.054, 0.359 ±0.046 vs 0.529±0.068) (P<0.01). (3) Disconnection of nuclei membrane, vacuolization in mitochondria, loss of nueleolus, and disconnection of neurofilaments were observed in the ultrastructure of baby rat brain tissue in both group 1 and 2. Conclusions Antenantal administration of dexamethasone can cause impairment of brain development in premature offspring rats and this might be related to the times of dexamethasone administered.     

Midwifery retention and coverage and impact on service utilisation in Afghanistan

Objective

to measure the rate of and determine factors associated with community midwifery education (CME) graduate retention in public sector health care in Afghanistan.

Design

cross-sectional.

Setting

performed in public health facilities of 11 Afghan provinces purposively selected by geographic location and security conditions, between October 2011 and April 2012. Facilities were selected by one of two criteria: either a registered deployment site for a CME graduate or randomly selected through population-proportionate sampling.

Participants

facility managers and midwives employed in public facilities at the time of data collection.

Measurements

three quantitative instruments were used: a facility checklist assessed staffing and service volume, and two separate questionnaires for midwives and facility managers, which measured employment duration and perceived barriers to midwife retention.

Findings

at 456 surveyed facilities, 570 midwives were interviewed. Overall, 61.3% (n=209/341) of CME graduates deployed in surveyed provinces were working in public sector facilities, whereas 36.8% were working at their assigned site. Facilities without midwife staff had lower average monthly volumes of antenatal care visits (14.6 (SD±22.7) versus 71.5 (SD±72.5)), family planning visits (10.4 (SD+13.9) versus 56.8 (SD+85.0)), or facility-based deliveries (0.55 (SD±2.2) versus 15.7 (SD±18.7)). Perceived reasons for leaving employment were insecurity (civil unrest/armed conflict) (46.4%), family disagreement (28.1%), increased workload without compensation (9.9%), and lack of appropriate housing (7.8%).

Key conclusions

CME graduate retention in public sector positions was relatively low and significantly impacted by insecurity and cultural issues related to women working outside the home.

Implications for practice

culturally appropriate measures are needed to attract and retain skilled female health care providers for rural public facilities in Afghanistan and similar settings. Advocacy to encourage family and community support for midwives working in rural facilities and providing amenities such as housing, education for children, and employment for the accompanying male family member are measures most likely to improve midwife retention.     

Three case reports of fetal growth retardation in the second trimester.

Antenatal and postnatal growth and development were assessed in a prospective study involving 100 children. 3 cases of second trimester growth retardation exhibiting varying degrees of catch-up growth are described.     

Growing future leaders: developing perinatal managers from within

Internal leadership development is a pressing issue in nursing because of the powerful influence of unit-level leaders/managers on staff nurse retention, the excessive costs of replacing this level of leadership as well as the costs of replacing staff, and the difficulty of finding strong candidates for both staff and leadership positions. This article offers a process of leadership development for frontline managers to be conducted within the facility. Models from the business community are helpful in constructing possibilities for internal development programs in nursing. Three courses, their content, and the experiential learning projects associated with didactic content are described.     

Child neurodevelopmental outcomes following preterm and term birth: What can the placenta tell us?

A significant proportion of children born preterm will experience some level of neurodevelopmental impairment. Changes in placental function have been observed with many antenatal conditions that are risk factors for preterm birth and/or poor neurodevelopment including fetal growth restriction and in-utero inflammation. This review will highlight placental factors that have been studied to understand the underlying mechanisms and identify biomarkers that lead to poor child neurodevelopmental outcomes. These include changes in gross morphological and histopathological structure and the placental inflammatory response to prenatal infection. Further, we will describe the placenta's role as both a barrier to maternally-derived bioactive substances critical for normal fetal brain development, such as cortisol, and a source of neuroactive steroids and neurotrophins known to have critical functions in neuronal proliferation, axonal growth, myelination and the regulation of apoptosis. Finally, emerging data supporting the potential utility of novel placental biomarkers in the early prediction of poor neurodevelopmental outcome in infants born both preterm and term will be discussed. These include the assessment of genetic variants (e.g. single nucleotide polymorphisms in placental tissue) and epigenetic biomarkers (e.g. placental microRNAs and placental DNA methylation). With the placenta the key tissue regulating the fetal environment, integration of observed changes in placental function with genetic and epigenetic variations may advance our ability to predict future infant health. Ultimately, this may facilitate targeted allocation of health resources with the aim of improving lifelong neurodevelopmental capability.     

Is there a role for audit in continuous professional development?

The aim of audit is to improve patient care by examining practice and unmasking areas requiring improvement. It is endorsed by professional bodies and health service management, and often linked, albeit perhaps indirectly, with further professional development. Audit utilizes significant health care resources; therefore, its use ought to be subject to critical evaluation and demonstrable effectiveness. To influence change, audit is inevitably linked to a method of feedback and motivation. Despite the long history and many published studies, there remains considerable debate and uncertainty as to its effectiveness and, consequently, cost–benefit. Published literature suggests the need for further research to determine in which areas audit will be beneficial and also to determine what factors influence the efficacy of audit and feedback. Given this uncertainty, the role of audit in continuous professional development remains speculative.     

Onset of Puberty: Mother Knows Best

Study ObjectiveSeveral strategies have been proposed to determine onset of puberty without examination by a trained professional. This study sought to evaluate a novel approach to determine onset of puberty in girls.Design, Setting, and ParticipantsThis study used the Cincinnati cohort of the Breast Cancer and the Environment Research Program. Girls were recruited at 6-7 years of age and followed every 6 months in the initial 6 years, and annually thereafter. Breast maturation and foot length were performed at each visit by health professionals certified in those methods. Mothers were asked to provide the age at which they believed that their daughter's shoe size had increased more rapidly.ResultsThese analyses include 252 participants. Age at increase in shoe size was correlated to age at onset of puberty (r = 0.21) and increase in foot length (r = 0.24). The difference of reported age of increased shoe size was 0.46 years before breast development.ConclusionReported increase in shoe size occurred somewhat earlier and was significantly correlated to age of breast development. These preliminary results suggest that mother's report of increase in shoe size appear to be as accurate as reports of other indirect methods of determining onset of puberty, such as self- or maternal estimates of breast development.     

Epigenetics of pregnancy: looking beyond the DNA code

Epigenetics is the branch of genetics that studies the different mechanisms that influence gene expression without direct modification of the DNA sequence. An ever-increasing amount of evidence suggests that such regulatory processes may play a pivotal role both in the initiation of pregnancy and in the later processes of embryonic and fetal development, thus determining long-term effects even in adult life. In this narrative review, we summarize the current knowledge on the role of epigenetics in pregnancy, from its most studied and well-known mechanisms to the new frontiers of epigenetic regulation, such as the role of ncRNAs and the effects of the gestational environment on fetal brain development. Epigenetic mechanisms in pregnancy are a dynamic phenomenon that responds both to maternal–fetal and environmental factors, which can influence and modify the embryo-fetal development during the various gestational phases. Therefore, we also recapitulate the effects of the most notable environmental factors that can affect pregnancy and prenatal development, such as maternal nutrition, stress hormones, microbiome, and teratogens, focusing on their ability to cause epigenetic modifications in the gestational environment and ultimately in the fetus. Despite the promising advancements in the knowledge of epigenetics in pregnancy, more experience and data on this topic are still needed. A better understanding of epigenetic regulation in pregnancy could in fact prove valuable towards a better management of both physiological pregnancies and assisted reproduction treatments, other than allowing to better comprehend the origin of multifactorial pathological conditions such as neurodevelopmental disorders.     

From germinal matrix to cerebellar haemorrhage

Abstract

For many years cerebellar development after preterm birth has been poorly investigated and has been studied without taking germinal matrix-intraventricular haemorrhage into account. Advanced neuroimaging techniques like magnetic resonance imaging, as well as the use of various acoustic windows (mastoid fontanelle, occipital foramen) have allowed for in vivo diagnosis of acquired focal haemorrhagic lesions in the cerebellum of very preterm babies. The vulnerability of the cerebellum also seems to be related to specific gestational ages, i.e., between 23 and 27 weeks, when rapid growth in cerebellar volume occurs and at a much faster rate than mean brain volume increase. In this paper, the contribution of the cerebellum in long-term motor cognitive, learning and behavioural functions, including psychiatric ones, is discussed.     

Common mental disorders during pregnancy and baby’s development in the first year of life

Background: Evidence shows that pregnancy and early postpartum periods are crucial to the development of the mother–baby relationship. Objective: The aim of this study was to evaluate the impact of common mental disorders (CMD) during pregnancy on child’s mental development during the first year. A prospective study was carried out with 204 pregnant women in the third trimester of pregnancy and continuing with their babies to 3.5 and 12 months of age. Method: To assess the presence of CMD, the Brief Symptom Inventory and the Inventory of the Clinical Evaluation of Depression were used. Evaluation of the babies’ mental development and the socio-emotional state was carried out using the Griffiths Mental Scale (0–2) and the Brief Infant Toddler Social and Emotional Assessment (BITSEA). Results: We observed 20 babies born to women with a positive diagnosis for CMD and who presented a positive screen in the BITSEA. We also observed a statistically significant relationship regarding the diminished development in certain Griffith’s subscales of babies whose mothers showed presence of psychotic, anxiety, hostility and depressive symptoms during pregnancy. Conclusion: We conclude that the presence of CMD influences the mental, social and emotional development levels of infants in their first year.     

Randomized controlled trial of prenatal zinc supplementation and the development of fetal heart rate

OBJECTIVES: This study was undertaken to evaluate whether prenatal zinc supplementation affects maturation of fetal cardiac patterns. STUDY DESIGN: A randomized double-blind controlled trial among 242 low-income Peruvian women was performed. Beginning at 10 to 16 weeks' gestation, women received supplements containing 60 mg iron, 250 microg folic acid with or without 25 mg zinc. Fetal heart rate (mean FHR, variability [HRV], number of accelerations) and movements (number and amplitude of movement bouts, time spent moving) were electronically monitored monthly from 20 weeks' gestation. Developmental trends were evaluated by supplement type among 195 women who completed the trial and had no serious complications of pregnancy. RESULTS: Zinc supplementation was associated with lower FHR, greater number of accelerations, and greater HRV. Supplementation effects on HRV and accelerations were more pronounced after 28 weeks' gestation. No differences in motor activity were observed. CONCLUSION: Prenatal supplementation of zinc-deficient mothers may be beneficial to fetal neurobehavioral development.     

超低出生体重儿随访和预后

超低出生体重儿（extremely low birth weight infants，ELBWI）的救治是一个高风险的工作。在过去的20多年间，随着早产儿监护和治疗技术的不断提高，无论是发达国家还是发展中国家ELBWI的生存率都得到很大的提高。尽管这些ELBWI在新生儿重症监护室（neonatal intensive care unit，NICU）度过了生命中最危险和最艰苦的时期，但出院对其来讲还将面临着各种需要解决的困难和问题。无论从体格发育还是精神神经发育来看，出院仅仅是生命中一个新的开始。出院后随访，仍然是ELBWI的整体治疗中不可缺少的组成部分，对于ELBWI提高生存质量，最大程度地减少不良预后，保证其能够健康成长等方面十分重要。     

Disorder of Sex Development: A Case of Late-Diagnosed Ovotestis and Its Postsurgical Follow-up

BackgroundTrue hermaphroditism is characterized by the presence of both testicular and ovarian tissue. This case report aimed to describe a case of ovotestis in adolescents.CaseA 17-year-old patient presented with undifferentiated genitalia. Thelarche occurred at age 14, menarche occurred at age 15, and menstruation was regular. Physical examination showed female phenotype, Tanner IV breasts, gynecoid hair, enlarged clitoris, and labia majora symphysis with a single orifice. The patient presented high levels of total testosterone. The left gonad contained typical ovarian tissue and the right gonad contained both seminiferous tubules and ovarian tissue (ovotestis). Vaginoscopy revealed a single orifice (urethra and vagina). Right gonadectomy confirmed the presence of ovotestis.Summary and ConclusionKnowledge of true hermaphroditism is important for early diagnosis and proper management.